APA Health Reform Matrix: Key Provisions by APA Priority

APA Health Reform Matrix: Key Provisions by APA Priority This document is a tool used to reference key provisions that are of special interest and benefit to psychology, psychologists, and the public whom we serve. This document does not contain a comprehensive list of all provisions in the health reform law. Provisions are listed in terms of their contribution to advancing APA s eight health reform priorities (listed in the first column). The middle column lists provisions in the new law, the Patient Protection and Affordable Care Act (P.L. 111-148). The third column lists select APA education and advocacy activities in support of each listed APA priority. This document was created by the American Psychological Association (APA) Public Interest Government Relations Office (PI-GRO), with input from government relations colleagues in the Executive Office, across APA Directorates, and APAPO. APA Priority Integrated Care Public Law 111-148 (as signed into law on 3.23.10) Senate Bill ESTABLISHING COMMUNITY HEALTH TEAMS TO SUPPORT THE PATIENT-CENTERED MEDICAL HOME (pp. 395-397) Authorizes grants to establish community-based interdisciplinary, interprofessional health teams to support primary care practices within the hospital service areas served by the eligible entities. Health team members may include behavioral and mental health providers. CO-LOCATING PRIMARY AND SPECIALTY CARE IN COMMUNITY-BASED MENTAL HEALTH SETTINGS (pp. 561-562) Authorizes grants and cooperative agreements to establish demonstration projects for the provision of coordinated and integrated services to special populations (adults with mental illnesses who have co-occurring primary care conditions and chronic diseases) through the co-location of primary and specialty care services in community-based mental and behavioral health settings. (Language from APA-Supported Community Mental Health Services Improvement Act - S. 1188/H.R. 1011) STATE OPTION TO PROVIDE HEALTH HOMES FOR ENROLLEES WITH CHRONIC CONDITIONS (pp. 201-205) A State, at its option as a State plan amendment, may provide for medical assistance under this title to eligible individuals with chronic conditions (which include mental health conditions) who select a designated provider, a team of health care professionals operating with such a provider, or a health team as the individual s health home for purposes of providing the individual with health home services. The term designated provider means a physician, clinical practice or clinical group practice, rural clinic, community health center, community mental health center, home health agency, or any other entity or provider (including pediatricians, gynecologists, and obstetricians) that is determined by the State and approved by the Secretary to be qualified to be a health home for eligible individuals with chronic conditions on the basis of documentation evidencing that the physician, practice, or clinic: A) has the systems and infrastructure in place to provide health home services; and B) satisfies the qualification standards established by the Secretary. A team of health care professionals means a team of health professionals that may: A) include physicians and other professionals, such as a nurse care coordinator, nutritionist, social worker, APA Activities Worked closely with congressional sponsors during the drafting of the Health Professions and Primary Care Reinvestment Act (S. 3708/H.R. 7302) and the Community Mental Health Services Improvement Act (S. 1188/H.R. 1011) APA Letters to House (7-16-09, 7-17-09, 11-5-09) APA Letters to Senate (11-21-08, 5-22-09, 6-12-09, 6-16-09, 10-19-09, 11-19-09) Coalition Letters to House (5-12-09, 7-17-09, 11-4-09) Coalition Letters to Senate (6-16-09, 7-8-09, 9-24-09) APA Staff Congressional Visits APA/American Geriatric Society (AGS) Eldercare Workforce Alliance Advocacy Days (6-23-09, 9-15-09): For more information, please contact Diane Elmore, PhD, MPH, in PI-GRO at delmore@apa.org. 1

Prevention and Wellness behavioral health professional, or any professionals deemed appropriate by the State; and B) be free standing, virtual, or based at a hospital, community health center, community mental health center, rural clinic, clinical practice or clinical group practice, academic health center, or any entity deemed appropriate by the State and approved by the Secretary. CAPACITY BUILDING IN PRIMARY CARE (pp. 498-499) Authorizes grants to schools of medicine or osteopathic medicine to establish, maintain, or improve academic units or programs that improve clinical teaching and research in specified fields or programs that integrate academic administrative units in specified fields to enhance interdisciplinary recruitment, training, and faculty development. Priority shall be given to applicants that: 1) propose innovative approaches to clinical teaching using models of primary care, such as the patient-centered medical home, team management of chronic disease, and interprofessional integrated models of health care that incorporate the integration of physical and mental health care; 2) provide training in the care of vulnerable populations such as children, older adults, homeless individuals, victims of abuse or trauma, individuals with mental health or substance-related disorders, individuals with HIV/AIDS, and individuals with disabilities; 3) teach trainees the skills to provide interprofessional, integrated care through collaboration among health professionals; 4) provide training in cultural competency and health literacy. (Language from APA-Supported Health Professions and Primary Care Reinvestment Act S. 3708/H.R. 7302) COMMUNITY-BASED COLLABORATIVE CARE NETWORKS (pp. 852-853) Authorizes grants to support community-based collaborative care networks, which are consortiums of health care providers with a joint governance structure (including providers within a single entity) that provide comprehensive, coordinated, and integrated health care services for low-income populations. PREVENTION AND PUBLIC HEALTH FUND (p. 423) Establishes a fund to provide for an expanded and sustained national investment in prevention and public health programs. COMMUNITY TRANSFORMATION GRANTS (pp. 446-448) Authorizes grants for the implementation, evaluation, and dissemination of evidence-based community preventive health activities in order to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities, and develop a stronger evidence-based of effective prevention programming. Grant activities may include: 1) creating healthier school environments; 2) creating the infrastructure to support active living and access to nutritious foods in a safe environment; 3) programs targeting a variety of age levels to increase access to nutrition, physical activity and smoking cessation, improved social and emotional wellness, enhance safety in a community, or address any other chronic disease priority area; 4) work-site wellness programming and incentives; 5) highlighting healthy options at restaurants and other food venues; 6) reduction of racial and ethnic disparities; and 7) addressing the needs of special populations, including all age groups and individuals with disabilities, and individuals in both urban and rural areas. PREVENTIVE SERVICES TASK FORCE (pp. 423-425) Authorizes a Task Force to review the scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of clinical preventive services for the purpose of developing recommendations for the health care community, and updating previous clinical preventive recommendations, to be published in the Guide to Clinical Preventive Services. Such recommendations shall consider clinical preventive best practice recommendations from a variety of organizations, including scientific societies. COMMUNITY PREVENTIVE SERVICES TASK FORCE (pp. 425-426) Authorizes a Task Force to 1. Coordinated Congressional Advocacy Training and Visits. 2. Full page Roll Call advertisement 3. National Congressional Call-in Day Distribution of APA Integrated Health Care for an Aging Population Task Force Report to members of key congressional offices Campaign for Mental Health Reform testimony on 1-22-09 to Senate HELP Committee APA Letters to Senate (5-22-09, 10-19-09, 11-19-09, 12-14-09, 12-15-09) APA Letters to House (6-16-09, 7-17-09, 11-5-09) Disability Prevention Letter to Senate (4-17- 09) Health Disparities Talking Points (5-8-09) Meeting with the HHS (5-16-09) Medicare Waiting Period Letter (5-22-09) Healthy Behaviors Letter (6-10-09) Coalition Letters (9-24-09, 11-4-09) Meetings with congressional staff and legislators Worked closely with congressional sponsors For more information, please contact Diane Elmore, PhD, MPH, in PI-GRO at delmore@apa.org. 2

review the scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of community preventive interventions for the purpose of developing recommendations, to be published in the Guide to Community Preventive Services. EMPLOYER-BASED WELLNESS PROGRAM (p. 465) Authorizes CDC to provide employers with technical assistance, consultation, tools, and other resources in evaluating such employers employer-based wellness programs, including: 1) measuring participation and methods to increase participation in such programs; 2) developing standardized measures to assess changes necessary to have a positive health impact on employees health behaviors, health outcomes, and health care expenditures; and 3) evaluating the impact of such programs on health status, absenteeism, productivity, workplace injury, and medical costs. during the drafting of the Melanie Blocker Stokes MOTHERS Act (S. 324/H.R. 20) Worked closely with congressional sponsor to modify language of Amendment S.A. 2883 regarding Centers of Excellence for Depression COVERAGE OF PREVENTIVE HEALTH SERVICES (pp. 13-14) Requires insurers to provide coverage for (without imposing cost-sharing requirements): 1) evidence based items or services that have in effect a rating of A or B in the current recommendations of the United States Preventive Services Task Force; 2) immunizations; and 3) evidence-informed preventive care and screenings for infants, children, and adolescents, and women as provided for in the comprehensive guidelines supported by HRSA. (Language related to women from the APA-Supported Amendment S.A. 2791 - Senator Mikulski) IMPROVING ACCESS TO PREVENTIVE SERVICES FOR ELIGIBLE ADULTS IN MEDICAID (pp. 441-442) Medicaid amended to include diagnostic screening, preventive, and rehabilitative services including: 1) any clinical preventive services assigned a grade of A or B by the United States Preventive Services Task Force; 2) with respect to adults, approved vaccines recommended by the Advisory Committee on Immunization Practices; 3) any medical or remedial services (provided in a facility, a home, or other setting) recommended by a physician or other licensed practitioner of the healing arts within the scope of their practice under State law, for the maximum reduction of physical or mental disability and restoration of an individual to the best possible functional level. SUPPORT, EDUCATION, AND RESEARCH FOR POSTPARTUM DEPRESSION AND SERVICES TO INDIVIDUALS WITH A POSTPARTUM CONDITION AND THEIR FAMILIES (pp. 226-227) Authorizes the Secretary to continue research to expand the understanding of the causes of, and treatments for, postpartum conditions. Activities include conducting and supporting: 1) basic research concerning the etiology and causes of the conditions; 2) epidemiological studies to address the frequency and natural history of the conditions and the differences among racial and ethnic groups with respect to the conditions; 3) the development of improved screening and diagnostic techniques; 4) clinical research for the development and evaluation of new treatments; 5) information and education programs for health care professionals and the public, which may include a coordinated national campaign to increase the awareness and knowledge of postpartum conditions. Authorizes grants for the establishment, operation, and coordination of effective and cost efficient systems for the delivery of essential services to individuals with or at risk for a postpartum condition and their families. (Language from the APA-Supported Melanie Blocker Stokes MOTHERS Act S. 324/H.R. 20) PROTECTIONS FOR AMERICAN INDIANS AND ALASKA NATIVES (p. 215) Prohibits cost-sharing for American Indians and Alaska Natives enrolled in any qualified health plan in the individual market through an Exchange with income at or below 300 percent of the federal poverty level. ADVANCING RESEARCH AND TREATMENT FOR PAIN CARE MANAGEMENT (pp. 466-469) 1) Authorizes an Institute of Medicine Conference on Pain; 2) encourages continuation and expansion of an For more information, please contact Diane Elmore, PhD, MPH, in PI-GRO at delmore@apa.org. 3

aggressive program of basic and clinical research on the causes of and potential treatment for pain; and 3) authorizes grants, cooperative agreements, and contracts to health professions schools, hospices, and other public and private entities for the development and implementation of programs to provide education and training to health care professionals in pain care. ELDER JUSTICE ACT (pp. 664-686) Creates a comprehensive approach to ensuring adequate public-private infrastructure and resolving to prevent, detect, treat, understand, intervene in, and, where appropriate, aid in the prosecution of elder abuse, neglect, and exploitation. (Language from APA-Supported Elder Justice Act - S. 795/H.R. 2006) INCENTIVES FOR PREVENTION OF CHRONIC DISEASES IN MEDICAID (pp. 443-446) Authorizes grants to States beginning in 2011 to carry out initiatives to provide incentives to Medicaid beneficiaries who successfully participate in the program (described below) and upon completion of such participation, demonstrate changes in health risk and outcomes, including the adoption and maintenance of healthy behaviors by meeting specific targets. The program is a comprehensive, evidence-based, widely available, and easily accessible program that is designed and uniquely suited to address the needs of Medicaid beneficiaries and has demonstrated success in helping individuals achieve one or more of the following: 1) ceasing use of tobacco products; 2) controlling or reducing their weight; 3) lowering their cholesterol; 4) lowering their blood pressure; 5) avoiding the onset of diabetes, or in the case of a diabetic, improving the management of that condition. A program may also address co-morbidities (including depression) that are related to any of the above conditions. EDUCATION AND OUTREACH CAMPAIGN REGARDING PREVENTIVE BENEFITS (pp. 426-428) Directs the Secretary to plan and implement a national public-private partnership for a prevention and health promotion outreach and education campaign to raise public awareness of health improvement across the life span. SCHOOL-BASED HEALTH CENTERS (SBHC) (pp. 428-432) Authorizes grants for the establishment and operation of school-based health centers, which provide comprehensive primary health services (including mental health). For grants to establish an SBHC, preference will be given to centers that serve a large population of children eligible for Medicaid. For grants to operate an SBHC, preference will be given for schools that serve communities with evidenced barriers to primary health care and mental health and substance use disorder prevention services for children and adolescents, communities with high per capita numbers of children and adolescents who are uninsured, underinsured, or enrolled in public health insurance programs, and populations of children and adolescents that have historically demonstrated difficulty in accessing health and mental health and substance use disorder preventive services. MEDICARE COVERAGE OF ANNUAL WELLNESS VISIT PROVIDING A PERSONALIZED PREVENTION PLAN (pp. 435-439) Amends Medicare to provide an Annual Wellness visit which includes a personalized prevention plan that includes a health risk assessment, and may contain the furnishing of personalized health advice and referral, the establishment of, or an update to, the individual s medical and family history, a list of current providers and suppliers that are regularly involved in providing medical care to the individual (including a list of all prescribed medications), a measurement of height, weight, body mass index, blood pressure, and other routine measures, detection of any cognitive impairment, and the establishment of, or an update to, the following: a screening schedule for the next 5 to 10 years, a list of risk factors and conditions for which primary, secondary, and tertiary prevention interventions are recommended or are underway, including any mental health conditions. For more information, please contact Diane Elmore, PhD, MPH, in PI-GRO at delmore@apa.org. 4

REMOVAL OF BARRIERS TO PREVENTIVE SERVICES (pp. 439-440) Eliminates coinsurance and deductible for personalized prevention plans, initial preventive physical examinations, and screening and preventive services covered by Medicare and recommended (assigned A or B ) by the U.S. Preventive Services Task Force. HEALTHY AGING, LIVING WELL (pp. 448-552) Authorizes CDC to provide grants to carry out pilot programs to provide public health community interventions (may include interventions to reduce tobacco use and substance abuse, and improve mental health), screenings (including mental health/behavioral health and substance abuse disorders), and follow-up clinical referrals for individuals who are between 55 and 64 years of age in order to reduce chronic disease risk factors found through screening. CENTERS OF EXCELLENCE FOR DEPRESSION (pp. 866-870) Authorizes grants to establish national centers of excellence for depression, which shall engage in activities related to the treatment of depressive disorders. Applications must include evidence that the institution provides, or can coordinate with other entities to provide, comprehensive health services with a focus on mental health services and subspecialty expertise for depressive disorders (among other things). Among required activities includes integrating basic, clinical, or health services interdisciplinary research and practice in the development, implementation, and dissemination of evidence-based interventions. Priority will be given to entities whose existing infrastructure or expertise provides appropriate, evidence-based and culturally and linguistically competent services. (Language from the APA-Supported Amendment S.A. 2883 Senator Stabenow) GRANTS FOR SMALL BUSINESSES TO PROVIDE COMPREHENSIVE WORKPLACE WELLNESS PROGRAMS (pp. 859-860) Authorizes grants to employers to provide their employees with access to comprehensive workplace wellness programs. COVERAGE OF COMPREHENSIVE TOBACCO CESSATION SERVICES FOR PREGNANT WOMEN IN MEDICAID (pp. 442-443) Requires coverage of and removes cost-sharing for counseling and pharmacotherapy for cessation of tobacco use by pregnant women in Medicaid. (Language from the APA- Supported Amendment S.A. 3076 Senator Durbin) MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAMS (pp. 216-225) Requires States to conduct a statewide needs assessment that identifies communities with concentrations of premature birth, low-birth weight infants, infant mortality, poverty, crime, domestic violence, high rates of high-school drop-outs, substance abuse, unemployment, or child maltreatment. Authorizes grants to eligible entities to enable the entities to deliver services under early childhood home visitation programs in order to promote improvements in maternal and prenatal health, infant health, child health and development, parenting related to child development outcomes, school readiness, and the socioeconomic status of such families, and reductions in child abuse, neglect, and injuries. The eligible entities will give priority to eligible families who reside in communities in need of such services, low-income families, pregnant women who have not attained age 21, families that have a history of child abuse or neglect or have had interactions with child welfare services, families with a history of substance abuse or need substance abuse treatment, families that have users of tobacco products in the home, families that have children with low student achievement, families with children with developmental delays or disabilities, families who are serving or formerly served in the Armed Forces who have had multiple deployments outside of the U.S. IMPROVING SERVICES FOR PREGNANT WOMEN WHO ARE VICTIMS OF DOMESTIC VIOLENCE, SEXUAL VIOLENCE, SEXUAL ASSAULT, AND STALKING (pp. 816-817) Authorizes For more information, please contact Diane Elmore, PhD, MPH, in PI-GRO at delmore@apa.org. 5

Workforce grants to states for pregnancy assistance who may then make funds available to the State Attorney General to assist Statewide offices in providing: 1) intervention services, accompaniment, and supportive social services for eligible pregnant women who are victims of domestic violence, sexual violence, sexual assault, or stalking; 2) technical assistance and training relating to violence against eligible pregnant women to be made available to a variety of organizations and individuals, including those working in health care settings. NATIONAL STRATEGY FOR QUALITY IMPROVEMENT IN HEALTH CARE (pp. 260-262) Authorizes the Secretary to establish a national strategy to improve the delivery of health care services, patient health outcomes, and population health. The Secretary shall identify national priorities for improvement in developing the strategy that will (among other things): have the greatest potential for improving the health outcomes, efficiency, and patient-centeredness of healthcare for all populations, including children and vulnerable populations; identify areas in the delivery of health care services that have the potential for rapid improvement in the quality and efficiency of patient care; address gaps in quality, efficiency, comparative effectiveness information, and health outcomes measures and data aggregation techniques; improve Federal payment policy to emphasize quality and efficiency; enhance the use of health care data to improve quality, efficiency, transparency, and outcomes; and reduce health disparities across health disparity populations and geographic areas. MENTAL AND BEHAVIORAL HEALTH EDUCATION AND TRAINING GRANTS (pp. 508-520) Authorizes grants for training to accredited master s, doctoral, internship, and post-doctoral residency programs of psychology for the development and implementation of interdisciplinary training of psychology graduate students for providing behavioral and mental health services (with a set-aside of not less than $10 million for doctoral, postdoctoral, and internship level training.) Priority will be given to institutions in which training focuses on the needs of vulnerable groups such as older adults and children, individuals with mental health or substance-related disorders, victims of abuse or trauma and of combat stress disorders such as posttraumatic stress disorder and traumatic brain injuries, homeless individuals, chronically ill persons, and their families. (Language inspired by the APA-Supported Graduate Psychology Education Act of 2009 S. 811/H.R. 2066; the Health Access and Health Professions Supply Act of 2009 H.R. 3109; and Health Professions and Primary Care Reinvestment Act S. 3708/H.R. 7302 110 th Congress) DEFINITION OF GRADUATE PSYCHOLOGY (p. 473) Refers to an accredited program in professional psychology. DEFINITION OF MENTAL HEALTH SERVICE PROFESSIONAL (p. 473) Includes an individual with a graduate or post-graduate degree from an accredited institution of higher education in psychology. GERIATRIC EDUCATION AND TRAINING (pp. 504-507) 1) Expands Eligibility for Geriatric Academic Career Awards to a variety of new disciplines, including faculty in psychology. (Language from APA-Supported Retooling the Health Care Workforce for an Aging America Act of 2009 - S. 245/H.R. 468) 2) Authorizes a new Geriatric Career Incentive Awards Program to provide financial support to foster greater interest among a variety of health professionals in entering the field of geriatrics, including students of psychology. (Language from APA-Supported S. 245/H.R. 468) 3) Expands Authority for Geriatric Education Centers to offer short-term intensive courses (referred to as a fellowship ) in geriatrics for faculty members in medical schools and other health professions schools with Psychology Workforce: Worked closely with congressional sponsors during the drafting of the Graduate Psychology Education Act of 2009 (S. 811/H.R. 2066); the Health Access and Health Professions Supply Act of 2009 (H.R. 3109); and the Health Professions and Primary Care Reinvestment Act (S.3708/H.R. 7302 110 th Congress) APA Staff Congressional Visits APA Letters to the Senate (10-19-09, 5-11- 09) APA Letters to House (6-16-09, 7-16-09, 7-17-09, 11-5-09) Coalition Letters to Senate (9-24-09) Coalition Letters to House (11-4-09) Geriatric Mental Health Workforce: Worked closely with congressional sponsors during the drafting of the Health Professions and Primary Care Reinvestment Act (S.3708/H.R. 7302 110 th Congress); and the Retooling the Health Care Workforce for an Aging America Act of 2009 (S. 245/H.R. For more information, please contact Diane Elmore, PhD, MPH, in PI-GRO at delmore@apa.org. 6

Benefit Plans programs in psychology or other health disciplines. The fellowship may be offered at graduate programs in psychology. Geriatric Education Centers receiving these grants are required to develop and offer training courses to family caregivers and direct care providers at no charge or minimal cost or incorporate mental health and dementia best practices training into their courses. (Language from APA-Supported S. 245/H.R.468) INVESTMENT IN TOMORROW S PEDIATRIC HEALTH CARE WORKFORCE (pp. 489-491) Authorizes a loan repayment program for qualified health professionals (including psychologists) who agree to be employed full-time for no less than two years providing pediatric care (including mental and behavioral health care). Priority will be given to those who have familiarity with evidence-based methods and cultural and linguistic competence healthcare services. (Language from APA-Supported Child Health Care Crisis Relief Act - S. 999/H.R. 1932) NATIONAL HEALTH CARE WORKFORCE COMMISSION (pp. 474-481) Establishes a National Health Care Workforce Commission that serves as a national resource and develops and commissions evaluations of education and training activities to determine whether the demand for health care workers is being met (among other things). The commission shall include no less than one representative of the health care workforce and health professionals (including psychologists and other behavioral and mental health professionals, including substance abuse prevention and treatment providers). The commission shall: 1) review current and projected health care workforce supply and demand; 2) make recommendations to Congress and the Administration concerning national health care workforce priorities, goals, and policies; 3) submit a yearly report to Congress and the Administration containing the results of such reviews and recommendations; and 4) submit a yearly report to Congress and the Administration on, at a minimum, one high priority area. High priority areas include topics such as integrated health care workforce planning; an analysis of the nature, scopes of practice, and demand for health care workers in the enhanced information technology and management workplace; and the education and training capacity, projected demands, and integration with the health care delivery system of mental and behavioral health care workforce. INDIAN HEALTH CARE IMPROVEMENT: AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM (p. 817-818; text in S. 1790) Authorizes grants to nine colleges and universities for the purpose of developing and maintaining Indian psychology career recruitment programs for encouraging Indians to enter the field of behavioral health. HEALTH CARE WORKFORCE ASSESSMENT (pp. 485-488) Establishes a National Center for Health Workforce Analysis to, in coordination with the National Health Care Workforce Commission, provide for the development of information describing and analyzing the health care workforce (among other things). UNITED STATES PUBLIC HEALTH SCIENCES TRACK (pp. 519-524) Establishes a track to grant appropriate advanced degrees. It will graduate not less than 100 behavioral and mental health professional students annually. EXTENSION OF PHYSICIAN FEE SCHEDULE MENTAL HEALTH ADD-ON (p. 300) Extends the Medicare mental health services restoration payment of 5 percent through December 31, 2010 for psychotherapy services. ESSENTIAL HEALTH BENEFITS REQUIREMENTS (p. 46) Mental health and substance abuse disorder services are included in the essential benefits package that Gateway (Exchange) plans must provide. APPLICABILITY OF MENTAL HEALTH PARITY (p. 63) The Federal Mental Health Parity Law shall 468) APA Letters to House (6-26-09, 7-16-09, 9-5-09) APA Letters to Senate (5-11-09, 7-20-09, 11-19-09) Eldercare Workforce Alliance Letters to House and Senate (5-12-09, 7-9-09; 11-2-09; 11-11-09; 12-8-09 (2); 12-28-09; 2-24-10; 3-11-10) APA Staff Congressional Visits Eldercare Workforce Alliance Advocacy Days (6-23-09, 9-15-09): 1. Coordinated Congressional Advocacy Training and Visits. 2. Full page Roll Call advertisement 3. National Congressional Call-in Day APA/American Geriatric Society (AGS) Congressional Visits Children s Mental Health Workforce: 1. Worked with many national children and adolescent organizations to ensure children and adolescent mental and behavioral health workforce issues were addressed in health reform 2. Coordinated Capitol Hill visits and letters of support 3. Coordinated grassroots activities with our respective members APA Letters to Senate (5-11-09, 5-22-09, 6-12-09, 6-16-09, 7-13-09) Coalition Letters to Senate (6-5-09, 9-24-09, 11-19-09, 12-14-09) APA Letter to House (7-17-09, 11-5-09) For more information, please contact Diane Elmore, PhD, MPH, in PI-GRO at delmore@apa.org. 7

apply to qualified health plans in the same manner and to the same extent as such section applies to health insurance issuers and group health plans. RULES RELATING TO ADDITIONAL REQUIRED BENEFITS (pp. 58) A Gateway (Exchange) plan may make a qualified health plan available notwithstanding any state law mandating benefits other than the essential benefits package. A state may require additional benefits but must assume the cost. PROHIBITING DISCRIMINATION AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES BASED ON HEALTH STATUS (pp. 38-42) A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish rules for eligibility based on any of the following: health status; medical condition (including both physical and mental illnesses); claims experience; receipt of health care; medical history; genetic information; evidence of insurability (including conditions arising out of acts of domestic violence); or disability. Coalitions Letter to House (7-17-09, 11-4- 09) APA/APAPO statement at congressional briefing cosponsored with National Academies of Practice (3-27-09) APA Staff Congressional Visits Health Disparities AFFORDABLE CHOICES OF HEALTH BENEFIT PLANS (pp. 55-63) Requires qualified health plans to include within health insurance plan networks those essential community providers that serve predominantly low-income medically underserved individuals. (Language from APA-supported HELP Committee Amendment Senator Mikulski) INDIAN HEALTH CARE IMPROVEMENT: BEHAVIORAL HEALTH TRAINING AND COMMUNITY EDUCATION PROGRAMS (pp. 817-818, S. 1790) Authorizes the study and compilation of types of staff positions whose qualifications include, or should include, training in the identification of mental illness or dysfunctional and self-destructive behavior. Training criteria will be provided by the appropriate Secretary for each type of position. Additionally authorizes the development and implementation or assistance in the development and implementation of a program of community education on mental illness. INDIAN HEALTH CARE IMPROVEMENT ACT (pp. 817-818, S. 1790) Reauthorizes the Indian Health Care Improvement Act and authorizes a variety of programs related to providing services and supports for health care in this population, including: Indian Women Treatment Programs; Indian Youth Program involvement; Inpatient and Community-Based Mental Health Facilities Design, Construction and Staffing; Behavioral Health Programs; Child Sexual Abuse and Prevention Treatment Programs; Domestic and Sexual Violence Prevention and Treatment program; Behavioral Health Research grants; Indian Your Suicide Prevention initiatives; and the Indians into Psychology Program (see Workforce.) (Language from the APAsupported Indian Health Care Improvement Reauthorization and Extension Act of 2009 S. 1790) UNDERSTANDING HEALTH DISPARITIES: DATA COLLECTION AND ANALYSIS (pp. 460-463) The Secretary shall ensure that, no later than 2 years following the enactment of this title, any federally conducted or supported health care or public health program, activity, or survey (including Current Population Surveys and American Community Surveys) collects and reports: 1) data on race, ethnicity, sex, primary language, and disability status; 2) data at the smallest geographic level such as State, local, or institutional levels; 3) sufficient data to generate statistically reliable estimates by racial, ethnic, sex, primary language, and disability status subgroups for applicants, recipients or participants using, if needed, statistical oversamples of these subpopulations, and 4) any other demographic data deemed appropriate by the Secretary regarding health disparities. Establishes standards for data collection including using OMB standards for race and ethnicity measures and developing standards for the measurement of sex, primary language, and disability status. Also requires surveying health care providers to identify: 1) locations where individuals with disabilities access primary, acute, and long-term care; B) the number of providers with accessible facilities and equipment to meet the needs of individuals with disabilities; and C) the number of employees of health care providers trained in APA Staff Congressional Visits APA Letters to House/Senate/White House (3-11-09, 4-16-09, 5-6-09, 5-22-09, 6-16-09, 7-14-09, 7-17-09,, 9-5-09, 11-19-09) Coalition Letters to House/Senate/White House (1-29-09, 4-23-09, 5-12-09, 5-20-09, 7-3-09, 9-24-09, 11-4-09) Participated in congressional briefings on health disparities-related issues in health reform Participated in several meetings and roundtables at the White House Met with Administration officials to discuss the inclusion of health disparities issues in health reform and to strategize Facilitated Congressional Advocacy Training For more information, please contact Diane Elmore, PhD, MPH, in PI-GRO at delmore@apa.org. 8

Research disability awareness and patient care of individuals with disabilities. Requires any reporting requirements to include requirements for the collection of data by race, ethnicity, sex, primary language, and disability status. Requires that data, measures, and analysis of such data be shared with other relevant federal agencies and reports made available to the public through public postings on the Internet websites of the Department of Health and Human Services (HHS). Requires the Secretary of Health and Human Services to ensure all appropriate privacy and security safeguards are used in the collection, analysis, and sharing of such data. QUALITY MEASURE DEVELOPMENT (pp. 263-266) Authorizes grants for the purpose of developing, improving, updating, or expanding quality measures. In awarding grants, priority will be given to the development of quality measures that allow the assessment of specific issues, including that of the equity of health services and health disparities across health disparity populations and geographic areas. IMPROVING WOMEN S HEALTH (pp. 413-419) Authorizes establishment of an Office of Women s Health within multiple agencies including HHS, CDC, AHRQ, HRSA, and FDA. Offices would report to the Director of the agency and set short-range and long-range goals and coordinate activities that relate to health issues that are of particular concern to women. Requires the Associate Administrator for Women's Services at SAMHSA to report to the Administrator, and the Director of the Office on Women s Health Research at NIH to report to the Director. CULTURAL COMPETENCY, PREVENTION, AND PUBLIC HEALTH AND INDIVIDUALS WITH DISABILITIES TRAINING (pp. 510-511) Establishes grants for the development, evaluation, and dissemination of research, demonstration projects, and model curricula for cultural competency, prevention, public health proficiency, reducing health disparities, and aptitude for working with individuals with disabilities training for use in health professions schools and continuing education programs. OFFICE OF MINORITY HEALTH (pp. 853-856) Transfers existing Office of Minority Health to the Office of the Secretary. Establishes individual offices of minority health within the CDC, HRSA, FDA, SAMHSA, AHRQ, and CMS. REWARDING QUALITY THROUGH MARKET-BASED INCENTIVES (pp. 783) Includes the implementation of activities that reduce health care disparities, including through the use of language services, community outreach, and cultural competency training in Rewarding Quality through Market Based Incentives provision. PATIENT-CENTERED OUTCOMES RESEARCH (pp. 609-620) Authorizes the establishment of a private, non-profit corporation that would be known as the Patient-Centered Outcomes Research Institute to assist patients, clinicians, purchasers, and policy makers in making informed health decisions by advancing the quality and relevance of clinical evidence through research and evidence synthesis. The research would focus on the manner in which diseases, disorders, and other health conditions can be effectively and appropriately prevented, diagnosed, treated, monitored, and managed, and would consider variations in patient subpopulations. Research conducted would compare the clinical effectiveness, risks, and benefits of two or more medical treatments, services, or items. and Visits for APA members National Health Disparities Working Group: 1) APA coordinated an ad hoc working group of more than 150 coalitions and organizations representing more than 35 million people 2) Worked with groups from the faith, racial and ethnic, LGBT, disability, HIV/AIDS, rural, consumer, insurance, and business communities to help make sure health reform addresses disparities 3) Sent letters to Congress and the Administration calling for a hearing on health disparities and stronger health disparities language, including leaving intact the data collection provisions in health reform legislation 4) Developed a directory of health disparities stakeholder organizations indicating their areas of expertise 5) Launched a grassroots campaign and rallies with major coalitions and consumer groups 6) Conducted congressional visits Hosted a congressional briefing on The Cost-Savings of Reducing Health Disparities organized by APA PI-GRO (9-22-09) APA Letters to Senate (10-19-09, 11-19-09) APA Letters to House (7-17-09, 11-5-09) Correspondence with Senate Finance Committee staff asserting the need to broaden the scope of expertise on the Board of Governors More than 100 psychological scientists visited nearly 160 members of Congress from 31 states, to educate them about the need to include behavioral interventions in health reform aimed at increasing For more information, please contact Diane Elmore, PhD, MPH, in PI-GRO at delmore@apa.org. 9

HIT Privacy and Security Consumers, Families and Caregivers comparative effectiveness research (APA s 5 th annual Science Leadership Conference; 11-17-09) The Health Information Technology for Economic and Clinical Health Act enacted in February 2009 includes strong privacy protections for mental health records. COMMUNITY LIVING ASSISTANCE SERVICES AND SUPPORTS (pp. 710-729) Establishes a new APA Letters to Senate (7-16-09, 11-19-09) national insurance program in order to: 1) help adults with functional limitations to maintain personal and financial independence and live in the community; 2) establish an infrastructure that will help address the APA Staff Congressional Visits Nation s community living assistance services and supports needs; 3) alleviate burden on family caregivers; and 4) address institutional bias by providing a financing mechanism that supports personal choice and Coalition Letters to Senate (9-24-09) independence. (Language from the APA-Supported Community Living Assistance Services and Supports (CLASS) Act - S. 696/H.R. 1721) Coalition Letters to House (11-4-09) FUNDING TO EXPAND STATE AGING AND DISABILITY RESOURCE CENTERS (pp. 352-353) Authorizes $10 million each fiscal year, beginning in FY2010 for five years to continue funding Aging and Disability Resource Centers. COMMUNITY FIRST CHOICE OPTION (pp. 179-183) Establishes the Community First Choice Option, which would create a state plan option to provide community-based attendant supports and services to individuals with disabilities who are Medicaid eligible and who require an institutional level of care. Eldercare Workforce Alliance Advocacy Days (6-23-09, 9-15-09): 1. Coordinated Congressional Advocacy Training and Visits 2. Full page Roll Call advertisement 3. National Congressional Call-in Day TRAINING FOR FAMILY CAREGIVERS AND DIRECT CARE PROVIDERS (pp. 504-506) Requires Geriatric Education Centers to develop and offer training courses to family caregivers and direct care providers at no cost or minimal cost. (Language from APA-Supported Retooling the Health Care Workforce for an Aging America Act - S. 245/H.R. 468) REMOVAL OF BARRIERS TO PROVIDING HOME AND COMMUNITY-BASED SERVICES (pp. 183-186) State options regarding home and community-based services include: 1) State Option to Provide Home and Community-Based Services to Individuals Eligible for Services Under a Waiver for eligible individuals; or 2) State Option to Offer Home and Community-Based Services to Specific Targeted Populations, in which a State may elect a plan to target the provision of home and community-based services to specific populations. Individuals in such State programs may also be provided full Medicaid benefits. SENSE OF THE SENATE REGARDING LONG-TERM CARE (pp. 187-188) It is the sense of the Senate that during the 111 th session of Congress: 1) Congress should address long-term services and supports in a comprehensive way that guarantees elderly and disabled individuals the care they need; and 2) long-term services and supports should be made available in the community in addition to in institutions. INCENTIVES FOR STATES TO OFFER HOME AND COMMUNITY-BASED SERVICES AS A LONG-TERM CARE ALTERNATIVE TO NURSING HOMES (pp. 805-809) Provides a targeted increase in the federal medical assistance percentage to States that undertake structural reforms proven to increase nursing home diversions and access to home and community-based services in their Medicaid programs. For more information, please contact Diane Elmore, PhD, MPH, in PI-GRO at delmore@apa.org. 10