A draft Medicare Local Medical Review Policy on Psychiatry/Psychology Services was introduced by Empire Medicare Services at the Medicare Carrier Advisory Committee (CAC) meeting on March 22, 2000. The policy would impose severe restrictions on inpatient and outpatient psychiatric and psychology services that would be covered under Medicare. At the request of GNYHA and other interested organizations, the comment period for this draft policy has been extended until the next CAC meeting on June 7, 2000.

Policy Impact: Hospitals currently report extensive delays or denials in payment for services under the existing Medicare policy. The proposed policy would place additional limitations on coverage of psychiatry and psychology services, including a requirement that informed consent be obtained prior to any psychiatric treatment, a standard not applied in this universal manner to any other clinical specialty area. In addition, the policy would restrict coverage for services and duration of treatment for specific diagnoses, set qualification and supervision requirements for nonphysician practitioners that exceed those set by the U.S. Health Care Financing Administration, and establishes outcome criteria that are open to subjective interpretation.

Members' Comments: GNYHA will be soliciting comments from members on the draft policy, and will actively pursue discussions with Empire to help shape the final policy. If you would like a copy of the draft policy, call Anita Wall at GNYHA.