April 1st, 2010

R.I. bills prioritize reimbursement, licensing

Insurance reimbursement and licensing matters are chief among the issues this legislative session that could affect psychologists in Rhode Island.

In conjunction with the Coalition of Mental Health Professionals of Rhode Island, an advocacy group, the Rhode Island Psychological Association (RIPA) pushed for the introduction of a bill in January that would serve as an amendment to the state’s parity law and require mental health and substance abuse services to be reimbursed at a rate comparable to medical services.

“Some insurance companies pay for behavioral health services on an arbitrary basis compared to medical services,” says Peter Oppenheimer, Ph.D., chairperson of the Rhode Island Psychological Association’s Legislative Committee. “In the spirit of parity, whatever system an insurance company uses to reimburse for medical care should be used to reimburse for behavioral health services.”

The bill specifically states that the same methodology be used to determine reimbursement for professional providers of medical treatment for mental illness and substance abuse that is used for reimbursement for professional providers of medical services.

Another bill introduced would require insurance companies to pay physicians at least 125 percent of Medicare rates. The bill notes that most Rhode Island physicians are paid less by health insurers than are physicians who provide the same services in Connecticut and Massachusetts. Basing payment on Medicare rates may be helpful, the bill says, since the Medicare program has a “well-established and generally fair method for determining physician reimbursement.”

“We’re not looking to tell insurance companies what to pay, but they should have a responsible rationale for how they’re paying,” Oppenheimer says. “It should be fair.”

The insurance-related legislation comes at a time when some psychologists have had trouble with reimbursements from United Behavioral Health, which has had a contract with the state since 2005. RIPA is currently talking with representatives from the company to try to resolve the issues.

Although the insurance reimbursement bills could have substantial consequences, Oppenheimer says he wishes the association could make more headway in improving access to high-quality health care.

“What we’d really like to be working on is meaningful healthcare reform, but because of what’s going on in the federal government, we won’t be able to do as much as we’d like,” he says. “We’re doing what we can.”

RIPA has also championed an act that would update the state’s licensing law to allow the board of psychology the discretion to suspend or dismiss a complaint against a psychologist without a finding so that the psychologist can participate in a colleague assistance program. The reason for the legislation is that offering treatment to psychologists who may be depressed or otherwise impaired or may be dealing with substance abuse issues, may be more effective than disciplinary action, Oppenheimer says.

RIPA may also weigh in on the issue of school psychologists in Rhode Island being granted licensure even though they don’t have doctorate degrees. If school psychologists submit a bill that would  grant them licensure, RIPA would oppose it.

“Our position – and the APA’s, too [under the newly revised Model Act for State Licensure of Psychologists] is that state licensing of psychologists is restricted to doctoral level degrees,” Oppenheimer says, adding that RIPA has “no interest in curbing their scope of practice.” [The APA had considered removing the exemption in the act that has long allowed the use of the “school psychologist” title for those without a doctoral degree; the exemption was upheld.] Oppenheimer and colleagues worked with members of the APA’s Division of School Psychology to recognize that schools are regulated by the Department of Education (rather than psychology boards).

“It comes down to training, expertise, level of skill and experience,” Oppenheimer says of the opposition to licensure. “We’re trying to have our profession recognized as doctoral-level, to be on par with medical doctors. But we respect what school psychologists are trying to do … They’re valuable, and we want to support them.”

By Ami Albernaz

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