Testing technician victory for psychologists in New York
On Oct. 26, New York Governor Andrew Cuomo signed legislation enabling licensed psychologists to once again use testing technicians under supervision to conduct psychological and neuropsychological assessments. For more than 12 years, a 2002 New York scope of practice law had been interpreted to prohibit the use of psychology technicians or psychometricians.
The victory comes after years of hard work and advocacy by the New York State Association of Neuropsychology (NYSAN) and the New York Psychological Association (NYSPA), with support from APA and the APA Practice Organization, APA Division 40 (Clinical Neuropsychology), the National Academy of Neuropsychology (NAN), the American Academy of Clinical Neuropsychology (AACN), the American Board of Professional Neuropsychology (ABN), and the National Association of Psychometrists (NAP).
The new law, which takes effect immediately, exempts the acts of testing technicians from the state’s psychology scope of practice laws, enabling them to administer and score standardized objective psychological and neuropsychological tests under the supervision of a licensed psychologist. This includes specific, predetermined and manualized administrative procedures that do not require interpretation or other judgments by the technician. Technicians do not select tests, analyze patient data or communicate results to patients.
Technicians are required to hold at least a bachelor’s degree in psychology or a related field. Additionally, they are trained and directly supervised by a licensed psychologist in non-school settings in ratios no greater than 3:1.
“Being able to use testing technicians again in New York brings us back in alignment with national practice standards” says NYSAN President Chris Morrison, PhD, ABPP. “Having trained technicians administer standardized measures allows psychologists and neuropsychologists more time to perform the integrated work of interpreting data, meeting with patients, providing input to integrated teams and other clinical work that draws upon their doctoral training.”
The use of technicians is a patient access issue as well. As a result of the ban on the use of testing technicians, patients scheduled for neuropsychological assessment services faced higher costs and longer wait times, particularly in rural areas and for services covered by Medicare and Medicaid. “The new law is a real boon for patients in New York,” says Morrison. “More patients can be seen, costs can be better controlled and it increases overall accessibility for lower income patients who tend to be in greater need of services due to health disparity issues.”
Several states have already addressed the issue of using testing technicians, including Arkansas, Oregon and North Carolina. In those three states, with the assistance of the APA Practice Directorate and the respective state psychological association, the issue was resolved either through regulations or newly enacted legislation allowing psychologists to use testing technicians. In all three cases, the psychologist is designated as the responsible party for services performed; technicians are not authorized to act independently. This is the same policy pursued by NYSAN and NYSPA in developing the New York legislation.
Timeline of the Advocacy Effort
In late 2002, the New York state legislature enacted the Mental Health Licensing bill which included provisions establishing psychology’s legal scope of practice and took effect in late 2003. The New York State Education Department (NYSED), which is the state regulatory body for all licensed professions, including psychology, interpreted the scope of practice law to exclude use of psychology technicians or psychometricians in the supervised administration and scoring of psychology and neuropsychological tests.
Both APA and NYSPA sent letters to NYSED raising opposition as part of advocacy efforts to persuade NYSED to reverse its position. In 2006, the NYSPA Neuropsychology Division along with other New York neuropsychologists created a separate organization, NYSAN, to pursue re-establishing technician use in New York. With support from APA, Division 40, NAN, AACN, ABN, and NAP, NYSAN hired a lobbyist to explore regulatory options for reversing or amending the interpretation to enable psychologists and neuropsychologists in New York to resume using testing technicians.
In 2008, NYSAN and NYSPA developed draft legislation that would add new provisions to the psychology licensing law allowing psychologists to employ psychological technicians to provide supportive services. At the same time, the organizations were pursuing a less costly, more expeditious and non-legislative strategy through NYSED, which they ultimately decided to pursue.
The unexpected retirement of NYSED’s deputy commissioner for the Office of the Professions in 2011 derailed the non-legislative approach. APA Executive Director for Professional Practice Katherine C. Nordal, PhD, joined NYSPA and NYSAN leaders in a joint meeting with the deputy commissioner’s successor to resolve the technician use issue. He recommended a legislative approach. On March 13, 2013, SB 4176 was introduced in the New York State Senate and the companion bill was introduced in the New York State Assembly on April 25, 2013.
NYSAN and its lobbyist met personally with the chairs and members of the Higher Education Committees in both houses and their legal staffs to educate them about psychological/neuropsychological assessments and the role of technicians. The lobbyist also worked to garner co-sponsors and support for the legislation. Nordal sent a Feb. 23, 2015, letter of support to the chairs of the Senate and Assembly Higher Education Committees at NYSAN’s request, and APA provided grant funding throughout the process.
The bill passed Oct. 26, 2015 and was signed the same day.
“This victory is an example of the amount of time it often takes to bring an advocacy effort to fruition,” says Nordal. “It’s also a testament to the value of inter-organizational collaboration and persistent and focused advocacy.”