APAPO begins to address issues with health insurance exchange rollout

Early wrinkle surfaces with Connecticut health plan.

By Communications staff

Nearly 3 million Americans reportedly visited healthcare.gov, the website for federally facilitated health insurance exchanges (HIEs), on Oct. 1 — the first day for HIE enrollment under the Affordable Care Act of 2010. Meanwhile, state HIE sites also had several million visitors.

Consumers aren't the only ones interested and engaged in the initial phase of the rollout.

The APA Practice Organization (APAPO) is part of an early advocacy effort to influence the process as qualified health plans (QHPs) gear up to participate in HIEs, with coverage beginning on Jan. 1, 2014. APAPO is collaborating with the Inter Organizational Practice Committee (IOPC), along with the Connecticut Psychological Association (CPA), to address a situation that recently arose in that state.

The IOPC is a coalition of representatives from all the major neuropsychological organizations in the U.S., including the American Academy of Clinical Neuropsychology (AACN/American Board of Clinical Neuropsychology), Div. 40 (Society for Clinical Neuropsychology) of APA, the National Academy of Neuropsychology (NAN) and the American Board of Professional Neuropsychology (ABN), as well as APAPO.

The coalition sent a Sept. 29 letter (PDF, 515KB) to Connecticut Lieutenant Governor Nancy Wynan, chairperson of the Board of Directors for the state-run health insurance exchange known as Access Health CT. The letter expressed concern with the behavioral health fee schedules published by HealthyCT, one of the QHPs participating in Connecticut's HIE.

Under that plan's reimbursement system, only medical doctors and advanced practice registered nurses (APRNs) are reimbursed for neuropsychological assessment. The fee schedule that includes neuropsychologists — the predominant providers of neuropsychological services — disallows reimbursement for neuropsychological assessment. As the coalition letter emphasizes, "Restricting reimbursement for psychological assessment to practitioners not trained to perform the services (APRNs) or with very few qualified practitioners (MDs) will dramatically limit access to neuropsychological services for Connecticut citizens."

Compounding the problems resulting from the HealthyCT fee schedule, masters and doctoral level behavioral health providers are combined into one reimbursement group and all paid at the same rate for authorized services. The letter noted the total years of training and education for psychologists, along with their unique specialized training and skills. It contrasted the HealthyCT scheme with Medicare and nearly all private insurance fee schedules — which recognize the differences between psychologists and lesser trained behavioral health providers.

Staff for APAPO are unaware of HIEs in other states limiting patient access to neuropsychological and psychological services in this manner.

The Connecticut Psychological Association brought the matter in that state to APAPO's attention and is leading the advocacy charge, having sent the initial organizational letter of concern on behalf of psychology to the Access Health CT chief executive officer and board of directors earlier in September.

APA Executive Director for Professional Practice Katherine C. Nordal, PhD, serves as APAPO's representative to the Inter Organizational Practice Committee. She noted that, given the massive scope of health care reform, professional psychology is certain to experience bumps in the road as HIEs begin to provide insurance coverage.

"With health insurance exchange enrollment under way, there are sure to be challenges and opportunities for us to influence the implementation process," said Nordal. "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. "

Sixteen (16) states including Connecticut are operating a state-level HIE on their own, while other states are partnering with or deferring to the federal government (Department of Health and Human Services) to operate the HIE for that state.

If you know of issues or concerns for practicing psychologists regarding participation or HIEs or QHP payment policies, please contact your state psychological association along with APAPO. Send an email or call (202) 336-5886 to report an issue to APAPO.

Visit the APA Practice Organization online to learn more about health insurance exchanges.