Introduction

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 health care 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 is a 501(c)6 organization under IRS rules that enables 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 August 2013 through January 2014, including key activities of both the APA Practice Directorate and the APA Practice Organization.

Playing an active role in health care reform implementation

With several key provisions of the Affordable Care Act taking effect Jan. 1, 2014, the Practice Directorate has been working to promote the continued role of professional psychology in the marketplace and protect consumer access to psychological services. 

On Sept. 26, 2013, in response to an Aug. 1 open request from Senate Finance Committee Chairman Max Baucus, D-Mont., and Ranking Member Orrin G. Hatch, R-Utah, the APA Practice Organization (APAPO) and APA submitted a detailed letter to the Senate Finance Committee addressing issues concerning Medicare and Medicaid, including reimbursement and patient access to care. The letter asked the mental health community for input on how to improve mental health care in those programs. Our response detailed several reforms that APA and APAPO believe will reduce the unmet mental and behavioral health needs of Americans, improve quality of care and better control rising costs

The APA Practice Organization (APAPO) was part of an early advocacy effort to influence the process as qualified health plans (QHPs) geared up to participate in state health insurance exchanges (HIEs). APAPO sent a Sept. 29, 2013, joint letter with the Inter Organizational Practice Committee (IOPC) and the Connecticut Psychological Association (CPA) to Connecticut Lieutenant Governor Nancy Wynan expressing concern with the behavioral health fee schedules published by HealthyCT, one of the QHPs participating in Connecticut's HIE. Since then, CPA had an Oct. 2013 in-person meeting and subsequent communications with HealthyCT and sent a letter seeking written confirmation and clarification of the issues discussed. HealthyCT has indicated that the company is looking further into the issues we raised to develop a response. 

APAPO will continue advocating to help ensure that licensed psychologists are adequately included and that consumers have access to psychological services they need through health plans that participate in the exchanges.

On Aug. 19, 2013 APA signed onto a joint letter with the Patients’ Access to Responsible Care Alliance (PARCA) urging Congress to oppose HR 2817, the Protect Patient Access to Quality Health Professionals Act of 2013. The bill proposed by U.S. Rep. Andy Harris, MD, R-Md., would have repealed a key patient-centered provision of the Affordable Care Act (ACA) that bars health plans from discriminating against health care providers who are acting within the scope of their licensure or certification under state law with respect to health plan participation or coverage. Though the proposed bill purports to protect patient access to quality health providers, it would actually limit access to and choice of qualified, licensed nonphysician providers such as psychologists. There has been no further legislative action on HR 2817 since our letter was sent, and it seems unlikely it will move forward in the legislative process during 2014.

Seeking appropriate reimbursement for psychologists in Medicare

After nearly a decade of incurring some of the biggest payment losses among Medicare providers, psychology had the second highest increase in the total payment pool allocated for services among specialty groups for 2014 under the 2014 Medicare final fee schedule. The Centers for Medicare and Medicaid Services raised the work values associated with the family of psychotherapy codes, thereby recognizing the difficulty and complexity of providing these services and affirming the value of mental health services. 

For the past several years, the American Psychological Association and APA Practice Organization (APAPO) have been extensively involved in ongoing advocacy that helped yield the positive outcome. Beginning in 2009, the organizations began their engagement in a CMS five-year review of the valuation of psychotherapy codes. The ultimate goal for organized psychology was to win the federal government’s recognition of greater cognitive effort and complexity — known as the work value — involved in delivering psychological services, accompanied by higher valuation of these services. Additional advocacy throughout 2013 involved the Government Relations Department for APAPO continuing on both the legislative and regulatory fronts to pursue necessary changes to Medicare payment for psychological services. 

On Feb. 6, 2014, three congressional committees with Medicare jurisdiction introduced a bicameral proposal to repeal the Medicare Sustainable Growth Rate (SGR) formula. The SGR formula is the current method used by the Centers for Medicare and Medicaid Services (CMS) to curtail Medicare provider costs. APAPO has been integrally involved in providing suggestions and feedback to the three committees that drafted the legislation, and will continue to advocate on behalf of professional psychology as legislation progresses.

Preparing members for participation in Medicare’s physician quality reporting program

The APA Practice Organization (APAPO) has updated the Quality Improvement Programs section of its Practice Central website with 2014 information for both new participants and those who are already reporting in Medicare’s Physician Quality Reporting System (PQRS). Resources include a list of measures available for 2014, a quick reference guide that links applicable codes to each measure, frequently asked questions and video tutorials on participating in PQRS. Starting in 2015, the Centers for Medicare and Medicaid Services (CMS) will begin imposing penalties for eligible providers who did not successfully participate in PQRS in 2013; 2014 marks the final year of bonus payments under the program. (2d, 2f)

Advocating for appropriate parity implementation to protect patient access to services

In response to a request from the U.S. Department of Labor, the APA Practice Organization (APAPO) submitted a comment letter on Jan. 8, 2014, addressing concerns related to implementation of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The Jan. 8 letter addressed five areas of importance for psychologists and access to psychological services: Enforcement, reimbursement disparities, transparency of medical necessity criteria, medical necessity and long-term mental health patients and Medicaid/CHIP. The MHPAEA Final Rule was released in Nov. 2013 and clarified and strengthened some important parity protections for mental health patients.

Seeking eligibility for incentive payments for psychologists under the Health Information Technology for Economic and Clinical Health (HITECH) Act

Eligibility for incentive payments for the adoption of electronic health records (EHRs) remains a legislative priority for the APA Practice Organization. On Nov. 12, 2013, Sen. Rob Portman, R-Ohio, introduced the Behavioral Health Information Technology Coordination Act (S. 1685) to ensure mental health providers are part of the nation’s electronic medical records network. Sen. Sheldon Whitehouse, D-R.I., introduced a similar bill, S.1517, the Behavioral Health Information Technology Act, in September 2013. All three behavioral health IT bills (including House bill HR 2957 sponsored by Rep. Tim Murphy, R-Pa., and Rep. Ron Barber, D-Ariz.,) have been referred to their respective committees and are awaiting consideration. The House bill currently has 33 co-sponsors and Sen. Whitehouse’s bill has six co-sponsors in the Senate. We are working to increase support for each of the bills by encouraging psychologists to reach out to their members of Congress through the Legislative Action Center and ask them to co-sponsor this legislation.

Challenging inappropriate health insurance company and managed care practices

On Dec. 7, 2013, Aetna Inc. agreed to a proposed $120 million settlement of a class action lawsuit filed by psychologists, other health care providers and patients in federal court in New Jersey. The APA Practice Organization has been collaborating actively with the New Jersey Psychological Association, a named plaintiff in this lawsuit, since 2009. As we have done with previous lawsuits, APAPO is providing guidance to help eligible psychologists submit their claims under the settlement.

Collaborating on the Clinical Practice Guidelines Initiative with the Science Directorate

The Clinical Practice Guidelines initiative is jointly overseen through the Science and Practice directorates. One member of the APA Clinical Practice Guidelines Advisory Steering Committee (ASC) was elected to the Board of Scientific Affairs so nominations are being received to fill that vacancy. Consistent with best practice for guideline development, the Board of Directors, in collaboration with the ASC, approved the appointment of two community members to serve as full members of the Guideline Development Panel (GDP) for PTSD Disorders. One potential community member for the GDP for Obesity has been identified and efforts are ongoing to recruit a second member. 

Each GDP (Depressive Disorders, PTSD and Obesity) continues to have monthly conference calls and each is focused on refining the scope of the guideline under development. RTI International has been providing technical assistance to the GDP for Depressive Disorders and has completed a draft report reviewing existing high-quality systematic reviews. Both the PTSD GDP and the Obesity GDP had their first in-person meetings in October 2013 and have been reviewing the evidentiary base of their respective topics. The ASC continues to have monthly conference calls. 

The revised conflict of interest form and policy for the Clinical Practice Guidelines Initiative has been completed. A manual of procedures for the initiative remains under development. 

The chair of the ASC presented at the 2013 APA Convention and APA staff presented at the Guidelines International Network conference (APA is a member). Three APA staff members presented to the Agency for Healthcare Research and Quality and representatives from their evidence-based practice centers on guideline development, particularly when using existing systematic reviews. The ASC completed a manuscript for the 2014 Annual Review of Clinical Psychology on the APA clinical practice guideline initiative.

Extending our political reach through APAPO-PAC

In 2013, APAPO-PAC raised a total of $201,000 from 1,659 contributors, an improvement over the totals from 2012. The PAC has contributed $122,000 to members of Congress so far this election cycle, both Democrats and Republicans. Practice Government Relations staff have attended 115 fundraisers so far. 

In September, 2013 APAPO-PAC hired a new PAC director, Heather Kaiser, who started a rebranding and marketing campaign for the PAC with a new APAPO-PAC logo and marketing materials, including an informational brochure.

APAPO-PAC worked throughout 2013 to track data to further PAC support of legislative issues. The PAC reevaluated the giving plan and is actively searching for champions or potential champions within the House and Senate who will help advance psychology’s legislative initiatives.

Providing members with resources and information related to Health Insurance Portability and Accountability Act (HIPAA) compliance

To aid the process of compliance with the HIPAA Privacy and Security Rules, the APA Practice Organization (APAPO) developed and updated several resources which can be found in the HIPAA Compliance section of APAPO’s Practice Central website. Sept. 23, 2013, was the deadline for psychologists and others covered under HIPAA to implement changes required by the HIPAA Final Rule, which was released in Jan. 2013 by the U.S. Department of Health and Human Services.

Educating members about the changing telepsychology landscape

Over the past several years, heightened legislative and regulatory activity at both the federal and state level has removed barriers and increased patient access to telehealth services. Despite growing demand for telehealth and telepsychology services, there are no comprehensive roadmaps for incorporating technology into health care service delivery. 

The APA Practice Directorate has been tracking developments at the federal and state levels governing the delivery of telepsychological or telemental health services and reviewing current public and private payer reimbursement policies to keep members informed and up-to-date on telepsychology service delivery. The  directorate’s Office of Legal & Regulatory Affairs updated the Telepsychology 50-state Review (previously called the Telehealth 50-state Review) to guide psychologists in navigating telepsychology regulations and provisions in their state. The Winter 2014 issue of Good Practice magazine included a special section on telepsychology and practical implications for psychologists. 

At its July 2013 meeting, the APA Council of Representatives approved the new Guidelines for the Practice of Telepsychology. The guidelines are intended to both educate and inform practicing psychologists about applying current standards of professional practice when using telecommunication technologies in providing psychological services.

Gauging APA Practice Organization member needs and interests through a wide-ranging survey

The APA Practice Organization conducted a November 2013 survey of all APAPO members to help gauge current member needs and professional interests. The 2013 survey builds on results from 2008 and 2011 surveys and provides opportunity for longitudinal analysis. Results will be distributed through various channels including APA’s Monitor on Psychology, as well as APAPO’s Good Practice magazine and  PracticeUpdate e-newsletter.

Educating the public about psychology and the value of psychological services

The Practice Directorate’s annual Stress in America survey was conducted online by Harris Interactive in Aug. 2013, and results were released during a press webinar on Feb. 11, 2014. This year’s survey, Stress in America™: Are Teens Adopting Adults’ Stress Habits?, explored how teen experiences with stress follow a similar pattern to adults. The results suggest that unhealthy behaviors associated with stress may begin manifesting early in people’s lives. Early coverage of the report was featured on USA Today, LA Times, NBC, CBS Radio and the Huffington Post, and detailed information is available online

The APA Practice Directorate expanded its psychotherapy awareness initiative in November 2013 with a new animated video and APA Psychology Help Center articles. The new video is the third in the series on psychotherapy and has been viewed nearly 60,000 times. The initiative, which launched in Sept. 2012, is designed to make consumers and the public more aware of the effectiveness of psychotherapy as a treatment option. 

In 2014, APA, through its public education campaign on Mind/Body Health, renewed its agreement with the YMCA of the USA (Y-USA), a partnership that has existed since 2008 to provide families and communities with resources for healthy living. APA also signed a memorandum of understanding (MOU) with the National Parent Teachers Association (National PTA) in early 2014 and is beginning to plan collaborative projects for 2014. This partnership will enable us to pursue mutual public education interests related to health and wellness. APA will provide expertise on mental and behavioral health, and the National PTA will provide the opportunity to reach 4 million members across 22,000 local chapters.

The APA Practice Directorate has also participated in multiple recent media events on practice issues. APA Executive Director for Professional Practice Katherine C. Nordal, PhD, was quoted in an Oct. 24, 2013, interview with NPR, an Oct. 24 interview with Kaiser Health News and a Dec. 20 interview with the Wall Street Journal, among others.

Providing resources and support through the Disaster Response Network

The Disaster Response Network held its biennial coordinators working meeting in Atlanta the first weekend in October. The coordinators came together to network and share information with each other and to learn about new developments in the field. A behavioral scientist from CDC spoke on Supporting Responder Psychological Wellbeing in Public Health Emergencies. Workshops led by the DRN Advisory Committee focused on cultural sensitivity, ethics and mass impact incidents. Staff led sessions on the use of social media in disaster and developing/sustaining state and provincial DRN programs.

At the 2013 APA convention, the DRN Advisory Committee led a symposium session on Readiness, Response, and Resilience: The Many Ways Psychologists Can Help with a Disaster.

In early September, the DRN director met by phone with the Committee of Executive Directors of State, Provincial and Territorial Associations (CESPPA) to discuss the results of a spring DRN member survey on participation, interest and ideas for future directions. The executive directors voiced appreciation for the findings and their association’s continued support of the program. 

Psychologists aided survivors and Red Cross workers on several disaster relief operations, including flooding in central Colorado and Calgary, Alberta, shooting at the Washington, D.C., Navy Yard, and local bus and train accidents and residential fires in several states.