Prescriptive authority among VPA legislative initiatives

By Rivkela Brodsky
January 1st, 2017

The Vermont Psychological Association has three main areas of focus for the 2017 state legislative session: healthcare reform, insurance coverage of telehealth services and prescriptive authority for psychology doctorates.

Healthcare Reform

The nonprofit professional association founded in 1950 that represents psychologists in the state of Vermont is working to make sure psychologists and other mental health providers are fairly reimbursed in new payment reform systems being developed in the state, said Rick Barnett, Psy.D., MSCP, past president and legislative chair for the Vermont Psychological Association.

The Centers for Medicare & Medicaid Services recently approved the Vermont All-Payer Accountable Care Organization Model. “This involves a waiver whereby one ACO (Vermont Care Organization) manages all the money from Medicare, Medicaid and Commercial Insurance,” Barnett said. “VCO is regulated by the Green Mountain Care Board to carry out health care reform initiatives.”

The association will be working with the board and legislators to make sure the mental health provider workforce is represented as payment reform continues. “We hope to continue to garner broad support based on simple supply and demand pressure as well as common sense collaborative efforts,” Barnett said.

However, there is some concern that changes in leadership may change the course of healthcare reform. “The local elections change the healthcare reform landscape a little because all the reform efforts were started and have evolved significantly under a Democratic leadership,” Barnett said. “Governor-Elect Phil Scott is a Republican and he’s uncertain if he’ll continue with All Payer Model or push to scrap it.”

Also, changes at the national level may impact this model. “Likewise, President-Elect Donald Trump and a Republican majority decision around health care reform, especially regarding federal Medicaid matching funds, may render the All Payer Model impossible to carry out.”

Telehealth services

Legislation introduced in the Vermont House in 2016 (HB 543) would require insurance companies to cover telemedicine services delivered in or outside a health care facility, according to the Vermont Legislature’s Web site.

This would include payment of “services provided by psychologists in their offices without the health care facility requirement for patients,” Barnett said. “That is, the bill will require insurance companies to pay for telemental health regardless of where the patient is in Vermont (at home, a family member’s house, or elsewhere).”

The association is hoping to see this bill pass in the 2017 session.

Prescriptive Authority

The association’s board of directors voted to move forward with legislation that would provide prescriptive authority for psychologist doctorates, Barnett said. The association has consulted an attorney and has a legislator interested in possible sponsorship of the bill.

Barnett said there are 170 psychiatrists in Vermont with 40 percent nearing retirement and 50 percent not accepting new patients and/or not accepting insurance. “Most psychiatric medications are prescribed by primary care providers, most of whom have minimal psychopharmacology training and are desperate for help from well-trained colleagues,” he said.

“We as a society already over-medicate our patients. Let’s smarten up and enhance our mental health workforce by allowing safe and responsible prescribing psychologists to work together with our patients and our healthcare team.”

The association is hoping to gain traction this session on this issue, although Barnett expects a battle. In particular, there may be challenges presented by psychiatrists. “However, the VPA has broad support from within the association as well as from nurses, naturopaths, mental health counseling colleagues and primary care providers, among other key stakeholders,” he said.

Barnett said the association is preparing for these three initiatives through informational outreach and meetings with policymakers and health care reform leaders.

There may be other pieces of legislation the association will be prioritizing as the session begins. Often, other legislation comes up during the session that will have a direct impact on mental health care in Vermont.

“VPA is committed to tracking and testifying on new legislation as it arises and as it’s appropriate to maintain the integrity of our profession and the quality of treatment we provide,” Barnett said.

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