From the Practice Directorate

The APA Practice Organization pursues issues related to coding and Medicare payment for diagnostic testing services provided by technicians and other ancillary staff.

Advisory Committee on Colleague Assistance and the Committee on Professional Practice and Standards

APA’s Board of Professional Affairs (BPA) is pleased to invite nominations for membership on its two committees, the Committee on Professional Practice and Standards (COPPS) and the Advisory Committee on Colleague Assistance (ACCA).

In a continuing effort to broaden representation in APA governance, BPA seeks nominations from a wide variety of sources. Self-nominations are welcomed.

COPPS is a standing committee to BPA. Its mission includes (1) the development, review, and evaluation of practice guidelines for providers of psychological services; (2) providing assistance with BPA to other APA bodies developing practice guidelines; and (3) monitoring, evaluating, and developing information regarding the scientific and professional aspects of psychological services.

While all applicants will be seriously considered, those with experience in guideline development, forensic psychology, in APA governance, and those who have a legal background are particularly encouraged to apply. BPA seeks candidates who will enhance the diversity of the Committee. Well-developed writing, editorial, and information research skills are an asset to the Committee.

Participation in COPPS requires a significant annual time commitment including two meetings in Washington, DC, work on individual projects, and conference calls. Committee members cannot serve simultaneously on another APA standing or continuing board committee and no one can serve consecutive term on a committee unless an exception is voted by two-thirds of the board.

There is one appointment available on COPPS, with a three-year term beginning in January 2005.

COPPS will review nomination materials and forward its recommendations to BPA, which will select the new member in the fall of 2004. All completed applications will be considered. Individuals with experience in forensic psychology, APA governance, and the legal system are particularly encouraged to apply. Well-developed writing editorial, and information research skills are an asset to the Committee. BPA and COPPS seeks candidates who will enhance the diversity of the Committee.

ACCA is an advisory committee to BPA. Its mission includes: (1) investigating the unique needs of psychologists for colleague assistance; (2) promoting the development and continuation of state-level colleague assistance programs and peer assistance networks; and (3) developing relationships between state ethics committees, boards of examiners, and colleague assistance programs.

Participation in ACCA requires a significant time commitment including two meetings per year in Washington, DC, work on individual projects, and conference calls.

There are two appointments available on ACCA, with a three-year term beginning in January 2005.

ACCA will review materials and forward its recommendations to BPA, which will select new members in the fall of 2004. Nominees are particularly sought with experience working with impaired or distressed professionals, occupational health programs, forensics issues, prevention/program development, and/or the effects of delivery system changes. Nominees who have previously worked with an ethics committee and/or state-level psychological association are encouraged. BPA and ACCA seek candidates who will enhance the diversity of the advisory committee.

The deadline for nominations is SEPTEMBER 17, 2004. Please send nominations, including a 75-word description of qualifications and a curriculum vitae to Ernestine Penniman, at the APA Address. Note that nominators of other individuals are responsible for ensuring that these materials are submitted. Electronic submissions are encouraged and should be sent to Ernestine Penniman.


Medicare Changes Are Favorable for Psychology

The Centers for Medicare and Medicaid Services (CMS) recently proposed a policy change that is welcomed by psychologists who provide testing services to Medicare beneficiaries. The federal agency that administers the Medicare program is proposing to allow "clinical psychologists" (defined as any doctoral-level psychologist recognized by Medicare who is qualified to provide both therapeutic and diagnostic services) to supervise ancillary staff such as technicians in doing psychological or neuropsychological testing.

Under current federal regulation, a physician must supervise anyone other than a psychologist who performs psychological or neuropsychological tests for Medicare beneficiaries. The diagnostic testing policy change is part of an extensive proposed federal rule on the 2005 Medicare fee schedule.

Expanding the current testing rule has been a priority on the APA Practice Organization's regulatory advocacy agenda, and we have actively sought the rule change for the past two years. In issuing its proposed rule, CMS noted the Practice Organization's rationale in support of the change. The language of the rule asserts that psychologists are uniquely qualified to direct test selection and interpret test data based on their knowledge of test measurement and development, psychometric theory, specialized assessment techniques, statistics, and human behavior.

Further, the agency noted that the rule change would reduce delays in testing, diagnosis, and treatment in rural areas where physicians are unavailable to supervise the tests.

Also as the Practice Organization advocated, the proposed rule allows psychologists to provide general supervision for psychological and neuropsychological testing. This is the same level required of physicians when supervising the same services. It means that the testing is conducted under the psychologist's overall direction and control, but the psychologist's presence is not required during the testing.

Comments on the proposed rule are due to CMS by September 24. We anticipate the agency's decision on finalizing the change to the diagnostic testing rule in November at the same time the 2005 Medicare fee schedule rule is finalized.

The proposed rule was published in the Federal Register on August 5 and can be downloaded from the CMS website at www.cms.hhs.gov/regulations/pfs/2005/1429p.asp. The provision that discusses the expansion of the diagnostic testing rule begins on page 332.

The Practice Organization continues to pursue issues related to coding and Medicare payment for diagnostic testing services provided by technicians and other ancillary staff.


Florida Psychological Association Joins Nationwide Managed Care Litigation

The Florida Psychological Association (FPA) has become a plaintiff in class action litigation against 63 Blue Cross Blue Shield companies throughout the country. The case is set in federal court in Miami.

In this litigation, various non-physician health providers and certain professional associations representing them allege that managed care companies conspired to reduce and delay payments to health professionals. The plaintiffs further allege that the conspiracy violated the RICO statute (the Racketeer Influenced Corrupt Organizations Act). RICO was originally enacted to prosecute organized crime, although it since has been applied in other contexts. The case including FPA involves extending RICO's application to reimbursement of health professionals by managed care companies.

According to FPA president Harry Reiff, PsyD, JD, the association is pleased to be getting involved in this cutting-edge legal action on behalf of organized psychology. "We believe that this case provides a good vehicle for addressing not only the systemic payment problems facing our practitioner members, but also for dealing with a variety of other managed care issues, such as medical necessity determinations and phantom panel problems," said Dr. Reiff.

The non-physician class had previously filed a similar complaint against the nation's 10 largest managed care companies - including Aetna, CIGNA, Humana, Anthem, and United Healthcare. FPA may also join that case when the next opportunity to add plaintiffs to the complaint arises. The conspiracy allegations in that earlier complaint focus on conspiracy among the 10 named managed care companies, while the allegations against the Blue Cross companies focus on a conspiracy among the Blues.

Both non-physician suits attempt to build upon the success of cases first filed in late 2000 by a class of physicians against the same two groups of companies. Like the non-physician action, the physician suits also assert RICO violations based upon a conspiracy to reduce and delay provider payment. Both the physician and non-physician cases are consolidated before federal judge Fredrico Moreno.

In the physicians' litigation against the largest managed care companies, Judge Moreno has given two rulings that are favorable to the plaintiffs. He allowed the physicians to proceed in a class action, and he denied the managed care companies' motion to dismiss the physicians' RICO claims prior to trial. The companies have appealed the decision involving the class action to the US Court of Appeals for the 11th Circuit.

Following the ruling allowing the class action, Aetna and CIGNA entered into comprehensive settlement agreements with the physicians. Each agreement exceeded 140 pages and addressed a wide range of managed care issues. The settlements involved multi-million dollar payments to the class, which translated to relatively modest cash payments to each physician who submitted a claim.

More significantly, the companies agreed through the settlements to implement a variety of policy changes over a four-year period, including:

  • Placing in provider agreements a definition of "medical necessity" that considers the physician's perspective that he or she exercised "prudent clinical judgment," instead of a definition that simply reflects the company's perspective.

  • Requiring the company to consider the recommendations of physician specialty societies when adopting clinical policies about what services are covered.

  • Procedures for appealing the company's medical necessity determinations.

  • Payment of interest based on prompt payment schedules that are more favorable than many state 'prompt payment' laws (which typically require the managed care company to pay claims within 30 days).

  • Provisions that simplify claim submission, payment and recredentialling procedures.

  • Agreements not to automatically "bundle" and "downcode" certain CPT codes, e.g., discontinuing systemic practices whereby the company approves or pays for a lesser service than the physician actually provided.

  • Greater transparency of company policy through website listings of various items, including information on claims and payment policies, procedures and justifications (for example, how "reasonable and customary" charges are determined).

Dr. Reiff hopes that the defendant companies will offer similar policy changes to the psychologists.

The APA Practice Organization is working closely with FPA and its lawyers to see that psychology is appropriately involved and represented in this legal case. "We want to ensure that the unique managed care issues involving psychology and mental health services delivery are adequately addressed in this important litigation," said APA Executive Director for Professional Practice Russ Newman, PhD, JD.


APA Psychologists Mobilize for Red Cross Response to Hurricane Charley

Psychologists from across the nation responded to a call by APA to help victims of Hurricane Charley.

The mobilization came at the request of the American Red Cross, which has a statement of understanding with APA, to send specially-trained psychologists onsite during disasters. The psychologists are part of APA's Disaster Response Network (DRN), a national pro bono network of psychologists who complete Red-Cross-sanctioned training and then volunteer assistance to relief workers, victims, and victim's families after manmade or natural disasters.

DRN members help disaster victims cope with extremely stressful and often tragic circumstances. The more than 2,000 DRN members help problem-solve, make appropriate referrals to community resources, advocate for workers' and victims' needs, and provide information. They also focus on providing general emotional support and help people marshal their own successful coping skills in often extremely stressful and tragic circumstances.

"We anticipate that psychologists will be assisting with the Red Cross relief operations throughout September," said Russ Newman, PhD, JD, APA's executive director for professional practice. "Our experience with the trauma and distress cased by disasters like Hurricane Charley has demonstrated the need for emotional, as well as physical, relief efforts. Psychologists around the country very much want to contribute to meeting that need."