Psychologists and their fellow mental health advocates saw a host of new psychology-friendly legislation passed at the state level in the past year. And while New Mexico's new law permitting appropriately trained psychologists to prescribe psychotropic medications is at the forefront, other states made inroads to improving access to mental health care.
One of the most widespread areas of state action was in mental health parity:
New Hampshire expanded its parity law to require insurers to cover anorexia, bulimia and chronic post-traumatic stress disorder at the same level as physical illnesses. The law also includes a mandated benefit for treatment for chemical dependency, including alcoholism, up to insurer-specified dollar or visit limits. Insurers must cover both inpatient and outpatient benefits for detoxification and rehabilitation services.
West Virginia passed legislation requiring parity for individuals with serious mental illness, including some substance-related disorders.
Alabama improved its mental health insurance parity law, putting teeth into a law passed in 2000. The new law specifies that health-care service plans and health-maintenance organizations must comply with existing laws that require group health plans to offer coverage for mental illness, excluding substance abuse.
South Carolina saw its parity for state workers expanded to include substance abuse conditions beginning Jan. 1, 2002 for a three-year pilot. The expansion was made when a new contract was developed between the state and its behavioral health-care provider.
"This is a real populist movement in state after state," says Michael Sullivan, PhD, assistant executive director for state advocacy in APA's Practice Directorate. "State legislators recognize the need, even though the federal parity bill hasn't yet been expanded by Congress."
Currently, 38 states have some kind of parity law in place, and 17 of them have provisions covering all mental disorders. While passing parity laws at the state level is a great step forward, psychologists' active support is still needed for the federal parity bill, says Sullivan: Since the federal Employee Retirement Income Security Act exempts self-insured companies from state parity laws, state laws do not apply to all health-care plans. In one stroke, a comprehensive federal parity law would fix that loophole in all states.
Georgia's Medicaid rehab option
A new regulation in Georgia makes it easier for health-care professionals to get Medicaid authorization for "rehab option" services, such as individual outpatient services delivered in clients' workplaces, homes and other settings instead of in therapists' offices.
"The problems we have in Georgia are not enough psychologists and more than enough services that have to be delivered, especially in our large rural areas," says Karl Schwarzkopf, PhD, director of Georgia's Division of Mental Health, Developmental Disabilities and Addictive Diseases. "Our Medicaid option required either a physician or a licensed psychologist to authorize the services, and our public mental health service providers couldn't find the appropriate staff to do so."
Recent policy changes allow Medicaid to reimburse for all "rehab option" treatment plans authorized by physicians, psychologists, clinical social workers and nurse practitioners, as well as for some services authorized by experienced marriage and family therapists and professional counselors. In cases that require greater levels of expertise, physicians and licensed psychologists are still the only providers authorized to sign treatment plans. Moreover, assessments and evaluation are still the purview of licensed psychologists.
Mandated benefits in Hawaii
Members of the Hawaii Psychological Association (HPA) teamed with other state and local organizations to lobby the Hawaii legislature to renew a mandated mental health benefits bill that was set to expire on June 30. The law, signed by the governor on June 28, requires employers to allow their workers 24 mental health sessions a year.
The bill's passage was particularly significant for two reasons, says HPA Legislative Chair Don Kopf, PhD. For one, this year's version is the first to include no sunset date. In addition, its passage safeguarded access to mental health care for thousands of employees in a year when Hawaii's tourism-based economy struggled after the events of Sept. 11, 2001. Without mandated coverage, advocates feared that employers would drop mental health benefits altogether, and that state and charity mental health services wouldn't have been able to meet the subsequent demand increase. Kopf and his colleagues also explained to lawmakers that overall medical costs would increase due to fewer mental health services.
"We were able to get across that having mental health on a par with physical health makes good sense all around," says Kopf. He plans to build on this year's success by encouraging the legislature to pass a mental health parity bill in the future.
Faster payments in Kentucky
Kentucky's General Assembly amended a 2000 law to include psychologists and social workers on a list of providers who insurers must pay within 30 days of receiving a claim with no errors. Previously, it wasn't clear that the prompt-pay law included the full range of mental health providers, says Sheila A. Schuster, PhD, director of professional affairs for the Kentucky Psychological Association (KPA).
"This law reflects our ability to work in coalition with other providers," says Schuster, adding that KPA's work with medical and hospital associations was key in gaining the legislative change.
The law applies only to claims filed after July 15, 2002--the date the legislation became effective.
Regulations in New Mexico
The work toward prescription privileges for psychologists in New Mexico didn't end when Gov. Gary Johnson (R) signed a prescription privileges bill into law on March 5. Although the law became effective July 1, the state's Board of Psychology Examiners and Board of Medical Examiners have established a joint committee to hammer out specific regulations for prescribing psychologists.
Just a few of the issues to resolve include formalizing psychopharmacology curriculum requirements, determining what exam will be used to test applicant psychologists and working out the details of the required 400-hour practicum. Both boards are required to submit progress reports to the legislature this month as well as in December 2003.
While New Mexico psychologists had hoped that the committee would have had a broader representation, including more psychologists, other prescribing professions and those from the state's rural areas, the committee's work appears to be progressing. "The feedback that we're getting is that the joint committee is working cooperatively and collaboratively," says Mario Marquez, PhD, legislative chair for the New Mexico Psychological Association (NMPA). Marquez and his colleagues at NMPA and APA are Monitoring the situation to ensure no roadblocks arise.
At the end of September, the chairs of the Board of Medical Examiners, Board of Psychological Examiners and the Pharmacy Board reported to the state legislature's Health and Human Services (HHS) Committee about their progress. The chairs explained their plan to have all psychologist prescribing procedures in place by December 2003.
At the hearing, some HHS committee members expressed their concern about the joint committee's composition and that the timeline was not as speedy as expected. The HHS committee subsequently decided to draft a letter to the joint committee requesting that members be added to better balance their regulatory work, such as someone from southern New Mexico, New Mexico State University, a mid-level prescriber, and a Native American.
Scope of practice in New York
Psychologists in New York saw the state legislature pass a bill that specifically defines their scope of practice. Previously, legislation only protected the title of psychologist, allowing anyone to provide psychological services.
"It protects the public by requiring the doctoral degree in psychology to engage in activities considered to be the practice of psychology," explains Billie Hinnefeld, director of legal and regulatory affairs in APA's Practice Directorate.
Psychology advocates in New York had worked for years to pass a scope of practice law, but faced opposition from organized medicine. To get the bill passed, the scope of practice language was included in a larger mental health therapy bill that created four licensed mental health professions in New York state: marriage and family therapists, mental health counselors, creative arts therapists and psychoanalysts. The bill also specifically prohibits psychologists from prescribing and administrating medications.
Despite the compromises, the bill has many benefits for psychology, says Gayle A. Everitt, New York State Psychological Association executive director. "It's probably one of the best scope of practice [laws] for psychologists in the country, in terms of definition," she says. "The scope is very broadly defined for psychology and provides a tremendous opening for psychology in terms of the future."
At Monitor press time, the bill was awaiting the governor's signature.
Patient privacy in Virginia
Virginia psychologists contacted their delegates early this year to generate support for a state law that would protect mental health-care providers and their notes from being subpoenaed to testify about parents in child-custody cases, except in cases of child abuse or neglect or when a parent provides written consent. It also stipulates that if a mental health-care provider does testify, the testimony is limited to the custody or visitation case in question.
The law will protect parents in marital or family therapy from having their therapists or therapy records appear in court during a custody battle, explains Jan Hembree, PhD, legislative chair of the Virginia Academy of Clinical Psychology. Because psychotherapy notes were not previously protected, many people considering divorce had discontinued therapy or altogether avoided it for fear that their records could be used against them in court. While the bill became law in April, the new rules will take effect in July 2003.
"A lot of people weren't getting the help they needed," says Hembree, "and now there will be some protection."
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