Feature

North Carolina's passage of mental health parity was one of the success stories of the 2007 legislative session in the states.

Signed into law in July, the measure provides full parity for nine major mental health conditions, including bipolar disorder, major depressive disorder, anorexia and bulimia, schizophrenia, paranoia, post-traumatic stress disorder and obsessive-compulsive disorder.

The legislation also provides financial parity--meaning parity for everything but duration of treatment--for other mental disorders.

That win isn't just a victory for psychologists in the state, says Dan Abrahamson, PhD, assistant executive director for state advocacy in APA's Practice Directorate. The new law will help advocates push Congress to enact a federal parity law.

"When you see state after state passing parity laws, it shows that there's a groundswell of support," he says, noting that about three dozen states now have such laws. "It opens their eyes and becomes something Congress can't ignore."

Another major success story was in Hawaii, where a prescriptive authority bill made it all the way to the governor's desk--the furthest yet in the effort to win the state's psychologists the right to prescribe medication.

"We got oh-so-close on prescriptive authority in Hawaii," says Abrahamson, noting that the bill made it through the state's House and Senate but didn't survive the governor's veto. The bill would provide for psychologists in federally qualified health centers to prescribe medications for mental health disorders in collaboration with patients' primary-care physicians.

Despite that defeat, Abrahamson sees the experience as a new milestone in the fight for prescriptive privileges in the state. The Hawaii Psychological Association has pursued similar legislation for several sessions and has made progress each time.

In addition, says Abrahamson, state-level efforts like Hawaii's help build momentum in other states. Nine states introduced prescriptive authority bills in 2007--indicating a trend over the past few years of more states actively pursuing prescriptive authority legislation, according to Abrahamson. As further evidence of the growing support, Abrahamson notes, legislators in Mississippi and Montana introduced prescriptive authority bills of their own in 2007.

'Bricks-and-mortar work'

Other wins, while not as flashy, are just as important, says Abrahamson.

"What people lose track of is the incredible amount of bricks-and-mortar work that constantly has to be done to safeguard and strengthen the profession," he says. Those gains include:

  • Extending health insurance coverage. In Washington state, the legislature added individual and small business insurance plans to the mental health parity law it passed in 2004. In West Virginia, the legislature extended the law requiring mental health parity for group insurance plans past its original sunset date of March 2007.

And thanks to support from the Connecticut Psychological Association, the state's legislature expanded and improved existing health-care programs, such as the state's insurance plan for uninsured children, federally qualified health-care centers, school-based health clinics and the state's Medicaid program for pregnant women and children. The legislation will also allow dependent children to remain on their parents' insurance plans until they're 26. By offering testimony and meeting with key legislators, Connecticut psychologists ensured that the new legislation includes mental health coverage.

In California, the legislature amended an existing law that prevents health-care plans from rescinding treatment authorization after treatment has been provided. The new bill further specifies that plans can't rescind authorization for any reason, including changes in a patient's contract or the plan's discovery that an eligibility determination wasn't accurate.

Psychologists also thwarted attempts to chip away at past gains. For instance, in Arizona psychologists helped to defeat a bill that would have allowed managed-care organizations to opt out of covering psychological care when issuing individual policies. And in Kansas, they successfully fought off an attempt to eliminate "vendorship"--a state mandate that requires insurance companies in the state to reimburse psychologists and social workers for services. Master's-level providers intent on gaining vendorship for themselves introduced the bill, apparently hoping that psychologists would support legislation creating joint vendorship for all three professions.

  • Addressing licensing, mobility and scope of practice. Legislators were also busy addressing a range of issues that affect how psychologists practice.

In Arkansas, a new law strengthens and clarifies psychology licensure by ending the state's two-tiered licensing system. After 2013, the doctoral degree will become the entry-level degree for practicing psychology in the state. Ending years of debate, the new law represents a compromise between the Arkansas Psychological Association and Arkansas Association of Masters in Psychology.

Other licensing-related legislation will help psychologists adapt to changing workplace trends. In Illinois, for example, a new law allows licensed psychologists from out of state to practice in the state on a temporary basis. It also allows psychologists licensed in other jurisdictions to practice in Illinois while waiting for their Illinois licensure applications to be processed.

"People now do more and more work in neighboring states or in an expert capacity across multiple state lines," explains Abrahamson. "This kind of temporary license law is an important strengthening of psychologists' ability to practice."

In North Carolina, the legislature passed a bill to clarify that the licensing board has the authority to write mobility-related rules.

Elsewhere, legislatures gave psychologists new powers. In Montana, a new law includes psychologists in the definition of mental health professionals who can make civil commitments without needing additional certification. Legislators also took action to ensure that nondoctoral-level providers have the training and experience they need. With support from the New Hampshire Psychological Association, a new law establishes a committee to study the licensing process for alcohol and drug counselors. In North Carolina, the legislature passed a bill clarifying that master's-level practitioners licensed under the psychology board must comply with psychology licensing laws, regardless of whether they are licensed under another discipline.

In West Virginia, a bill that would have created a Marriage and Family Therapy Board of Examiners was defeated. The bill would have called for psychologists to meet a separate set of requirements and would have brought them under the jurisdiction of another board to treat clients that they're already licensed to treat.Y

Rebecca A. Clay is a writer in Washington, D.C.