Successful advocacy yields changes to CMS publication on mental health

Centers for Medicare and Medicaid Services amends online content after APA Practice voices concerns

by Legal and Regulatory Affairs department

June 23, 2011— The APA Practice Directorate secured swift action from the Centers for Medicare and Medicaid Services (CMS) following the directorate’s call for the federal agency to correct misinformation in a CMS publication about mental health service delivery.

Several members contacted APA to report that the CMS Medicare Learning Network (MLN) “Mental Health Services” publication, issued in February 2011, listed clinical nurse specialists (CNS), nurse practitioners (NP), physicians assistants (PA) and certified nurse midwives (CNM) as “Mental Health Professionals” who are “recognized as being eligible… to provide diagnostic and therapeutic treatment for mental, psychoneurotic, and personality disorders.”

In a letter to CMS on behalf of the APA Practice Directorate (PDF, 128KB) dated May 25, 2011, the Practice Directorate’s Director of Regulatory Development Elizabeth Winkelman, JD, PhD, detailed the misinformation in the “Mental Health Services” publication and requested CMS either revise the booklet or remove it from the CMS website. Dr. Winkelman’s letter explained that although CNSs, NPs, PAs and CNMs may be allowed to bill for certain diagnostic services related to mental health under the Medicare laws and regulations, they are not generally considered mental health professionals.

In addition, the letter pointed out that none of these providers is permitted under state laws to conduct comprehensive psychological or neuropsychological testing. The letter referred to the Medicare Benefit Policy Manual chapters covering services for various types of providers, as well as the APA “Report of the Task Force on Test User Qualifications,” which provides information on the training and experience recommended for the use of psychological tests.

As a result of the Practice Directorate’s advocacy, the “Mental Health Services” publication was promptly taken down from the CMS website to undergo review by the CMS component responsible for Mental Health Services policy. CMS reposted the booklet as of June 17, 2011 with an Errata Sheet identifying numerous “corrections or changes,” including most of the revisions that APA had requested.

The Practice Directorate has responded to CMS, thanking the agency for making these changes and requesting that the revisions be integrated into an updated publication that will be clearer and more user-friendly.


For more information, contact the Legal and Regulatory Affairs department by email or at (202) 336-5889.