Perspective on Practice

APA's Practice Directorate pores daily over information about psychological practice, proposed regulations and legislation that can significantly affect psychological services and the patients we serve. A few recent examples: • Practice staff attorneys collaborated with the Texas Psychological Association (TPA) in a district court case. In 2010, the Texas Association of Psychological Associates, which represents licensed master's-level psychological associates, filed a lawsuit seeking a legal declaration that the Texas State Board of Examiners of Psychologists had no statutory authority to prevent licensed psychological associates from practicing independently because the licensing statute did not specifically require supervision. TPA argued that the state legislature clearly intended that the independent practice of psychology be limited to individuals trained at the doctoral level. In August, the judge agreed, affirming the statutory authority of the State Board of Examiners of Psychologists to require that master's-level trained psychological associates be supervised by licensed psychologists who, under Texas law must be trained at the doctoral level. (Read more about this case.)

  • In May, APA's Practice Directorate alerted the Centers for Medicare and Medicaid Services (CMS) about misinformation in their "Mental Health Services" publication, for example, that psychological and neuropsychological testing could be performed by clinical nurse specialists, nurse practitioners, physician assistants and certified nurse midwives. As a result of our advocacy, the publication was removed from the CMS website to undergo review. CMS reposted the booklet in July with an errata sheet identifying "corrections or changes," including most of APA's requested revisions. (Read more online.)

  • As part of our advocacy to promote psychologists as key players in today's health-care system, we wrote to U.S. Department of Health and Human Services Secretary Kathleen Sebelius in June to support the inclusion of psychologists as eligible participants in accountable care organizations, in which individual health-care providers, group providers and hospital systems come together to provide services to a defined population.

  • We cultivate relationships with and provide input into standards development for several accrediting organizations, including CARF (rehab centers and hospital facilities), the Joint Commission (health care organizations and programs) and the National Committee for Quality Assurance (NCQA) with the goal of promoting high quality mental health care. This year, we have submitted comments on eight proposed sets of standards and reviewed numerous others. Among our victories: gaining a stronger focus on behavioral health care in the NCQA's patient centered medical home standards — including an expanded use of depression screening and substantially broadened language in its standards to include mental as well as physical health care. For example, the term "primary-care physicians" was replaced with "primary-care clinicians," allowing psychologists to serve as primary-care clinicians when appropriate.

  • Practice legal staff are collaborating with the Massachusetts Psychological Association and Massachusetts Neuropsychological Society to confront changes in neuropsychological benefits management by Blue Cross/Blue Shield of Massachusetts that impede access to medically necessary care for subscribers. With the two other groups, we wrote a letter to the Massachusetts attorney general detailing how the company's systematic denial of requests for medically necessary neuropsychological assessment harms consumers. We argued that while review criteria are meant as a benchmark or starting point for determining what level of assessment is necessary in light of the patient's specific condition and needs, that Blue Cross/Blue Shield of Massachusetts uses the criteria inappropriately as absolute limits, regardless of the patient's unique circumstances as communicated in the authorization request. (Read more online.)

I encourage you to alert us to any policies or practices in your state that could adversely impact patient care. As always, I welcome your comments.