States made significant progress this year in maintaining and improving practice opportunities for psychologists, both in terms of new professional roles like prescriptive privileges and by increasing and protecting insurance coverage for psychological services.

"There were a number of creative advances made in eliminating barriers to psychologists' practice in the 2004 state legislative sessions," says APA Executive Director for Professional Practice Russ Newman, PhD, JD. "We commend the state psychology leaders for their achievements."

To sum up the year's work, here's a review of some of the progress--and defeats--in state advocacy for access to psychological services.

Prescriptive authority

In a key victory for professional psychology, the Louisiana legislature voted in April to grant prescriptive privileges to specially trained psychologists, and in May, Democratic Gov. Kathleen Blanco signed the bill into law. Louisiana is the second state to give specially trained psychologists authorization to prescribe certain drugs related to the diagnosis and treatment of mental health disorders. New Mexico became the first to pass such legislation in 2002.

The Louisiana law is designed to enhance the relationship between physicians and psychologists, considering that most psychological disorders are managed by primary-care physicians who largely welcome the role of psychologists in assisting in mental health management, says James Quillin, PhD, president of the Louisiana Academy of Medical Psychologists--a group of 50 psychopharmacology graduates that works with the Louisiana Psychological Association on prescription issues.

"Louisiana's achievement is particularly impressive because it bolsters the progress being made in New Mexico, proving the passage of legislation there was no anomaly and is part of a larger trend," says Michael Sullivan, PhD, assistant executive director for state advocacy in APA's Practice Directorate.

To be implemented, the Louisiana law needs to go through a rule-making process that will be overseen by the Louisiana State Board of Examiners in Psychology in the coming months.

In New Mexico, the regulatory process to implement the state's prescriptive authority law is reaching the final stages. The proposed prescriptive authority rules and regulations--a collaboration between the state's Board of Psychologist Examiners and Medical Board--were published in July for 30 days of public comment. The Board of Psychologist Examiners then held two public rule hearings to receive testimony on the proposed regulations on Sept. 10 in Las Cruces and on Sept. 17 in Albuquerque. Newman testified at the hearing in Albuquerque in support of the regulations (see APA weighs in on implementation of New Mexico regs).

Medicaid battles

State budget problems have caused widespread cuts in the Medicaid program. Some of these cuts have targeted optional services, which include adult outpatient psychological services.

However, state associations in New York, Georgia and Maine fended off efforts to eliminate psychological services under Medicaid. In New York, legislators tried to cut all mental health coverage and Georgia legislators tried to cut mental health services provided to children--both attempts failed. In Ohio, legislation was introduced to restore cuts that were made this year.

North Carolina psychologists also made progress in the fight for mental health coverage by successfully advocating for legislation that expanded public psychologists' access to service reimbursement under Medicaid. The law names psychologists as directly enrolled, independent providers of services to adults under Medicaid; psychologists were included only as providers for children in the 2000 law.

The North Carolina Psychological Association (NCPA), through frequent communication, developed a strong relationship with the Division of Medical Assistance (DMA), the state's Medicaid agency, to lobby for passage of the bill, says NCPA Executive Director Sally Cameron. The relationship has helped smooth efforts to have DMA introduce the legislation that includes psychologists as adult providers and to increase Medicaid rates as needed for providers being reimbursed for less than their market value, she adds.

"Bottom line, our working on building a relationship with DMA staff has paid off," Cameron says.

Indeed, "Many state associations have fought hard to maintain coverage," Sullivan says.

Legal protections

West Virginia followed in the footsteps of a 2003 Florida law by passing legislation that allows licensed psychologists to provide "good-faith" custody evaluations during divorce proceedings without fear of being wrongly sued by disgruntled parents--provided the evaluation process is consistent with APA's "Guidelines for Child Custody Evaluations in Divorce Proceedings." The law says a parent cannot anonymously file an administrative complaint charging bias or incompetence against a court-appointed psychologist.

The law, based on APA's guidelines, removes obstacles to psychologist participation in an area that's very litigious, Sullivan says.

Massachusetts made progress protecting psychologists too. The Massachusetts legislature repealed a restrictive contract rule that chained psychologists to noncompete agreements even after the private companies they worked for went out for business. Now, if a hospital or nursing home shuts down, the psychologists that worked exclusively for it would be able to be hired by the new company that took over.

Licensure obstacles

Psychologists in Washington state made it possible for some early-career psychologists to become licensed at an earlier point in time. Previously, new psychologists were required to log two years of clinical supervision, including one after they completed their doctorate. But under the new licensing guidelines, those two years can be completed predoctorally. The change was a part of legislation eliminating unnecessary barriers that slow or prevent qualified applicants from being credentialed health-care providers. It was designed to ease the health-care personnel shortage.

Also regarding licensure, the Colorado Psychological Association prevented legislators from consolidating the boards that regulate mental health professions into one omnibus board that would have handled both master's-level and doctoral-level providers. The Colorado Department of Regulatory Agencies (DORA) proposed the change during the reauthorization of the Colorado state licensing law, which occurs once every five years. Fortunately, CPA members including president Lisa Kaley-Isley, PhD, managed to persuade DORA against the change, which, in their eyes, would have lessened the value of a doctoral degree.

Mental health parity

Psychologists in Missouri made a major stride this year, passing a comprehensive mental health parity law.

Under the bill, group policies will cover all mental illnesses, except for substance abuse, in the same manner that they cover physical illnesses. Individual insurance policies continue to be governed by existing laws, which already mandate mental health coverage. Missouri is the fourth state to expand a limited mental health parity law to one that covers all mental health diagnoses.

It's a trend that Sullivan says is very encouraging. "Thirty-eight states have passed parity laws and half are comprehensive," he says. "The more there are at the state level, the more pressure there is for full parity on the national level."

The passage of a national law would spread parity to all private insurers, some of whom are not now subject to state parity laws because of the national Employee Retirement Income Security Act.