Taleb Khairallah

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.

Testing Codes

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 unrecognized.

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 to: http://www.apapractice.org/apo/payments.html#

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 Medicaid programs.

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 states.

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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