State Leadership Conference
Getting a law passed is sometimes only half the battle, said psychologists at the 2003 State Leadership Conference session "Implementing laws once passed: staying the course." Implementing the law presents another set of challenges, said Michael Sullivan, PhD, assistant executive director of state advocacy in APA's Practice Directorate.
The session focused on the implementation challenges posed by three state laws--New Mexico's prescriptive authority law, Vermont's disclosure law on medical loss ratio and a Connecticut Medicaid law, which would threaten adult psychological services if implemented.
On March 5, 2002, New Mexico became the first state to give psychologists with the appropriate postdoctoral training the right to prescribe psychotropic medications.
"Since we passed the bill, we have hit the ground running to keep everything alive and moving in a forward direction," said Elaine LeVine, PhD, prescriptive authority chair of the New Mexico Psychological Association.
The prescribing law, which took effect last July, is on track for implementation by the end of 2003 as required by the law. The New Mexico Boards of Psychologist Examiners and Medical Examiners established a joint committee to develop implementing regulations. LeVine said the committee's work has been delayed as a result of concerns expressed by some state legislators that the committee does not include sufficiently broad representation. Further delays have stemmed from the new governor, Bill Richardson, asking for the resignations of all state licensing board members in order to reconstitute the boards with members of his choosing.
LeVine is nevertheless confident that New Mexico psychologists will soon be prescribing. The new law has helped to increase awareness and understanding of the state's mental health needs, LeVine notes. Also, she said, psychologists in the state are now being asked to serve on committees that address primary-care issues.
Elsewhere, in Vermont, psychologists are working to implement a state law requiring managed-care companies to disclose financial information. Alexandra Forbes, legislative chair and federal advocacy coordinator for the Vermont Psychological Association, said the legislation, enacted in 2000, followed managed care coming to the state. Since the law went into effect, the Vermont Psychological Association has been analyzing data from managed-care companies.
Managed care has become a "profit-making industry," Forbes said, and as psychologists, "we have an obligation to stop it from stealing the good health care of our communities. I think this legislation gives us a tool. But the big question is where do we take this tool, and what do we do with it? That's our next step."
Of course, not all laws would help psychologists if implemented. In Connecticut, the state legislature enacted a law late last year making it possible for all optional services under Medicaid to be eliminated. With that law in place, a budget was put forward this year that would eliminate optional Medicaid services, including adult psychological services.
Connecticut Psychological Association members are working to repeal the newly enacted law by encouraging the legislature to pass a bill that restores optional services.
The provision in the law "slipped through the legislature," said Daniel Abrahamson, PhD, director of professional affairs with the Connecticut Psychological Association. Department of Social Services regulations implementing the law were released on Dec. 17, 2002, and went into effect Jan. 1. "A whole system was being thrown into chaos, and many people didn't even know [about the law]," Abrahamson said.
Connecticut Psychological Association members have worked to inform the public about what is happening--hoping to spark change. They contacted the media, state representatives and senators and posted action alerts on listservs. They have also obtained legal guidance to determine whether the state gave subscribers the required 30-day written notice that their Medicaid benefits were going to be terminated and what legal strategies might be available in trying to repeal the cuts.