State Leadership Conference

More than 580 participants from 59 states, provinces and territories gathered in Washington, D.C., March 13-16 for the APA Practice Organization's 2004 State Leadership Conference--an annual event that helps set psychology's policy agenda at the federal and state levels.

The conference brought together a broad range of professionals interested in advocacy--including early-career psychologists--to discuss strategies and directions for practitioners. Each year, state delegations meet during the conference, coordinate their goals with those of APA and share practical information about accomplishing professional psychology's advocacy agendas.

At this year's conference, APA Executive Director for Professional Practice Russ Newman, PhD, JD, said the theme, "Strategic resilience for the profession: getting a jump on change," was meant to urge psychologists to bring innovative solutions to a health-care system that is not working, and to influence whatever health-care reforms may be in the offing.

"Strategic resilience is about the pursuit of 'zero trauma'--the goal of forever morphing to take advantage of opportunities and incipient trends without the need for gut-wrenching overhauls, chaotic reorganizations or dramatic turnarounds," explained Newman at the opening session. "Strategic resilience is about constantly making the future rather than just defending the past."

Newman identified several innovative strategies for achieving psychology's goals and objectives, including:

  • Finding more aggressive ways to promote psychology and psychological services to consumers and third-party payers.

  • Illuminating creative ways to use Congress and the courts to ensure access to quality psychological services.

  • Taking advantage of the developing trend in the United States to recognize the importance of lifestyle in physical health.

  • Capitalizing on reforms that will likely target chronic-disease management to provide more efficient and effective care.

  • Changing the paradigm so that good physical health is subsumed under the larger umbrella of good psychological health.

  • Finding new ways to use technology to make practicing psychology easier and to better serve patients.

This year's successes

Despite the challenges of working within the current health-care system and political climate, Newman said, the past year yielded many successes, including:

  • Prescription privileges (RxP). Nine states--Florida, Georgia, Hawaii, Illinois, New Hampshire, Oregon, Tennessee, Texas and Wyoming--introduced RxP legislation in 2003, and six of the states were granted committee hearings on their bills--the largest number ever in one year. So far in 2004, Georgia, Hawaii, Illinois, Louisiana, Maine, New Hampshire, Oklahoma and Tennessee have introduced RxP bills. And psychology groups from Guam, where prescription privileges were established in 1999, and New Mexico, with its 2002 legislation, are continuing work to implement their laws.

  • Improved state laws. In Missouri, new regulations require Medicaid to reimburse psychologists for services provided to adults; in the past, only services to children had been covered. In New York, the New York State Psychological Association (NYSPA) won increased payment for services for patients who are jointly eligible for Medicaid and Medicare. In Pennsylvania, a new continuity-of-care law requires attending physicians to take reasonable steps to involve a hospitalized patient's psychologist in treatment. And in Maryland, the state passed a new managed-care accountability law that requires managed behavioral health-care companies to publicly disclose financial information to make it clear what is being spent on direct care.

  • Virginia's case against managed care. A 2003 settlement in a lawsuit filed by the Virginia Academy of Clinical Psychologists against Blue Cross/Blue Shield of the National Capital Area and its mental health carve-out, CareFirst (formerly Value Options), awarded psychologist and consumer plaintiffs significant concessions. It also preserved the plaintiffs' right to appeal fraud claims dismissed in trial court. Included in this appeal is the allegation that CareFirst misrepresented to consumers the existence of a large, stable panel of health professionals and intended to pare back the panel by forcing a rate reduction. Oral arguments before the D.C. Court of Appeals could occur as early as May, Newman added.

  • Oxford Health Plan's repeal of retrospective audits. The Practice Directorate recently teamed up with NYSPA to challenge Oxford Health Plan's practice of retrospective audits of patients' mental health records. Oxford demanded large refunds, primarily from New York psychologists, for what the company described as "insufficient" record-keeping. A letter from APA and NYSPA--illustrating how the audit and recoupment practice were in conflict with Oxford's contractual agreement with its psychologists and in violation of New York managed-care law--convinced Oxford to stop its audit and repayment demands.

"All of which goes to show you, some days the good guys do win," Newman said.

Forging ahead

Despite these state successes, however, the federal health-care reform agenda remains slow-moving, Newman said. Mental health parity never made it to the congressional leadership's agenda in 2003. However, Sen. Pete Domenici (R-N.M.) got a commitment from the Senate leadership in early 2004 to bring the Paul Wellstone Mental Health Equitable Treatment Act to the floor.

"I am optimistic that, this year, given the chance, we will finally achieve broad-based parity for all people in need of mental health services," Newman said.