As the Federal Advocacy Coordinator for Division 51, I am frequently
asking for your assistance on issues important to the practice of
psychology. Having worked closely with the APA Practice Organization
for 8 years, I can tell you that there is often a lot more going
on “behind the scenes” that you may not hear about. So, I want to
take this opportunity to let you know about the work that was done
to secure new testing codes along with all of the advocacy efforts
following Hurricane Katrina. I look forward to providing similar
updates for you in the future. As always, if you have any questions
of concerns, please feel free to let me know.
Psychologists providing testing services now have a more accurate
way to bill as seven new Current Procedural Terminology (CPT®) codes
became effective on January 1. Implementation of the codes reflects
a change in thinking by the Centers for Medicare and Medicaid Services
(CMS), which by awarding work values to the codes is finally acknowledging
that psychologists are engaged in professional work when providing
psychological and neuropsychological testing services.
These changes are the result of continued advocacy by APA over
the past several years. Due to concerns about the level of professional
work involved in furnishing testing services, previously CMS only
reimbursed psychologists for the estimated costs of practice expense,
essentially overhead, and a small amount for malpractice insurance.
The psychologist’s time and effort in providing the service went
Previous attempts in 2002 and 2003 to obtain professional work
values for the testing codes failed to gain approval from the American
Medical Association’s reimbursement committee. APA continued its
efforts by engaging staff from the AMA’s coding and reimbursement
committees in a strategy to revise the testing codes. APA developed
a proposal that more closely identified the psychologist’s involvement
in the testing service, thus making the codes more suitable for the
assignment of professional work values.
APA gained the approval of the coding committee to revise the codes
in 2004 and then used survey data from psychologists across the country
to persuade the reimbursement committee to recommend professional
work values for the codes in 2005. Later that year, CMS adopted the
reimbursement committee’s recommendations and assigned professional
work values for the revised codes.
The professional work values assigned to the new codes will significantly
improve the amount paid by Medicare for these services. The previous
psychological and neuropsychological testing codes (96100, 96115
and 96117) were all reimbursed at an average hourly rate of $74.
Under the 2006 Medicare fee schedule, average payments for outpatient
testing services under the new codes will increase from 26% to 69%.
For a complete list of the revised codes and their new values go
Hurricane Relief Efforts
In the weeks and months following Hurricane Katrina, Congress focused
its attention on a wide range of proposals to provide relief to hurricane
evacuees, including relief for evacuees’ health care needs. In late
December 2005, the Senate approved a measure to provide a 100% federal
match of existing Medicaid plans for those states with evacuees.
Significantly, this measure will allow states the option of expanding
their Medicaid mental health services while receiving the 100% federal
match for up to nine months. This program will enhance opportunities
for psychologists in the affected states of Louisiana, Mississippi,
and Texas, as well as in other states where evacuees currently reside
that do not normally cover outpatient psychologist services in their
This critical provision was included in the Budget Reconciliation
legislation that passed both the House of Representatives and the
Senate in December in the final hours of the Congressional session.
Due to amendments made in the Senate, however, the Budget Reconciliation
legislation must come before the House for one more vote before final
passage; as of this writing a vote is predicted for early February
2006. T he Practice Organization is pleased that, in the interim,
state-by-state Medicaid waivers are allowing funds to be spent on
mental health services not previously covered by the hurricane affected
Among the dozens of earlier proposals considered by Congress, one
sponsored by Senate Finance Committee Chairman Charles Grassley (R-IA)
and Ranking Member Senator Max Baucus (D-MT) initially appeared quite
promising. Known as the Emergency Health Care Relief Act (S. 1716),
the bill also sought to create a Disaster Relief Medicaid program
to provide evacuees below the poverty line 100% federal payment of
their health care for up to ten months.
Importantly, and at our urging, S.1716 would have required coverage
for a wide range of mental health services as part of the proposed
relief, including for example s creening, assessment and diagnostic
services, psychotherapy, rehabilitation and other therapies, medications
prescribed by “health professionals,” inpatient care and other mental
health services, as well as alcohol and substance abuse treatment
resulting from circumstances related to Katrina, and family counseling
for Katrina survivors and for first responders. The Practice Organization
particularly appreciated the sponsors’ express recognition of mental
health services as an important part of Disaster Relief Medicaid.
This bill stalled in the Senate due to budgetary concerns, however.
The debate in Congress over the need to offer some form of health
care relief to the Hurricane victims certainly presented the Practice
Organization with a unique opportunity to inform members of Congress
about the significant mental health repercussions of major natural
disasters and the extensive volunteer relief services that psychologists
have been providing “on the ground” to hurricane victims through
the Disaster Response Network. In September, APA’s Chief Executive
Officer, Norman Anderson, Ph.D., sent a letter to the Senate, prepared
by the Practice Organization, endorsing S.1716. The Practice Organization
also developed and distributed widely an informational fact sheet
concerning the substantial mental health needs of disaster survivors,
highlighting the fact that when natural disasters cause extensive
community-wide destruction and disruption – as with Hurricanes Katrina
and Rita -- 25 to 30% of the survivors are likely to develop anxiety
disorders, including post traumatic stress disorder (PTSD), depression
and other clinically significant problems. The fact sheet is available
at: http://www.apapractice.org/apo/pracorg/legislative/HurricaneImpact.html# The
Substance Abuse and Mental Health Services Administration (SAMHSA)
recently confirmed these statistics, and is now projecting that up
to 500,000 people may be in need of professional assistance as a
result of the hurricanes. The SAMHSA news release is available at: http://www.samhsa.gov/news/newsreleases/051207_hurricane.htm.
Senator Trent Lott (R-MS), who suffered the personal loss of his
home, and other key Members of Congress on Capitol Hill have very
favorably received this information.
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