From the Practice Directorate
New Mexico Governor Signs Landmark Law on Prescription Privileges for Psychologists
On March 5th, New Mexico Governor Gary Johnson (R) signed legislation into law authorizing properly trained psychologists to prescribe psychotropic medications to patients, making New Mexico the first state in the country to institute such a law.
New Mexico House Bill 170, introduced by Rep. Edward Sandoval (D), recommended a prescription training program based on a proven model used by the Department of Defense to train psychologists in the military to prescribe psychotropic medications for their patients. To receive a prescribing license in New Mexico, psychologists must complete at least 450 hours of coursework; a 400 hour/100 patient practicum under physician supervision; and pass a national certification examination. The academic component includes psychopharmacology, neuroanatomy, neurophysiology, clinical pharmacology, pharmacology, pathophysiology, pharmacotherapeutics, pharmacoepidemiology, as well as physical and lab assessments.
According to the newly signed law, after completing coursework, supervised training and passing a national exam, psychologists licensed to practice in New Mexico are eligible for a two year license allowing them to prescribe under supervision of a physician. At the end of two years if the supervisor approves, and the psychologist’s prescribing records pass an independent peer review, the psychologist can apply to prescribe independently. As an independent prescriber, the psychologist maintains a collaborative relationship with the patient’s health care practitioner.
According to the National Conference of State Legislatures, four other states in the country have pending legislation on prescription privileges for psychologists: Georgia, Illinois, Hawaii and Tennessee. Psychologists in Guam gained prescription privileges in 1999. In the last 10 years, 13 states have introduced prescription privileges legislation. In addition, 31 state psychological associations have prescription privileges task forces lobbying for legislation.
The media recently has called attention to a notice issued by the Centers for Medicare and Medicaid Services (CMS) informing local Medicare insurance carriers that they can not automatically refuse to pay for services solely because a beneficiary has dementia, e.g., Alzheimer’s. In some cases, the media may have created the misimpression that this is a new Medicare coverage decision. In fact, the CMS action does not create any new benefits. Instead, it prevents carriers from installing computer edits that would systematically deny payment for claims with an ICD-9 code of dementia.
In its notice, CMS defines dementia as “the general loss of cognitive abilities, including an impairment of memory, and may include one or more of the following: aphasia, apraxia, agnosia, or disturbed planning, organizing, and abstract thinking abilities. Dementia excludes the loss of intellectual functioning cause by clouding of consciousness.”
CMS acknowledges that advances in diagnostic techniques enable physicians and psychologists to diagnose some dementia patients in the earliest stages and that dementia patients might benefit from several different types of physical and mental health therapies throughout the course of the disease. Yet some Medicare carriers had been quick to deny any therapy services billed for a dementia patient. The CMS notice in essence now requires carriers to consider a claim for a Medicare beneficiary with dementia in light of the service provided and determine if the service was medically necessary.
A diagnosis of dementia is so broad that by itself it may not support Medicare’s requirement that each service be medially necessary. The CMS notice directs carriers to educate providers to use primary and secondary diagnoses that would support payment for services to patients with dementia. Carriers are still expected to look for aberrant billing practices such as submitting claims for a high volume of a particular service or billing for a service that does not seem to coincide with the beneficiary’s diagnosis and to take corrective action when necessary.
CMS originally issued its notice disallowing automatic refusal of payment for dementia patient services in a program memorandum to Medicare carriers available online: www.hcfa.gov/pubforms/transmit/AB01135.pdf.
APA members with questions about this CMS notice should contact the Practice Directorate’s government relations staff via email: Practice.
This year’s Practice Directorate Town Hall meeting on Saturday, August 24, 8-11:00 a.m. during the APA Convention in Chicago will mark the debut of a new, Internet-based resource that over time will provide practitioners with the information and tools they need to manage their practices. This new Web-based gateway, or “portal,” will help practitioners keep up-to-date on issues, comply with current and emerging regulations, and make meaningful connections with others in the profession. Be among the first to preview this exciting new offering by attending this year’s breakfast meeting in Chicago.