Feature

Last year, state advocates helped widen consumers' access to mental health resources by working with legislators on laws to assert prescriptive authority, create new services and protect existing benefits, and grant mental health insurance parity.

Prescriptive authority

Louisiana's psychologists earned prescriptive authority in 2004 and started prescribing in 2005. However, until this year, medical psychologists were not included in the state statute among the categories of health professionals authorized to prescribe psychotropic medications in the state's public psychiatric health-care facilities. So, to preclude psychiatry from impeding medical psychologists' ability to practice fully in these settings, the Louisiana Psychological Association helped pass a bill giving medical psychologists the explicit authorization to prescribe in state psychiatric facilities.

Psychologists in Tennessee were once again denied prescriptive privileges this year, but the Tennessee Psychological Association (TPA) did defeat an effort by the state's medical association to block any immediate possibility of gaining them. A small paragraph at the end of a bill calling for a committee to study the reasons for high prescription use in the state indicated that the legislature would not allow any changes in practitioners' scope of practice involving prescription privileges.

"The last paragraph was the real intent of the bill-to slow us down," says Lance T. Laurence, PhD, TPA's legislative and professional affairs officer. Instead, it garnered negative press for the Tennessee Medical Association, explains Laurence. "We are preparing for another hard run at passage in 2007," he concludes.

Public health funding and health-care benefits

On the heels of APA's successful 2006 fight to stop the Health Insurance Marketplace Modernization and Affordability Act-which would have eliminated many state-level protections for mental health services-the Washington Psychological Association helped defeat a 2006 state bill that would have eliminated such mandated benefits as mental health parity, chemical dependency treatment and children's neurodevelopmental therapy for employees working at companies with 50 or fewer employees.

"The bill would have made it possible for the insurance industry to offer small businesses a health insurance package with none of the nine mandated benefits," says Lucy Homans, PhD, director of professional affairs for the Washington Psychological Association. The package would also have removed many antidiscrimination requirements, notes Homans.

Consumers in two other states will have greater access to mental health care, thanks to psychologists' efforts

  • The Kentucky Psychological Association worked with a state coalition to shift $2 million from state psychiatric hospitals to community-based services that will reduce the need for admissions and readmissions.

  • The North Carolina Psychological Association worked with a coalition to get state legislators to devote $100 million toward public mental health treatment, therapy for developmental disabilities and substance abuse programs.

Licensing and psychological testing

Psychologists in three states worked to uphold professional standards in licensing and testing.

In California, the governor's administration proposed in 2005 that-instead of the legislature granting the usual five-year renewal-it vote to eliminate the psychology licensing board, which would be absorbed by the board which certified licensed master's degree marriage counselors and social workers. The proposed board would have only one member psychologist.

"We argued that it would be inappropriate for non-psychologists with no training outside of mental health to be regulating psychologists," says Charles Faltz, PhD, director of professional affairs for the California Psychological Association.

As a result, the board was granted a one-year renewal in 2005, and a two-year renewal for 2006. The association is currently advocating for a regular five-year renewal that all licensing boards receive.

The Ohio Psychological Association also defeated an attempt to consolidate psychology licensure with other professional boards. And in Maryland, psychologists opposed other mental health professionals' bid to conduct psychological testing. A previously passed bill, Title 17, allows counselors to administer and interpret "appraisals," but prohibits them from using tests or methods that require specialized psychological training. Only counselors whom the psychology and professional counselors' licensing boards had determined to have training equivalent to a licensed psychologist would be allowed to perform these specialized tests. A proposed bill would have eliminated the Psychology Board's participation in this determination. The bill died in subcommittee due the efforts of the Maryland Psychological Association.

Parity

Late in 2006, three state legislatures still in session were actively considering mental health insurance parity bills. Thirty-nine states already have parity laws that apply to private group health insurance coverage, while an additional three states have parity laws on the books that cover state employees. The laws generally take two forms: broad-based parity laws that provide equivalent insurance coverage for mental health disorders as for physical illnesses, not limited by diagnosis; and "biologically based" or "serious mental illness (SMI)-only" laws that provide parity coverage pegged to specified disorders.

The New Jersey Senate was working on a bill that would replace the state's current SMI-only parity law with a new law that would provide an estimated 2.5 million state residents with broad-based parity coverage. As of Monitor press time, the bill had passed a key Senate committee and was headed to the full Senate.

In New York, the Senate passed Timothy's Law, a bill requiring that insurance companies cover treatment for all biologically based mental health conditions in adults and conditions that cause suicidal or harmful symptoms in children.

At press time, the Senate had approved the bill, the State Assembly had agreed to it but had not yet signed it. Gov. George Pataki then had until the end of the year to sign the bill, but it was uncertain whether he would, according to Gayle Everitt, JD, executive director of the New York Psychological Association. If he didn't, the association had plans to resubmit the bill for the 2007 legislative session.

Ohio lawmakers in both the House and Senate were considering identical bills that would provide parity coverage for a designated list of SMI diagnoses. Newly elected Ohio Gov. Ted Strickland, PhD, a psychologist who formerly served as a member of the U.S. House of Representatives, is a longtime advocate of broad-based parity.