2014 APAPO Annual Report to the APA Council
The APA Practice Organization's (APAPO) annual report to the APA Council of Representatives highlights many of the ways the organization serves its practitioner members through legislative, legal and regulatory and marketplace advocacy initiatives.
For more information on any of the content in this presentation, please contact the Practice Directorate via email or by phone at (800) 374-2723.
2014 APA Practice Organization report to the APA Council of Representatives
By Katherine C. Nordal, PhD, APA executive director for professional practice
I'm delighted to have the opportunity to provide this annual report about the APA Practice Organization, or APAPO.
First of all, I want to emphasize that APA and the APA Practice Organization are distinct legal entities. I'll mention a bit more about this distinction in a moment.
I also want to point out that the material about APAPO I'm presenting today does not represent the entire Practice Directorate agenda. Our directorate activities also include important APA initiatives such as educating the public about mind/body health and developing clinical practice guidelines in collaboration with the Science Directorate.
The next few slides about the organization and operation of the APAPO may be especially informative for those of you who are new to Council this year.
APA is considered a 501(c)(3) organization under Internal Revenue Service rules, while APAPO is a 501(c)(6) organization.
A 501(c)(6) organization focuses on advancing a particular trade such as professional psychology, while a 501(c) (3) organization serves the public benefit.
There are other basic differences. For example, compared to a 501(c)(3), a 501(c)(6) organization like the APA Practice Organization can engage in unrestricted lobbying and can work with our new political action committee, APAPO-PAC, to facilitate political giving.
Although APAPO is a companion organization to APA, the two are legally distinct organizations.
In 2012, the APA Practice Organization Board of Directors created APAPO-PAC, a new national PAC for psychology connected directly to our c(6) organization. We have a PAC director on board who is committed to growing our political giving opportunities.
The Education Advocacy Trust, which is part of the APA Practice Organization, advocates for psychology as a health profession. The Board of Educational Affairs is responsible for oversight of the Trust.
The Education Advocacy Trust (EdAT) is overseen by Trustees who are members of the APA Board of Educational Affairs. EdAT provides the mechanism for education advocacy that is not allowable in the APA C(3). Revenue for EdAT is currently very small, but steadily increasing. The APAPO-PAC will be conducting the first email solicitation next month to provide support for education advocacy initiatives.
APAPO is governed by a Board of Directors comprising the same officers who govern APA as Board members. The same Committee for the Advancement of Professional Practice (CAPP) members who are elected to the APA C3 CAPP constitute the APAPO C6 CAPP.
As described in APAPO's bylaws, the 501(c)(6) CAPP is responsible for identifying, planning and implementing projects that are important to the protection, defense and enhancement of professional practice. CAPP recommends to the Board the funding needed for such projects.
New in 2014 are three committees – Good Governance, Membership Retention and Recruitment, and Finance – with members from the APAPO Board and CAPP.
These new committees reflect APA CEO Dr. Norman Anderson's current objectives for advancing APAPO in collaboration with me and Practice staff:
- Developing strategies to enhance the effectiveness of APAPO governance structures;
- Improving member retention and recruitment by better engaging the practitioner community with APAPO;
- Enhancing financial sustainability by increasing non-dues revenue streams and other means;
- Increasing the viability of the Education Advocacy Trust (EdAT); and
- Developing goals related to growing the APAPO-PAC.
This slide shows how the APA Practice Organization and APA compare as far as budget and staff resources.
Our 2013 operating expenses of nearly 4.7 million dollars compares to a figure of more than 104 million dollars for APA. APA is legally prohibited from providing financial resources to help fund the APAPO's work on behalf of professional psychology. The APA Practice Organization had the resources of about 14 full-time equivalent staff in 2013 to support our work on behalf of the (c)(6). The corresponding figure for APA is nearly 570 full-time equivalent staff.
APAPO's mission is to advance, protect and defend the professional practice of psychology. APA members who pay the annual Practice Assessment to APAPO are constituents of the APA Practice Organization. We are dedicated to serving the professional interests and needs of members in varied practice settings and at all stages of their career.
I'd like to highlight the advocacy work in support of professional psychology that we do through the APA Practice Organization, beginning with legislative advocacy. All of the legislative advocacy on behalf of practice is done through the APA Practice Organization. This is one of APAPO's major functions.
This year's top legislative priorities will be reflected in the messages that our State Leadership Conference participants take to hundreds of meetings next month with their members of Congress and staff on Capitol Hill:
First, Medicare payment. Because private reimbursement rates follow Medicare's lead, Medicare payment is crucial for safeguarding reimbursement for psychological services. In 2014, we will continue to address three areas of Medicare payment: the Medicare payment formula, which penalizes providers like psychologists, the Sustainable Growth Rate formula, or SGR, and sequestration, which involves annual across-the-board Medicare payment cuts through 2026. On Feb. 6, three congressional committees with Medicare oversight passed legislation to repeal SGR. Our Government Relations staff is working with Congress to ensure that psychologists are included on even footing with other providers regarding payment structures and incentives as SGR and Medicare payment reform move forward.
Our second priority is inclusion of psychologists in the "physician" definition under Medicare. Unnecessary physician supervision requirements in Medicare hamper psychologists from providing to Medicare patients their full range of services within state licensure. So, we continue urging Congress in 2014 to pass bills that include psychologists in the Medicare "physician" definition. Gaining this victory would end inappropriate physician supervision without increasing Medicare costs.
And our third legislative priority is psychologists' eligibility for federal incentive payments to adopt electronic health record keeping. We are continuing to call on Congress to pass legislation that would make licensed psychologists eligible for federal incentive payments already available to certain providers who integrate electronic health records into their practice. Psychology has now gained three bills, two in the Senate and one in the House of Representatives, to accomplish this goal.
Working in a partisan Congress has certainly been a challenge. In a climate of near-constant gridlock and ongoing pressure to slash federal spending, coupled with lost psychology champions like Rep. Henry Waxman, D-CA and Rep. George Miller, D-CA, and Senators Max Baucus, D-MT, and Jay Rockefeller, D-WV, we've had our work cut out for us.
But despite the challenging environment on Capitol Hill, we have achieved some recent gains in the legislative and regulatory arenas. The release of the Medicare final fee schedule for 2014 by the Centers for Medicare and Medicaid Services marked the first time since 2007 that the payment pool allocated for Medicare psychological services was increased.
We support the recent congressional legislation to repeal the SGR and have provided comments about ways the legislation could also address underlying systemic problems with the Medicare physician fee schedule.
APAPO has successfully advocated 16 times to help prevent the SGR cut from going into effect, and we are pleased that Congress is moving forward on this issue. The process still has a long way to go, however, since there is not yet any agreement on how to pay for the more than $100 billion the legislation is projected to cost.
In addition to our legislative advocacy, APAPO's work on behalf of the practice community involves the legal system and regulatory processes affecting practice.
The APA Practice Organization remains actively involved in monitoring implementation of the 2008 federal mental health parity law and intervening as appropriate. Since 2011, APAPO has been collaborating with 11 state psychological associations to challenge unprecedented rate cuts by Humana as a violation of the Interim Final Rule related to the parity law. The Final Parity Rule released in Nov. 2013 affirms the importance of the provider reimbursement requirement under the parity law.
In January 2014, at the request of the Department of Labor, we submitted a letter addressing the final parity law and five areas of importance for psychologists and access to psychological services – including the need for enforcement, the problem with reimbursement disparities, transparency of medical necessity criteria and other issues.
Last year we began our advocacy work to ensure that state health insurance exchanges provide proper access to psychological services. In September 2013 APAPO sent a joint letter to Connecticut's Lieutenant Governor expressing concern with the behavioral health fee schedules published by HealthyCT, one of the plans in the state exchange. The plan's reimbursement schedule omitted neuropsychologists from the providers listed for neuropsychological services and gave psychologists the same payment rate as masters-level mental health providers.
APAPO and the Connecticut Psychological Association argued in their letter that these problems could create network adequacy issues and limit access to neuropsychological services in CT. The HealthyCT plan has indicated that they intend to address our concerns.
Also in 2013, APAPO worked with at least 10 SPTAs on legislative activity related to applied behavior analysis (ABA). At least 34 states already have laws or regulations relating to ABA. Nine additional states are currently pursuing autism legislation. Of particular concern, several state laws passed a few years ago restrict psychologists' practice in this area. Since we became actively involved and the APAPO Board adopted its 2012 policy "Statement on Behavior Analysis and Behavior Analysts," no new laws restricting psychologists' practice related to applied behavior analysis have been passed.
In August 2013, the US District Court in New Jersey gave preliminary approval to a $120 million settlement of a class action lawsuit filed by psychologists, other health care professionals and patients against Aetna. The lawsuit alleges that Aetna used a faulty database from Ingenix and underpaid claims for services delivered by out-of-network providers. The APA Practice Organization has collaborated on the lawsuit with the New Jersey Psychological Association, a named plaintiff, since 2009. As we have done with three prior class action settlements, APAPO is providing detailed guidance for members on how to submit settlement claims before the March 28 filing deadline.
Meanwhile, APAPO has been providing guidance and consultation to practitioners and state associations seeking to develop alternative practice models designed to effectively deliver psychological services in a changing health care world. We are exploring ways to further support alternative practice initiatives by state associations and individual practices.
Another of our marketplace initiatives is providing support to states such as New York and New Jersey that are pursuing or considering pursuing legislation to remove antiquated state laws that prohibit psychologists from forming multi-disciplinary corporations and limited liability companies. Eliminating these barriers will foster practice models that help enable integrated health care service delivery.
APAPO also supports Medicaid advocacy efforts taking place at the state level. Grants from our Committee for the Advancement of Professional Practice are available to states looking to modify legislation and regulations to improve Medicaid participation by psychologists and reimbursement for psychological services. In 2013, Minnesota successfully used CAPP grant funds to gain psychologists' reimbursement by the state Medicaid program for providing consultation services to primary care providers.
APAPO continues to promote psychologists' roles in hospitals and health systems –including medical staff membership and practicing to the full scope of their licensure. The increased focus on integrated care under health reform will likely result in new opportunities for practitioners. Our Legal & Regulatory Affairs staff recently completed a 50-state review of hospital medical staff membership laws in order to facilitate SPTA advocacy in this area.
Now I want to shift the focus to how we help individual members with their professional needs and interests. Year after year, we assist more than one thousand practitioners with a wide range of legal and regulatory questions and concerns. Here's just a brief sample of topics and issues where we frequently have inquiries from members:
- HIPAA. APAPO has developed and updated several resources to aid members with HIPAA compliance. The resources are found in the HIPAA Compliance section of APAPO's Practice Central website.
- Record keeping. Increasingly, we assist members with questions about electronic health recordkeeping, ranging from very basic information to far more technical inquiries. We have also provided guidance in Good Practice magazine and in our PracticeUpdate e-newsletter.
- Telepsychology. We are providing member education on issues related to telepsychology such as reimbursement, informed consent, practice across state lines and other legal/regulatory issues.
- Responding to subpoenas. For many years, this has been one of the most frequent reasons that members contact our Legal and Regulatory Affairs Office. We have extensive information about responding to subpoenas on our Practice Central website.
- Duty to warn and protect. We've had an increased volume of these calls in the wake of the Newtown and other shootings. Psychologists typically want to know if duty to warn applies to particular practice situations and what professional responsibilities they may face.
The HIPAA Final Rule went into effect in September 2013, and as I just mentioned, APAPO has worked diligently to aid members with compliance.
Available HIPAA compliance materials on our website include:
The HIPAA Final Rule: What you need to do now, a free resource for APA Practice Organization members, with inserts to update existing HIPAA forms used by practitioners. It also provides a detailed explanation of key changes for psychologists in the Final Rule.
In addition, we updated our Privacy Rule Primer last summer and created a FAQs document to assist members with using Final Rule resources. The HIPAA for Psychologists Compliance Product and CE Course and HIPAA Security Rule Online Compliance Workbook are also available on Practice Central.
In response to the hundreds of member inquiries we received last year about HIPAA compliance, we published related articles and videos regularly in our member communications.
I'd like to focus a bit more on our marketplace advocacy for practicing psychologists and psychological services.
Health care reform is one of our primary APAPO marketplace advocacy initiatives. In 2014, for the second year in a row, health care reform implementation is reflected in the theme of our annual State Leadership Conference. This year, the focus for SLC is on Creating Roadmaps for Practice.
Also related to health care reform, the health insurance exchanges established under the Affordable Care Act create a marketplace for millions of individuals to purchase private health care coverage. In anticipation of their rollout in January 2014, we mounted an educational campaign through our regular member communications channels to educate our practitioners about the exchanges and potential issues related to psychologists' involvement.
Among their efforts to engage psychologists in state-based implementation of health care reform, numerous SPTAs have convened health care reform summits. These events have served as educational, strategic planning and brainstorming forums for positioning psychologists to play a role in health care reform as it evolves at the state level. I've had the pleasure of participating in 19 of these summits since 2011.
Keeping a pulse on member needs and interests helps inform our advocacy work and member communications. In November 2013, we conducted a survey of APAPO members that builds off two previous member surveys from 2008 and 2011. The surveys provide valuable insights into the professional interests and concerns of our members.
I want to share just a couple highlights from our 2013 member survey results. Between 80 and 90 percent of respondents indicate that they are "extremely interested" or "interested" in having information from us about the following topics: legal updates, regulatory compliance such as HIPAA, psychology-related news, legislative updates, ICD code usage and information on the latest treatment procedures and models.
A majority of respondents also indicated that they are interested in having information about working with Medicare and Medicaid as well as fact sheets and handouts for clients from APA Practice.
Protecting reimbursement for psychological services continues to be a top priority for members, with 98 percent indicating that it is "extremely important" or "important" for APA Practice to pursue. Legislative advocacy efforts are a close second. Public education efforts, raising the visibility of psychology in the marketplace and protecting the doctoral degree also ranked as important. These results suggest that our major activities through both the APA Practice Organization and APA Practice Directorate match closely with members' perception of importance.
Stay tuned for more member survey results through our regular member communication channels.
We use a variety of mechanisms to inform members about what APAPO is doing to advocate on their behalf and to provide information and resources that psychologists need to practice in today's evolving health care marketplace.
Our award-winning Good Practice print magazine, which helps members keep apprised of important developments and offers practical guidance, continues to be a highly-valued resource for members.
Our PracticeUpdate e-newsletter brings timely news and information to practitioners. We also disseminate breaking developments through targeted e-blasts on time-sensitive topics such as Medicare reimbursement.
Our online home for APAPO members is Practice Central, located at apapracticecentral.org. Nearly 400,000 people visited the Practice Central website in 2013, up from just over 250,000 the year before. Reimbursement for new psychotherapy billing codes, HIPAA compliance and information about ICD-10-CM were the most popular topics in 2013. We're continuing to expand the wide range of information and resources available at Practice Central for practitioners at various stages of their career and in diverse practice settings.
The laws and regulations that fundamentally affect the day-to-day practice of psychology are enacted and implemented at the state level. So many of our advocacy activities involve partnering with state, provincial and territorial psychological associations, or SPTAs.
The APA Practice Organization Committee for the Advancement of Professional Practice, or CAPP, provides hundreds of thousands of grant dollars annually to SPTAs for organizational infrastructure support and legislative advocacy initiatives. CAPP grants also are awarded for emergency requests as well as to the Council of Professional Associations of Psychologists in Canada.
I'm happy to report that, although we've had to trim APAPO expenses in other areas, the CAPP grant funding level for 2013 was maintained at the same level as in 2012. Each year, many SPTAs benefit from the funds provided by CAPP grants. For example, 26 states and DC received organizational development grants last year, while 13 states were provided with legislative grants.
This slide shows just a few examples of how CAPP legislative grants for 2013 supported a variety of professional initiatives, such as:
- Pursuing efforts to defend scope of practice regarding psychological assessment in Georgia
- Ensuring parity in private insurance and Medicaid in Kentucky
- Ensuring psychologists' role in behavioral health homes in Minnesota
- And supporting the inclusion of psychologists in the legislative process as Vermont considers a single payer plan.
APAPO is fighting for practitioners on Capitol Hill, in the courts and the marketplace. We're the only national organization with such a broad advocacy agenda working exclusively on behalf of the professional practice community. If we weren't here for psychology practice, who else would be?
Here's some of what the profession would sacrifice if not for APAPO:
- Challenging Medicare and private sector payment cuts
- Supporting litigation and regulatory action against managed care/insurance company abuses
- Advocating for practitioners' interests in health care reform
- Affirming the doctoral standard for independent practice in state licensing laws
- Confronting assaults on psychologists' scope of practice
Our APAPO budget relies heavily on Practice Assessment revenues. Member support is vital for sustaining APAPO's advocacy on behalf of professional psychology. So please help us spread the word among practitioners: Membership in APAPO matters. The greater our numbers, the more we can do on behalf of professional psychology. As we repeatedly tell our members: You help others. APAPO is here to help you.
As you can see, we have a very ambitious agenda. Unlike APA, however, APAPO has a limited governance structure to support our c(6) work – just the Committee for the Advancement of Professional Practice. We need a governance group that can devote all of its time to moving our c(6) activities forward.
Shortly after this annual report, you will be asked to vote on a proposed motion from the Board to approve in principle sunsetting the c(3) responsibilities of CAPP so it can focus entirely on its c(6) responsibilities. I want to invite everyone interested to an APAPO-sponsored luncheon tomorrow where the participants will be invited to share thoughts and concerns about this proposed motion. The lunch will take place tomorrow from 12:15 to 1:30 in the Senate room. We're hoping for a good turnout.
And that leads to my wrap-up of this annual report. A critical component of serving our members is hearing from them – about what they need from us and how we might better serve their professional interests. We're always eager for input from members. Email and toll-free phone contact information is listed on this slide.
Thank you for your time and attention to the important work of the APA Practice Organization.