Practice Directorate activity highlights — January through July 2008

Review news of the Practice Directorate's major activities and achievements on behalf of psychology so far this year

by Communications Staff

August 28, 2008 — The Practice Directorate is involved in a broad range of activities on behalf of practicing psychologists and consumers of psychological services. Virtually all of the directorate's efforts reflect the rapidly changing health care system and related opportunities and challenges for professional psychology. In April 2008, Dr. Katherine Nordal officially began her tenure as Practice Directorate Executive Director.

The directorate agenda supports members of the APA and the APA Practice Organization (APAPO), a companion organization to APA housed administratively in the Practice Directorate. The APA Practice Organization was created in 2001 as a 501(c)(6) organization under IRS rules to enable unrestricted advocacy on behalf of practicing psychologists.

Following are brief highlights of selected directorate activities and significant developments thus far in 2008. Further information is available by sending an e-mail or calling the directorate office as noted in each section below.

Gaining a law that reverses Medicare payment cuts for psychological services and phases in Medicare coinsurance parity

One of the APA Practice Organization's top legislative priorities for 2008 has been to reverse steep cuts in Medicare payment for psychological services. Psychology took a major step forward on July 15 when Congress overrode a presidential veto of the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331).

The new law will restore $45 million to psychotherapy and related services cut as a result of the five-year review by the Centers for Medicare and Medicaid Services, halt the 10.6 percent Sustainable Growth Rate (SGR) cut, provide a 1.1 percent Medicare payment update for 2009 and expand federal appropriations for mental health services delivery to residents of rural areas. Further, the APAPO succeeded in gaining a provision that will phase in Medicare coinsurance parity. Currently, Medicare beneficiaries are responsible for 50 percent of the bill for mental health services, but only 20 percent for other services. Under the coinsurance parity provision, by 2014 mental health services would enjoy the same 80/20 percent split. Additional details about H.R. 6331 are available in the July 2008 issue of the PracticeUpdate e-newsletter from the APAPO.

Also related to Medicare payment, the Practice Directorate has contested Medicare limitations on psychologists who bill the program for health and behavior services and testing services in 2008. The Practice Directorate is advocating for the National Correct Coding Initiative (NCCI) to remove "Medical Unlikely Edits" (MUEs) that limit the number of hours of testing services and health and behavior interventions that can be billed per patient per day.

For additional information, please e-mail the Government Relations Department or call (202) 336-5889.

Achieving an historic agreement on parity in insurance coverage of mental health services

In June, the U.S. Senate and House reached an historic agreement on the terms for a full mental health parity bill.
From the time that the House passed its version of the parity bill in early March (the Senate passed its version, S. 558, last September), the two chambers have been engaged in intense negotiations to reconcile differences between the two versions. The APA Practice Organization was involved throughout these negotiations, along with other key stakeholders from the mental health, insurer and employer communities.

When enacted the new federal parity law will: 

  • End insurance discrimination against mental health and substance use disorder benefits coverage for over 113 million Americans, requiring full parity coverage with physical health benefits. 

  • Extend to all aspects of plan coverage, including day/visit limits, dollar limits, coinsurance, copayments, deductibles and out-of-pocket maximums. 

  • Preserve strong state parity and consumer protection laws while extending parity protection to 82 million more people who cannot be protected by state laws. 

  • Ensure parity coverage for both in-network and out-of-network services.

For additional information, please e-mail the Government Relations Department or call (202) 336-5889.

Positioning the APA Practice Organization to take on an active role in health care reform

The APA Practice Organization considers health care reform an important legislative priority and recognizes that there is strength in numbers when working on such a complex and high-profile issue. As a result, we recently joined two new health care reform coalitions. Affiliating with these coalitions is one component of the APAPO's preparations for playing a leadership role once the next session of Congress takes up health care reform.

In April, the APAPO accepted an invitation to be a founding member of Health Care First, a collaboration of consumer and provider associations working to involve additional advocacy organizations in achieving comprehensive reform in 2009. In addition, the APAPO also has signed on as a supporting organization of Divided We Fail. This coalition of more than 80 groups will work to educate the public about the importance of good health coverage as a key component of long-term financial security.

Through Divided We Fail, the APAPO will cultivate opportunities throughout the U.S. for psychologists to participate in town hall meetings, press conferences and community forums.

For additional information, please e-mail the Government Relations Department or call (202) 336-5889.

Clarifying appropriate use of the psychological and neuropsychological testing codes

In response to ongoing advocacy by the APA Practice Directorate, in June 2008 the Centers for Medicare and Medicaid Services (CMS) posted on the agency's Web site questions and answers (Q&As) that clarify how the Current Procedural Terminology (CPT)(r) codes for psychological and neuropsychological testing should be used. APA requested this information after a CMS transmittal issued in 2006 resulted in confusion about Medicare's rules for billing multiple codes when testing is administered by a technician or computer. The Q&As clarify when the professional codes for psychological and neuropsychological testing, 96101 and 96118 respectively, can be used to account for the integrative interpretation and comprehensive report writing for services administered by a technician or computer. Additional details are available in the July 2008 issue of the PracticeUpdate e-newsletter.

For additional information, please e-mail the Government Relations Department or call (202) 336-5889.

Aiding the profession's quest for prescriptive authority

The Practice Directorate and the Committee for the Advancement of Professional Practice (CAPP) continue to help numerous states work toward achieving and implementing legislation that gives qualified licensed psychologists the authority to prescribe psychotropic medications. Support from the national level for state psychological associations includes CAPP grants and close consultation with state psychology leaders.

This year, there were prescriptive authority (RxP) bills pending in seven states: California, Georgia, Hawaii, Mississippi, Missouri, Oregon and Tennessee. Although most bills did not make it out of committee, Missouri's bill was approved and passed out of committee and headed to the Senate floor for consideration and possible vote. However, the legislature's attention was diverted to another legislative priority, resulting in a number of bills — including the RxP bill — being stalled in the Senate.

For additional information about prescriptive authority initiatives, please e-mail the Legal and Regulatory Affairs Department or call (202) 336-5886.

Seeking to ensure the availability of psychological services for veterans

In April 9 testimony before the Senate Committee on Veterans Affairs, Randy Phelps, PhD, deputy executive director of the APA Practice Directorate, testified on improving recruitment and retention of psychologists in the Veteran Affairs system. Dr. Phelps shared with the committee current APA initiatives to assist veterans.

Following his April appearance before the Senate, Dr. Phelps was invited to testify before the House Veterans' Affairs Health Subcommittee on May 22.

Dr. Phelps built on his earlier testimony by addressing the issues of full clinical privileges for doctoral psychologists in the VA and enhancing access to care in rural areas through prescriptive authority.

The 11th annual Department of Veterans Affairs (VA) Psychology Leadership Conference held in May 2008 drew more than 160 VA psychologists, the largest number of conference attendees to date. With its theme, "Integrated Mental Health and Behavioral Health Care: Psychology's Role," participants discussed ways to expand services provided to veterans and how to position new VA psychologists for leadership roles. The annual conference is co-sponsored by the APA Practice Directorate, APA Div. 18 (Psychologists in Public Service) and the Association of VA Psychology Leaders.

For additional information about the VA Psychology Leadership Conference, please e-mail the Practice Directorate Executive Office or call (202) 336-5878.

Contesting proposed title restrictions related to psychology practice

On June 12, the APA sent a letter to the principal policy-making body of the American Medical Association (AMA) strongly opposing a proposed resolution that supported restricting the use of "doctor," "resident" and "residency" in medical settings to physicians, dentists and podiatrists.

The APA's letter from President Alan Kazdin, PhD, and Chief Executive Officer Norman Anderson, PhD, discussed psychologists' long history of using the term "doctor" in medical settings and cautioned that applying the restrictions called for in the resolution would confuse patients.

The AMA House did not adopt the proposed resolution.

For additional information, please e-mail the Legal and Regulatory Affairs Department or call (202) 336-5886.

Convening the 25th annual State Leadership Conference

The theme of this year's 25th annual State Leadership Conference (SLC) was "Leading Change: Advocating for Psychology Practice." The March 2008 event drew more than 500 psychology leaders from U.S. states, Canadian provinces and U.S. territories to Washington, DC, for four days of networking, leadership training and advocacy, and workshops. Topical highlights included pay-for-performance, collaborative care, and addressing the needs of returning veterans and their families.

As in past years, the event culminated in SLC attendees visiting their elected officials on Capitol Hill, where they urged Members of Congress and their staff to support full health insurance parity legislation and to eliminate substantial cuts in Medicare payments for psychological services.

For additional information about the State Leadership Conference, please e-mail the State Advocacy Department or call (202) 336-5864.

Educating psychologists and advocating for appropriate safeguards in the development and use of health information technology

Another of the messages that SLC participants took to Capitol Hill was the need for appropriate privacy safeguards in health information technology (HIT) legislation. The APAPO considers patient records privacy a necessary cornerstone of any congressional bills intended to promote the development of HIT.

In March 2008, the APA Board of Professional Affairs (BPA) formed an HIT working group comprising members of BPA, CAPP and additional APA members. The working group will advise BPA and other groups on HIT developments and areas of concern to APA members, including implementation challenges. The group will also recommend experts who can represent APA's interests in external groups involved with policy making and strategies to enhance the development and use of HIT.

For additional information about the BPA working group on health information technology, please contact the Practice Research and Policy Department or call 202-336-5911.

Helping to meet the needs of low-income families involved in child custody disputes

Since 2004, the Practice Directorate has operated a Parenting Coordination Program with Family Court of the DC Superior Court. The nation's first program of this type, the initiative provides pro bono services to low-income families involved in child custody disputes, while providing training for closely supervised advanced psychology students at Argosy University. The Family Court has signed a Memorandum of Understanding with APA that will create and fund an office within the court to oversee the program. Further, the Practice Directorate is close to securing funding from the Casey Foundation that will help replicate the program in other courts around the country.

Through a newly formed task force of the BPA Committee on Professional Practice and Standards, APA is developing its first set of guidelines related to psychologists' involvement in parenting coordination. The task force comprises subject matter experts in parenting coordination.

For additional information, please e-mail the Legal and Regulatory Affairs Department or call (202) 336-5886.

Aiding individuals and communities in the aftermath of disasters

From January through April 2008, APA's Disaster Response Network (DRN) members responded to 38 local disasters, mostly through their local American Red Cross chapter, local fire and rescue squads and state offices of emergency services. Since May, DRN members from Illinois, Indiana, Iowa, Wisconsin, Kansas and Nebraska have responded to tornadoes and floods in their states, while California DRN members have been offering assistance in the wildfire evacuations and sheltering in California.

In response to the shootings at Northern Illinois University in February, DRN and APA Public Education Campaign representatives worked together to produce a document for the APA Help Center for consumers entitled, "Managing Your Distress in the Aftermath of Shootings." The material also was posted to the university's Web site.

Following two large-scale international disasters this spring-a cyclone in Myanmar and an earthquake in China-APA members were eager to find out how they could help. In response, the APA Disaster Response Network, in collaboration with the International Affairs office, developed the APA Statement on the Role of Psychologists in International Emergencies.

For additional information about the Disaster Response Network, please e-mail the Public Relations Department or call (202) 336-5898.

Affirming the value of psychologically healthy workplaces

Another of the directorate's outreach activities helps the business community appreciate the value of psychology and the connection between employee health and well-being and organizational performance.

During the March 2008 State Leadership Conference, the APA Practice Directorate presented its third annual Psychologically Healthy Workplace Awards. Five companies received awards for using a diverse array of workplace practices that enhance both employee well-being and organizational performance. Nine companies also received APA's Best Practices Honors, which recognize companies for a particularly innovative program or policy that contributes to a healthy and productive work environment.

Additional details about the awards are available at the Web site of the Psychologically Healthy Workplace Program.

For additional information about the Psychologically Healthy Workplace Program, please e-mail the Corporate Relations and Business Strategy Department or call (202) 336-5900.

Addressing the health needs of rural residents

The Committee on Rural Health (CRH) is planning a joint Primary Care Initiative meeting with the Education Directorate Public Policy Office that will be held during the Fall 2008 APA Consolidated Meetings. With the goal of increasing the number of psychologists in community health centers, this meeting will bring together APA members with expertise in rural primary care with federal agency and community health center representatives.

Meanwhile, the CRH also is working to increase feedback from the Rural Health Coordinator Network. The network currently consists of about forty state, provincial and territorial psychological association representatives who address mental health care access issues for rural populations. The coordinators help promote the practice of rural psychology by working with primary care and state mental health organizations. The CRH has prepared a survey for the Rural Health Coordinators in order to gather information on the work of the network volunteers and to determine current needs.

For additional information about the work of the APA Rural Health Committee, please e-mail the State Advocacy Department or call (202) 336-5864.