APA Practice: Working for you

Brief highlights of selected Practice Directorate activities and significant developments from February 2010 through July 2010

by Communications Staff

July 28, 2010 — Playing an active role in health care reform and parity implementation. Updating the Psychologist Locator. Expanding public education about psychology and the value of psychological services.

If you’ve missed these highlights and other recent news from the American Psychological Association (APA) Practice Organization and APA Practice Directorate, here’s a wrap-up of how we’ve been advocating for professional psychology in the past six months.

This report contains selected highlights of Practice Directorate activities from February 2010 through July 2010. Further information is available by sending an e-mail or calling the directorate office as indicated below.

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

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

  • Encouraging member participation in the Medicare Psychotherapy Codes Surveys
    For additional information, please e-mail the Government Relations Department or call (202) 336-5889.

  • Challenging abusive managed care practices
    For additional information, please e-mail the Legal and Regulatory Affairs Department or call (202) 336-5886.

  • Supporting congressional action to exempt small practices from the Federal Trade Commission’s “Red Flags” requirements
    For additional information about the status of pending legislation, please e-mail the Government Relations Department or call (202) 336-5889.

  • Convening the 27th annual State Leadership Conference
    For additional information about the State Leadership Conference, please e-mail the State Advocacy Department or call (202) 336-5864.  

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

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

  • Updating the Psychologist Locator service
    For additional information, please e-mail the Executive Office.

  • Seeking to ensure the availability of adequate psychological services for veterans
    For additional information, please e-mail the Practice Directorate Executive Office or call (202) 336-5913.

  • Aiding the profession’s quest for prescriptive authority 
    For additional information, please e-mail the Legal and Regulatory Affairs Department or call (202) 336-5886.

  • Working to institute California regulations to permit psychologists in institutional settings to practice fully and independently within their scope of licensure
    For additional information, please e-mail the Legal and Regulatory Affairs Department or call (202) 336-5886.

  • Engaging in initiatives following the devastating earthquake in Haiti and oil disaster in the Gulf of Mexico
    For additional information, please e-mail the Public Relations Department or call 202-336-5898.

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 able to do.

Following are brief highlights of selected Practice Directorate activities and significant developments from February to July 2010. Additional information about the topics here can be found at the URLs listed.

Playing an active role in health care reform and parity implementation

On March 23, President Obama signed H.R. 3590, the Patient Protection and Affordable Care Act (PPACA) into law. This historic health care reform law resulted from months of intense congressional discussion, committee and floor action, and debate.

During this legislative process, the American Psychological Association Practice Organization (APAPO) successfully advocated to preserve Medicare psychotherapy payments for psychologists, protect traditional psychological practice, and open up new opportunities for psychologists in the private health care system and in public health programs, such as Medicare and Medicaid. PPACA requires that mental health and substance use disorder services are part of the essential benefits package that all qualified health plans provide through state Health Benefits Exchanges. These services must be provided at parity with medical/surgical services.

The Paul Wellstone and Pete Domenici Mental Health Parity & Addiction Equity Act (MHPAEA) became law in October 2008. With the federal government’s publication of the Interim Final Rule (IFR) to implement this full mental health insurance parity law, clear guidance and strong consumer protections become effective for health plan years beginning on or after July 1, 2010. For most plans, this means that the IFR will apply on January 1, 2011.
The APA Practice Organization urged the federal departments involved with the IFR to ensure its final implementation. On May 3, APAPO filed comments in support of the IFR, emphasizing the importance of applying parity to prohibit separate deductibles and related cost sharing and for the implementation of the law as it applies to treatment limitations including benefits management.
APAPO also wrote and garnered signatures for the Mental Health Liaison Group (MHLG) comments in support of the parity IFR. The MHLG is the most significant mental health and substance use coalition in Washington, DC. Through the Practice Organization’s efforts, 55 national organizations signed their support for the IFR—the most signatories for any MHLG letter in its long history.

Several issues of the APA Practice Organization’s Practice Update e-newsletter devoted articles to educating members about regulatory implementation of the law.

APA Executive Director for Professional Practice, Katherine C. Nordal, PhD, participated by invitation as a speaker at “The Wellstone-Domenici Mental Health Parity and Addiction Equity Act: Implications for All Stakeholders Conference” in late June. As part of a panel of providers, she spoke about the implications of parity implementation from the perspective of the psychology community. Dr. Nordal also was invited to participate in a special conference session about measures that could be used to evaluate the impact of the parity law.

Six Points You Need to Know About the Mental Health Parity Law

Mental Health Parity Rule is Favorable for Psychology

Since You Asked…About Implementation of the Federal Parity Rule

Update on Regulatory Implementation of Federal Parity Law

Seeking appropriate Medicare reimbursement for psychological services 

As part of the Patient Protection and Affordable Care Act signed into law in March, Congress approved extending the 5 percent Medicare psychotherapy payment restoration for all of 2010 retroactive to January 1. In 2007, the Centers for Medicare and Medicaid Services (CMS) reduced Medicare Part B reimbursement for all Medicare services to offset increases in payment for evaluation and management services. The American Psychological Association Practice (APAPO) argued successfully that psychologists were disproportionately affected by the cuts. In response, Congress restored 5 percent in payments for psychotherapy services through the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), but this restoration expired on December 31, 2009. As the new health care reform law restores payments only for 2010, the APAPO continues to seek further extension of the restoration.

On June 25, President Obama signed the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (H.R. 3962), postponing the 21.3 percent Sustainable Growth Rate (SGR) cut in Medicare payments retroactive to June 1 and through November 30, 2010. The new law also gives a 2.2 percent increase in Part B reimbursement for services delivered from June 1 through November 30. This is the third time that Congress has postponed the SGR cut this year alone.

The Medicare “sustainable growth rate,” or SGR, payment formula ties Medicare provider payments to factors related to the national economy. In recent years, the formula would have operated automatically to cut most provider payments if Congress had not acted to postpone the scheduled payment cuts. The American Psychological Association Practice Organization (APAPO) continues to keep up the pressure for Congress to enact a permanent solution to the flawed SGR payment formula.

In addition to keeping psychologists up-to-date on these developments related to Medicare reimbursement, we recently informed members of the upcoming shift in Medicare’s Physician Quality Reporting Initiative (PQRI) from a voluntary program to one in which penalties will be assessed against providers who do not successfully participate beginning in 2015.

Historic Law Includes Psychotherapy Payment Restoration

Law Postpones SGR Payment Cut Again

PQRI to Shift from Bonus Payment to Penalty Program

Encouraging member participation in the Medicare Psychotherapy Codes Surveys

For the first time in 10 years, The Centers for Medicare and Medicaid Services (CMS) is preparing to review the value of the work that psychologists and other professionals do in providing psychotherapy services. In June, a random sample of APA Practice Organization members received surveys regarding specific psychotherapy services.
The surveys are part of the process known as the “five-year review” in which CMS looks at certain codes and determines whether they are overvalued or undervalued.  Late in 2009, the American Psychological Association formally requested that CMS review psychotherapy codes during its 2010 five-year review of codes in the Medicare fee schedule.

Call for Members to Complete Medicare Psychotherapy Codes Surveys

Challenging abusive managed care practices

The APA Practice Organization updated members on the class action lawsuit settlement with United Healthcare (United) in an April 2010 PracticeUpdate article. We will provide further guidance for psychologists about eligibility and how to submit a claim in the July issue. The settlement resolves a case alleging that United used the flawed database of its subsidiary Ingenix to reduce the "usual, customary and reasonable" (UCR) rates on which the company based reimbursement for out-of-network services. Psychologists are part of the nationwide provider class that is eligible to submit claims to the $350 million settlement fund.

The APA Practice Organization is collaborating with the New Jersey and California state associations on similar ongoing nationwide class actions alleging that CIGNA, Aetna and WellPoint Anthem BCBS also used United’s Ingenix database to reduce UCR payments to psychologists for out-of-network services.

This spring and early summer, the Practice Organization also provided legal support to the New Jersey Psychological Association on its lawsuit against the New Jersey State Health Benefits Plan and the companies that manage mental health benefits for the plan (Magellan and Horizon BCBS). The suit, filed at the end of 2009, alleges that defendants violated patients’ privacy and applicable privacy law when attempting to restrict use of out-of-network psychologists through measures such as intrusive telephonic interviews. In May 2010, the court ordered the parties to participate in mediation, which is scheduled to start in late July. Attorneys for the APA Practice Organization will coordinate with NJPA’s counsel in preparing for that mediation.

October 5, 2010 is Deadline to File Claims in the United Healthcare Ingenix Settlement

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

Staff has advocated with key members of Senate Banking Committee and Federal Trade Commission (FTC) for exemption of psychologists from the FTC’s Red Flags requirements. The term "Red Flags" refers to "potential patterns, practices or specific activities” that could indicate the possibility of identity theft. Entities covered under the Rule are required to develop and implement written identity theft prevention programs.

The Rule originally became effective on January 1, 2008 with full compliance originally required by November 1 of that year. However, enforcement of the Red Flags Rule has been delayed five times so far. The Practice Update e-newsletter has kept members apprised of the continued delays in implementation of the rule.

In October 2009, the U.S. House of Representatives passed a bill that would exempt psychology (and other health care) practices with fewer than 20 employees or fewer. The APA Practice Organization supports the passage of similar Red Flags Rule legislation pending in the Senate as of July 2010.

FTC Delays Red Flags Rule Enforcement Through December 31, 2010

Convening the 27th annual State Leadership Conference

Nearly 500 psychology leaders participated in the 27th annual State Leadership Conference (SLC) held March 6-9 in Washington, DC. The annual advocacy training conference for leaders in professional psychology practice brings together psychologists from the states, US territories and Canada, along with APA governance and divisions, to advocate for issues important to practicing psychologists. This year’s theme, the power of advocacy, provided context for nearly three dozen workshops, plenary sessions, and networking opportunities to address many aspects of the practice advocacy agenda.

Following briefings by Government Relations staff for the American Psychological Association Practice Organization (APAPO), attendees headed to Capitol Hill where the conference culminated in more than 300 meetings of SLC participants with their members of Congress and staff. The grassroots advocates for professional psychology called on congressional officials to: 

  • Extend through 2011 the restoration of outpatient mental health reimbursement cut by CMS 

  • Make psychologists eligible for psychotherapy and evaluation and management (E&M) code reimbursement 

  • Add psychologists to the Medicare “physician” definition 

  • Pass health reform that integrates psychological services in primary care, preventative services and benefit packages

State Leadership Conference

Hundreds of Psychology Leaders Take Messages to Capitol Hill

Affirming the value of psychologically healthy workplaces

APA’s 2010 Psychologically Healthy Workplace Awards and Best Practices Honors were presented at a ceremony on March 6, during the SLC. In conjunction with the ceremony, the Practice Organization hosted its 2010 Psychologically Healthy Workplace Conference as a forum designed to bring business and psychology together to help employees and organizations thrive.

Organizations Honored as Psychologically Healthy Workplaces

Expanding public education about psychology and the value of psychological services

The APA Mind/Body Health Campaign continues to educate the public about the connection between psychological and physical health and seeks to position psychologists as experts trained to help people understand the impact of lifestyle and behaviors on mind/body health. Among recent campaign activities: 

  • In APA poll results released on March 31, fewer than one in five adults reported being very successful at making health-related improvements to their lives. As part of APA’s media outreach efforts related to the poll results, the association highlighted psychologists’ roles in helping people gain skills to successfully change unhealthy behaviors. 

  • On April 28, as part of the American Psychological Association’s partnership with the YMCA of the USA, psychologists participated in the nation’s largest health day for children and families.

  • During Mental Health Month in May, APA offered interviews, podcasts and videos for consumers and bloggers shared their own.

  • On May 18, as part of Mental Health Month, bloggers joined the APA’s Mental Health Blog Day Party. Throughout the month, Dr. Nordal and David Ballard, PsyD, MBA, the Practice Directorate’s Assistant Executive Director for Marketing and Business Development, presented weekly interviews and video presentations on mental health topics. In June, as part of Men’s Health Month, APA’s Mind Your Body Blog offered resources for men on health, stress and parenting.

Psychologists Focus on Mind-Body Health at Healthy Kids Day Event

Americans Report Willpower and Stress as Obstacles in APA Poll

Mental Health Month Offers Resources, Engages the Blogosphere

Your Mind Your Body Blog Reaches Out to Men

Updating the Psychologist Locator service

Our Psychologist Locator, a free service for practitioners who have paid the 2010 Practice Assessment, has been updated and expanded to include a wide range of information. The Locator helps consumers seeking psychological services find appropriate psychologists. Consumers are able to search the newly updated Psychologist Locator in a variety of ways, including by geographic location as well as by psychologists’ areas of specialization, ages served and insurance accepted. Practitioners have the ability to include a photo and a video in their listing.

Help the Public Find Your Practice

Seeking to ensure the availability of adequate psychological services for veterans

The 13th annual Veterans Affairs (VA) Psychology Leadership Conference, an opportunity for VA psychologists to share best practices and new research and promote leadership opportunities, attracted a record turnout this May.

On March 17, Deputy Executive Director for Professional Practice Randy Phelps, PhD, took part in the House Committee on Veterans’ Affairs “Heroes Homecoming Roundtable.” Participants, including U.S. Department of Defense staff and directors of soldier support groups, discussed veterans’ reintegration.

In May, Ron Palomares, PhD, Assistant Executive Director, Governance Operations, presented a keynote and a workshop on the psychological needs of service members, veterans and their families with a focus on building resilience at the VA Family Symposium, sponsored by the Tuscaloosa VA Medical Center Staff.

Veterans Affairs Psychology Leadership Conference Focuses on Patient Care

Aiding the profession’s quest for prescriptive authority

Staff for the APA Practice Organization work closely with state psychological associations, approximately 35 of which have prescriptive authority task forces. In 2010, prescriptive authority legislation was introduced or carried over from the previous session in six jurisdictions: Arizona, Illinois, Mississippi, Oregon, Virgin Islands and Wisconsin.

In late February, the Oregon state legislature approved SB 1046, granting prescriptive authority for appropriately trained psychologists. The House and Senate both voted in favor of the bill and sent it to the governor the first week of March. But the Governor vetoed the bill on April 8, 2010. The Oregon Psychological Association’s efforts were supported by a legislative grant from the Committee for the Advancement of Professional Practice (CAPP).

APA Chief Executive Officer Norman Anderson, PhD, provided testimony to the Virgin Islands legislature in support of prescriptive authority.

Prescriptive Authority Passes Oregon Legislature

Working to institute California regulations to permit psychologists in institutional settings to practice fully and independently within their scope of licensure

After more than 20 years of legal and legislative wrangling, regulations intended to allow California psychologists to be in charge of their patients’ inpatient hospital care finally went into effect on April 3. APA testified in California on the proposed regulations and submitted two letters supporting the regulations overall, while requesting some changes. Many of the changes requested ultimately were adopted.

Finally: Pro-Psychology Hospital Regulations in California

Engaging in initiatives following the devastating oil disaster in the Gulf of Mexico and earthquake in Haiti

APA’s Disaster Response Network (DRN) created resources to help people who work and live in states directly affected by the massive oil spill and anyone following media coverage. These resources were posted at the Psychology Help Center for consumers and were periodically featured on the APA website’s homepage. 

In February, APA President Carol Goodheart, EdD, presented a donation for $10,000 from the association to the American Red Cross (ARC) International Response Fund for Haiti. The DRN engaged in several initiatives to help people affected by the devastating earthquake in Haiti.

APA Offers Resources for Those Affected by Gulf Oil Disaster

APA Donates to Haiti Relief Fund

Disaster Response Network Engages in Outreach after Earthquake in Haiti

Calming the Tremors