Perspective on Practice

When health insurance exchanges went live on Oct. 1, the healthcare.gov website drew five times more visitors than predicted. Like any major new product, the site experienced glitches with its rollout, and implementation will continue to be a work in progress. The exchanges are a centerpiece of the Affordable Care Act, designed to provide coverage for uninsured Americans beginning Jan. 1. They will bring mental health care access — and access to mental health care at parity — to millions who didn't have it before.

While the exchanges are intended to improve Americans' access to health care, there are issues related to their development and implementation that will affect psychologists and other health-care providers. For example, as part of our early advocacy efforts to influence the process, the APA Practice Organization (APAPO) is collaborating with the Connecticut Psychological Association and the Inter Organizational Practice Committee to address a situation that recently arose in that state.

Under one plan in Connecticut's exchange, only physicians and advanced practice registered nurses are reimbursed for neuropsychological assessment. Neuropsychologists — the predominant providers of neuropsychological services — are excluded from reimbursement, a situation that could dramatically limit access to neuropsychological services for that plan's participants.

We are also concerned by some health plans' narrow networks. All health plans offered through the exchanges must be certified by federally recognized accreditors as qualified health plans, or QHPs. To be accredited as QHPs, plans must meet certain criteria as defined by the Department of Health and Human Services.

Companies that seek certification as QHPs must demonstrate that their plan maintains a network with a sufficient number and type of health-care providers, including those providers specializing in mental health and substance abuse services. This is to ensure that the plan offers benefits under all 10 identified essential health benefits categories, one of which is mental health and substance use services. However, the Affordable Care Act does not specify what providers, or how many, must be included in a provider network.

Insurers seem to be building narrower networks with fewer providers than are typically found in commercial health plan provider networks. It remains to be seen whether these smaller networks, which may have a limited number of psychologists, will satisfy the Affordable Care Act's network adequacy criterion.

What does this mean for you? Psychologists should research plans offered through the exchange in their states to determine if they are in-network for any of those plans. It is also important to understand how your state defines the scope of mental health and substance abuse services and to regularly check and review your patients' coverage.

Most states have been working with local stakeholders to design and implement the health insurance exchanges. You can check with your state psychological association to find out how it is involved in your state's exchange implementation process.

Also, if you know of issues or concerns for practicing psychologists regarding participation in the exchanges or QHP payment policies, contact APAPO and your state psychological association. To report an issue to APAPO, email the Office of Legal and Regulatory Affairs or call (202) 336-5886.

For more information about health insurance exchanges, read the four-part series on APAPO's Practice Central website. Also look for the article "Health Insurance Exchanges: An Overview for Psychologists" in the fall 2013 issue of Good Practice magazine, available to APAPO members online (PDF, 1.2MB).