From the Practice Directorate

The Senate and House have reached an historic agreement on the terms for a final full mental health parity bill.

Senate and House Achieve Historic Agreement on Parity

The Senate and House have reached an historic agreement on the terms for a final full mental health parity bill. The compromise is expected to move quickly through both chambers. From the time that the House passed its version of the parity bill, H.R. 1424, in early March (the Senate passed its version, S. 558, last September), the two chambers have been engaged in intense negotiations to reconcile differences between the two bills.

The APA Practice Organization has been involved throughout these negotiations, along with other key stakeholders from the mental health, insurer and employer communities, including the National Alliance on Mental Illness (NAMI), U.S. Chamber of Commerce, the National Retail Federation, America's Health Insurance Plans (AHIP), BlueCross BlueShield Association and Aetna.

The final gap between the Senate and House bills was closed as negotiations led to agreement over three key outstanding issues:

  • Preemption. The House accepted the stronger Senate language, which defers to the current HIPAA standard. This standard is extremely protective of state law, ensuring that stronger state parity and other consumer laws will remain in place.

  • Out-of-Network Services. The Senate accepted the stronger House language that makes clear that out-of-network mental and substance use disorder services will be provided at parity when a plan provides out-of-network physical health services.

  • Covered Services. The House agreed to drop mandated coverage for all DSM diagnoses but ensured that all mental health conditions and substance use disorders would be covered by mirroring the standard for mental health under the current federal parity law.

Together, we have worked for the better part of a decade to end mental health and substance use benefits discrimination. This breakthrough would not have been possible without the tireless perseverance and dedication of psychologists across the country who have advocated year after year on behalf of their patients.

When enacted the new federal parity law will:

  • Completely end insurance discrimination against mental health and substance use disorder benefits for over 113 million Americans, requiring full parity coverage with physical health benefits.

  • Extend to all aspects of plan coverage, including day/visit limits, dollar limits, coinsurance, copayments, deductibles and out-of-pocket maximum.

  • Preserve strong state parity and consumer protection laws while extending parity protection to 82 million more people who cannot be protected by state laws.

  • Ensure parity coverage for both in-network and out-of-network services.

Look for further details on the bill at

APA/VA Psychology Leadership Conference Draws Record Turnout

The 11th annual APA/VA Psychology Leadership Conference boasted record attendance, with more than 160 Department of Veterans Affairs (VA) psychology leaders meeting last month in Dallas-Fort Worth. The conference is co-sponsored by the American Psychological Association (APA) Practice Directorate, Association of VA Psychologist Leaders (AVAPL) and APA Division 18 (Psychologists in Public Service).

Founded in 1998, the yearly conference showcases the highest quality of patient care to U.S. veterans while addressing the professional needs and concerns of VA psychologists. The annual conference provides an opportunity for participants to share their contributions to this goal while seeking to cultivate growing numbers of psychology leaders in the upper levels of the VA health care system.

The 2008 conference theme was "Integrated Mental Health and Behavioral Health Care: Psychology's Role." In his opening remarks, Randy Phelps, PhD, deputy executive director of the Practice Directorate, spoke of the progress psychology has made in achieving leadership roles in the VA, the largest health care system in the country. The VA is also the largest single employer of psychologists in the U.S.

James Bray, PhD, president-elect of the APA, delivered the keynote on integrated care models and the future of professional practice. A panel on integrated care convened as well, with presentations by leaders in the field.

The new APA Executive Director for Professional Practice, Katherine Nordal, PhD, who participated in the conference during her first week on the job, described the speakers as "thought leaders" who offered "cutting-edge paradigms" related to integrated care. "The private sector has a lot to learn from the VA in this area," she observed.

In her own remarks, Dr. Nordal reminisced about growing up in a military family, drawing warm applause when she revealed her talent for spit-shining boots and polishing brass. Dr. Nordal told the attendees that she appreciated their commitment to the nation's veterans and their family members and applauded VA psychologists for their "desire to bring the best behavioral health care to those who have risked their lives in serving our country."

Other conference panels included experts on post-traumatic stress disorder and trauma, as well as latest developments in the assessment of traumatic brain injury.

APA Past President Pat DeLeon, PhD, MPH, JD, focused on the future of psychology and the need for continuing to expand the boundaries of psychology's scope of practice.

On the last day of the conference, participants attended one of two half-day workshops on acceptance and commitment therapy or implementing the recovery model.

APA Practice Organization Joins Coalitions on Health Care Reform

For more than a decade, as health care costs spiraled upward and the number of Americans without health insurance continued to rise, health care reform remained on the back burner of the national political agenda.

Yet certain factors suggest that health care reform may regain the national spotlight in 2009. There is growing concern about the ailing U.S. health care system among consumers, health professionals and congressional leaders. Meanwhile, all of the major presidential candidates have focused attention on health care reform.

The APA Practice Organization (APAPO) considers health care reform an important legislative priority and recognizes that there is strength in numbers when working on such a complex and high-profile issue. As a result, the APAPO recently joined two new health care reform coalitions.

Engaging in coalitions is intended to help set the stage for APAPO's active involvement as the issue of health care reform regains prominence. "Our participation will position us to promote necessary change as a key player in the debate," said Assistant Executive Director for Government Relations Marilyn Richmond, JD. "We intend to be part of the debate and part of the solution."

Health Care First
In April, the APAPO accepted an invitation to be a founding member of Health Care First, a collaboration of consumer and provider associations working to involve additional advocacy organizations in achieving comprehensive reform in 2009.

Spearheaded by Families USA, which advocates for high-quality, affordable health care for all Americans, Health Care First is hosting briefings by prominent pollsters and strategists. These events are intended to educate coalition members about current public opinion on health care reform and to showcase messages that resonate with both the public and policy makers.

Health Care First anticipates taking an active role in supporting comprehensive health care reform legislation.

Divided We Fail
In addition, the APAPO also has signed on as a supporting organization of Divided We Fail. This coalition of more than 80 groups was organized by AARP, the Business Roundtable, the Service Employees International Union and the National Federation of Independent Business. Divided We Fail will work to educate the public about the importance of good health coverage as a key component of long-term financial security.

Through Divided We Fail, the APAPO will cultivate opportunities throughout the U.S. for psychologists to participate in town hall meetings, press conferences and community forums.

Affiliating with these coalitions is one component of the APAPO's preparations for playing a leadership role once the next session of Congress takes up health care reform. "Together with our allies and using our three-part strategy of direct lobbying, grassroots mobilization and political giving, psychology is working to ensure that one day soon all Americans will have access to affordable health care," said Richmond.

The APA Practice Organization's coalition efforts are guided by the four principles for health care reform approved by the APA Council of Representatives in August 2007:
1) Everyone should have coverage that provides affordable health care for all basic services.
2) Basic health care services eliminate the artificial distinction between "mental" and "physical" health, recognize the inseparable relationship between mental and physical well being and offer access to treatment for "mental health conditions" equivalent in all respects to access for "physical health conditions."
3) Basic health care services include the psychological treatment of physical conditions in order to maximize rehabilitation and quality of life.
4) Basic health care services include appropriate prevention services that address the role that behavior plays in seven of the ten leading causes of mortality and morbidity.

Greetings to My Practitioner Colleagues
by Katherine Nordal, PhD

Note: This inaugural column by the new APA Practice Directorate Executive Director Katherine Nordal, PhD, first appeared in the May 2008 issue of APA Monitor.

Since only some of you know me, but most do not, I want to tell you a little about myself. I come to APA following 30 years of clinical practice, mostly in the private sector. I entered practice at a time when it was generally easier than now to establish a private practice. There were not many other mental health professionals in the marketplace and the economic forces that have so adversely impacted health-care practice were not yet in play.

Like most practitioners, I too have wrestled with PPOs, HMOs, managed-care companies, Medicare and Medicaid. These and other forces have threatened practice and severely limited access to high-quality psychological services for many populations, particularly the underserved. Unfortunately, psychotherapy skills are now a commodity available from many sources. Payers have chosen to purchase that commodity from the least expensive vendor and have driven down the market value of psychotherapy.

As a result, fees for psychotherapy have not increased in years, and have actually dropped in many cases. This situation has been very demoralizing for those psychologists whose primary passion is providing psychotherapy services.

As marketplace forces changed and because I was practicing in a semi-rural area, I already knew our practice had to be diverse to be viable. In order to do what was dearest to my heart, serve children and their families, we broadened the scope of our practice to include activities such as: fitness-for-duty evaluations for business, industry and public safety entities; development and management of employee-assistance programs; inpatient psychiatric and substance abuse programs consultation; civil commitment examinations; consultative evaluations for school districts, youth courts, and departments of human services; civil forensic evaluations and consultation; and IMEs for workers' compensation carriers and disability insurance carriers.

I found a diverse practice to be stimulating, challenging and professionally rewarding. And it allowed me to continue to treat the patients I wanted to work with, even with changing patterns of reimbursement.

Despite the changing structure and economics of health care, and those changes still to come, I remain passionate and optimistic about the future of psychology practice. I believe that psychologists are the crème de la crème of behavioral health-care practitioners.

We have a very large and diverse practice community including but not limited to independent practitioners, institutional practitioners in large interdisciplinary health-care settings, university counseling centers, community mental health centers, state psychiatric hospitals, state and federal prisons, the military services, public health service, community health and rural health clinics, the Indian Health Service, Department of Veterans Affairs and our schools. What a richness we bring to the health-care arena!

We are also the experts in human behavior across a broad range of applications and find many of our psychologists using their skills to address critical issues in organizational settings and the legal system.

Our mission in the Practice Directorate is to protect, defend and enhance professional practice. To that end, we will continue to address access to care and reimbursement issues through legal, regulatory and legislative venues; advocate for expanded scope of practice including hospital practice and prescription authority; develop new markets and practice resources for practitioners; and develop increasingly effective public education campaigns. Much of this activity takes place through the APA Practice Organization, the APA affiliate supported by practice assessment monies from licensed members.

We are constantly reassessing our objectives and strategies in order to be more responsive to the needs of our practice community. I encourage you to help us by communicating your concerns and ideas either directly or through your division or state, provincial and territorial psychological association.

I believe that all psychologist practitioners deserve a fulfilling professional life given their level of education and training and their top-notch services. While we understand that there are continuing challenges for us, particularly in the health-care arena, there are also terrific opportunities. We invite you to work together with us and be part of those exciting possibilities!