Practice Directorate Activity Highlights
August 2009 through January 2010

This report contains selected highlights of Practice Directorate activities from August 2009 through January 2010. Further information is available by contacting the directorate office as indicated below. 

Rolling out Practice Central as the new online home for practitioners. For additional information, contact the Practice Directorate Communications Department by e-mail, or by calling 202-336-5877.

Educating employers, the public and psychologists about implementation of the federal mental health parity law. For additional information about our work with the employer community, contact the Marketing and Business Development Department by e-mail or by calling 202-336-5900. For additional information about educational resources for the public available at the Psychology Help Center, contact the Public Relations Department by e-mail or by calling 202-336-5898. For additional information about federal regulations to implement the parity law, contact the Government Relations Department by e-mail or by calling 202-336-5889.

Playing an active advocacy role in health care and Medicare reform. For additional information, contact the Government Relations Department by e-mail or by calling 202-336-5889.

Collaborating on class action lawsuits against large managed care companies. For additional information, contact the Legal & Regulatory Affairs Department by e-mail or by calling 202-336-5886.

Compiling and publicizing results of an APA member survey on health insurers. For additional information about the survey, contact the Legal & Regulatory Affairs Department by e-mail or by calling 202-336-5886. For information about data compilation and analysis, contact the Practice Research & Policy Department by e-mail or by calling 202-336-5911.

Helping to achieve federal funding for the Mentally Ill Offender Treatment and Crime Reduction Act in Fiscal Year 2010. For additional information, contact the Government Relations Department by e-mail or by calling 202-336-5889.

Pursuing advocacy and educational activities related to the drive toward electronic health record keeping. For additional information, contact the Legal & Regulatory Affairs Department by e-mail or by calling 202-336-5886.

Shaping federal rules governing the delivery of psychological services in inpatient rehabilitation facilities. For additional information, contact the Legal & Regulatory Affairs Department by e-mail or by calling 202-336-5886.

Supporting congressional action to exempt small practices from the Federal Trade Commission’s “Red Flags” requirements. For additional information about the FTC rule, contact the Legal & Regulatory Affairs Department by e-mail or by calling 202-336-5886. For additional information about legislative advocacy, contact the Government Relations Department by e-mail or by calling 202-336-5889.

Expanding public education about psychology and the value of psychological services. For additional information, contact the Public Relations Department by e-mail or by calling 202-336-5898.

Engaging in initiatives following the devastating earthquake in Haiti. For additional information, contact the Public Relations Department by e-mail or by calling 202-336-5898.

Supporting the concept of recovery for people with serious mental illness. For additional information, contact the State Advocacy Department by e-mail or by calling 202-336-5864.

The Practice Directorate engages in a broad range of activities on behalf of practicing psychologists in diverse settings and consumers of psychological services. The directorate’s primary activities involve advancing and protecting professional psychology and consumers’ access to psychological treatment.

APA Executive Director for Professional Practice Katherine C. Nordal, PhD, provides staff leadership for the work of the APA Practice Directorate as well as the APA Practice Organization (APAPO), a companion organization to APA. The APAPO was created in 2001 as a 501(c)6 organization under IRS rules to enable additional advocacy for the professional practice community beyond what APA, as a 501(c)3 organization, can do.

Following are brief highlights of selected Practice Directorate activities and significant developments from August 2009 through January 2010.

Rolling out Practice Central as the new online home for practitioners

As of 2010, the APA Practice Organization has a new online home for members. Our revamped Web site, Practice Central at www.apapracticecentral.org, offers one-stop access to a wide variety of materials tailored to practicing psychologists, including:

• Continuing Education (CE) courses and other professional development resources

• Guidance and updates on legislative and legal issues for practitioners

• How to use billing codes and other practical pointers on reimbursement

• Information to help build, manage, market and diversify your psychology practice

• Client and public education resources

The Practice Directorate is regularly adding information, resources and products to Practice Central.

Educating employers, the public and psychologists about implementation of the federal mental health parity law

After years of persistent advocacy by the APA Practice Organization, the Wellstone-Dominici Mental Health Parity Act of 2008 became law – with January 1, 2010 slated as date for the new law to take effect. The Practice Directorate worked actively during the latter half of 2009 to begin making employers, the general public and psychologists aware of the full parity law.

Our Employer’s Guide to the Mental Health Parity and Addiction Equity Act provides initial guidance for the business community by outlining how the steps that employers take in complying with the law can improve organizational outcomes. In an October 2009 media tour that reached more than 2.5 million radio listeners across the nation, David Ballard, PsyD, MBA, the Practice Directorate’s Assistant Executive Director for Marketing and Business Development, discussed the decade-plus fight to end insurance discrimination against those seeking treatment for mental health and substance use disorders and the resulting full mental health parity law.

Educational material about the law – such as the article, “How Does the New Mental Health Parity Law Affect My Insurance Coverage?” – is available to consumers at the Psychology Help Center available at www.apa.org. Further, the November 2009 issue of the PracticeUpdate e-newsletter contains questions and answers for practitioners about the mental health parity law.

New material will be added to Practice Central at www.apapracticecentral.org in 2010, for example, as the Practice Directorate disseminates information about federal rules to implement the mental health parity law. At the end of January, federal agencies released proposed regulations related to this law.

Playing an active advocacy role in health care and Medicare reform

Due to persistent advocacy by APAPO and grassroots psychologists, health care and Medicare reform legislation pending at the end of 2009 contained favorable provisions for professional psychology, including:

• a mandate that mental health and substance use services be a core benefit provided at parity with physical health services by all plans that participate in a new insurance pool designed to extend health coverage to more Americans

• extension of a 5 percent payment boost for Medicare psychotherapy services that APAPO first achieved for a two-year period beginning in 2008

• inclusion of mental and behavioral health providers on primary care teams that deliver integrated services

Throughout the 2009 congressional debate on health care and Medicare reform, seeking appropriate Medicare reimbursement levels for psychological services was a top priority for APAPO, and it continues to guide our advocacy work.

One major factor affecting Medicare payment is the Sustainable Growth Rate (SGR), which the Centers for Medicare & Medicaid Services (CMS) is required to implement each year. For 2010, the SGR was slated to impose a 21.2 percent reduction in payments for all Medicare services. APAPO advocated actively to block this reduction, through direct lobbying on Capitol Hill and broad-based grassroots mobilization of practicing psychologists across the U.S. On December 19, President Obama signed legislation that postpones the scheduled 21.2 percent SGR cut through February 28, 2010.

Another key provision for professional psychology -- an extension of the Medicare payment restoration for psychotherapy services -- is part of health care reform bills pending as of January 2010. Following implementation of widespread Medicare payment cuts by CMS, the APA Practice Organization successfully persuaded Congress to restore 5 percent in Medicare payments for psychotherapy services beginning in 2008 through the end of 2009. Thanks to persistent lobbying by our Government Relations staff, both the House and Senate health care and Medicare reform bills include provisions that would extend this psychotherapy services payment restoration.

Yet the future of pending health care reform proposals is uncertain as of late January 2010, in part because the majority of Democrats in the Senate declined to 59 – not enough members to break a Republican filibuster of a final vote on health care reform. As Congress determines how to move ahead in 2010, APAPO will continue working to ensure that professional psychology’s priorities are included in any health care reform that moves forward, whether through pending legislative proposals or another legislative vehicle.

Grassroots action plays a crucial role in our legislative advocacy efforts. From August 1, 2009 through January 27, 2010, psychologists utilized our online Legislative Action Center to send their Senators and Representatives nearly 23,000 email messages advocating for Medicare and health care reform priorities.

Collaborating on class action lawsuits against large managed care companies

In mid-2009, the APA Practice Organization collaborated with the New Jersey and California State Psychological Associations in filing nationwide class action lawsuits against three of the largest managed care companies in the U.S. -- WellPoint Anthem Blue Cross Blue Shield, Aetna and CIGNA. The lawsuits, which allege that the companies used flawed databases that substantially reduced reimbursement to psychologists, seek to reform how the companies reimburse psychologists and to compensate those affected by underpayment. Through the fall and winter of 2009, discovery (the process of document production and interrogatories) and briefing on the companies’ motions to dismiss the lawsuits have proceeded intensely.

The Aetna and CIGNA cases in New Jersey are moving very quickly for cases of this size. Depositions have started, and counsel expects that representatives of NJPA will be deposed in a few months. In May 2010, the parties are scheduled to file their briefs and present arguments to the court on whether the cases meet the legal standards for proceeding as a class action (as opposed to proceeding as separate individual cases).

Compiling and publicizing results of an APA member survey on health insurers

In December 2009, the Practice Directorate concluded its nationwide survey of psychologists seeking their ratings of the largest insurance and managed care companies, along with Medicare and Medicaid, regarding these insurers’ service to mental health patients and their treatment of psychologists. The directorate has been evaluating the data from several thousand completed surveys.

Preliminary analysis of key ratings shows statistically significant differences in perceptions of various insurers’ performance on factors such as patient access to care from psychologists, authorizing appropriate care and respecting patient privacy. In 2010, the Practice Directorate will publicize survey results to employers, consumers, state regulators, psychologists and the insurers themselves. Highlighting quality differences among insurance companies is intended to give employers and consumers better information for selecting mental health coverage and to encourage competition among insurers to provide better care.

Helping to achieve federal funding for the Mentally Ill Offender Treatment and Crime Reduction Act in Fiscal Year 2010

APAPO was active in gaining a federal Fiscal Year 2010 appropriation of $12 million for the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA), a federal grant program to help states and localities improve mental health services delivery for non-violent offenders and reduce the criminalization of individuals with mental health disorders. Congress reauthorized MIOTCRA for $50 million through 2014.

Pursuing advocacy and educational activities related to the drive toward electronic health record keeping

The Practice Directorate is working to address issues related to the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, including responding to proposed government regulations and certification standards by the quasi-governmental groups recognized in the Act. Our most recent response was to standards proposed by Certification Commission for Health Information Technology (CCHIT) regarding capabilities of electronic behavioral health records.

The Fall 2009/Winter 2010 issue of the APA Practice Organization’s Good Practice magazine included an article, “Rewards and Risks of Electronic Health Record Keeping,” a Q&A with Tyler Story, PhD, a neuropsychologist affiliated with Duke University Medical Center.

Shaping federal rules governing the delivery of psychological services in inpatient rehabilitation facilities

On July 31, 2009, The Centers for Medicare & Medicaid Services (CMS) released a final rule on inpatient rehabilitation facilities (IRFs) that reflects the Practice Directorate's comments on the rule as proposed by CMS. Specifically, as APA urged a month earlier in a letter to CMS, the final rule requires the provision of psychological services as needed and does not limit the delivery of these services to neuropsychologists only.

The newly revised rule governs payment rates and polices for Medicare's payment system for IRFs. In addition to updating rates, the rule clarifies the requirements for inpatient admissions and post-admission procedures. The new final rule requires IRFs to provide both psychological services and social services as needed.

Supporting congressional action to exempt small practices from the Federal Trade Commission’s “Red Flags” requirements

The U.S. House passed a bill in October 2009 that would exempt psychology practices with 20 employees or fewer from the Federal Trade Commission’s (FTC) “Red Flags Rule,” and allow larger practices that have not had identity theft problems to apply for an exemption from the Rule. As of January 2010, APAPO was supporting similar legislation in the Senate and is working with Senate staff to ensure that psychology is specifically included in the list of professions that will be exempted from the Rule. In light of pending legislation, the FTC has again delayed the enforcement of its Red Flags Rule -- most recently, until June 1, 2010.

Throughout 2009, the APA Practice Organization kept members informed about successive delays in enforcement of the FTC Rule, providing guidance and updates through regular articles in our Practice Update e-newsletter.

Expanding public education about psychology and the value of psychological services

Since 1996, the psychologist-driven APA Public Education Campaign (PEC) has informed the public about psychology and the value of psychological services. The campaign is a carefully orchestrated set of grassroots activities designed to systematically disseminate a strategically developed flight of messages about psychology and psychological services for target audiences.

In November 2009, APA’s annual Stress in America survey – a key element of the PEC for several years -- made headlines around the world. In the first few days following its release, the survey reached nearly 28 million people through 850 stories on TV and radio, and in newspapers, blogs and news and health Web sites, including NBC’s Today Show, MSNBC, USA Today, the Wall Street Journal blog and the Chicago Tribune.

The PEC’s current Mind/Body Health initiative includes a partnership with the National YMCA that greatly facilitates community outreach. APA and YMCA are working together on initiatives to promote health and wellness. An initial workshop, “Making Healthy Choices for Your Family,” was made available during 2009 to APA members and the more than 2,600 YMCAs throughout the U.S. serving more than 20 million people.

The Web site associated with APA’s Public Education Campaign features articles and information for consumers related to psychological issues affecting one’s daily physical and emotional well-being. As of January 2010, the site is part of the newly revamped www.apa.org and is now known as the Psychology Help Center.

Considerable additional information about the campaign is contained in a report for the February 2010 APA Council of Representatives meeting concerning reauthorization of the PEC.

Engaging in initiatives following the devastating earthquake in Haiti

Following the catastrophic earthquake in Haiti, the American Psychological Association (APA) Disaster Response Network (DRN) engaged in a number of initiatives in January 2010, including:

• distributing guidelines for psychologists about international disaster response work and psychological resources for people in the United States and Canada who are distressed about deceased or injured persons in Haiti;

• offering culturally sensitive and informed psychological support through Red Cross chapters and local government agencies to support sizable Haitian communities in states such as New York, Massachusetts, and Florida, as well as in Washington, D.C. and Ontario, Canada;

• meeting planes of U.S. citizens being repatriated to this country from Haiti;

• preparing to offer psychological support to relief and rescue workers returning from Haiti; and,

• communicating and collaborating with the American Red Cross Disaster Mental Health activity, agencies of the U.S. Department of Health and Human Services, and other non-governmental organizations.

In addition, APA staff in both the Public and Member Communications and Practice Directorates worked on media outreach and response to provide news reporters and producers with appropriate experts on the mental health issues raised by natural disasters such as the earthquake in Haiti. DRN members have been interviewed for national media outlets including Time magazine and Guideposts.

Further, as related to DRN activity, in the midst of the H1N1 epidemic, the Practice Directorate disseminated material for practitioners during the fall of 2009 about client appointments and H1N1.

Supporting the concept of recovery for people with serious mental illness

Following the APA Council of Representatives’ August 2009 endorsement of the concept of recovery for people with serious mental illness, the APA Task Force on Serious Mental Illness/Serious Emotional Disturbance worked with the Public Interest Directorate on a grant application to foster recovery-oriented training opportunities for psychologists who work with people with serious mental illness. If the grant is obtained, a group will survey the field of psychology and develop a curriculum in recovery-oriented treatments.