Hills and Valleys: During the exciting 2013 APA State Leadership Conference (SLC), Katherine Nordal noted: "The clock is ticking toward full implementation of the law and January 1, 2014 is coming quickly. But January 1st is really just a mile marker in this marathon we call health care reform…. We can't hope to finish the marathon called health care reform if we're not at the starting line. Fortunately, many psychology leaders have embraced our call to action." With the steady implementation of President Obama's Patient Protection and Affordable Care Act (ACA), our nation's mental and behavioral health providers (regardless of professional discipline) are increasingly being held to the standards and nuances of the overall healthcare system. For over two and a half decades, Jim Georgoulakis has represented psychology's voice on the American Medical Association's (AMA's) Resource Value Update Committee, which is responsible for advising the Centers for Medicare and Medicaid Services (CMS) on payment policy for services contained in the Current Procedural Terminology (CPT) reimbursement system. His visionary perspective on the considerable challenges facing our practitioners as they face the inevitable integration of federal, state, and private sector requirements:
"Psychologists and Compliance Plans: Recently various lit-serves and publications have raised the issue of compliance plans which have unfortunately left a number of psychologists confused as to whether they should develop compliance plans for their practices. The answer is clearly an unequivocal 'Yes' and there should be no further debate on this matter. This fall, in an AntiFraud newsletter, the former Department of Health and Human Services (HHS) Inspector General (IG) Richard Kusserow made a number of statements regarding Medicare and Medicaid mental health fraud to the effect that mental health benefits have been 'a special enforcement problem that stretches back decades.' 'Many healthcare fraud investigators believe mental health caregivers such as psychiatrists and psychologists have the worst fraud record of all medical disciplines.' Support for this assertion comes from Assistant U.S. Attorney Ted Radway, who stated that in Medicaid there has been 'an explosion of fraud in community-based mental health treatments, including billing for services not rendered.'
"The current IG of HHS Daniel Levinson is also very clear on the need for a compliance plan. In his keynote address to the Health Care Compliance Association 2014 meeting, he stated that every provider should have a compliance plan. He noted that a one or two person practice will have a different compliance plan than a large organization. He also emphasized that each compliance plan should be unique to the practice – he cautioned against an off the shelf program. The IG also discussed the training materials (written, audio, and video) that his office has produced to assist providers. These materials can be located on the OIG web site which includes a section titled Compliance 101. In this package it is important to note specific videos on compliance program basics, documentation, and operating an effective compliance program. Additionally, there is a caption that states 'ultimate responsibility for complying with federal fraud and abuse laws lies with the provider of the service.'
"In the main psychologists were very supportive of the passage of the ACA. However, the ACA included a new section [Section 6401 (a)] which established a new Section 1866 (j) (8) which reads that a provider of medical or other items or services or a supplier shall, as a condition of enrollment in Medicare, Medicaid, or CHIP, establish a compliance program that contains certain 'core elements' of a Federal Compliance Program. The core elements of such a compliance program have been available on the OIG web site since 1999. As to be expected when reviewing the compliance plan requirements of the 50 states, there is considerable variability among the states with New York having the most comprehensive and the oldest requirements (i.e., mandatory plans since 2009).
"The AMA provides CE credit for participating in the OIG training on compliance. This training is web based and is included in the OIG's web site. Similar to physicians, I would hope at some time in the near future psychologists would stop debating on whether compliance plans are necessary, develop similar training CE programs, and move forward and improve our standing in the health care compliance community."
Exciting New Faces and New Agendas: The Illinois Psychological Association, with the guidance and leadership of Beth Rom-Rymer, in particular, succeeded this year in passing prescriptive authority legislation, which is the first RxP bill to be signed into public law since Louisiana's on May 6, 2004. "With the passage of our prescriptive authority bill, that gives opportunity for graduate students to take the core component of their training in Clinical Psychopharmacology pre-doctorally, close observers have wondered if only the young students will take the training. Others have asked, 'Will access to care issues really be addressed?' Still others have questioned, 'In what ways will the identity of the clinical psychologist change as (s)he also takes on the identity of the prescribing psychologist? As we are only at the beginning of our prescriptive authority journey, I will, today, address the question of 'Who wants to prescribe' by drawing some portraits of just a few psychologists who have expressed their intention to prescribe in Illinois and/or who are already in the process of gaining their eligibility to prescribe. These examples are in no way exhaustive but represent the diverse spectrum of psychologists, in Illinois, who will be prescribing.
"* Karla is an early career psychologist, is Director of Behavioral Health and Pastoral Care at a Federally Qualified Healthcare Center (FQHC) that serves a largely Hispanic and African American population on the west side of Chicago. She has almost completed her training in clinical psychopharmacology from Fairleigh Dickinson University and is looking forward to soon completing the other components of her training. * Jane has wanted to be a prescribing psychologist since she was a teenager and she is now 62 years old! A practicing clinical psychologist, she is currently taking the core training in clinical psychopharmacology from Fairleigh Dickinson University. She is looking forward to taking the undergraduate science courses on-line and/or at a nearby community college. * Dick is a mid-career clinical psychologist who had been in a joint practice with his pediatrician father for 25 years. He had been a pre-med major as an undergraduate and has completed all of the undergraduate sciences courses; the core training in clinical psychopharmacology from NOVA Southeastern University; and has taken and passed the PEP. These dedicated colleagues are leading the way to our future.
"Since the passage of our legislation, I have been in contact with leaders in more than 10 states in which prescriptive authority initiatives have been reinvigorated. Indiana is one of those states, where, although never implemented, their original effort became public law back in 1993. Other states include Hawaii, California, Idaho, Arizona, Texas, Nebraska, Missouri, Michigan, Ohio, Florida, Virginia, and Maryland. It was a particular pleasure to be able to speak at the convocation of the most recent graduating class of the New Mexico State Psychopharmacology training program where we honored Elaine LeVine for the monumental pioneering work that she has done for all of us in the RxP arena. The enthusiasm at the grass roots level is contagious!" (Beth Rom-Rymer). A journey of a thousand miles begins with a single step. Aloha,
Pat DeLeon, former APA President – Division 42 – November, 2014
