Psychology addresses barriers to psychological services in state Medicaid expansion

Analysis of opportunities and challenges to psychologist participation and reimbursement

By Legal & Regulatory Affairs staff

Sept. 27, 2012—Under the Affordable Care Act (ACA), which was fundamentally affirmed by the June 28 Supreme Court decision, millions of consumers are expected to move into the Medicaid system. This likely development creates potential opportunities for the expansion of psychological services.

Medicaid is a state-based program. Therefore, state programs vary as to the provision of and payment for mental health services. The Practice Directorate has identified that, although additional psychologists will be needed in Medicaid, there are several barriers to psychologist participation and reimbursement.

As part of the APA Practice advocacy initiative to address barriers to psychological services in Medicaid, we engaged Epstein, Becker & Green — a law firm with expertise in health care law — to analyze and prepare a sampling of challenges to psychological services delivery in five states, as well as opportunities for overcoming those challenges.

The following chart is an informational tool which overviews restrictive state provisions and identifies opportunities to ensure psychologist participation and reimbursement in Medicaid. It may serve as a resource for state psychological associations and practitioners to familiarize themselves with potential barriers to Medicaid participation and initiate related advocacy efforts.

The chart covers sample state provisions and opportunities for removing the barriers to:

  • Independent provision of services 

  • Scope of practice 

  • Reimbursement for services provided under supervision 

  • Payment for Health and Behavior (H&B) CPT® codes 

  • Same-day billing 

  • Telemedicine service

View the Compilation of Medicaid State Barriers to Psychological Services chart (PDF, 80KB).

For more information, contact the Legal and Regulatory Affairs department by email or at (202) 336-5886.

Current Procedural Terminology® (CPT) copyright 2011 American Medical Association. All rights reserved.