2003 Annual Reports for Boards and Committees

Committee for the Advancement of Professional Practice

The Committee for the Advancement of Professional Practice (CAPP) serves a dual role, having governance responsibilities in both the 501(c)(6) APA Practice Organization, which is funded by the practice assessment, and the 501(c)(3) American Psychological Association. In serving as the administrative agent of the APA Board of Directors, CAPP has responsibility to exercise general governance supervision in the management of the 501(c)(6) companion organization, and over the relevant affairs of the Practice Directorate. This report will briefly summarize both aspects of CAPP’s activities during 2003.

Members

According to Association Rule 90-2.1, CAPP consists of nine regular members who shall be psychologists who provide health care services, who are licensed to practice psychology in at least one state, district, or province, and who pay the annual assessment, and two special members, who need not be psychologists, chosen for their expertise. The 2003 members of CAPP were: Patricia Bricklin, PhD (Chair); Jean Carter, PhD; John Corrigan, PhD; Jessica Henderson Daniel, PhD; Rosalind Dorlen, PsyD; Patricia Johnson, PhD; Elaine Orabona Mantell, PhD; Stanley Moldawsky, PhD; Michael Ranney, MPA; and Melba Vasquez, PhD. Gerald Koocher, PhD, served in an ex-officio capacity as APA Treasurer and Carol Goodheart, EdD, served as the APA Board of Directors liaison.

Priorities

In carrying out its dual missions for the APA Practice Organization and for the APA, CAPP has developed and reaffirmed several overarching priorities. All of these are in the service of promoting the mutual professional interests of practicing psychologists in all settings through a wide range of advocacy activities focusing on policymakers, legislatures, the legal system, purchasers and consumers of services, and the overall healthcare marketplace. They include:

• Maintaining and pursuing a strong advocacy agenda
• Generating additional resources for practitioners and the profession
• “Re-branding psychology” as a major helping profession
• Expanding the applications of psychology
• Building a professional network of key alliances and connections
• Integrating the practice community

(c)(6) Mission

In the Articles of Incorporation for the APA Practice Organization, CAPP is charged with the responsibility “to identify, plan and implement projects important to the protection, defense, and enhancement of professional practice and recommend to the Board of Directors the needed funding for such projects". As a separately incorporated (c)(6) organization, the Practice Organization is able to do advocacy on behalf of the profession free of the IRS provisions that constrain advocacy by a (c)(3) organization.

(c)(6) Programs and Activities

Several major program areas and activities of the APA Practice Organization carry out CAPP’s (c)(6) mission and priorities on behalf of practicing psychologists. During 2003, these included a number of major components of CAPP’s advocacy agenda, as well as undertakings designed to generate additional resources for the purposes of doing increased advocacy and providing more services to practice assessment payers.

CAPP oversaw the continued development of an information technology infrastructure, through the practitioner portal, APApractice.org, which continues to support the practice community with easily accessible practical resources. The Portal contains an array of informational material and products to help practitioners comply with the Health Insurance Portability and Accountability act (HIPAA) of 1996. In late January 2003, the Practice Organization and the APA Insurance Trust launched HIPAA for Psychologists, a comprehensive online course for psychologists designed to facilitate compliance with the HIPAA Privacy Rule. HIPAA for Psychologists includes the necessary state-specific forms that comply with the federal Privacy Rule and relevant state law, as well as all of the policies, procedures, and other documents needed to comply with the rule. This product has been available on APApractice.org since product launch.

CAPP and the Practice Organization took other steps to inform practitioners about the Privacy Rule and related requirements with which practitioners were required to comply as of April 14, 2003. For example, the APA Monitor ran a series of articles the first three months of the year focusing on various aspects of the Privacy Rule of particular interest to practicing psychologists. In August 2003, the Practice Organization and the APA Insurance Trust sent a mailing to all APA members who pay the Practice Organization Practice Assessment to advise them of specific steps they should take in order to gain a one-year extension (until October, 15, 2003) on complying with the HIPAA Transaction Rule. This document, titled, “Getting Ready for HIPAA: A Psychologist’s Guide to the Transaction Rule” also appears online at www.APApractice.org (visit “Your HIPAA Compliance Center”), along with a host of additional materials related to the HIPAA rules that affect practitioners. In addition, the Practice Organization trained all State Psychological Association (SPA) Directors of Professional Affairs to give workshops on the Privacy Rule. These workshops were presented in more than 30 state psychological associations and generated significant non-dues revenue for these SPAs.

One of the practical resources newly added to www.APApractice.org is a ‘crosswalk’ designed to help users determine which ICD-9-CM diagnosis code corresponds to a particular DSM-IV-TR code. Under HIPAA, insurance companies that process insurance claims electronically are only required to accept ICD-9-CM diagnosis codes. For practitioners who historically have used only the DSM codes, the ‘crosswalk’ facilitates the conversion of DSM-IV-TR codes to ICD-9-CM codes if required by an insurer.

CAPP continued to support the APA Practice Organization’s top legislative advocacy priorities that focus on achieving full, non-discriminatory insurance coverage for mental health services as compared with physical health services. This initiative has involved working to close loopholes in the 1996 federal parity law, whose provisions were extended through December 2003.

Since the introduction of the Paul Wellstone Mental Health Equitable Treatment Act (MHETA) in late February 2003, CAPP has supported the Practice Organization in helping to build momentum toward passage of this legislation. The Practice Organization has activated its nationwide network of Federal Advocacy Coordinators to encourage legislators to co-sponsor and support the MHETA. Further support for this legislation resulted from meetings on Capitol Hill involving hundreds of participants in the APA Practice Organization’s March 2003 State Leadership Conference (SLC). During discussions with their elected officials and key staff members, SLC attendees addressed the importance of closing loopholes in the current federal mental health parity law by passing appropriate full mental health parity legislation such as MHETA. By April, the MHETA had gained a majority of cosponsors in both the House and Senate.

Further, the Practice Organization took the lead role in developing a June 2003 letter signed by 145 national organizations that encouraged President Bush to renew his efforts to help achieve full mental health parity legislation in 2003.

The Practice Organization and CAPP continued to help a number of states work toward achieving legislation to give qualified licensed psychologists the authority to prescribe psychotropic medications. Support from the national level for state psychological associations included CAPP grants and close consultation with state psychology leaders. Directorate staff worked on RxP legislative strategies with leaders in nine states that introduced prescriptive authority legislation in 2003. Six state legislatures held committee hearings on these bills, the largest number ever, clear evidence of the positive momentum from New Mexico. In March of 2002, New Mexico became the first state in the country to gain a law giving properly trained psychologists the right to prescribe. Practice Organization staff continued to work with the New Mexico Psychological Association leadership as they monitored the work of the New Mexico Board of Psychological Examiners and the New Mexico Board of Medical Examiners in developing the regulations to implement the prescriptive authority law passed in March. (Note: Early in 2004, Louisiana became the second state to enact a prescriptive authority law.)

CAPP awarded $531,827 in grants to State, Provincial, and Territorial Psychological Associations (SPTAs) in 2003, including $150,000 in legislative grants, for RxP legislation in seven states and an advocacy effort in Vermont for an Any Willing Provider Law. The law is a proposed amendment to the Parity Act (Act 25) and would allow any willing provider to choose to join a network, which they believe would open the managed care insurance panels and enable consumers to receive expanded access to mental health treatment. CAPP also supported the annual State Leadership Conference: “Leading Psychology Forward: Staying the Course in Uncertain Times, ” the premier advocacy training event for practitioners.

CAPP also continued to provide resources to implement the legislative and regulatory strategies that have been put in place by the Practice Organization to influence the changing health care system. The Practice Organization closely monitored the events surrounding the passage of the Medicare Prescription Drug Benefit Law late in 2003 given its potential effect on hospital-based psychology. This law was the largest expansion of the Medicare program since its inception in 1965.

Psychology advocates worked for several months leading up to the law’s passage seeking to retain a provision that would provide Medicare funding for hospital-based psychology internship training programs. That provision was one of only a very few provider-specific provisions included when the Senate passed its prescription drug bill in late June. The House leadership opposed such provider-specific provisions, and the House version of the bill did not include psychology training program funding. Therefore, the provision needed to be negotiated in conference committee.

Thanks to considerable legislative advocacy by grassroots psychologists around the county and increased political giving by APA members, the profession created strong bipartisan support for the provision on the conference committee tasked with reconciling differences between the Senate and House bills. Unfortunately, psychology’s provision was one of last items to be dropped from the bill just before it passed Congress. Ultimately, it was overshadowed by larger debates about the prescription drug benefit and other structural changes being proposed for Medicare.

In a favorable development for practitioners, as part of the new law, Congress changed the physician fee schedule formula resulting in a 1.5% increase in Medicare payments for 2004 and 2005. If Congress had not made the modification, participating Medicare providers would have faced a 4.5% payment decrease in 2004. The APA Practice Organization worked with AMA and other health associations to promote the fee schedule change.

CAPP supported the Practice Organization’s recent Medicare-related development reflecting policymakers’ growing recognition of the value of psychological services. A Senate appropriations bill for Fiscal Year 2004 includes report language calling on the Center for Medicare and Medicaid Services (CMS) to study the cost savings and quality of care benefits from incorporating psychological interventions in the treatment of cardiovascular disease for Medicare beneficiaries. (Note: Final language supporting the demonstration project was adopted early in 2004)

In addition to legislative and regulatory strategies, the Practice Organization continues to engage in legal strategies to influence the evolving health care delivery system. A major thrust of related efforts involves confronting inappropriate managed care policies and procedures that harm health professionals and their clients.

CAPP supported the work that the Practice Organization has done on the managed care front with the lawsuit brought by the Virginia Academy of Clinical Psychologists (VACP) and individual plaintiffs against CareFirst and its behavioral health subcontractor. In March 2003, defendants settled the psychologists' and consumer plaintiffs' breach of contract claims that

were scheduled for trial a month later. Defendants' settlement gave plaintiffs everything they could have recovered at trial, plus the right to appeal previously dismissed claims that CareFirst defrauded mental health consumers and should be subject to punitive damages. The plaintiffs submitted an opening brief to the District of Columbia Court of Appeals in November 2003 and their reply brief in January 2004. Oral argument on the appeal is scheduled for June 2004.

CAPP also supported the Practice Organization on a recent initiative, in collaboration with the New York State Psychological Association, challenging Oxford Health Plans about their retrospective audits of mental health professionals’ patient records. Reflecting members’ complaints, the psychology organizations insisted that Oxford stop making demands for large refunds from New York psychologists following the audits. The organizations expressed concern that Oxford’s actions were inconsistent with the company’s agreements with psychologists and not in compliance with patient confidentiality law. Further, the psychology groups questioned the extrapolation methodology underlying the audit process.

In a written response, Oxford representatives stated that the company would discontinue its audit and repayment demands in connection with claims of inadequate record keeping. The company also publicly announced that it would even return money that providers already had repaid.

The letter from Oxford further asserted that the company intends to refocus prospectively rather than retrospectively on record keeping practices and wishes to work with mental health associations to develop documentation standards. The Practice Organization has agreed to meeting as an ‘opportunity to discuss issues necessary to maintain good collaborative relations between Oxford and the psychology community.’

(c)(3) Mission

In the Association Rules, CAPP is charged with the responsibility to: (a) be the administrative agent of the Board of Directors exercising general governance supervision over the relevant affairs of the Practice Directorate, (b) recommend to Council through the Board of Directors procedures for the enhancement of human welfare through the professional practice of psychology, (c) identify projects important to the enhancement of human welfare through the professional practice of psychology, and (d) recommend to the Board of Directors the needed funding for such projects.

(c)(3) Programs and Activities

Several major program areas and activities of the APA Practice Directorate carry out CAPP’s (c)(3) mission and priorities as articulated above. During 2003, these included a number of major programs benefiting the public through the professional practice of psychology.

CAPP oversaw the activities of the APA Disaster Response Network(DRN) that has recruited a growing number of psychologists to aid communities throughout the country. Through this program, directed by APA Practice Directorate staff in connection with state DRN programs and local Red Cross chapters, volunteer psychologists trained in disaster response assist victims and relief workers at natural and manmade disasters. In 2003, DRN volunteers responded to the California Wildfires, Hurricane Isabel, the Station Nightclub Fire as well as participated and collaborated with Disaster Services Organizations, representatives from foreign countries, university seminar series and conferences.

CAPP continued its oversight of the public education campaign and worked to support the association’s recently launched “Resilience for Kids & Teens,” the newest component of APA’s ongoing Road to Resilience initiative that began shortly after the terrorist attacks of September 2001. APA collaborated with Time for Kids, a weekly magazine geared to fourth- through sixth-graders, on a special September 2003 magazine issue on resilience. Approximately 2.2 million school children and their parents and teachers received materials designed to foster resilience and help children ‘bounce back’ from adversity. The outreach included 88,000 educators who received a teachers’ guide with suggestions for communicating resilience messages in the classroom.

One early step taken to introduce APA members to the campaign’s resilience messages for children involved the Practice Directorate’s 2003 Institute for Psychology in the Schools held during the APA Convention. The Institute program, “Resilience: Inoculating Children From the Inside Out,” focused on how psychologists can teach parents, school staff, and other caregivers to help children better develop their own resilience skills.

CAPP continued to support the Directorate’s involvement in asserting and broadening psychology’s influence in the health care marketplace, through a number of initiatives. One such initiative involves the directorate and its Business of Practice Network (BOPN) assisting a number of states with developing Psychologically Healthy Workplace Awards (PHWA) programs.

The PHWA is sponsored by state psychological associations and supported by APA to recognize organizations committed to workplace well-being and to creating a psychologically healthy workplace environment for employees. The PHWA initiative helps inform business leaders about the value of psychological services, consistent with APA’s public education efforts.

In October 2003, 15 companies were recognized as part of a new PHWA program known as “Best Practices Honors.” The organizational honorees are state-level PHWA winners that state psychological associations had nominated for national recognition. APA announced the Best Practices Honors during the Institute for Health and Productivity Management’s (IHPM) annual awards ceremony. IHPM is dedicated to promoting health in the workplace, and the organization plans to help support the PHWA program as APA develops it on the national level.

CAPP and the Practice Directorate have pursued various activities in recent years to help affirm psychologists’ roles as primary health care professionals. APA wants policy makers and other health professionals to understand how psychologists’ evolving activities extend beyond mental health care to the broader health care delivery system.

For the sixth year in a row, APA’s nominee was selected to participate in a prestigious primary health care policy fellowship sponsored by the U.S. Department of Health and Human Services. The APA-nominated participant, Scott Meit, Ph.D., is a clinical psychologist in the Department of Family Medicine at West Virginia University.

CAPP continued collaboration with BPA in the implementation of the PracticeNetä survey system. The Practice Directorate has implemented an Internet-based data collection system known as PracticeNet that surveys licensed psychologists about what transpires during the delivery of services. Participants are volunteer APA members who provide clinical services in any setting.

CAPP oversaw many other activities in 2003, including the CAPP Task Force on Serious Mental Illness and Serious Emotional Disturbance (TFSMI), whose focus is evaluating policy issues supporting the unique contributions of psychologists in working with these populations within the changing mental health delivery system. The TFSMI members were among several committees and task forces that contributed to the preparation of APA’s response to the federal Substance Abuse and Mental Health Services Administration (SAMHSA). The Task Force provided major consultation and input in recommending priorities for implementation of the President’s New Freedom Commission on Mental Health Report. The Commission’s final report, released in July 2003, offers goals and concrete recommendations for revamping the nation’s mental health services delivery system.

The Committee on Rural Health (CRH), which reports to the APA Board of Directors and APA Council through CAPP, continued to provide CAPP with information on its initiatives to ensure that the behavioral health care needs of rural and frontier Americans are met. The Committee met in April for its annual business meeting as well as conducted business throughout the year via e-mail. The Committee worked to support such issues as providing access to care in rural areas through prescriptive authority for psychologists, providing mental health expertise to the National Rural Health Association (NRHA), and integrating behavioral health care with primary health care. The Committee developed a Prescriptive Authority Source Book: A Guide for States as its project for the year. This source book is a convenient compilation of material that has proven to be useful to state, provincial or territorial psychological associations interested in obtaining prescriptive authority (RxP). It was distributed to state, provincial and territorial psychological associations to assist in their RxP initiatives. The Committee also sponsored a Rural Health Forum at the APA Convention in Toronto where psychologists with a rural focus were able to discuss issues affecting their practices.

The CAPP Integration Work Group continued to provide a forum for representatives of APA practice divisions and state psychological associations to dialogue and to work toward integrating the diverse practice agendas.

In addition, for the sixth year in a row, the Practice Directorate and the Association of Veterans Affairs Psychologist Leaders (AVAPL) co-sponsored the VA Psychology Leadership Conference. The annual meeting gives VA psychologists an opportunity to develop advocacy strategies that support the need for quality psychological services for the nation’s veterans. The theme of this year’s conference was, “Added Value and Expanding Roles of VA Psychologists” because in these challenging times for health care delivery, it is increasingly important that psychologists clearly articulate the breadth of their roles and their value to the system.