Nevada psychology interns now authorized to bill Medicaid

Nevada Psychological Association successfully advocates for interns’ enrollment in state-run insurance program.

By Hannah Calkins

On Feb. 22, Nevada Medicaid approved new rules (PDF, 1.25MB) allowing appropriately supervised doctoral psychology interns to enroll as Medicaid providers, making Nevada the 18th state to do so.

The victory is the result of a 10-year advocacy effort involving the Nevada Psychological Association, Nevada Medicaid, the state’s Department of Health and Human Services (DHHS) and the psychology board, as well as the Centers for Medicare and Medicaid Services (CMS), says Caroline Bergner, JD, an advocacy and policy fellow in the APA Education Directorate and the Practice Directorate’s legal and regulatory affairs department.

Doctoral interns in Nevada can now enroll as Medicaid providers — or, as Medicaid calls them, Qualified Mental Health Professionals (QMHPs) — after registering with the Nevada Board of Psychological Examiners.

“Nevada’s unique path to this outcome demonstrates how much this varies state by state,” Bergner says. “There are 18 states where psychology interns can be reimbursed by Medicaid, and each state followed a different process and has different rules. For instance, Nevada requires interns to register with the board of psychology.”

The decadelong negotiation has more to do with slow-moving bureaucratic systems than with oppositional forces, says Lindsey Ricciardi, PhD, who was president of the Nevada Psychological Association (NPA) from 2012 to 2013.

Ricciardi says that NPA began working on the issue in 2007, when they realized it would be difficult to fund more internships if sites could not bill Medicaid for interns’ services. At the time, there was just one APA-accredited internship in the state. So, NPA raised the issue with Nevada’s DHHS and the state Medicaid agency.

The roadblock, Ricciardi says, was that interns training to be marriage and family therapists (MFTs) and licensed clinical social workers (LCSWs) were able to bill Medicaid, as long as they were registered with their respective regulatory boards. “But our training is so different from MFTs and LCSWs, and it was hard for Medicaid to understand and appreciate how psychology interns would have oversight within their home institution.”

In 2012, Nevada chose to expand Medicaid under the Affordable Care Act, and the governor was under pressure to focus on mental health reform. “That year, the political climate was ripe for us to advocate for psychologists to have interns serving the Medicaid population,” Ricciardi says.

Ultimately, DHHS was comfortable allowing psychology interns to be Medicaid providers as long as they registered with their respective regulatory board, like MFT and LCSW interns.

Over the next five years, Ricciardi and her colleagues at NPA slowly pushed the issue through Nevada Medicaid, the psychology board, CMS, and then — finally — back to Nevada Medicaid, which formally added interns to the list of eligible QMHPs at their Feb. 22 hearing.

“Having patience has been the hardest part of this process, as meetings were rescheduled and rescheduled again,” Ricciardi says. But it’s been worth the wait. “Nevada has very few psychologists per capita, so expanding access has been crucial.”

The APA Practice Organization and the APA Education Directorate are committed to removing barriers to psychologists’ and interns’ full participation in the Medicaid system. We have collaborated with states and state psychological associations in 13 states, and we will continue this collaboration despite possible changes to the Medicaid system. If you are interested in working together on these issues, please contact Caroline Bergner, JD.