State progress and case studies

The statutes are copyrighted by the state of Colorado (please see §2-5-115, C.R.S.). Any person wishing to reprint and distribute all or a substantial part of the statutes in either printed or electronic format must obtain prior permission of the Committee on Legal Services.

Colorado Legislative Authority

12-43-101. Legislative declarationopens in new window (PDF, 508KB)

The general assembly hereby finds and determines that, in order to safeguard the public health, safety, and welfare of the people of this state and in order to protect the people of this state against the unauthorized, unqualified and improper application of psychology, social work, marriage and family therapy, professional counseling, psychotherapy and addiction counseling, it is necessary that the proper regulatory authorities be established and adequately provided for. The general assembly therefore declares that there shall be established a state board of psychologist examiners, a state board of social work examiners, a state board of marriage and family therapist examiners, a state board of licensed professional counselor examiners, a state board of registered psychotherapists, and a state board of addiction counselor examiners with the authority to license, register,= or certify, and take disciplinary actions or bring injunctive actions, or both, concerning licensed psychologists and psychologist candidates, licensed social workers, licensed marriage and family therapists and marriage and family therapist candidates, licensed professional counselors and licensed professional counselor candidates, registered psychotherapists and licensed and certified addiction counselors, respectively,= and mental health professionals who have been issued a provisional license pursuant to this article.

Colorado Regulatory Authority

8.200 Physician Servicesopens in new window (PDF, 706KB)

8.200.2 Providers

8.200.2.B Physician services that may be provided without a physician order by non-physician providers.

2. Licensed Psychologists may provide and order covered mental health goods and services in accordance with the scope of practice as described in the Colorado Revised Statutes without a physician order.

a. Services ordered by a licensed psychologist but rendered by another provider shall be signed and dated by the licensed psychologist contemporaneously with the rendering of the service by a non-licensed mental health provider.

Minnesota Legislative Authority

256B.04 Duties of State Agencyopens in new window

Subdivision 1. General

The state agency shall supervise the administration of medical assistance for eligible recipients by the county agencies hereunder.

Subdivision 1a. Comprehensive health services system

The commissioner shall carry out the duties in this section with the participation of the boards of county commissioners, and with full consideration for the interests of counties, to plan and implement a unified, accountable, comprehensive health services system that:

• Promotes accessible and quality health care for all Minnesotans.
• Assures provision of adequate health care within limited state and county resources.
• Avoids shifting funding burdens to county tax resources.
• Provides statewide eligibility, benefit and service expectations.
• Manages care, develops risk management strategies and contains cost in all health and human services.
• Supports effective implementation of publicly funded health and human services for all areas of the state.

Minnesota Regulatory Authority

General MHCP Non-Enrollable Mental Health Provider Requirementsopens in new window.

The following types of individual providers are authorized to provide mental health services under clinical supervision in specialty-specific service settings:

• Mental Health Practitioners
• Mental Health Practitioner Clinical Trainees
• Mental Health Rehabilitation Workers
• Mental Health Behavioral Aides
• Mental Health Case Managers

Mental Health Practitioners

Mental health practitioners providing services for the treatment of mental illness, who are not eligible for enrollment, must be under clinical supervision of a mental health professional and must be qualified in at least one of the following five ways:

1. Holds a bachelor's degree in a behavioral science/related field, from accredited college/university and meets either a or b:

a. Has at least 2000 hours of supervised experience in the delivery of mental health services to recipients with mental illness.

b. Is fluent in the non-English language of the cultural group to which at least 50 percent of the practitioners recipients, completes 40 hours of training in the delivery of services to recipients with mental illness and receives clinical supervision from a mental health professional at least once a week until the requirements of 2000 hours of supervised experience are met.

2. Has at least 6000 hours of supervised experience in the delivery of mental health services to recipients with mental illness. Hours worked as a mental health behavioral aide I or II under CTSS may be included in the 6000 hours of experience for child recipients.

3. Is a graduate student in one of the mental health professional disciplines and is formally assigned by accredited college/university to an agency or facility for clinical training.

4. Holds a masters or other graduate degree in one of the mental health professional disciplines from an accredited college/university.

5. Tribally certified mental health practitioner who is serving a federally recognized Indian tribe.

In addition to the above criteria:

• A mental health practitioner for a child recipient must have training working with children.
• A mental health practitioner for an adult recipient must have training working with adults.

Mental Health Practitioners Who Are Qualified as Clinical Trainees

A mental health practitioner working as a clinical trainee must:

• Be complying with requirements for licensure or board certification as a mental health professional including supervised practice in the delivery of mental health services for the treatment of mental illness. 
  
  Or
  
  
• Be a student in a bona fide field placement or internship under a program leading to completion of the requirements for licensure as a mental health professional.

The clinical trainee's clinical supervision experience helps the practitioner gain knowledge and skills necessary to practice effectively and independently and may include supervision of:

• Direct practice.
• Treatment team collaboration.
• Continued professional learning.
• Job management.

Case Study

Nevada achieved intern reimbursement through the regulatory advocacy process. When the Nevada Psychological Association (NPA) approached Nevada Medicaidopens in new window about allowing supervised interns to bill, the state Medicaid office informed them that if psychology interns registered with the psychology licensing board they would be able to do so. This followed a similar process to that of Marriage and Family therapists and Licensed Clinical Social Workers whose interns register with their respective licensing boards and thus they are subject to some “oversight” by the board. To read more about the process NPA followed, see this advocacy case studyopens in new window by Lindsey Ricciardi, PhD. 

Once the psychology licensing board developed a system for tracking the internsopens in new window, the next step was to request a state plan amendment through the Centers for Medicaid and Medicare Services that would allow interns to be billing providers. Once CMS approved that change, then Nevada Medicaid had to promulgate rules, which were officially approvedopens in new window on Feb. 22, 2017.

Ohio Legislative Authority

5164.02 [Renumbered from 5111.02] Rules to implement chapteropens in new window.

A. The medicaid director shall adopt rules as necessary to implement this chapter. The rules shall be adopted in accordance with Chapter 119. of the Revised Code.

B. The rules shall establish all of the following:

The amount, duration and scope of the medicaid services covered by the medicaid program.

1. The payment amount for each medicaid service or, in lieu of the payment amount, the method by which the payment amount is to be determined for each medicaid service;
2. Procedures for enforcing the rules adopted under this section that provide due process protections, including procedures for corrective action plans for, and imposing financial and administrative sanctions on, persons and government entities that violate the rules.

C. The rules may be different for different medicaid services.

D. The medicaid director is not required to adopt a rule establishing the payment amount for a medicaid service if the director adopts a rule establishing the method by which the payment amount is to be determined for the medicaid service and makes the payment amount available on the internet web site maintained by the department of medicaid.

Ohio Regulatory Authority

5160-8-05 Psychology services provided by licensed psychologistsopens in new window.

A. Scope. This rule sets forth provisions governing payment for psychology services provided by licensed psychologists in non-institutional settings.

B. A doctoral-level psychology intern completing a required internship, if the following conditions are met:

1. The service is provided under the general supervision of the psychologist responsible for the patient's care.
2. The psychologist responsible for the patient's care has face-to-face contact with the patient during the initial visit and not less often than once per quarter (or during each visit if visits are scheduled more than three months apart).
3. The psychologist responsible for the patient's care keeps on file official documentation of the internship, including the beginning and ending dates.
4. The psychologist responsible for the patient's care includes in the patient's medical record documentation that appropriate service was provided under general supervision, that the psychologist checked and updated the medical record at least once a week, and that all requirements for payment were met.

Case Study

Kevin Arnold, PhD, ABPP discusses efforts in Ohio to secure Medicaid reimbursement for interns. (A transcript of the videoopens in new window (PDF, 270KB) is available to download.)

Oklahoma Legislative Authority

§63-5003. Legislative declaration — Purposeopens in new window.

A. The Legislature recognizes that the state is a major purchaser of health care services, and the increasing costs of such health care services are posing and will continue to pose a great financial burden on the state. It is the policy of the state to provide comprehensive health care as an employer to state employees and officials and their dependents and to those who are dependent on the state for necessary medical care. It is imperative that the state develop effective and efficient health care delivery systems and strategies for procuring health care services in order for the state to continue to purchase the most comprehensive health care possible.

B. It is therefore incumbent upon the Legislature to establish the Oklahoma Health Care Authority (OHCA) whose purpose shall be to:

1. Purchase state and education employees' health care benefits and Medicaid benefits.
2. Study all state-purchased and state-subsidized health care, alternative health care delivery systems and strategies for the procurement of health care services in order to maximize cost containment in these programs while ensuring access to quality health care.
3. Make recommendations aimed at minimizing the financial burden which health care poses for the state, its employees and its charges, while at the same time allowing the state to provide the most comprehensive health care possible.

Oklahoma Regulatory Authority

317:30-5-275. Eligible providersopens in new window

A. Licensed Psychologist must be licensed to practice in the state in which services are provided. Payment is made for compensable services to psychologists licensed in the state in which face to face services are delivered.

B. Psychologists employed in state and federal agencies, who are not permitted to engage in private practice, cannot be reimbursed for services as an individually contracted provider.

C. Services provided by practitioners who have completed education requirements to begin an internship or a post-doctoral fellowship in an accredited clinical psychology academic training program and are under current board approved supervision toward licensure are eligible for reimbursement. Each supervising psychologist must have a current contract with the OHCA.

D. For those licensure candidates who are actively and regularly receiving board approved supervision, or extended supervision by a fully licensed clinician if board's supervision requirement is met but the individual is not yet licensed, each supervising psychologist must have a current contract with the OHCA.

E. In order for services provided by clinical psychology interns completing required internships, post-doctoral fellows completing required supervision for licensure to be reimbursed, the following conditions must be met:

1. The licensed practitioner billing SoonerCare must have a letter on file covering the dates of services of the internship or post-doctoral fellowship.
2. The psychology intern or post-doctoral fellow must be under the direct supervision of the licensed psychologist responsible for the member's care.
3. The licensed psychologist responsible for the member's care must:
   1. Staff the member's case with the intern or fellow.
   2. Actively direct the services.
   3. Be available to the intern or fellow for in-person consultation while they are providing services.
   4. Agree with the current plan for the member.
   5. Confirm that the service provided by the intern or fellow was appropriate.
4. The member's medical record must show that the requirements for reimbursement were met and the licensed psychologist responsible for the member's care has reviewed, countersigned, and dated the notes in the medical record at least every week so that it is documented that the licensed psychologist is responsible for the member's care.

Case Study

Stephen Gillaspy, PhDopens in new window (PDF, 206KB), successfully advocated reimbursement for intern and fellow services to his state's Medicaid agency.

Case Study

Oregon achieved intern reimbursement as part of a larger piece of legislationopens in new window that integrated care in patient-centered primary care homes and behavioral health homes. This method of seeking reimbursement involved a much larger scale overhaul to the state’s system of care.

Interns were listed as one of the reimbursement-eligible providers ("Behavioral Health Clinicians") in that piece of legislation. It defines "Behavioral Health Clinicians" as a broad base of providers who can provide care in these primary care and behavioral health homes: licensed psychologists, professional counselors and others who are able to treat mental illness within their scope of practice.

Oregon delivers care to its Medicaid beneficiaries through Coordinated Care Organizations, and this legislation reflected that unique delivery system. Oregon's legislation is critical to both elevating the importance of psychologists' work and seeing it as part of the professional collaboration that the Affordable Care Act envisioned.

Case Study

Texas had to combine both legislative and regulatory advocacy strategies to achieve intern reimbursement.

First, Texas Psychological Association (TPA) met with the state Medicaid department, and representatives from their state Medicaid office said that the first step required was passing legislation that allowed psychologists to supervise and delegate work to interns. A 1996 decision by the Attorney General had removed psychologists' ability to do that because it was not specifically authorized by statute. Psychologists across the state mobilized to get the appropriate legislation passedopens in new window.

Once the legislation was passed, TPA worked with Medicaid to develop proposed changes to their Medicaid manual to allow for services provided by supervised interns to be reimbursed by Texas Medicaid. APA submitted a letter of support for these changes to their manual. The final rulesopens in new window (PDF, 197KB) were promulgated in December 2016 and services provided by supervised interns are now eligible for reimbursement by Medicaid.

Sharon Berry, PhD, ABPP, shares some motivational words of wisdom to keep you engaged in a campaign for intern Medicaid reimbursement over the long haul.