State psychological associations take leadership role in health care reform implementation

State efforts are crucial to ensure opportunities for psychologists in the health care system

By Communications staff

March 8, 2012—The theme of the 2012 State Leadership Conference (SLC) in Washington, DC, March 10-13 is “Bringing Psychology to the Table: State Leadership in Health Care Reform.”

Passage of national health care reform under the Patient Protection and Affordable Care Act (ACA) has set the clock ticking toward 2014, when many of the Act’s major components are slated to go into effect. The efforts of state psychological associations to ensure opportunities for psychologists in the health care system are crucial.

For example, states will be at the forefront of implementing health care reform through Medicaid redesign. According to APA Executive Director for Professional Practice Katherine C. Nordal, PhD, “As half the 32 million Americans who will gain health coverage through the Affordable Care Act are to be enrolled in Medicaid, it’s vital for psychologists to be included as Medicaid providers in their states.”

In addition, an ACA provision mandates the creation of state level health insurance exchanges through which health plans will be made available to individuals and small businesses. The health care reform law also strongly encourages the formation of Accountable Care Organizations, or ACOs, as a model for developing delivery systems. The Centers for Medicare and Medicaid Services defines an ACO as "an organization of health care providers that agrees to be accountable for the quality, cost and overall care of Medicare beneficiaries who are enrolled…" While it is unclear exactly how ACOs will be structured, large integrated systems that directly employ physicians most likely will be the first to evolve into ACOs.

Here are just a few examples of the early work of state associations as health care reform is carried out.

Medicaid Redesign

A major priority for states preparing for health care reform implementation should be to look at Medicaid redesign in their states, says New York State Psychological Association (NYSPA) President Donna Rasin-Waters, PhD. “This will set the pace for health care reform in each state,” she says.

Washington state expects about 100,000 new Medicaid enrollees in 2014. So the Washington State Psychological Association (WSPA) worked to ensure access to mental health services for Medicaid recipients. WSPA supported Senate Bill 5394—Promoting Primary Care Health Homes to Manage Chronic Care, and advocated to include a mental health condition and substance abuse disorder in the definition of chronic care and behavioral health providers in the multi-disciplinary team for Medicaid recipients with chronic diseases. The bill passed, with WSPA’s desired definitions.

“Our hope is that new laws [like this] will give psychologists a toe in the door in treating Medicaid recipients with chronic diseases in health care homes,” says Lucy Homans, EdD, director of professional affairs & legislative consultant for WSPA. She pointed out that only those psychologists in clinical practice who work in a community mental health center or inpatient setting in the state are currently Medicaid providers.

Policy Change

State associations are actively involved in impacting policy— pursuing legislative change and participating in government boards tasked with implementing health care reform at the state level.

Maryland Psychological Association (MPA) Professional Affairs Officer Paul Berman, PhD, sits on the state’s health care exchange board of directors advisory board tasked with looking at issues related to the Essential Health Benefits package and insurance companies operating in and outside of the exchange.

“Maryland is one of the states at the forefront of implementing the policies and requirements to begin a health care exchange and the MPA is trying to be involved in all these different levels,” Berman says.

The North Carolina Psychological Association (NCPA) was active in legislative efforts to review and revise state confidentiality laws and determine what needed to be changed for the appropriate exchange of patient information for North Carolina’s proposed health information exchange. 

“A coalition of mental health professionals and advocates came together to help craft something we all agree on and support,” says NCPA Executive Director Sally Cameron. Senate bill 607 (PDF, 93KB)—An Act to Conform Medical Record Confidentiality Laws, passed in June.

NYSPA is seeking legislation to break down barriers for psychologists who wish to form limited liability companies with medical doctors. “We are pursuing this legislation because we believe it is critical for psychologists to be able to form business entities and partner in the new integrated system,” says Rasin-Waters.

Coalitions

State associations are concentrating on coalition building to impact reform. “The single most effective way to magnify your influence in health care reform is to work with strong coalitions, and if possible to get in leadership positions on them,” says MPA Executive Director/Director of Professional Affairs Elena J. Eisman, EdD, ABPP.

Among the alliances being cultivated by the Massachusetts Psychological Association (MPA) is longtime leadership of the Massachusetts Mental Health Coalition, which developed a position paper on the role of behavioral health in ACOs, global payments and health care reform. The position paper was submitted to the state’s commissioner of mental health and formed the original thinking for her taskforce to address the issue of the role of behavioral health in ACOs and global payment structures. It was also sent to the legislators working on the governor’s and alternate bills on health care and payment reform.

MPA is also working with a coalition under a grant from the Children’s Health Insurance Program reauthorization Act (CHIPRA) to determine gaps in integrating children’s services. Coalition members include schools, dentists, hospital systems, insurers, legislators and consumers, among others.

Diana L. Prescott, PhD, is a member of the Maine Primary Care Association (MPCA) board. “I believe psychologists are going to need to be prepared to connect to health care delivery in a very different way than we are accustomed to doing,” says Prescott, who takes what she learns at MPCA back to the Maine Psychological Association, where she serves as APA Council Representative, Federal Advocacy Coordinator and Rural Health Coordinator. “I am keeping my ears open at MPCA meetings to hear what is changing, trying to figure out how psychologists can fit into this,” she says.

In Kentucky, state psychological association Federal Advocacy Coordinator & Legislative Liaison Shelia A. Schuster chairs Kentucky Voices for Health a coalition of 250 organizations Schuster calls the “consumer voice on health issues.”

“They’ve taken the lead on keeping people informed and dialoguing with the administration here in Kentucky on the Affordable Care Act,” Schuster says. “We’ve been out there [on this issue] from the very beginning and we’ve gotten some traction. We’ve been called upon to testify, to vet ideas about how the insurance exchanges will be set up.”

Education

Just as important as endeavoring to ensure professional psychology has a seat at the table as health care reform is implemented is educating member psychologists about the opportunities and challenges they will face. New York, Maryland and Massachusetts are among the state associations that have recently held health care reform summits for their members.

“Maryland, like many states, is aware of how health care reform will be impacting individual psychologists and the practice of psychology,” says Berman. MPA has set up a taskforce to look at the issue and what the MPA can do in areas of education, helping people diversify and become aware of changes in their practices, and assist in making those changes,” he explains.

As health care reform is implemented at the state level, state psychological associations are actively advocating for the profession. “We’re really trying to be strategic,” says Homans. WPA is asking, “What will have the impact on the most psychologists, how can we do the most good and where are we mostly likely to be successful as we look at this huge series of bills that are going to be coming down the pike.”


Look for additional information about health care reform implementation and state-level activity, including coverage of the 2012 State Leadership Conference, in the Practice Update newsletter and the May issue of APA’s Monitor on Psychology.