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Practice Directorate activity highlights: August 2011 to January 2012

By Communications staff

March 8, 2012—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 services.

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.

Brief highlights of selected Practice Directorate activities and significant developments from August 2011 to January 2012 can be found under the appropriate tabs below.

Health care

Playing an active role in health care reform implementation

Much of the hard work of health care reform implementation will be carried out on the state level. Some of the critical roles states have to play in bringing health care reform to reality have been stipulated in the law, including the creation of health insurance exchanges, the redesign and expansion of Medicaid services, and the requirements of accountable care organizations. Psychologists must be prepared to take advantage of developing opportunities and state psychological associations must take an active role in directing and supporting the advocacy activities of their members. To this end, the March 2012 State Leadership Conference (SLC) theme will be “Bringing Psychology to the Table: State Leadership in Health Care Reform.” Practice Directorate and Practice Organization staff members are hard at work preparing for this 29th SLC, to be held in Washington, DC.

The APA Practice Organization began the State Implementation of Health Care Reform initiative with an advisory group comprising state leaders representing various constituencies. The initiative works to generate resources and expertise that state psychological associations can use to position psychology for maximal participation in health care reform within their states. In October and December, Dr. Nordal addressed health care reform summits sponsored by the state psychological associations of Massachusetts and Maryland, respectively.

Also in October 2011, the APA Practice Directorate commended the National Committee for Quality Assurance (NCQA) for its efforts to integrate mental and behavioral health into NCQA’s medical home model. During the development phase of these tools, the Practice Directorate submitted comments recommending specific changes to enhance behavioral health services.

Providing guidance to members regarding implementation of the federal mental health parity law

On November 17, 2011, the Department of Labor – one of the three federal agencies responsible for enforcement of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act – released a list of frequently asked questions (FAQs) to help people understand and benefit from the 2008 federal parity law. The FAQs deal with common questions raised by psychologists with regard to the February 2010 Interim Final Rule, the regulations that implement and expand on the parity law. The Practice Update e-newsletter from the APA Practice Organization featured an article on the Department of Labor’s guidance.

Pursuing advocacy to influence the inclusion of mental health providers in Health Information Technology for Economic and Clinical Health (HITECH) incentive payments

APAPO continues to meet with congressional offices to build support for and gain cosponsors of The Behavioral Health Information Technology Act of 2011 (S. 539), legislation pursued by APAPO and introduced in the spring of 2011 after The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted by Congress in 2009 as part of the American Recovery and Reinvestment Act, failed to include psychologists and most other non-physician providers among those eligible to receive Medicare and Medicaid incentive payments and grant funds to adopt electronic health record keeping (EHR).  
 
A similar bill is expected to be introduced in the House by Rep. Tim Murphy (R-PA), who sits on the committee with jurisdiction over the issue. APAPO believes this issue is more likely to move in the Senate than in the House, but will have a better sense of its chances once the bill is introduced and Representatives react.  In addition, APAPO will again feature the bill as one of three issues to be discussed when psychology leaders meet with their members of Congress and staff during the 2012 State Leadership Conference in March.

Medicare

Seeking appropriate Medicare reimbursement for psychological services

At the end of 2011, Congress reached a short-term agreement and President Obama signed legislation (HR 3765) that blocked two key Medicare payment cuts from taking effect on January 1. The new law enacted on December 23 prevented the 27.4 percent Sustainable Growth Rate (SGR) cut and extended the 5 percent psychotherapy payment restoration through February 29, 2012. Legislative leaders also agreed to appoint conferees to expedite negotiations between the House and Senate toward a measure addressing the payroll tax and Medicare reimbursement for the remainder of 2012. Based on earlier action by the Centers for Medicare and Medicaid Services (CMS), a 3 percent payment cut due to changes in the “practice expense” portion of Medicare reimbursement took effect on January 1.

HR 3765 marks the thirteenth time Congress has blocked the SGR cut since 2001 and the fourth time the APA Practice Organization (APAPO) has secured the psychotherapy extender since 2008. Practitioners faced a particularly challenging climate this year in light of Congress’s unprecedented focus on deficit reduction and the broadening divide between legislative leaders.

But professional psychology argued successfully that the psychotherapy payment extension is needed in light of the current CMS Five Year Review of psychotherapy codes, which continues into 2012.

Seeking appropriate Medicare reimbursement levels for psychological services has remained a top priority of APAPO. Professional psychology has employed a combination of direct lobbying by our Government Relations team, grassroots mobilization of practitioners through the Federal Advocacy Network, and participation in political giving facilitated by AAP/PLAN, psychology’s national political action committee.

Even with Congress out on winter recess, the APA Practice Organization urged continued advocacy by practicing psychologists to prevent drastic reductions in Medicare reimbursement beyond the current two-month reprieve in payment cuts. 

Grassroots psychologists were instrumental in helping to secure the recent blockage of Medicare payment cuts. Psychologists used the online Legislative Action Center at our Practice Central website to send more than 35,000 messages in 2011 urging members of Congress to reject steep Medicare cuts.

Advocating for inclusion of psychologists in the Medicare definition of “physician”

Early last year key allies of professional psychology in the Senate and House introduced legislation to include psychologists in the Medicare “physician” definition, which would help eliminate barriers to the services psychologists provide by removing inappropriate physician supervision requirements imposed by Medicare.

Passage of this legislation would improve the Medicare mental health benefit accessibility to the beneficiary population poised to explode in the coming decades. APAPO continues working to increase the number of bill co-sponsors and will again feature the bill as one of three issues to be discussed when psychology leaders meet with their members of Congress and staff during the 2012 State Leadership Conference. Psychologists sent more than 14,000 messages in 2011 via APAPO’s Legislative Action Center to their elected officials urging them to include psychologists in the Medicare definition of “physician.” APAPO hopes the bipartisan support for physician definition legislation will encourage its movement this year.

Doctoral standard

Defending the doctoral standard for independent psychology practice

On August 18, 2011, Austin, Texas District Court affirmed the statutory authority of the Texas State Board of Examiners of Psychologists (Board) to require that Masters-level trained “psychological associates” be supervised by licensed psychologists, who are required under Texas statute to be trained at the doctoral level. In 2010, The APA Practice Organization (APAPO) Committee for the Advancement of Professional Practice (CAPP) awarded TPA an emergency grant of $10,000 that was used to fight this legal battle in Texas. Further, Practice Directorate staff attorneys collaborated with TPA regarding legal issues and strategy, including providing an analysis of Texas’ licensing law in comparison to other state laws. The Texas Association of Psychological Associates has filed an appeal.

At the urging of the West Virginia Psychological Association (WVPA), the legislature considered updating a nearly 40-year-old licensure law that makes it the only state in the country to grant the title of psychologist to those with less than a doctorate. On January 8, the legislature held a public hearing on the issue (PDF, 30KB). Practice Directorate Assistant Executive Director of State Advocacy Dan Abrahamson, PhD, testified to APA’s longstanding commitment, as reflected in the APA Model Act for State Licensure of Psychologists (PDF, 111KB), to the doctorate as the entry level degree for the independent practice of psychology. His remarks were reinforced and expanded upon by the strong testimony of several WVPA leaders who have been working on this issue for many years.

APA Executive Director for Professional Practice Katherine C. Nordal, PhD, sent a letter to West Virginia Legislature Representative Jim Morgan, chair of the house government operations committee, urging support for the WVPA proposal (PDF, 210KB) requiring the doctoral degree. In her January 6 letter, Dr. Nordal noted that because the state allows individuals with master’s level education and training to be licensed for the independent practice of psychology with the title “psychologist,” consumers cannot readily discern the varying levels of education and training.

On January 11, the House government committee announced it is not planning to produce a bill this year, leaving the WVPA looking to the Senate to move this issue forward.

PQRS

Providing guidance to members regarding the Physician Quality Reporting System

Since 2007, Medicare has offered incentive payments to eligible professionals, including psychologists, who report data on designated outpatient service measures as part of a program known as the Physician Quality Reporting System. When the 2012 Medicare Final Rule, released in November 2011, stipulated several changes to the Physician Quality Reporting System, the APA Practice Organization educated members on these changes via the Practice Update e-newsletter.

In August 2011, APAPO produced a video on bonus payments for psychologists available via the Physician Quality Reporting System. The video, carried in the Practice Update e-newsletter, guides psychologists through the basics of the Physician Quality Reporting System, including information on bonus payments, eligible measures, how to report and the transition to a mandatory reporting program in 2015.

Testing codes

Clarifying appropriate use of the psychological and neuropsychological testing codes

In response to advocacy efforts by government relations staff at the APA Practice Organization and the Epilepsy Foundation, in December The Centers for Medicare and Medicaid Services (CMS) issued clarification on Medicare billing and payment policy for the use of Current Procedural Terminology (CPT®) codes when billing for psychological or neuropsychological testing services. The testing codes were revised in 2006 to enable psychologists and physicians to bill for testing services administered by a technician or computer. The clarification addressed issues of when more than one code can be billed and when psychologists can bill for professional time as well as for testing administered by a technician or computer, among other issues.

Insurance

Challenging inappropriate health insurance company and managed care practices

In November 2011, a New Jersey state court judge in Newark heard oral arguments on defendants’ motion to dismiss a privacy lawsuit brought by the New Jersey Psychological Association (NJPA) and two patients in the state health benefits plan. The lawsuit alleges violation of privacy laws based on intrusive demands for patient information to determine medical necessity. The court ruled in NJPA’s favor, denying defendants’ motion in all respects. The defendants appealed the rejection of their motion to dismiss. An appellate court judge rejected the defendants’ attempt in January 2012, so the case likely will proceed. APAPO supported NJPA's litigation with an emergency CAPP grant and considerable attorney consultation on HIPAA, privacy and additional issues.

In October the Practice Organization and the Florida Psychological Association (FPA) sent a joint letter to the federal agencies responsible for enforcing the federal mental health parity law, alleging that Blue Cross Blue Shield of Florida’s (BCBS) proposed 33 to 54 percent cut in reimbursement rates for psychologists is a violation of the Interim Final Rules (IFR) issued in February 2010 to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. While pursuing the Florida case, the Practice Directorate’s Legal and Regulatory Affairs Department also is tracking drastic reimbursement cuts in other states such as Missouri and Kansas with an eye to appropriate advocacy actions.

Public education

Educating the public about psychology and the value of psychological services

The Practice Directorate Public Relations staff in coordination with the Legal and Regulatory Affairs department continues to work with the Coalition for Patients’ Rights (CPR), more than 35 organizations representing a variety of licensed health care professionals. CPR seeks to counter efforts by the AMA Scope of Practice initiative that is designed to limit patients' choice of health practitioners.

Practice Directorate staff were interviewed by media on a variety of topics including virtual therapy, workplace, managed care and federal and state legislative issues affecting practitioners. Media coverage included The New York Times, Wall Street Journal and USA Today; magazines such as Fortune and Money; and CNN News Source, which distributes programming to its nationwide affiliates.

In September 2011, Public Relations staff and the Psychologically Healthy Workplace Program hosted a chat and question and answer session on Facebook with PWHP consultant and psychologist Dr. Matt Grawitch. Dr. Grawitch answered questions on APA’s Facebook page about workplace stress and adjusting to a new schedule when children return back-to-school.

APA released its annual stress survey on January 11, 2012 with a town hall focusing on health consequences of stress, especially for caregivers and those living with chronic illness, as well as the necessity of prevention and integrated care. The town hall was webcast to a live audience. The webcast and media coverage has already been seen by more than three million viewers with an estimated publicity value at more than 1.5 million dollars as of February 2012.

Educating members about the Disaster Response Network

At the 2011 APA Convention, APA’s Disaster Response Network brought experts together to present symposium sessions on “Understanding the Complexities of Disaster Mental Health Response: The American Red Cross, U.S. Government and APA’s Disaster Response Network” and “Honoring the 10th Anniversary of 9/11 - APA Disaster Response Network.” In collaboration with the American Red Cross in the National Capital Region, the DRN held a Foundations of Disaster Mental Health training for approximately 40 licensed mental health professionals. The DRN also hosted a special 20th anniversary reception at the Newseum to recognize and thank DRN members for their volunteer contributions.

In November, the DRN program brought together 40 Coordinators from across the US and Canada to discuss developments in disaster psychology, present information on working with diverse populations, offer guidance on running state and provincial DRN programs, and support networking.      

Throughout the year DRN members and staff continued to further our partnership with the American Red Cross on both a local and national level.

Guidelines

Playing an active role in treatment guidelines development and promotion

In its August 2011 meeting, the steering committee that is managing APA’s treatment guidelines effort decided that the topics of the first two clinical treatment guidelines to be developed by APA will be depressive disorders and obesity. The full scope of each guideline (such as whether the depressive disorders guideline should include bipolar disorder) will be determined at a future stage jointly by the steering committee and the panel that is appointed to develop the guideline. However, the steering committee did specify that the depressive disorders guideline should consider both psychosocial and psychopharmacological treatments.

In its October meeting, the steering committee finalized its call for nominations for individuals to serve on the depression guideline development panel, addressed issues related to conflicts of interest, studied how to proceed in commissioning systematic reviews and worked on portions of the Manual of Procedures. In November, the steering committee closed the open call for nominations to serve on the depression guidelines development panel (GDP); the steering committee will make GDP membership recommendations following their February 2012 conference call.

APA is also actively developing guidelines related to telehealth. The APA/ASPPB/APAIT Task Force for the Development of Telepsychology Guidelines for Psychologists, comprising four psychologists each from APA and the Association of State and Provincial Psychological Boards and two from the APA Insurance Trust, met for the second time November 15-16.  Members reviewed the current research and policy literature related to relevant international, national and state statutes, regulations and guidelines on the use of technology in the delivery of psychological services and discussed various models for inter-jurisdictional practice. The taskforce plans to share a draft of their guidelines during a public comment period in the spring of 2012.

Resources

Enhancing member resources by creating a wiki

In an effort by staff in the APA Practice Directorate and Information Technology Services to make PsycLINK more accessible to and user-friendly for APA members, in December 2011 the resource was migrated into a new wiki whose platform boasts a menu of options that encourage members to contribute through a variety of modalities. All users will now log into PsycLINK via the new APA Communities portal using their MyAPA account. This will allow them to associate content from PsycLINK to other APA Community “spaces,” (as they become available) which are other groups to which they may belong as APA members.

Additionally, PsycLINK users will be able to complete a unique personal profile, containing information about their professional interests, and even “friend” other PsycLINK and APA Communities users in order to remain apprised of any interesting content that is posted by certain members. Members are encouraged to log into APA Communities (using their MyAPA account) and click on “PsycLINK” under the “spaces” toolbar on the APA Communities dashboard in order to begin using all that it has to offer.

Beta-testing began on January 20 to determine if the content was successfully migrated into and interacted well with PsycLINK. Beta-testing continued until February 6 and the system is scheduled for release to all members on February 21.