Editor’s note: A team of reporters from New England Psychologist recently spoke with key state association members to learn about legislative and practice issues important to them in 2012.
Legislators in Hartford last year approved the establishment of a quasi-public agency to develop a health insurance exchange, making Connecticut one of 14 states to set up marketplaces for consumers to shop for health insurance either online or by telephone. The move meets a requirement of federal healthcare reform.
The Connecticut Health Insurance Exchange would serve individuals not enrolled in an employer-sponsored insurance program, Medicare or Medicaid and small businesses with up to 50 employees and must be operational beginning Jan. 1, 2014. Its 14-person board of directors has a lot of work to do before then and is currently in the process of hiring an executive director. The Obama administration has declined to identify a uniform set of essential benefits, allowing individual states to specify benefits within four tiers of coverage.
The Connecticut Psychological Association sees itself as a stakeholder in the exchange’s development, says President Barbara S. Bunk, Ph.D. That’s why the association pledges to keep a close watch on the exchange board’s progress and make itself available to the board and legislators to provide information on mental health treatment and its importance to overall physical health.
“Mental health is frequently in danger,” Bunk explains. “We run the risk of being thought of as a carve-out or nonessential service.”
Connecticut ranked fourth in the nation in 2009 after the District of Columbia, Massachusetts and Alaska in healthcare expenditures per capita ($8,654 compared to the U.S. average of $6,815), according to data from the Kaiser Family Foundation.
The economy continues to challenge association members who must balance serving clients and the administrative demands of maintaining their practices, Bunk says. The association is planning a traveling speaker series responding to member feedback for more information on managing the business end of their practices, such as marketing.
Since 2012 is a short session year of 50 days, the Maine legislature will not be addressing any bills with a significant impact on the practice of psychology. Still, the Maine Psychological Association will have its hands full on two other fronts.
First, the MePA plans to direct energies towards an increased relationship with the Maine Primary Care Association, holding workshops to help link individual psychologists and primary care practices throughout the state.
“We would like to work more closely with the people providing health care especially in rural centers,” says MePA Executive Director Sheila Comerford.
Secondly, a most pressing concern for the Association will be cuts proposed by Gov. Paul LePage – $221 million from MaineCare (Maine’s version of Medicaid).
The cuts will eliminate coverage for 54,000 Maine residents including some working parents, young adults and childless adults.
Additional proposals will eliminate chiropractic, dental, occupational and physical therapy, podiatry and sexually transmitted disease clinics. Generic drug use would be increased and payments for hospital services reduced. Sixty million would be cut by eliminating the use of Medicaid funds to pay for housing.
Although there are no cuts directly to mental health care, with fewer clients covered, there will be a reduction in the need for mental health services.
“It will be grim for a lot of people and there will be ripple effects,” says Comerford. “A lot of health care providers will lose their jobs.”
Hearings on the budget were held in early January and the issue has been sent to the Appropriations Committee for discussion.
“I’m hopeful that not all the cuts will go through,” Comerford says, “but I think a fair amount will.”
Catherine Robertson Souter
Elena J. Eisman, Ed.D., ABPP, executive director/director of professional affairs, Massachusetts Psychological Association, says the MPA has two main legislative priorities; both are sponsored by Rep. Ruth D. Balser (D-Newton).
“One of our priorities has been to deal with transparency legislation which would require the medical necessity authorization criteria be made public,” Eisman says.
In addition to requiring health insurance entities to make the criteria public, the legislation would allow the criteria to be challenged and reviewed as to evidence basis and clinical appropriateness. “(The criteria) could be challenged if they aren’t consistent with the scientific literature,” Eisman says.
The other piece of legislation that Eisman lists as a priority involves licensure for behavioral analysts. Balser’s legislation would establish a committee on behavior analysts and applied behavior analysis within the board of registration of psychologists. The board of registration of psychologists would appoint the committee and the committee would develop criteria for the licensure of licensed behavior analysts, including both academic qualification and supervised experience. Rules created by the committee would be subject to approval by the board of registration of psychologists.
“We want to make sure there are criteria where licensing them individually, as we believe it’s important to keep behavioral analysts linked to psychology, which is where the science started,” Eisman says.
Eisman adds the major practice issues facing psychologists in Massachusetts are healthcare reform and payment reform. “We are working very hard to make sure psychologists have a role in whatever new systems are created.”
She says the MPA wants to ensure there are reimbursements for technical assistance to connect to electronic systems; that practices can connect to the super highway of information and those psychologists not part of larger health systems can connect to it in a meaningful way; and that confidentiality issues are addressed in these information super highways.
Eisman says there are a lot of changes taking place and everyone’s more at risk and the MPA could use more help and participation from Massachusetts psychologists.
“It’s important (for psychologists) to understand that they need to support both advocacy at the federal level, as well as the state level, because we do different things that impact their practice.”
In New Hampshire, psychology currently falls under the jurisdiction of the Board of Mental Health Practitioner (BMHP), which also oversees the regulation of independent clinical social workers, clinical mental health counselors and marriage and family therapists.
Feeling that the profession of psychology would be better served by an independent board, the New Hampshire Psychological Association worked together with several state representatives to introduce a bill in 2011 to create one.
That bill is currently being held in subcommittee in order to give newly appointed BMHP board members a chance to address the proposed changes.
While waiting for that decision, the NHPA chose to work to introduce a similar bill in the Senate. This way, by the time the bill works its way through the Senate procedure, it should be ready for a vote on the House side as well.
The main concern with the existing board, says NHPA’s Executive Director Kathryn Saylor, Psy.D., is that an omnibus board with only one psychologist cannot be representative of the entire realm of psychological practice.
A new board would not increase costs for the state since all New Hampshire boards must show a 25 percent profit, which is put back into the state budget.
The hearing for the Senate bill was held on Jan. 12 and a vote was expected after New England Psychologist’s press time.
Two other bills before the House include one to change wording in the procedures for the BMHP and another to limit the ability of the BMHP to consider certain complaints against psychologists. “It will prohibit BMHP from considering complaints against judicially appointed and forensic psychologists unless the originating court has substantiated the basis of the complaints,” says Saylor.
Both of these bills have been assigned to committee but no hearing dates have been set.
Catherine Robertson Souter
Autism insurance reform advocates applauded last summer when Gov. Lincoln Chafee signed legislation making Rhode Island the 27th state to require private health insurance companies to cover the diagnosis, testing and treatment of autism spectrum disorder. But language in the law could end up disrupting treatment for the children it was designed to help.
That led the Rhode Island Psychological Association’s legislative committee to meet with lawmakers, advocates and state officials last fall in hopes of changing provisions governing client eligibility and credentials of therapists providing treatment. The issues are at the top of RIPA’s 2012 legislative agenda, says President Lisa M. Rocchio, Ph.D.
Under the new law, therapists must be both licensed health care professionals and certified in applied behavior analysis. But only about a half dozen of the state’s 719 licensed psychologists are ABA certified, Rocchio says. ABA certification is obtained after completing 225 hours of graduate coursework through the nonprofit Behavior Analyst Certification Board. Many association members, however, are already qualified based on their training and within the scope of their practices.
Another problem: a $32,000 cap on benefits per year and an age limit cutting off services at age 15.6. However, Medicaid currently provides services to these clients and would likely cover them after they use their allotted private insurance benefits.
RIPA is proposing language to ensure treatment is performed or supervised by a licensed health care professional under rules for providers consistent with Medicaid requirements.
RIPA’s schedule of 2012 workshops will cover a variety of topics to assist members with ethical, clinical and practical matters. A growing number of inquiries from members concerned about using email, Skype and social media sites like Facebook prompted a full-day session scheduled for October with risk management and ethics expert Eric Harris, Ed.D, J.D.
Rick Barnett, Psy.D., LADC, M.S. Clinical Psychopharmacology and president of the Vermont Psychological Association, says the VPA is focused on three overlapping legislative priorities in 2012.
One is Act. 48 (passed in 2011), healthcare reform legislation that initiates a path toward a single-payer system in Vermont. “However, several steps must be taken to reach that goal,” Barnett says. “In 2012, VPA wants to continue to position itself as a key player in this process to preserve mental health as a core component in the overall healthcare system.”
“Along these lines, our legislative committee is working hard to assure that parity is truly enacted during the reform efforts,” Barnett says. “Although Vermont has some of the strongest parity laws in the country, there are loopholes that undermine the nature of parity. VPA wants to make sure that parity and integrated care are central to the process of moving towards a single payer.”
Additionally, as a result of Tropical Storm Irene last August, the Vermont State Hospital was closed. “Since that time, the state has been scrambling to find suitable arrangements for the most psychiatrically vulnerable patients,” Barnett says. “VPA is concerned about how intensive inpatient psychiatric treatment services are developed in 2012 not only for the displacement caused by closing VSH, but also for the broader population seeking outpatient services or those possibly referred for inpatient care. In arriving at solutions to this significant problem, VPA is certain to let legislators know how their decisions may affect mental health services as a whole, across the state.”
Barnett adds the major practice issues psychologists are facing are: stable or falling reimbursement rates for psychological services (i.e., cuts in Medicare and Medicaid funding); and workforce retention and development.
“VPA is actively involved in insurance issues through our insurance committee. VPA works closely with other mental health associations (NASW-VT, Counselor’s Association, VT Psychiatric Association) to address all the aforementioned issues in addition to workforce retention and development. It’s a very proactive, collaborative time to be a member of VPA,” Barnett says.
By Pamela Berard