Practice Directorate Activity Highlights: February 2011 through July 2011

Executive Summary

This report contains selected highlights of Practice Directorate activities from February through July 2011. Further information is available by contacting the directorate office as indicated below.

Playing an active role in health care reform implementation. For additional information, please email the Government Relations Department or call (202) 336-5889.

Advocating for appropriate implementation of the federal mental health parity law. For additional information, please email the Government Relations Department or call (202) 336-5889.

Seeking appropriate Medicare reimbursement for psychological services. For additional information, please email the Government Relations Department or call (202) 336-5889.

Successfully gaining introduction of federal legislation to include psychologists in the Medicare definition of “physician”. For additional information, please email the Government Relations Department or call (202) 336-5889.

Challenging inappropriate health insurance company and managed care practices. For additional information, please email the Legal and Regulatory Affairs Department or call (202) 336-5886.

Calling for corrections to inaccurate information from CMS about mental health services delivery. For additional information, please email the Legal and Regulatory Affairs Department or call (202) 336-5886.

Pursuing advocacy and educational activities to influence the implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act. For additional information, please email the Legal and Regulatory Affairs Department or call (202) 336-5886.

Convening the 28th annual State Leadership Conference. For additional information about the State Leadership Conference, please email the State Advocacy Department or call (202) 336-5864.

Affirming the value of psychologically healthy workplaces. For additional information, please email the Corporate Relations and Business Strategy Department or call (202) 336-5900.

Expanding and enhancing member communications for 2011. For additional information about the status of pending legislation, please email the Communications Department or call (202) 572-3028.

Playing an active role in guidelines development and promotion. For additional information, please email Governance Affairs or call (202) 336-5878.

Meeting the needs of service members, veterans and their families. For additional information about Give an Hour and related partnerships, please email the Public Relations Department or call (202) 336-5898.

Expanding public awareness of psychology and the value of psychological services. For additional information about the APA Public Education Campaign, please email the Public Relations Department or call (202) 336-5898.

Disaster response in the wake of tornadoes and flooding. For additional information, please email the Public Relations Department or call (202) 336-5898.

Practice Directorate Activity Highlights

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, is legally permitted to do.

Following are brief highlights of selected Practice Directorate activities and significant developments from February through July 2011.

Playing an active role in health care reform implementation

In the wake of a January 2011 US House of Representatives vote in favor of repealing the health care reform law, a February Senate vote against a repeal, and the judiciary’s ongoing involvement in legal challenges to health care reform, the APA Practice Organization (APAPO) continues to advocate on behalf of professional psychology and to safeguard critical beneficial reforms that have already been attained through the Affordable Care Act.

In a June comment letter (PDF, 265KB) to the Department of Health and Human Services, APA Chief Executive Officer Norman B. Anderson, PhD, and Dr. Nordal urged inclusion of clinical psychologists as participants in Medicare Accountable Care Organizations (ACOs).

Further, in a June letter (PDF, 59KB) to the Chairman of the House Subcommittee on Health, the APA Practice Organization (APAPO) voiced support for the Medicare Decisions Accountability Act of 2011 (HR 452), a bill to repeal the Medicare Independent Payment Advisory Board (IPAB). The letter was presented as part of the record in the June 14 Congressional hearing on the issue.

Advocating for appropriate implementation of the federal mental health parity law

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act took effect on January 1, 2010. In February, the federal government published its Interim Final Rule (IFR) to implement this full parity law. The IFR, which provides clear guidance and strong consumer protections, took effect on January 1, 2011 for most health plans to which the law applies. The Practice Directorate is collaborating with state psychological associations to advocate for psychology when insurance companies may be involved with questionable practices related to mental health benefits management in light of the federal parity law.

In 2010, APAPO became aware that Blue Cross Blue Shield of Illinois (BCBS-IL) intended to change its mental health benefits management, with BCBS-IL announcing new authorization requirements for outpatient therapy. APAPO worked closely with the Illinois Psychological Association (IPA) to address the BCBS-IL proposal and helped IPA prepare a letter to BCBS-IL objecting to implementation of the new requirements.

Late in December, BCBS-IL announced that the company was withdrawing the authorization requirements for outpatient therapy, and in May 2011 the company reiterated to IPA that it will not try to re-institute the authorization requirements that had been slated to take effect in January.

In consultation with psychological associations in states where BCBS companies have imposed similar authorization requirements, APAPO is working to determine the extent to which the Illinois arguments and success can be replicated elsewhere. Further, we are monitoring the extent to which insurers are continuing or implementing other objectionable benefit management practices, such as intrusive telephone reviews.

The Practice Directorate worked to increase member and public awareness and understanding of parity implementation. The APAPO published a special section on implementation (PDF, 1.0MB) of the federal mental health parity law in the Winter 2011 issue (PDF, 1.0MB) of Good Practice magazine.

The APA Practice Directorate helped develop an APA survey designed to get a better understanding of what Americans know about parity and about their mental health coverage. Among survey findings: An overwhelming majority of Americans remain unaware of the Mental Health Parity and Addiction Equity Act of 2008 and unfamiliar with the term “mental health parity,” and 45 percent are unsure if their insurance reimburses them for mental health care.

In February, Executive Director for Professional Practice Katherine C. Nordal, PhD, worked to improve public awareness with a radio media tour where she answered questions about mental health parity in 17 interviews aired by more than 1000 stations and reaching 12 million listeners.

As part of a March 2011 State Leadership Conference workshop panel regarding parity law implementation, Senior Special Counsel for Legal and Regulatory Affairs Alan Nessman JD, outlined several questions psychologists should ask in assessing whether an insurance company may be involved with questionable practices in light of the federal parity law. The Practice Update e-newsletter shared the list of questions in an article later that month.

Seeking appropriate Medicare reimbursement for psychological services

In February 2011, following months of delays, CMS announced that psychologists would soon begin to receive retroactive restoration payments for Medicare psychotherapy services provided between January 1 and July 1, 2010. The restoration payments were one aspect of many Medicare payment changes included in the Patient Protection and Affordable Care Act (PPACA) of March 2010. The provision in PPACA followed the December 31, 2009 expiration of an earlier five percent payment restoration for psychotherapy services. The APA Practice Organization successfully advocated for reinstatement of the psychotherapy monies for all of 2010, retroactive to January. A later law extended the additional five percent Medicare psychotherapy payments through 2011.

In more than 300 meetings with their members of Congress and staff in March, attendees of the March 2011 State Leadership Conference advocated for protection of Medicare mental health payment.

Also in March, APAPO produced a video, published in the Practice Update e-newsletter, on bonus payments for psychology via the Medicare Physician Quality Reporting System (formerly known as the Physician Quality Reporting Initiative). The video guides psychologists through basics of the system, including information on bonus payments, eligible measures, how to report, and the transition to a mandatory reporting program in 2015.

Successfully gaining introduction of federal legislation to include psychologists in the Medicare definition of “physician”

In late February and early March, key allies of professional psychology in the Senate and House introduced legislation to include psychologists in the Medicare “physician” definition, an important step toward ensuring that psychologists are able to provide Medicare mental health services free of unnecessary physician supervision requirements that hinder patient access. (2a) In advocating for the legislation, representatives of the APA Practice Organization (APAPO) emphasize that psychologists are key Medicare mental health providers. (2c). In mid-March State Leadership Conference attendees took to the Hill the advocacy message that Congress should include psychologists in Medicare’s “physician definition.”

In April Assistant Executive Director for Government Relations Marilyn Richmond, JD, sent a letter on behalf of the APAPO to members of Congress requesting cosponsorship of Medicare “physician” definition bills in the House and Senate. In the letter (PDF, 87KB) Richmond pointed out that of psychologists in the physician definition will not expand their scope of practice, but rather “provide for a long-overdue reassessment of the services psychologists may provide within licensure without supervision.”

Challenging inappropriate health insurance company and managed care practices

In the spring of 2011, the APA Practice Directorate collaborated with the Massachusetts Psychological Association (MPA) and Massachusetts Neuropsychological Society (MNS) to confront changes in neuropsychological benefits management by Blue Cross/Blue Shield of Massachusetts (BCBSMA) that impede access to medically necessary care for subscribers. The three groups jointly sent a letter to the Office of the Attorney General of Massachusetts detailing how consumers are harmed by the company’s systematic denial of medically necessary neuropsychological assessment requests.

Calling for corrections to inaccurate information from CMS about mental health service delivery

The APA Practice Directorate secured swift action from the Centers for Medicare and Medicaid Services (CMS) following the directorate’s call for the federal agency to correct misinformation in a CMS publication about mental health service delivery. In a May 2011 letter to CMS (PDF, 129KB), the Practice Directorate detailed misinformation in the “Mental Health Services” publication and requested that the agency either revise the booklet or remove it from the CMS website. In June, CMS posted an Errata Sheet containing “corrections or changes” incorporating most of APA’s suggested revisions along with the booklet on their website. CMS also has taken steps to make print versions of the Errata Sheets available. According to agency representatives, the booklet will go through yearly review next winter and CMS will incorporate the revisions from the Errata Sheet.

Pursuing advocacy and educational activities to influence the implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act

The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 excludes psychologists and most other non-physician providers from receiving Medicare and Medicaid incentive payments and grant funds to adopt electronic health record keeping systems (EHRs). As federal rules to implement the HITECH Act take effect, the APA Practice Organization (APAPO) continues to push for the full inclusion of psychologists under the Act’s incentive programs. Following the hard work of psychology, in coalition with other mental health and substance abuse providers and treatment facilities, the Senate introduced legislation on March 10 that would make mental health practitioners and facilities eligible for HITECH incentive payments related to EHRs.

In more than 300 meetings with their Members of Congress and staffs at the State Leadership Conference in mid-March, attendees took the message to the Hill that Congress should make psychologists eligible for incentive payments through the HITECH Act as one of three key advocacy messages.

As a member of the Behavioral Health Information Technology Coalition, APA participated in a bipartisan Senate briefing on July 20, 2011 to examine the benefits of extending financial incentives for adopting health information technology (HIT), including electronic health records, to mental health and addiction treatment providers and facilities. (2a) A panel of health IT experts and health care providers, including APA member and Director of Behavioral Health Care for Jefferson Regional Medical Center in Pittsburgh, PA, Joseph F. Cvitkovic, PhD, discussed how the inclusion of mental and behavioral health in HIT would improve coordination of care and outcomes for millions of patients, as well as reduce costs in the health care system.

Convening the 28th annual State Leadership Conference

Nearly 500 psychology leaders participated in workshops, symposiums and networking opportunities at the 28th annual State Leadership Conference in Washington March 12-15. On the final day of the conference, attendees took three key advocacy messages to the Hill and shared this in more than 300 meetings with members of Congress and staff: Congress should protect payment for Medicare mental health services, Congress should include psychologists in Medicare’s “physician” definition, and Congress should make psychologists eligible for incentive payments through the HITECH Act.

Affirming the value of psychologically healthy workplaces

An online survey conducted on behalf of APA by Harris Interactive between January 31 and February 8, 2011 found many employees feel undervalued and stressed out at work and many are dissatisfied with aspects of their job (2a, 3d). In March, the Practice Directorate’s Assistant Executive Director of Marketing and Business Development David Ballard, PsyD, MBA, recorded 15 radio interviews on the survey and the benefits of creating a psychologically healthy workplace, reaching out to more than 14.5 million listeners. The radio media tour allowed radio talk show hosts and producers to ask questions about APA’s recent workplace survey and the benefits of creating a Psychologically Healthy Workplace.

In recognition of employers who understand the link between employee well-being and organizational performance, the American Psychological Association honored eight organizations at its sixth annual Psychologically Healthy Workplace Awards in Washington, D.C., on March 12. The ceremony was broadcast live online for the first time

APAPO sponsored the 2011 Psychologically Healthy Workplace Conference April 8-9 in Chicago. Designed for employers and the psychologists who work with them, the conference offered sessions that provided practical, relevant information to help employees and organizations thrive.

Expanding and enhancing member communications for 2011

Practice Update, the e-newsletter for members from the APA Practice Organization, increased publication from once to twice a month and added videos as a periodic feature in 2011. The e-newsletter increased its focus on sharing clinically useful information with practitioners through regular installments of Research Roundup and Practitioner’s Bookshelf. Consumer education materials are included regularly in Good Practice, including a fact sheet on building resilience in the Spring 2011 issue (PDF, 1.9MB) and one on mental health insurance under the federal parity law in the Winter 2011 issue (PDF, 1.0MB).

Playing an active role in guidelines development and promotion

In February the APA Council of Representatives approved and adopted as APA policy the following guidelines relevant to professional practice: Guidelines for the Practice of Parenting Coordination, Guidelines for Psychological Practice in Health Care Delivery Systems, Guidelines for Psychological Evaluations in Child Protection Matters.

Practice Update carried an item on passage of the guidelines and the Spring 2011 issue of Good Practice included a Q and A for practitioners on cultivating a role in parenting coordination (PDF, 164KB). Additional content related to the guidelines is planned for future issues.

Meeting the needs of service members, veterans and their families

The March 2011 State Leadership Conference included a workshop on “Psychology’s Response to our Military’s Mental Health Needs". APA is a partner of Give an Hour and SOFAR, with the Practice Directorate helping spread the word about their mission, commitment and the process by which psychologists can volunteer their services to military personnel and their families.

In May the 2011 VA Psychology Leadership Conference brought together more than 200 Department of Veterans Affairs psychology leaders to share best practices and promote leadership opportunities. The annual conference is co-sponsored by the APA Practice Directorate, Division 18 (Psychologists in Public Service) and the Association of VA Psychologist Leaders.

Expanding public awareness of psychology and the value of psychological services

The grassroots network of psychologists involved in APA’s multi-directorate Public Education Campaign (PEC) works to educate the public about how the science and application of psychology benefits society and improves lives. On March 9, psychologists brought messages directly to legislators’ doorsteps with Mind/Body Health fairs convened at state capitols in Florida and Texas.

In honor of Mental Health Month in May, APA’s second annual Mental Health Blog Party held May 18 encouraged bloggers around the country to share their thoughts, tips and personal experiences on topics related to mental health and emotional wellness. In addition, APA hosted a series of Facebook chats in May and June in which psychologists addressed a particular issue and answered questions posed to them:

  • On May 11, Assistant Executive Director for Practice, Research and Policy Lynn Bufka, PhD, answered questions live about anxiety.
  • On May 26, Executive Director for Professional Practice Katherine C. Nordal, PhD, led a chat about how friends and family members can support loved ones in efforts to improve their mental health.
  • On June 9, Assistant Executive Director of Marketing and Business Development David W. Ballard, PsyD, MBA, led a chat on workplace stress

Mental Health Month activities at APA Practice Directorate

In July, the landing page of the Psychology Help Center of the APA Website added a link to content titled "What Do Practicing Psychologists Do?" The newly updated content provides a succinct overview of the broad range of services provided by licensed psychologists, with multiple links to additional material.

Disaster response in the wake of tornadoes and flooding

The APA Disaster Response Network (DRN) helped the American Red Cross (ARC) fill disaster mental health volunteer positions for relief operations across several southern states, including Alabama, Mississippi, North Carolina and Tennessee, in response to tornadoes and flooding in April and May, and also supported June and July flood relief in Minot, North Dakota. More than 50 DRN members were mobilized to travel outside their state and even more worked locally to support chapter disaster relief operations. Psychologists helped by assessing and triaging distressed survivors, promoting resilience and coping skills, and intervening to mitigate problems and make referrals to community resources. Through their Red Cross chapters, DRN members in Colorado, New Hampshire and New Jersey have been providing post-deployment support to returning disaster responders.