2004 Annual Report Committee for the Advancement of Professional Practice

(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 2004, 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 enhancement of its primary communications vehicle and information technology infrastructure, the practitioner portal, APApractice.org, which continues to support the practice community with easily accessible practical resources. Early in 2004, the Practice Organization launched a biweekly member newsletter, PracticeUpdate, sent via email to APA members who pay the Practice Assessment and practice-oriented APAGS members, i.e., those with access to APApractice.org. Shortly afterwards, all members with access to the site received a copy of, “APApractice.org: Put the Power to Work for You.” This overview guide was prepared to acquaint users with the site's design, its principal subject areas, and special features.

One of the practical resources added to www.APApractice.org in 2004 was a 'crosswalk' designed to help users determine which ICD-9-CM diagnosis code corresponds to a particular DSM-IV-TR code. Under the Health Insurance Portability and Accountability Act (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 and the Practice Organization have continued their support of practitioners with understanding and complying with the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

In planning for the compliance date, the Practice Directorate developed “The HIPAA Security Rule Primer,” which should be made available on APApractice.org in early in January 2005. This primer provides an overview of the Security Rule, which outlines steps a psychologist must take to protect confidential information from unintended disclosure through breaches of security. This rule applies to electronically transmitted or stored protected health information, or EPHI, as defined in the Security Rule.

CAPP continued to support the APA Practice Organization's top legislative advocacy priorities. On the federal legislative front, psychology advocates continue to press for passage of the full mental health insurance parity law known as the Paul Wellstone Mental Health Equitable Treatment Act (MHETA). Senate sponsors secured a commitment from Republican congressional leaders late last year that this parity bill would be among the first to move to the Senate floor in 2004. Despite a record number of 69 cosponsors in the Senate and 245 in the House of Representatives, Congress did not pass the MHETA by the end of its 2004 session.

CAPP supported the APA Practice Organization in taking a number of steps in 2004 to push for congressional action on MHETA and will continue its support in 2005:

• Psychology leaders met with 350 legislators and their staff members during the Practice Organization's March 2004 State Leadership Conference. During these visits, psychology advocates spoke with their elected officials about the importance of ending discrimination in health insurance coverage, citing the benefits and projected minimal cost impact of enacting MHETA.

• Psychologists throughout the country also are meeting with legislators in their districts and engaging in local media outreach to support parity legislation. Thanks to the efforts of Federal Advocacy Coordinators, at least a half-dozen editorials, op-eds, and letters to the editor appeared this spring in newspapers including the Des Moines Register and Hartford Courant.

• The APA Practice Organization has helped to build the coalition of groups advocating for parity that now includes more than 360 organizations.

The Practice Organization and CAPP continue to help a number of states work toward achieving – and now implementing – legislation that gives qualified licensed psychologists the authority to prescribe psychotropic medications. Support from the national level for state psychological associations includes CAPP grants and close consultation with state psychology leaders.

New Mexico recently became the first state to implement its 2002 law allowing licensed psychologists with the appropriate training and certification to prescribe psychotropic medications. The regulations to activate the law were filed in December 2004 and took effect in January of 2005.

Psychology anticipates opposition in the upcoming legislative session as psychiatry reportedly has spent $100,000 on a lobbying campaign in New Mexico to undermine implementation of the law and ultimately to repeal it.

Another RxP milestone was reached in January 2005, when regulations to implement Louisiana's prescription privileges law for psychologists were published and became effective immediately, enabling qualified psychologists to prescribe in consultation and collaboration with the patient's primary or attending physician, and with the concurrence of that physician.

Seven states plan to introduce prescriptive authority legislation in 2005 (Connecticut, Hawaii, Missouri, Illinois, Oregon, Tennessee and Wyoming).

CAPP demonstrated its support of state initiatives throughout 2004 by awarding $574,127 in grants to State, Provincial, and Territorial Psychological Associations (SPTAs). It also awarded $152,500 in legislative grants for RxP legislation in seven states. CAPP also supported the annual State Leadership Conference: “Strategic Resilience for the Profession: Getting a Jump on Change,” the premier advocacy training event for practitioners.

During the fall of 2004, CAPP and the Practice Organization accomplished an important step in their advocacy to gain higher reimbursement rates for practitioners who bill Medicare for psychological testing and assessment services. In November, the American Medical Association's CPT Editorial Panel approved the Practice Organization's request to replace the current CPT testing codes with an expanded set of codes beginning in 2006.

The new codes will allow for establishing clearly whether the test administration portion of the service is done by a psychologist, or instead by a technician or computer. The Practice Organization successfully sought these codes as part of a persistent, multi-year effort to obtain a “professional work value” for testing and assessment codes reflecting the time and effort expended by a psychologist in providing these services.

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.

In December 2004, a federal judge in Miami gave preliminary approval to a settlement by CIGNA HealthCare in a nationwide class action suit against the company and 12 other managed care companies. Members of the “class” in the settlement include all psychologists and other non-physician professionals who provided services to subscribers of the defendant companies from January 1, 1990 to December 22, 2004. The class alleges that the companies conspired to reduce and delay payment to them.

The settlement establishes an $11.55 million fund for payment to the class members who file claims by May 27, 2005. CIGNA also has agreed to an array of policies that will improve the way the company does business with psychologists.

The APA Practice Organization became involved in the settlement negotiations with CIGNA in order to press the unique concerns of psychology. Although it is not a party in this case, the Practice Organization became a signatory to the settlement in December 2004, thereby allowing the organization to enforce certain settlement provisions on behalf of APA members.

Further, the Practice Organization has coordinated with the Florida Psychological Association (FPA), which in 2004 became a plaintiff in the parallel class action before the same judge in Miami. The class action in which FPA is involved asserts similar claims against the nation's 63 Blue Cross Blue Shield companies.

(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 2004, these included a number of major programs benefiting the public through the professional practice of psychology.

CAPP oversaw the Practice Directorate's activities with the APA Disaster Response Network (DRN) and continues to help stimulate community-based education and outreach efforts through the ongoing APA public education campaign about the value of psychology and psychological services and by coordinating assistance in the aftermath of disasters. Outreach efforts are organized through the public education campaign, Talk to Someone Who Can Help, as well as through the Disaster Response Network in partnership with the American Red Cross.

The directorate has been involved with several efforts – including a national consumer poll and focus groups – designed to help inform future directions for the APA public education campaign. A January 2004 telephone poll of 1,000 Americans between the ages of 18 and 64 demonstrated positive attitudes about psychologists and mental health treatment. The findings also pointed to cost and lack of insurance coverage as potential barriers for people getting the help they need.

In August 2004, the Practice Directorate unveiled a revamped consumer website, the APA Help Center at www.apahelpcenter.org, in connection with the public education campaign. The more user-friendly website, originally launched in 1996 when the campaign began, gives consumers access to expanded free information, facts and tips.

The Help Center is just one component of the APA public education campaign, which itself is undergoing a redesign. Periodic public opinion survey research and focus group testing have identified some current themes and messages that will both connect with consumers and distinguish psychologists from the many other health and mental health professionals in the marketplace.

In particular, the public increasingly is aware of the important link between psychological health and physical health, or the 'mind-body connection' as consumers often refer to it. While the APA public education campaign always has included information about the mind-body connection, the new campaign focus will have as its central theme the critical and unique role that psychologists play in dealing with problems at the intersection of psychological and physical health.

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. The APA Practice Directorate uses various strategies to assert and broaden psychology's influence in the health care marketplace. One such initiative involves working with the directorate's Business of Practice Network to assist state, provincial and territorial psychological associations (SPTAs) with developing Psychologically Healthy Workplace Awards (PHWA) programs. The directorate provides financial assistance to SPTAs to help them develop their awards programs.

The successful PHWA program has experienced tremendous growth. In just five years, participation has grown to a total of 39 associations in the U.S. and Canada. Collectively, SPTAs have honored more than 180 organizations for their commitment to programs and policies that enhance the health and well being of their employees.

In addition to revising existing promotional materials, the Practice Directorate is currently developing a new Psychologically Healthy Workplace Award website, scheduled for launch in April 2005. The website is designed to raise the visibility of the awards program, increase participation, and provide tools that will add functionality, while reducing administrative demands for both SPTAs and APA. The website will include informational content geared toward the business community, the general public, and the media, as well as functional components that will allow for an online application process and provide tools to facilitate the evaluation, tracking, and reporting of results.

Further, the directorate is currently developing the instruments and processes necessary to support a 2006 launch of the next component of the program, the new APA Psychologically Healthy Workplace Awards, which will receive nominations from among the state provincial and territorial winners.

The Practice Directorate is involved with other innovative projects beyond the PHWA initiative. Early in June, the District of Columbia Psychological Association (DCPA) along with other groups unveiled a pilot “parenting coordinator” program designed to assist indigent parents or custodians involved in child custody disputes. While parenting coordinators have been available in several states in recent years, this is the first pro bono project of its kind geared to low-income families.

Parenting coordinators assist parents and other caretakers in creating custodial, visitation, or shared parenting arrangements that center on children's' needs rather than on conflict between the adult caretakers. Coordinators will assist with parenting issues and help identify treatment needs for parents and children. Psychology graduate students supervised by psychologist faculty members from Argosy University will serve as parenting coordinators.

The pilot program is funded by a grant awarded to DCPA from the APA Committee for the Advancement of Professional Practice (CAPP). Other organizational participants include the Family Law Section of the District of Columbia Bar, which will provide training for attorneys involved in the program.

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 seventh year in a row, APA's nominee was selected to participate in the prestigious Primary Health Care Policy Fellowship sponsored by the U.S. Department of Health and Human Services. The APA's nominee for the 2004 program was Garret D. Evans, Psy.D. Dr. Evans has strong credentials as an educator, practitioner and researcher who espouses a collaborative approach to primary health care. Further, he is committed to increasing access to these services, particularly mental and behavioral health in primary care, for rural Americans.

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. Surveys have investigated the presence and treatment of substance use problems among psychologists' patients, the reported use of various specific treatment interventions and behaviors and the impact of managed care and payment concerns on professional practice. See. www.apapracticenet.net for more information.

CAPP oversaw many other activities in 2004, 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 continued to support APA's recommendation of priorities for implementation of the President's New Freedom Commission on Mental Health Report and support of projects in Serious Emotional Disturbance related to system reform and best practices. The Committee completed its development of a training matrix; a document that is a compendium of needs made by psychologists for serious mental illness and serious emotional disturbance assessment, treatment and programmatic advances. This matrix is available as a resource on the APA website as well as on APApractice.org. Task Force member, Dr. Arthur Evans, organized and chaired a panel on health disparities at the 2004 APA Convention in Hawaii. Participants included Drs. Lonnie Snowden, Larke Huang, Mario Hernandez and Candace Fleming. It was the Committee's hope that the panel would serve as a springboard for broader concern and discussion about psychologists' role in addressing health disparities.

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 March and October for its annual business meetings as well as conducted business throughout the year via e-mail. The Committee selected two primary projects for 2004. The first project was to update and expand the APA RuralPsych website. The Committee uses the website to bring its work on issues of rural health to the APA constituency. The website will also help facilitate access to good mental healthcare through its extensive bibliography and its inclusion of papers and power point presentations that are excellent guides for training and funding in rural areas. The numerous links to other rural health sites can facilitate psychologists' successful employment in rural areas. The Committee's second project was to complete a set of research articles that offer up-to-date review of critical aspects of rural mental health including using technology in rural areas, current efforts in training, financial resources, prescriptive authority in rural areas, and examples of successful rural program implementation. The Committee plans to complete this project and submit the articles for publication by March 2005. The Committee also sponsored a business meeting at the APA Convention in Honolulu, HI, where it met with members of the APA Council's Rural Caucus to discuss issues affecting access to behavioral health care in rural areas.

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 seventh 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, “VA Psychology Goes to Washington: Working Together To Keep Veterans First”. The Honorable Anthony Principi, then Secretary of the Department of Veterans Affairs, was the keynote speaker and a number of key leaders from the Department of Veterans Affairs, APA, and Capitol Hill were in attendance.