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FALL 2002 Association for the Advancement of Psychology AAP Targets Races To Washington Watch On November 5th Update: Changes in the national political electoral environment are about as easy to predict as the rise and fall of the stock market. Many attempt to Mental Health do so, but few if any are consistently accurate. Given that currently there is only a one seat Democratic margin in the Senate, and only a six seat gain by Democrats would shift control in the House, November 5th will Advocacy Tim Murphy most likely prove to be a most memorable day in the history of American politics. With so much riding on the upcoming mid-term elections, Inside the Advance thought it would be stimulating to provide AAPers with a list of races to watch on election day that are thought to be both important Beltway nationally because of their potential impact on changing control of Con- The Mental Health Liaison Group (MHLG) gress, and because the outcome of the race is important to psychology’s met on September 6, 2002 (see story on legislative agenda MHLG inside this issue of Advance). The fol- THE HOUSE lowing are highlights from Dr. Robert Nichols’ Ted Strickland (D-OH-6) – First psychologist elected to report to AAP of the range and depth of issues Congress. and actions considered by this lead coalition Brian Baird group on mental health advocacy in Washing- Brian Baird (D-WA-3) – Second Psychologist elected to ton. Dr. Nichols is AAP’s liaison to the Congress. MHLG, and Peter Newbould of the American Tim Murphy (R-PA-18) – A clinical psychologist, he will Psychological Association Government Rela- likely win in his first attempt for national office. tions Office currently serves as co-chair of the Karen Thurman (D-FL-5) – Major supporter of Medicare MHLG Policy Committee. GME has very tough race as a result of redistricting. • Request by the Bazelon Center Nancy Johnson (R-CT-5) – High ranking Ways and Means that AAP sign on to a letter objecting Committee member and friend to psychology has tough race to some provisions of a proposed Sen- against another incumbent as a result of redistricting. ate law (S 2826) that would require RACES TO WATCH states to record the names of persons Ted Strickland CONTINUED ON PAGE 3 with mental problems who should be denied purchase of guns. The gun control issue goes back to the so-called HIPAA ALERT Brady bill which required gun buyers to undergo a quick screening of crimi- Although the compliance date for the HIPAA "Privacy Rule" is April, 2003, nal and mental health records to see if the compliance date for the HIPAA "Transaction Rule" is October 16, 2002. they could qualify for purchase of a Most solo practitioners and group practices will not be able to begin by this firearm. The bill was strongly favored date. All must therefore request an "Extension" by October 15, 2002. by liberals and opposed by the NRA The extension form may be completed online at http://www.cms.gov.hipaa. and others. The bill contained a pro- At the bottom you will find a link titled: Standard Model Compliance Form. vision barring firearms to persons with This will link you to the page where you can download the Compliance Form. mental disabilities but that provision The Compliance Form can also be filed through the mail to: was not enforced. Now, in response to the NRA argument that we don't Model Compliance Plan Center for Medicare and Medicaid Services need new gun laws but should enforce P.O. Box 8040 Baltimore, Maryland 21244-8040 WASHINGTON UPDATE CONTINUED ON PAGE 5 Executive Director’s Column PFEIFFER’S PFUNNIES by Steve Pfeiffer Americans’ Appetite for Health Care Psychotherapeutic Reform Is technique has been evolving and changing Growing – for a hundred years. Post 9/11 Stephen M. Pfeiffer, Ph.D. From Freud and Jung, W hat happened to the national fervor for health care reform that nearly came to fruition during the first half of 2001? A key element of that reform, to Perls and Rogers, the Patients’ Bill of Rights, has all but disappeared as to Beck and Kohut, it remains frozen by Congressional inactivity. Are we it is clear that each psychologists the only ones feeling like the sky is falling on our nation’s health care system? The answer accentuates a different is clearly, no. However, like so many other issues that point of focus for had traction and loomed large in the public policy ameliorating life arena prior to 9-11, health care reform has been moved off the legislative radar screen, a victim of the height- distress. ened national security concerns which understandably became America’s number one priority. Now though, fully one year later, there again appears to be growing concern about health care in this country. According to a Harris Poll released in Some seekers of early September, the United States has a "considerable change search their appetite" for health care reform, and a "stronger con- past for the roots of sensus for radical reform is building" among the pub- lic, employers, providers and others in the health care their unhappiness. industry. Psychologists, of course, have held these beliefs for almost a decade now. In the survey, Harris researchers interviewed sepa- rate samples of 1,013 adults, 406 physicians, 305 employers, 101 health plan managers and 301 hospital managers to determine "what they thought of the nation's health care system." According to the survey, I guess you could call 56% of the public, 46% of physicians, 48% of employ- ers, 50% of health plan managers and 51% of hospital me post-modern. managers said that the health care system requires I, personally, much "radical change." Although public opinion has fluctuat- prefer to be miserable ed on the issue over the past 20 years, 56% of the pub- lic said that they favor "radical change" of the health in the here and now. care system. The survey predicted that dissatisfaction with the health care system would increase over the next few years as a result of increased out-of-pocket costs, concerns about prescription drug prices and a EXECUTIVE DIRECTOR’S COLUMN CONTINUED ON PAGE 3 Illustration by Pagaard 2 ADVANCE • FALL 2002 RACES TO WATCH FROM THE DESK OF THE CHAIR CONTINUED FROM PAGE 1 Connie Morella (R-MD-8) – Ronald E. Fox, Ph.D. situation Friend to psychology and vulnera- ble in a shifted district. I have said it before and I will keep on saying it: our profession is a total zero when it comes to political should be intolerable Earl Pomeroy (D-ND) – Ways giving. Compared to what we should for all of us -- and Means member and friend to be doing given the size and strength - those who psychology. of our profession, we have done are regular Jim Matheson (D-UT-2) – Friend nothing. Compared to what is need- contributors to psychology with new constituents ed given the dire straits in which we as well as as result of redistricting. are currently operating, we are sell- those who are Clay Shaw – (R-FL-22) – High ing out our future. Compared to our sitting on their pocketbooks worry- ranking Ways and Means member aspirations and how we want to be ing about the future of practice. will have tight race. seen in the socio-political landscape, Do we really want and expect leg- THE SENATE we are nowhere. Compared to what islators to pay attention to our other professions of even lesser size issues? Then we have to help them Paul Wellstone (D-MN) – Major are doing, we do not measure up. stay in office. Do we really want to mental health parity champion. Likely to be the closest Senate race Lest you think my assessment is stop managed care abuses and get in the nation. too harsh, consider the following them off our backs? Then we need facts. Last election cycle (2 years) a some big time political allies in Con- Jean Carnahan (D-MO) – Friend total of 39,000 special assessment gress and right now, we have very who is locked in close race with for- payers contributed $197,000 to our few. Do we really want to be seen as mer House member Jim Talent. PAC. Compare that level of giving to a player in developing new solutions Tim Johnson (D-SD) – Appropri- Optometrists whose 23,000 members to the nation’s health care needs? ations Committee member in tough in the AOA contributed $1,029,000; Then we need to become known in battle with House member John or to the 10,000 Chiropractors in the the halls of Congress as a political Thune. ACA who gave $407,000. The reality. Do we really want to obtain Tom Harkin (D-IA) – Longtime 29,500 Nurse Anesthetists in the significant federal support for profes- supporter Harkin is dueling with AANA gave a whopping $1,198,000. sional training and demonstrations of House member Greg Ganske who Even the 11,000 Podiatrists in the new practice applications? Then we has been a friend on patients’ rights APMA contributed $443,000 or over must show that supporting us is bill. I twice the amount given by psycholo- worth it in terms of help for legisla- gists, despite the fact that we out- tors in meeting their own needs. EXECUTIVE DIRECTOR’S COLUMN number them by a factor of over 3 to This is not a complicated business. CONTINUED FROM PAGE 2 1! Something is drastically wrong FROM THE DESK OF THE CHAIR possible increase in the number of with this picture. To my mind, this CONTINUED ON PAGE 5 uninsured Americans. The survey also found: • The percentage of doctors who IN THIS ISSUE endorsed radical change reached a AAP Targets Races To Watch On AMA Vows to Prevent Future low of 32% in 1994 but has increased November 5th . . . . . . . . . . . . . . 1 Psychologist Prescribing Laws . 13 over the past eight years, perhaps as a HIPAA Alert . . . . . . . . . . . . . . . . . 1 HIPAA Privacy Rules result of anger about managed care. Modifications . . . . . . . . . . . . . . . . 13 Washington Update . . . . . . . . . . . 1 • In 1999, health plan managers had remarkably positive attitudes about How AAP/PLAN Monies are FEATURES the health care system, but the per- Disbursed . . . . . . . . . . . . . . . . . . 4 Executive Director’s Column . . . 2 centage who favor radical change has Our Man In Washington . . . . . . 6 increased over the past three years, Pfeiffer’s Pfunnies . . . . . . . . . . . . . 2 AAP Advocacy Award Winners . 7 from 31% in 1999 to 50% in 2002. From the Desk of the Chair . . . . 3 APA Selects New CEO . . . . . . . . . 8 Movers & Shakers . . . . . . . . . . . 10 • Although employer attitudes about the health care system have shifted APA Pursues Resolution of CPT PLAN Contributors’ very little, 48% favor radical change Code Problems . . . . . . . . . . . . . . . . 9 Honor Roll . . . . . . . . . . . . . . . . 20 EXECUTIVE DIRECTORS”S COLUMN CONTINUED ON PAGE 14 3 How AAP/PLAN Monies Are Disbursed: The Basics of Campaign Contribution Decisions The following Q & A addresses a number of the most common province of Psychology’s legislative agenda would find other questions that AAP receives concerning how AAP/PLAN determines avenues to exercise those concerns, but AAP is very deter- which candidates will receive support from the PAC. Keep in mind mined to maintain our long held position with regard to that AAP (Psychology’s only membership organization operating a activity exclusively connected to Psychology’s interests. Try PAC at the federal level) administers a campaign contribution fund to imagine how ineffective our political program would be if or political action committee (PAC). The PAC is formally known as we only supported individual candidates who were able to AAP/PLAN which stands for Psychologists for Legislative Action pass a litmus test based on the myriad of social concerns Now. An extremely small number of psychologists shoulder the held by psychologists. Though good arguments could be entire burden of supporting Psychology’s political giving program. made for all, without a doubt, to try to base PLAN’s support There is, however, growing optimism that AAP will begin to increase on such a wide range of social issues would render our polit- its numbers with added impetus and education given to special assess- ical activities useless. ment payers provided by the two-year-old APA Practice Organiza- Q – I am a staunch Democrat and would like AAP/PLAN to sup- tion. Such activities were previously prohibited because of the APA’s port only Democratic candidates. Why is money being contributed to tax status. Republican candidates? Q - How does AAP determine which candidates running for House A – AAP/PLAN is a bi-partisan PAC. This means that and Senate seats will receive contributions from PLAN? we have no affiliation to either political party. Remember A - AAP works very closely with the Government Rela- our fundamental mission is to support candidates who are tions Office at the APA Practice Organization to develop sympathetic to Psychology’s legislative agenda. So, it would our political giving program. We engage in weekly collabo- be very unwise to support only one party or the other, espe- rative consultation about these matters, and also annually cially considering the current composition of Congress. No convene several meetings to review and revise the program piece of legislation important to us could ever clear any com- in consultation with a team of Washington based political mittee if Psychology was limited by having the support of consultants. Candidates who receive our support are pre- only one party or the other. To illustrate, if every Democrat dominantly members of the key Congressional Committees serving the Commerce Committee was on our side, but we with jurisdiction of psychology matters. In the House, these failed to elicit any Republican support, all of our mental committees are: The House Ways and Means Committee, health initiatives would have been dead on arrival for the The House Commerce Committee, and the House Educa- past eight years because Republicans have controlled, not tion and Workforce Committee. In the Senate they are: The only every committee in the House, but the entire House of Senate Finance Committee and The Senate Health, Educa- Representatives since 1994. tion, Labor and Pensions Committee. Since we are a bi-par- Q - I contribute to AAP/PLAN, yet this year no candidate in my tisan PAC, our contributions are made without regard to the state received any contribution from Psychology’s PAC. Why is this? political party of the candidate. The overwhelming majority A - Contributions to federal candidates are based solely of PLAN contributions are given to incumbents simply on which candidate is most likely to be able to benefit Psy- because they are re-elected at a rate that is in the 90+ per- chology’s legislative agenda. Geography plays no role in the cent range. Given our limited resources, it would be foolish selection of whom PLAN will support. Since PLAN to gamble our resources on candidates that not only have far resources are limited, we must marshal those resources very lower probability of getting elected, but even if they were judiciously. As a result, if a state’s congressional delegation elected would not likely serve on a committee that would be has no member serving on a Congressional Committee with of much use to Psychology, as mentioned above. jurisdiction over health care, training or educational matters, Q - I strongly favor gun control legislation and would like to see PLAN resources would likely be spent elsewhere where we AAP take a more active role in supporting candidates who firmly could get more bang for our buck. One other group of legis- advocate for gun control laws. Does AAP participate in these kinds of lators that routinely receive support from PLAN are mem- public policy matters? bers of both party’s leadership. On occasion, PLAN will A - AAP and AAP/PLAN have one very clear mission support members of Congress known as back-benchers who with regard to public policy. AAP’s goal is to support the are particularly supportive of Psychology’s issues and may election of candidates who are sympathetic to Psychology’s be influential in promoting our agenda. Of course, if we are legislative agenda, period. Although AAP members have a successful in growing the amount of money PLAN can con- wide range of personal concerns in the area of public policy, tribute, we would broaden the net of our contributions to AAP has only one concern as stated above. We would hope cover a wider range of candidates. that AAP members with strong interests outside the CAMPAIGN CONTRIBUTION DECISIONS CONTINUED ON PAGE 7 4 ADVANCE • FALL 2002 WASHINGTON UPDATE FROM THE DESK OF THE CHAIR CONTINUED FROM PAGE 1 CONTINUED FROM PAGE 3 existing laws, Sen. Schumer (D-NY) Most of us like to help those who help What we need to do to bring our profes- has proposed a new rule that would us. Members of Congress are no differ- sion front and center in the awareness of enforce the mental health provision ent. It is not a matter of buying votes or Congress is obvious. We already have and deny some funds to states that fail crooked politicians with their hands out. the academic credentials and a respected to do so. Below are the proposed rules Such persons can be found in Congress, science based discipline, what we do not that would define what mental health to be sure -- just as there are unethical have is a track record of responsible and conditions must be reported: psychologists preying on the public. sustained political giving. REQUIREMENT- The requirement However, neither instance is characteris- This is not rocket science. We either of this subsection is that the State tic of either group as a whole. Like us, play or go home and up to now, we have shall provide the name of and other most politicians want to do good things decided not to play. The frustrating relevant identifying information to benefit the public. They want to thing about all this is that we are so close relating to persons adjudicated as make a difference and to contribute to to having the income we need to be a mental defective or those committed the general enhancement of our society. player. If our 50,000 special assessment to mental institutions to the Attor- But the simple fact is that they cannot do payers committed themselves to giving ney General for inclusion in the any good for anyone without remaining just $25 per year, we would raise national instant criminal background in office. Influence and effectiveness $1,250,000, which would be second only check system. (2) DEFINITION- and ability to carry the water on impor- to physicians among all health care For purposes of paragraph (1), an tant legislation seldom adheres to fresh- provider groups! That we have not adjudication as a mental defective men legislators. The cooperative liaisons done so is a shame. That we know what occurs when a court, board, commis- and loyalties required are built carefully it takes and continue to do nothing is a sion, or other government entity over time in the everyday work of leg- tragedy. What we are doing is equiva- determines that an individual is men- islative battles. lent to committing professional suicide tally retarded or of marked subnor- If we want to be seen as a significant, by starvation. I prefer something quick- mal intelligence, mentally ill, or responsible profession willing to pay our er like becoming a taxi driver. We can mentally incompetent, including--(A) own way, then we must have our issues do better. If we do not, we have no one defendants in criminal cases adjudi- become their issues. If not, they will else to blame but ourselves: not APA, cated as not guilty by reason of help us when and as they can; which, as not Congress, not an uncaring public, insanity, or found incompetent to we have seen is not too much. Our pro- not managed care --just ourselves. It stand trial; (B) individuals who are a fessional future is in our own hands. really is that simple. Really. I danger to others as a result of a men- tal disorder or illness; (C) individu- als involuntarily committed to a mental institution by a court, board, AAP/PLAN BOARD OF TRUSTEES commission, or other authority; (D) Ronald Fox, Psy.D., Ph.D. .................................................................. Chair individuals committed because they lack the mental capacity to contract Daniel Abrahamson, Ph.D. .............................................................. Trustee or manage their own affairs; and (E) Jerry H. Clark, Ph.D. ....................................................................... Trustee individuals found to be a danger to Jean A. Carter, Ph.D. .................................................. Secretary/Treasurer themselves as a result of a mental Nanci C. Klein, Ph.D. ....................................... Trustee/Newsletter Editor disorder or illness. (3) EXCEP- Charles D. Spielberger, Ph.D. .......................................................... Trustee TION- This subsection does not Stephen M. Pfeiffer, Ph.D. ........................................... Executive Director apply to--(A) a person--(i) in a men- Karen Rivard ............................................................. Administrative Officer tal institution for observation; or (ii) All opinions expressed in this newsletter are those of the authors voluntarily committed to a mental and do not necessarily represent the opinions of the AAP Board of Trustees. institution; or (B) information pro- tected by doctor-patient privilege. (4) PRIVACY PROTECTIONS- For any information provided under the NOTICE TO READERS national instant criminal background FEDERAL LAW PROHIBITS the solicitation of non-AAP members for con- check system, the Attorney General shall work with States and local law tributions to AAP/PLAN. Any information in this publication that may enforcement and the mental health be construed as such solicitation is intended for AAP members only and should be disregarded by others. I WASHINGTON UPDATE CONTINUED ON PAGE 17 5 Our Man in Washington Robert S. Nichols, Ph.D. S.M. in Hyg. AAP Liaison to the Mental Health Liaison Group W hen Graham Greene needed a fictional man to become a spy in “Our Man in Havana”, he created represented by full-time legislative liaison/governmental relations staff members. These representatives pro- 2. We wrote, and most member organizations signed, advocacy letters on the following topics: (a) a letter to Jim Wormold, a vacuum cleaner vide very detailed and up-to-date DHHS urging tighter privacy protec- salesman who, unethically but humor- information during MHLG delibera- tions in federal laws (This letter had ously, submitted false, fictional tions. Other groups, like ours, send to be carefully worded to get consen- reports. By contrast, when AAP representatives who are not primarily sus since some MHLG provider needed a man in Washington to legislative liaison folks and whose role agencies want more access to infor- attend the meetings of the Mental is to report back to their organiza- mation while other MHLG clinical Health Liaison Group (MHLG), it tions about MHLG activities and pro- groups i.e., psychiatry, counseling, asked me to volunteer in hopes my posed decisions so their agency chiefs psychology, etc., want less access); reports would be very factual. So far, can decide which MHLG actions (b) the need to give more federal they have been. If you want to par- they wish to support. funds to states to partially relieve tially check on the accuracy of my The MHLG’s work is directed by their Medicaid budget problems; (c) reports, you can look at the MHLG an elected steering committee which endorsement of Representative web pages at www.mhlg.org. provides overall guidance and meets Kennedy’s bill for more child mental Readers may recall I described the as needed. Most of the detailed health services; (d) supporting more MHLG in the Summer, 1998 issue of MHLG work is done by two subcom- federal funds to deal with mental Advance. Briefly, it’s an informal mittees, one dealing with mental health problems after the 9/11 organization of 50 national mental health policy and the other with fed- attacks; (e) opposition to proposals health organizations who want to eral mental health budgets. The policy which would limit mental health coordinate their federal advocacy group meets monthly and the budget insurance to cover only “severe men- efforts. Memberships include (1) group meets more frequently for a tal illness”; (f) support for Senator organizations representing clinical few months each year to develop sug- Kennedy’s proposal to give health providers (e.g., psychology, social gested mental health budgets for the insurance to more workers who now work, psychiatry, psychiatric nurses, next fiscal year. I represent AAP on lack it. These and other letters sent by etc.); (2) patient advocacy groups both of these committees. The cost to the MHLG, are on the MHLG web (e.g., anxiety, depressive and manic AAP is minimal, since annual MHLG page. depressive, Tourette syndrome, atten- dues are only $200/yr. 3. The budget committee prepared a tion-deficit/hyperactivity disorders); Here is a partial list of MHLG 60 page report describing the major (3) public advocacy groups (e.g. activities during the past 12 months: federal mental health programs and Alliance for the Mentally Ill, National recommending desirable funding lev- 1. We received briefings about (a) Mental Health Association, Bazelon els for FY 2003 . This report is done the New Freedom Commission on Center for Mental Health Law) and each year and is used in advocacy Mental Health, created by President (4) provider organizations (e.g. State with legislative staffs and executive Bush to study the problems in current Mental Health Program Directors, agencies. It provides a good overall mental health services and propose Country Behavioral Health Direc- view of federal mental health activity improvements; (b) proposed improve- tors, National Council for Communi- which is helpful to many staffers. It ments in HIPAA revenue codes; (c) ty Behavioral Health Care). also suggests which programs we feel new HIPAA service codes; (d) the These groups coordinate their are most in need of increases by vary- status of the National Mental Health advocacy efforts during MHLG ing the amounts of increase we pro- Awareness Campaign; (e) legislation meetings by exchanging information, pose for each program. The full report proposed by Rep. Patrick Kennedy to receiving briefings from federal exec- is available on the MHLG web page. expand mental health services for utive and legislative staffs and various children; (f) the status of proposed 4. It organized a June 6 rally in advocacy groups, and developing pol- mental health parity legislation; (g) front of the Capitol in support of icy papers and recommendations to the serious funding shortages facing mental health parity. More than 2000 be used in advocating with federal most state Medicaid programs which people were present at noon on a very executive agencies and federal legisla- mean shortfalls for Medicaid-funded hot and very sunny day. A majority tors. Some of the organizations are mental health programs. OUR MAN IN WASHINGTON CONTINUED ON PAGE 7 6 ADVANCE • FALL 2002 CAMPAIGN CONTRIBUTION CONTINUED FROM PAGE 4 AAP Honors 2002 Q - My Congressman invited me to a fundraiser here in the state. Can I get Advocacy Award Winners AAP/PLAN to buy a ticket? A - Perhaps, but recognize that one 2002 AAP Advocacy Award of AAP’s primary goals is helping pro- vide access for Practice Organization Judith Stellar, Ph.D. lobbyists to Members of Congress on Capitol Hill. These lobbyists comprise Each year AAP honors a psychologist who has gone above the core of Psychology’s effort to influ- and beyond the call of duty in the area of political advocacy for ence legislators’ positions concerning psychology. our issues. Also very important, how- This year AAP had no trouble identifying our AAP Advocacy ever, is constituent involvement in can- Award winner, Judith Stellar, Ph.D., despite the fact that she is didates’ election campaigns. AAP rather soft spoken and her style is quite the opposite of what Judith Stellar, Ph.D. always tries to encourage this kind of one normally associates with a stereotypical fundraiser. Rebecca participation. So, from time to time Buller, the Minnesota Psychological Association’s Executive Director, says that AAP/PLAN contributes to local events Judy is the only psychologist that has this kind of passion for political advocacy in for candidates, but given our limited Minnesota and says that Judy combines tenacity with gentleness in her appeals to resources we'll be more able to afford fellow professionals. this if you and/or your colleagues con- tribute as well. I Last year, when invited to participate in the Black Tie Dinner for her own Sena- tor from Minnesota, she was at first reluctant to commit to raising even a thousand OUR MAN IN WASHINGTON dollars to come to the dinner, thinking it would be difficult to succeed based on CONTINUED FROM PAGE 6 some past experiences with local political fundraisers that she had hosted in her home. Well, after only a little prodding she committed to the dinner. Within a of legislators now say they support week or two AAP got a call from her inquiring if we could accommodate another parity but it has not been enacted into person at dinner from Minnesota because she now thought she could fund, not law. The consensus as of this writing only her own plate, but an additional one as well. Then we got another call shortly is that the success of parity is heavily thereafter asking if we could fit a third Minnesotan. In the end, Dr. Stellar raised dependent on President Bush who enough money in Minnesota to send four colleagues to the dinner. has said he favors parity but has not She was a rabid Paul Wellstone supporter before that dinner and her intensity of yet actively intervened in support of it. support has increased even more in the past year. As many AAPers know, Paul’s The American Psychological Asso- Senate race in Minnesota is thought by most pundits as likely to be the toughest ciation provides very intensive and Senate race in the nation. Judy recently completed a fundraising drive with Min- effective support to the MHLG. nesota psychologists which resulted in the Wellstone campaign adding $13,000 to Peter Newbould, from the APA Prac- its coffers, all from psychologists. That kind of success speaks for itself. tice Organization, is co-chair of the AAP has enormous respect for the work that Dr. Stellar has done in Minnesota MHLG policy committee and also on the Wellstone campaign and in setting a high standard for local fundraising arranges for a lot of background efforts everywhere. administrative support. Ellen Garri- son of the Public Policy Directorate 2002 AAP Media Award and Doug Walter of the Practice Mary Ann Childers Organization also are involved on many issues. In addition, many of the For the past three years AAP has recognized the valuable MHLG meetings take place in the contribution that members of the media have made in promot- APA building. Those APA members ing the public’s perception of mental health by awarding AAP’s who fund the Practice Organization Media Award to distinguished journalists. The first two hon- should be particularly aware that the orees in this category were both members of the print media. MHLG is one of the many important This year we were particularly pleased that our award winner activities supported by their special Mary Ann Childers was a broadcast journalist. assessment contributions. AAP selected Mary Ann Childers for this honor because she sets a high standard If you have questions about the for one who is dedicated to her profession. She is currently the co-anchor for the MHLG, I can be reached at DrRobt- AAP ADVOCACY AWARDS Nich@aol.com. I CONTINUED ON PAGE 9 7 APA Selects New CEO N orman B. Anderson, PhD, became the CEO-Elect of the American Psychological Association funding initiatives totaling over $90 million in five years. New Investigator Award from the Society of Behavioral Medicine, (2) the 1991 Award for Outstanding The success of the Office prompted on September 1, 2002. He will Congress to triple its budget, enabling Contributions to Health Psychology become CEO on January 1, 2003, it to have greater latitude in develop- from the American Psychological with the retirement of current CEO ing NIH-wide funding activities. Association, and (3) a Research Sci- Raymond D. Fowler, PhD. Before leaving NIH, Dr. Anderson entist Development Award from the Trained as a practitioner and a sci- initiated several activities to help National Institute of Mental Health. entist, Dr. Anderson has dedicated guide future funding directions in the Dr. Anderson is a Fellow of the much of his professional life to study- social and behavioral sciences, includ- American Psychological Association, ing the relationships between health ing reports on social and cultural the American Psychological Society, and behavior and health and race. the Society of Behavioral Medi- His priorities at APA will include cine, and the Academy of Behav- bringing psychology’s broad Appointed by then NIH Director ioral Medicine Research and is a expertise to healthcare, the public Past-President of the Society of and policy makers, and to Dr. Harold Varmus in 1995, Behavioral Medicine. Currently, expanding the role of psycholo- he is President of the Board of the gists in our nation’s healthcare Dr. Anderson worked closely Directors for filmmaker Steven system, the workplace, and edu- Spielberg’s STARBRIGHT Foun- cation. with the scientific community dation of Los Angeles. He is also Prior to joining APA, Dr. nationally to quickly establish on the Advisory Committee for Anderson was Professor of Public Issues for the Advertising Health and Social Behavior at the the Office’s long-term goals and Council, on the Advisory Council Harvard University School of for the National Institute on Drug Public Health, where his interests to develop strategies for Abuse at NIH and currently chairs the National Academy of Science centered on health disparities and achieving them, resulting in Panel on the Future of Research mass media approaches to public health. He is widely known as the first OBSSR Strategic Plan. on Race, Ethnicity, and Health in the former Associate Director of Later Life. the National Institutes of Health He is also Editor-in-Chief of the (NIH) and the first Director of the forthcoming Encyclopedia of Health NIH Office of Behavioral and Social dimensions of health and religion, and Behavior. In addition, Anderson Sciences Research (OBSSR). At spirituality and health, and commis- and his wife, health and fitness writer NIH, he was charged with facilitating sioning the National Academy of Sci- P. Elizabeth Anderson, will release behavioral and social sciences ence’s report on the future of behav- their co-authored book, Emotional research across all of the [then] 24 ioral and social sciences research Longevity: What Really Determines Institutes and Centers of the National (New Horizons in Health Science: How Long You Live, in early 2003. Institutes of Health. Under his An Integrative Approach, National A graduate of the North Carolina purview was behavioral and social Academy Press). Central University in Durham, NC, research in such areas as cancer, heart Prior to going to NIH, Dr. Ander- Anderson earned master’s and doctor- disease, mental health, diabetes, son was Associate Professor in the al degrees in clinical psychology from aging, and oral health. Department of Psychiatry and Psy- the University of North Carolina at Appointed by then NIH Director chology: Social and Health Sciences Greensboro. He received additional Dr. Harold Varmus in 1995, Dr. at Duke University. There he studied clinical and research training at the Anderson worked closely with the the role of stress in the development Schools of Medicine at Brown and scientific community nationally to of hypertension in African Americans Duke Universities, including a post- quickly establish the Office’s long- and directed the NIH-funded doctoral fellowship in psychophysiol- term goals and to develop strategies Exploratory Center for Research on ogy and aging at Duke. Dr. Ander- for achieving them, resulting in the Health Promotion in Older Minori- son is licensed to practice psychology first OBSSR Strategic Plan. Under ties. He received several awards for in two states: Maryland and North his leadership, the Office organized his research, including: (1) the 1986 Carolina. I 8 ADVANCE • FALL 2002 AAP ADVOCACY AWARDS CONTINUED FROM PAGE 7 APA Practice Directorate Chicago CBS morning news and for Pursues Resolution of CPT the 11 am news. Throughout her career, she has been widely recog- Code Reimbursement Problems nized for field reporting from around the world. Stationed in Israel, Mary Ann Childers was the first Chicago television reporter to file from the S ince the January 1, 2002 imple- mentation of the six new CPT health and behavior assessment and Practice Directorate interventions with the Federal government and private insurance carriers: Persian Gulf during the War in 1991. intervention codes (96150 – 96155), From the outset, the Practice In addition, she has reported from the APA Practice Directorate has vig- Directorate has successfully worked Africa, Central America and Great ilantly tracked and actively attempted with CMS to correct problems with Britain. Childers is best known for to resolve payment issues with the new codes. her medical reporting, which has Medicare and insurance carriers. The included accompanying a team of NEW YORK Practice Directorate is using all possi- plastic surgeons from the University The Practice Directorate staff and ble means to resolve payment prob- of Illinois to Guatemala to perform Eric Garfinkel, a New York psychol- lems and to ensure that psychologists facial reconstructions on children ogist, met with the Carrier Medical are promptly reimbursed for their with birth defects. Director of Empire Medicare Ser- services. From AAP’s perspective, her con- vices (carrier for lower New York Coverage of the codes under the tributions to mental health issues are State), and he has confirmed to the Federal Medicare program: most meaningful. She is an active Practice Directorate that the carrier The Centers for Medicare and Medic- member of the Mental Health Associ- will reimburse a psychologist for pro- aid Services (CMS) have stated that ation of Illinois’ Board of Trustees. viding services under the codes. The Medicare will cover five of the six When we were discussing Mary Ann Practice Directorate is continuing to health and behavior codes. CMS list- with Jan Holcomb of the Illinois work with the New York State Psy- ed the codes and their respective val- Mental Health Association, she was chological Association to address ues in the 2002 Physician Fee Sched- most impressed by the way Mary Ann problems with another Medicare car- ule published in the November 1, uses her influence with CBS to rier (Upstate) in New York. 2001 Federal Register with a designa- always make sure that mental health CALIFORNIA tion that the codes were “active” and issues are well covered, no easy feat therefore billable for covered services Northern California: The Practice as anyone who has ever tried to get provided on or after January 1, 2002. Directorate staff contacted the med- coverage for mental health matters on Specific problems addressed ical director who stated that the carri- TV knows. Drs. Terry Koller and by the Practice Directorate: er should not be denying psycholo- Nancy Molitor of the Illinois Psycho- Psychologists in six states have noti- gists reimbursement for services cap- logical Association have the highest fied the Practice Directorate of claims tured by the new codes solely on the regard for Mary Ann’s work and her denied under the codes. The informa- basis that a psychologist provided the support of their issues. tion sent revealed that the denials fell service. The medical director said he Mary Ann is married to Jay would advise his staff that the denials into three categories. In the largest Levine, the Chief Correspondent for of these codes solely on the basis that category, occurring in four of the CBS evening News in Chicago. the provider of services is a psycholo- six states, the denials stated that a Together they offer psychology gist is inappropriate and this practice psychologist was not the appropriate opportunities to make input and should stop. type of provider for these services. impact a major media market in the In the second category, claims were Southern California: The office of greater Chicago area. denied because they did not include a the medical director informed the It was with great appreciation and referral from a physician. In the third Practice Directorate that health and respect for her contributions to the category, denials stated only that the behavior services provided by psy- field of mental health that AAP hon- services were not covered. In each of chologists would be paid as long as ored Mary Ann Childers with the these cases the denial was inappropri- the code included the appropriate 2002 AAP Media Award. I ate. modifier (AH). CPT CODE REIMBURSEMENT PROBLEMS CONTINUED ON PAGE 15 9 THE AAP AT WORK CHICAGO, ILLINOIS AAP’s annual Century Club Reception was held high above Chicago on the 80th floor of the old Amoco Building (now the Aon Building.) in the Mid-America Club. Unlike the experience of five years ago which was punctuated by torrential rain, thunder and light- ning, this year’s event took place under clear skies and afforded attendees spectacular views of the entire Chicago area. The real highlight of the evening, howev- er, was the fact that history was once again made in psy- chology’s political advocacy program. Only ten years Congressman Brian Baird (D-WA); State Senator Tim ago, the first psychologist elected to Congress, Dr. Ted Murphy (R-PA), U.S. Congressional Candidate; Strickland (D-OH), was introduced to national Psy- Congressman Ted Strickland (D-OH). chology at the Century Club Reception held in Wash- ington, D.C with a good deal of fanfare. Four years later he was joined by Congressional candidate/psychol- ogist, Dr. Brian Baird (D-WA) at the same event in Toronto and AAPers were ecstatic. This year, a third psychologist will be elected to Congress, Dr. Tim Mur- phy (R-PA), and Psychology’s successes are palpable. All three spoke at the reception and were honorees at a Leadership Circle Dinner held to benefit their cam- paigns following the reception. It was quite apparent in listening to them speak from the podium that Psycholo- gy has been and will continue to be well represented on Capitol Hill by these three fine legislators. With the Marilyn Richmond, Assistant Executive Director addition of Dr.Tim Murphy, Psychology will also now of APA Practice Organization Government have representation on both sides of the political aisle. Relations Office, Deanna Yates, President-elect Psychology’s future in legislative advocacy looks of the Texas Psychological Association. brighter, indeed, as the election of these three individu- als appears to be imminent. I Phil Zimbardo, APA President, and Brian Baird (D-WA). Major Debra Dunivin, Russ Newman, Director of APA’s Practice Directorate, and Ted Strickland (D-OH). 10 ADVANCE • FALL 2002 Elizabeth Robinson, Christina Maslach, and Ruth Paige, former APA BoD member. Mike Roberts, APA Ethics Committee member and Tim Murphy (R-PA). Sally Horwatt, and Arthur Kovacs, Div. 42 APA Council Rep. Nina Thomas, New Jersey APA Council Rep., Carol Goodheart, APA BoD member. Jerry Clark, AAP BoD member, and Mae Lee Billet-Ziskin, California APA Council Rep. Rudy Nydegger, New York State Psychological Assn. President, June Feder, NYSPA Disaster Response Coordinator and Gayle O’Brien, NYSPA Executive Director. 11 Why do these psychologists actively support AAP? Philip Zimbardo, Ph.D. Dorothy Cantor, Ph.D. Charles D. Spielberger, Ph.D. Norine Johnson, Ph.D. Ronald Fox, Ph.D. Because they want to stop Managed Care’s destruction of mental health treatment. Because they want to broaden the impact of the Mental Health Parity Act passed by Congress. Because they want to influence the health-care legislation Congress is poised to enact that will have far-reaching consequences for psychologists. The Association for the Advancement of Psychology (AAP) is psychology’s ONLY organization providing campaign support to federal political candidates (APA is precluded from this activity by its federal tax-exempt status). AAP operates a bi-partisan political action committee, PLAN, which supports the political campaigns of candidates sympathetic to the concerns of psychologists and was ranked by the Center for Responsive politics in the top 15% of all health care PACs. Psychology’s influence in shaping future health care legislation depends on your support. Join thousands of your colleagues. Brian Baird, Ph.D. Become an AAP member today! Ted Strickland, Ph.D. U.S. Congressman U.S. Congressman M E M B E R S H I P A P P L I C A T I O N Please complete this form and mail to Association for the Advancement of Psychology: P.O. Box 38129, Colorado Springs, Colorado 80937 • Fax: 719/520-0375 PAYMENT: Ì All Individual Members ($95.00) $_____________ Ì Sponsoring Organizations ($150.00) $_____________ I All dues are annual. I All checks should be made payable to AAP. NAME _____________________________________________________________________________________________ I Your AAP dues may be ADDRESS _________________________________________________________________________________________ paid by a corporate check and may be CITY/STATE/ZIP ___________________________________________________________________________________ partially deductible as a business expense for If paying by credit card: Ì VISA® Ì MasterCard® federal tax purposes. CARD NUMBER __________________________________________________ EXPIRATION DATE _____________ I AAP dues are not deductible as SIGNATURE _______________________________________________________________________________________ charitable AREAS OF PRIMARY CONCERN (Please rank numerically. Ten being best.) contributions for Ì PRACTICE _____ Ì SCIENCE _____ Ì PUBLIC INTEREST _____ Ì EDUCATION _____ federal income Call or visit our website: 1-800-869-6595 / www.aapnet.org ADVANCE • FALL 2002 AMA Vows to Prevent Future Psychologist Prescribing Laws When it appeared that the original non-M.D.s and for the AMA to work T he American Psychiatric Associa- tion’s (Apa) efforts at increasing the influence of psychiatry in the resolution might be sidetracked by concerns about the ability of state at the invitation of component soci- eties to develop strategies concerning AMA achieved some success at the medical societies to set their own leg- the expansion of scope of practice. organization’s annual meeting in islative agendas, delegate John McIn- Also, the AMA agreed to increase Chicago in June, 2002. Apa and the tyre, M.D., a former Apa president, its staff support directed to scope of American Academy of Child and met with the NMMS delegation to practice issues. James Scully, M.D., Adolescent Psychiatry (AACAP) develop a substitute resolution that chair of the Section Council on Psy- introduced a resolution calling on the ultimately received the support of that chiatry and the senior delegate, said, AMA to investigate the facts leading delegation, the appropriate AMA ref- “Dr. McIntyre did a brilliant job in to the passage of HB 170, the law erence committee, and the House of creating a joint resolution with the granting prescribing authority to psy- Delegates. McIntyre testified before New Mexico delegation. We received chologists in New Mexico. the reference committee on legislation overwhelming support concerning The resolution also called for the that granting prescribing privileges to scope of practice from other state and AMA to develop a mechanism to psychologists would “undermine the specialty societies.” Scully is the resolve any future policy and/or fabric of medical education.” Alexander G. Donald Professor and strategic differences among the spe- Louis Kraus, M.D., the alternate chair of the department of neuropsy- cialty societies and state and county delegate from AACAP, spoke about chiatry and behavioral science at the medical associations represented the complexities of prescribing for University of South Carolina School within the AMA’s House of Dele- children, saying, “The concept that of Medicine. The Section Council on gates. This provision was a response psychologists would be able to treat Psychiatry is composed of the dele- to the fact that the New Mexico Med- children safely is unfathomable.” gates and alternate delegates of Apa ical Society (NMMS) had not Among other provisions, the final and AACAP, along with invited rep- opposed HB 170, despite the legisla- resolution calls for the AMA to work resentatives of allied psychiatric tion’s conflict with AMA policy and with specialty societies to monitor the organizations. I the wishes of its members as indicated status of initiatives that would permit by an online survey. prescribing by psychologists or other HIPAA Privacy Rule Modifications Finalized paying claims. Instead, providers will have to notify patients of T he Department of Health and Human Services on August 14, 2002 published final modifications to the HIPAA Privacy Rule. On August 9, 2002, the Bush administration formally rolled their remaining rights and have to make “a good-faith effort to obtain a written acknowledgment of receipt of the notice.” back some major protections for the privacy of medical records The Times further reports that the secretary of health and adopted by President Bill Clinton. At the same time, it also set human services, Tommy G. Thompson, said the rules struck a new standards for the use of personal information to market pre- common-sense balance. “The prior regulation, while well inten- scription drugs and other health care products. tioned, would have forced sick or injured patients to run all around The new rules, the first comprehensive federal standards for town signing consent forms before they could get care or medi- medical privacy, will affect virtually every doctor, patient, hospital, cine,” Mr. Thompson said. drugstore and health insurance company in the United States. Administration officials made the change despite opposition The rules, the final version of changes proposed in March, from consumer advocates, patients’ rights groups and several embody more than five years of work and have the force of law. provider groups. Most health care providers and insurers have to comply by April The APA Practice Organization submitted comments on the 14, 2003, or face civil and criminal penalties, including a $250,000 proposed modifications that are most relevant to practicing psy- fine and 10 years in prison for the most serious violations. chologists, including elimination of the patient consent require- According to a report in the Sunday, August 10, 2002 New York ment, as well as reiteration of the importance of the psychotherapy Times, the Bush administration decided to abandon the core of the notes patient authorization requirement and the “minimum neces- Clinton rules, a requirement that doctors, hospitals and other sary” requirement. The Practice Organization comments are avail- health care providers obtain written consent from patients before using or disclosing personal medical information for treatment or HIPAA PRIVACY RULE MODIFICATIONS FINALIZED CONTINUED ON PAGE 14 13 EXECUTIVE DIRECTOR’S COLUMN CONTINUED FROM PAGE 3 today, the highest percentage between July rejected four competing Medicare sary” include only 19% of physicians and 1993 and 2002. drug benefit bills. The House passed a smaller percentages of all other groups The survey concluded that a majority Republican-sponsored bill that included a surveyed. of those interviewed did not have a good Medicare drug benefit in June. Efforts to The survey provides other indicators opinion of the health care system as it is negotiate a compromise in the Senate are that the public’s sentiment for change of now. In addition, the survey predicted a hampered by how to reconcile Senator America’s deteriorating health care sys- big push for reform as employers and Grassley's (R-IA) determination to have tem is moving in the right direction. health plan managers have become more private health plans run a drug benefit Chief among the reasons why we may hostile toward the system in 2002 than in with Senator Kennedy's (D-MA) goal of expect to see a big push for health care past. offering uniform Medicare coverage to all reform on the horizon after the elections is seniors. On another front, physicians and the finding that employers are more hos- Despite these poll results, it is not likely other Medicare providers are turning up tile toward the system now than they that we will be popping any champagne the pressure for a bill that would reverse were in any of the Harris Polls’ previous corks this Fall over health care reform. Medicare reimbursement cuts scheduled surveys. So too are health plan managers. Congress has had a full plate of health to take effect this fall. Under changes care issues with which they have strug- The public also appears to have a con- mandated by the 1997 Balanced Budget gled since the beginning of the year siderable appetite for health care reform, Amendment, home health agencies face a including among others, Medicare even if the radical change score is lower 15% cut in their Medicare payments on reform, patients' rights and the growing than it was in some previous years, partic- October 15. In addition to these, generic numbers of uninsured. It is highly unlike- ularly in the early 1990s. But only 17% of drugs, medical malpractice, and the ly that anything of substance will emerge the public thinks that the system works perennial issue of the uninsured continue in any of these areas during the shortened pretty well and only minor changes are to be hot topics of debate and a fair session of Congress now underway prior necessary. Almost twice as many (31%) amount of rhetoric inside the beltway. to the Fall elections. Needless to say, our think that we need to completely rebuild own mental health parity legislation may The bad news is that legislators in the system, with almost everyone else experience a similar fate in the short term, Washington are still deeply scarred by the (49%) thinking that fundamental despite the public statements made by 1994 debate and defeat of the Clinton changes are needed. President Bush last Spring about the health care reform proposal which has I am betting that the 108th Congress, importance of passing such a measure. rendered them nearly incapable of tack- regardless of which party ends up in con- Even though an august newspaper, the ling the big picture of health care reform. trol of either house and despite the politi- Washington Post, published an editorial The good news is that only very small cal danger surrounding health care on September 9th, reversing its former minorities of any of the five groups sur- reform, will have no choice but to begin position on mental health parity and now veyed in the Harris research (the public, substantial reform of the system. Let’s urging its passage, hope remains dim for physicians, employers, health plan man- make sure that Psychology will be at the Fall legislation. The likelihood of passing agers, and hospital managers) hold a good table to participate in the decision making related health reform measures is also tenu- opinion of the health care system as it is process. Talk to your friends and col- ous, at best. now. Those who believe that “on the leagues and make sure they join you in whole the health care system works pretty To illustrate how problematic health supporting AAP. I well and only minor changes are neces- care issues are in Congress, the Senate in HIPAA PRIVACY RULE MODIFICATIONS CONTINUED FROM PAGE 13 HIPAA PRIVACY RULE MODIFICATIONS able for review at http://www.apa.org/practice/privacy_302.html. activities of the third party, without the individual's authorization. The following information summarizes the final modifications as The Rule clarifies that doctors and other covered entities commu- defined by the Department of Health and Human Services: nicating with patients about treatment options or the covered enti- ty's own health-related products and services are not considered Marketing -- The final Rule requires a covered entity to obtain marketing. For example, health care plans can inform patients of an individual's prior written authorization to use his or her protect- additional health plan coverage and value-added items and servic- ed health information for marketing purposes except for a face-to- es, such as discounts for prescription drugs or eyeglasses. face encounter or a communication involving a promotional gift of nominal value. The Department defines marketing to distinguish Consent and Notice -- The Department makes changes to pro- between the types of communications that are and are not market- tect privacy while eliminating barriers to treatment by strengthen- ing, and makes clear that a covered entity is prohibited from selling ing the notice requirement and making consent for routine health lists of patients and enrollees to third parties or from disclosing care delivery purposes (known as treatment, payment, and health protected health information to a third party for the marketing HIPAA PRIVACY RULE MODIFICATIONS FINALIZED CONTINUED ON PAGE 15 14 ADVANCE • FALL 2002 CPT CODE REIMBURSEMENT PROBLEMS CONTINUED FROM PAGE 9 TEXAS ments made to a psychologist for (serving Wisconsin, Illinois, Michi- When Trailblazer, the Medicare health and behavior services. The gan, and Minnesota) has confirmed to carrier in Texas, stated in its Novem- Practice Directorate argued on the the Practice Directorate that it will ber 2001 newsletter that the new patient’s behalf that the plan’s cover- reimburse psychologists for providing codes would not be covered, the Prac- age of the patient’s physical health services under the codes. tice Directorate immediately contact- problem should include behavioral The Practice Directorate is also ed CMS. The CMS regional office interventions. The Practice Direc- voicing objections directly to each of in Dallas resolved the problems with torate learned recently that Carefirst the insurance carriers that have Trailblazer soon after the request. reversed its denial and reimbursed the denied psychologists reimbursement Trailblazer, which is also the patient for behavioral intervention under the new codes. A letter from Medicare carrier in Maryland, services. the Practice Directorate, outlining the Delaware, and Virginia, corrected its The Practice Directorate’s ongoing errors in each denial, whether the initial notice and is now paying psy- efforts to secure payment for the claim involves Medicare or a private chologists for services under the codes: insurance plan, is going to the medical codes. The Practice Directorate is contin- director of each insurance carrier, GEORGIA, MINNESOTA, uing its work to obtain reimburse- instructing them to revise their prac- MISSISSIPPI AND OHIO ment for psychologists providing tices as soon as possible. After psychologists in these states health and behavior services. At this Ongoing outreach to psychologists were denied payment the Practice time Practice Directorate staff is and the State Psychological Associ- Directorate sent a letter to each carri- engaged in discussions with CMS and ations: er’s medical director explaining the the local Medicare carrier in Florida The Practice Directorate will con- value of the codes and asking that the to resolve coverage issues. The carri- tinue to work with individual psy- denials be reviewed. Shortly there- er’s medical director recently chologists and the State Psychological after the carriers informed the Prac- informed Practice Directorate staff Associations to address reimburse- tice Directorate that the denials were that he fully expects psychologists to ment problems pertaining to the new due to computer problems that have utilize the new codes but is looking to health and behavior codes. Anyone now been corrected. In Ohio, Dr. CMS for additional guidance con- encountering problems in billing the Alice Randolph helped gain reim- cerning coverage of the services. codes, either in independent practice bursement for psychologists through In Pennsylvania and Washington or through work in an institution her direct outreach to the local carri- State, the Practice Directorate has such as a hospital or medical center, is er. contacted the local Medicare carriers asked to notify the Government Rela- MARYLAND (Private insurance about denied claims and is working tions office at 202 / 336 - 5889. through FEHBP) along with the respective State Psy- More information about the codes chological Associations to resolve can be found on the Practice Direc- A beneficiary under the Federal these problems as soon as possible. torate’s website at www.apa.org/prac- Employees Health Benefits Plan offered by Carefirst Blue Cross Blue The medical director of another tice/cpt_2002.html. I Shield sought reimbursement for pay- carrier, Wisconsin Physician Services HIPAA PRIVACY RULE MODIFICATIONS CONTINUED FROM PAGE 14 care operations) optional. The Rule requires covered entities to Uses and Disclosures Regarding Food and Drug Adminis- provide patients with notice of the patient's privacy rights and the tration (FDA)-Regulated Products and Activities -- The final privacy practices of the covered entity. The strengthened notice Rule permits covered entities to disclose protected health infor- requires direct treatment providers to make a good faith effort to mation, without authorization, to a person subject to the jurisdic- obtain patient's written acknowledgement of the notice of privacy tion of the FDA for public health purposes related to the quality, rights and practices. The final Rule promotes access to care by safety or effectiveness of FDA-regulated products or activities removing mandatory consent requirements that would inhibit such as collecting or reporting adverse events, dangerous prod- patient access to health care while providing covered entities with ucts, and defects or problems with FDA-regulated products. This the option of developing a consent process that works for that assures that information will continue to be available to protect entity. The Rule also allows consent requirements already in place to continue. HIPAA PRIVACY RULE MODIFICATIONS FINALIZED CONTINUED ON PAGE 17 15 Ad 16 ADVANCE • FALL 2002 WASHINGTON UPDATE CONTINUED FROM PAGE 5 community to establish regulations and protocols for pro- tions Office chairs a MHLG committee that has been trying to tecting the privacy of information provided to the system. inform people about these new regulations and how best to (5) STATE AUTHORITY- Notwithstanding any other pro- comply with them. The APA Practice Organization has also vision of this subsection, a State may designate that records provided good briefing material for psychologists. transmitted under this subsection shall be used only to • A briefing on mental health parity (S543) by Ellen Gerrity, determine eligibility to purchase or possess a firearm. Ph.D., a member of Senator Paul Wellstone's staff. The brief- The bill has strong support among liberals and also among ing included both good news and not-so-good news about conservatives and Senator Ted Kennedy has also indicated his S543. The good news is that the bill is now supported by 67 support, apparently without realizing the problems presented Senators, 243 Representatives and over 250 organizations, by the mental health provisions. Those provisions are now con- including many that are not primarily involved in mental health tained in an unenforced federal regulation but in the future advocacy. President Bush has also said he favors parity. The would be contained in the law itself. bad news is that no action has been taken on the bill in either From a mental health perspective, the bill has many prob- the Senate or the House. In the Senate, more support has lems: (1) the definitions of mental health problems are very been garnered by negotiating with former opponents to remove broad and sometimes very vague; (2) there are not enough some of the more "objectionable" parts of the bill. Dr. Gerrity guarantees that the lists will not become public; (3) existence did not give many specifics on these negotiations. However, of the list may make mental health patients more unwilling to she did say Wellstone will stand firm on not allowing a cost admit problems and accept treatment; (4) there is no good pro- exemption clause beyond the CBO figure of 0.9% which is its vision for people to get off the list once they go on it. There is estimate of the probable additional cost of parity. Senator Well- also some concern about the fact that the bill would provide stone is also are holding firm on making all currently covered $375 million to create these lists, but offers no treatment money DSM conditions eligible for care and not just SMI/SED condi- whatever, at a time when new mental health dollars are very tions. Dr. Gerrity pointed out that including all currently cov- hard to get. ered DSM conditions does not add much to the total costs which come mostly from the more expensive care needed for • Proposed letter to Sen. Baucus, chair of the Senate SMI/SED. Finance Committee, asking that copayments for Medicare mental health services be reduced from the present 50% to Action on the bill is delayed in part because the Congress is 20% as it is for all other medical conditions. So far, 29 organi- very busy dealing with homeland security reorganization and zations have signed on, including AAP. the possible campaign against Iraq. It is not known when the Senate leadership will bring up the bill for action. While Bush • A quick briefing by Jim Pyles, a lawyer representing the has said he favors parity he has not taken any specific action American Psychoanalytic Association. He pointed out that supporting it. There have been some proposals to add parity the new HIPAA rules that begin to go into effect on 15 Octo- language to an appropriations bill. That has failed in the past ber, and are finally fully effective on 14 April 2003, essentially but it remains a possibility now. destroy the right of clients to refuse release of their confidential medical information. He indicated the new federal HIPAA Dr. Gerrity did not have much information regarding regulations may be challenged on the basis that they violate prospects in the House of Representatives. She spent consid- constitutional provisions (4th and 5th Amendments) and con- erable time thanking us for past support and urging more sup- tradict judicial decisions granting privacy for mental health port in the future. She suggested we contact people who have data. They are also open to challenge on the grounds that there said they support the bill but have not taken active advocacy were procedural irregularities in the way the regulations were roles (such as some administration folks) and urge them to do formulated. Meanwhile they will be enforced on more than more. She will try to give us 48 hours advance notice when 600,000 providers, both individual and organizational. Doug the bill is finally called up for action so we can get our advoca- Walter from APA Practice Organization Government Rela- cy folks busy. I HIPAA PRIVACY RULE MODIFICATIONS CONTINUED FROM PAGE 15 public health and safety, as it is today. may keep patient charts at bedside, doctors can talk to patients in Incidental Use and Disclosure -- The final Rule acknowledges semi-private rooms, and doctors can confer at nurse's stations that uses or disclosures that are incidental to an otherwise permit- without fear of violating the rule if overheard by a passerby. ted use or disclosure may occur. Such incidental uses or disclo- Authorization -- The final Rule clarifies the authorization sures are not considered a violation of the Rule provided that the requirements to the Privacy Rule to, among other things, eliminate covered entity has met the reasonable safeguards and minimum necessary requirements. For example, if these requirements are HIPAA PRIVACY RULE MODIFICATIONS FINALIZED met, doctors' offices may use waiting room sign-in sheets, hospitals CONTINUED ON PAGE 19 17 Ad 18 ADVANCE • FALL 2002 HIPAA PRIVACY RULE MODIFICATIONS CONTINUED FROM PAGE 17 separate authorization requirements for covered entities. Patients recipient entering into a data use agreement, in which the recipient will have to grant permission in advance for each type of non-rou- would agree to limit the use of the data set for the purposes for tine use or disclosure, but providers will not have to use different which it was given, and to ensure the security of the data, as well as types of forms. These modifications also consolidate and streamline not to identify the information or use it to contact any individual. core elements and notification requirements. Other provisions: Minimum Necessary -- The final Rule exempts from the mini- • Hybrid Entities -- The final Rule permits any entity that per- mum necessary standards any uses or disclosures for which the cov- forms covered and non-covered functions to elect to use the hybrid ered entity has received an authorization. The Rule previously entity provisions and provides the entity additional discretion in des- exempted only certain types of authorizations from the minimum ignating its health care components. necessary requirement, but since the rule will only have one type of • Health Care Operations: Changes in Legal Ownership -- The authorization, the exemption is now applied to all authorizations. final Rule clarifies the definition of "health care operations" to allow Minimum necessary requirements are still in effect to ensure an indi- a covered entity who sells or transfers assets to, or consolidates or vidual's privacy for most other uses and disclosures. merges with, an entity who is, or will be, a covered entity upon com- The Department clarifies in the preamble that the minimum nec- pletion of the transaction, to use and disclose protected health infor- essary standard is not intended to impede disclosures necessary for mation in connection with such transaction, which include due dili- workers' compensation programs. The Department will actively gence and transferring records containing protected health informa- monitor to ensure that worker's compensation programs are not tion as part of the transaction. unduly affected by the Rule. • Group Health Plan Disclosures of Enrollment and Disenroll- Parents and Minors -- The final Rule clarifies that state law, or ment Information -- The final Rule allows a group health plan, a other applicable law, governs in the area of parents and minors. health insurance issuer, or HMO acting for a group health plan to Generally, the Privacy Rule provides parents with new rights to disclose to a plan sponsor, such as an employer, information on control the health information about their minor children, with limit- whether the individual is enrolled in or has disenrolled from a plan ed exceptions that are based on state or other applicable law and offered by the sponsor without amending the plan documents. professional practice. For example, where a state has explicitly • Accounting of Disclosures -- The final Rule exempts disclosures addressed disclosure of a minor's health information to a parent, or made pursuant to an authorization from the accounting require- access to a child's medical record by a parent, the final Rule clarifies ments. The authorization process itself adequately protects individ- that state law governs. In addition, the final Rule clarifies that, in the ual privacy by assuring that the individual's permission is given both special cases in which the minor controls his or her own health infor- knowingly and voluntarily. The final Rule also exempts from the mation under such law and that law does not define the parents' accounting requirements incidental disclosures, and disclosures that ability to access the child's health information a licensed health care are part of a limited data set. The Rule provides a simplified alterna- provider continues to be able to exercise discretion to grant or deny tive approach for accounting for multiple research disclosures that such access as long as that decision is consistent with the state or includes providing a description of the research for which an indi- other applicable law. vidual's protected health information may have been disclosed and Business Associates -- The final Rule gives covered entities the researcher's contact information. (except small health plans) up to an additional year to change exist- • Disclosure for Treatment, Payment, or Health Care Operations ing written contracts to come into compliance with the business of Another Entity-- The final Rule clarifies that covered entities can associate requirements. The additional time will ease the burden of disclose protected health information for the treatment and payment covered entities renegotiating contracts all at once. The Department activities of another covered entity or a health care provider, and for has also provided sample business associate contract provisions. certain health care operations of another covered entity. Research -- The final Rule facilitates researchers' use of a single • Protected Health Information: Exclusion for Employment combined form to obtain informed consent for the research and Records -- The final Rule clarifies that employment records main- authorization to use or disclose protected health information for tained by a covered entity in its capacity as an employer are exclud- such research. The final Rule also clarifies the requirements relating ed from the definition of protected health information. The modifica- to a researcher obtaining an IRB or Privacy Board waiver of tions do not change the fact that individually identifiable health authorization by streamlining the privacy waiver criteria to more information created, received, or maintained by a covered entity in closely follow the requirement of the "Common Rule," which gov- its health care capacity is protected health information. erns federally funded research. The transition provisions have been expanded to prevent needless interruption of ongoing research. The final Rule also includes technical corrections and additional clarifications related to various sections of the existing rule. The Limited Data Set -- The final Rule permits the creation and dis- final Rule is designed to ensure that protections for patient privacy semination of a limited data set (that does not include directly identi- are implemented in a manner that maximizes privacy while not fiable information) for research, public health, and health care oper- compromising either the availability or the quality of medical ations. In addition, to further protect privacy, the final Rule condi- care. I tions disclosure of the limited data set on a covered entity and the 19 CONTRIBUTORS HONOR ROLL PSYCHOLOGISTS FOR LEGISLATIVE ACTION NOW Leadership Circle—$1,000 Sally Singer Horwatt, Ph.D. Sharon L. Greenburg, Ph.D. Jean A. Carter, Ph.D. Norine G. Johnson, Ph.D. Frederic C. Hartman, Ph.D. Philip Chanin, Ed.D. Harvey P. Kaufman, Ed.D. Sabra Stair Hassel, Ph.D. Jerry H. Clark, Ph.D. W. Criss Lott, Ph.D. Emily Herbert, Ph.D. Nicholas A. Cummings, Ph.D. C. Gerald O'Brien, Ph.D. Kalman M. Heller, Ph.D. John Flora-Tostado, Ph.D. Terry J. Orme, Ph.D. Veronica Hoegler, Ph.D. Louise Jeffrey, Ph.D. Sheila A. Schuster, Ph.D. Russell M. Holstein, Ph.D. Arthur L. Kovacs, Ph.D. Edward S. Sczechowicz, Ph.D. Bruce A. Howard, Ph.D. Lance T. Laurence, Ph.D. Peter L. Sheras, Ph.D. Clifford A. Johannsen, Ph.D. Michael C. Markovitz, Ph.D. Patron’s Court—$250 Jennifer F. Kelly, Ph.D. Richard W. Millard, Ph.D. Norman Abeles, Ph.D. Cheryl A. Kilpatrick, Ph.D. Louis F. Mortillaro, Ph.D. Daniel J. Abrahamson, Ph.D. Nanci C. Klein, Ph.D. Rosemarie S. Moser, Ph.D. Laurence Abrams, Ph.D. Alex H. Levi, Ph.D. Russell S. Newman, Ph.D. David H. Barlow, Ph.D. Micki Levin, Ph.D. Ruth Ochroch, Ph.D. Rhoda Baruch, Ph.D. Robert K. Madsen, Ph.D. Stephen M. Pfeiffer, Ph.D. E. Paul Bayon, Psy,D. William J. McCann, Psy.D. Herman Rummelt, Ph.D. J. Gilbert Benedict, Ph.D. John C. Meidlinger, Ph.D. Reuben J. Silver, Ph.D. Mary Kathryn Black, Ph.D. K. Daniel O'Leary, Ph.D. Charles D. Spielberger, Ph.D. Gayle R. Berg, Ph.D. Nathan W. Perry, Ph.D. Gilbert S. Spitzer, Ph.D. R. M. Binderman, Ph.D. Carol Randolph, Ph.D. Deanna F. Yates, Ph.D. William P. Bryant, Ph.D. Anthony M. Ricci, Ph.D. Benefactor’s Circle—$500 William L. Buchanan, Ph.D. Elizabeth A. Robinson, Ph.D. Judith E. N. Albino, Ph.D. Linda Padou Burkett, Ph.D. Morgan Sammons, Ph.D. Margaret Beekman, Ph.D. J. Paul Burney, Ph.D. Lester Schad, Ph.D. Stanley Berent, Ph.D. Elizabeth Carll, Ph.D. Howard V. Selinger, Ph.D. James E. Boscardin, Ph.D. Carolyn C. Chinlund, Ph.D. Joseph B. Sheare, Ed.D. David B. Clark, Ed.D. Mary Ann Clark, Ph.D. Harrison M. Smith II, Ph.D. Ronald E. Fox, Psy.D., Ph.D. Rosario O. Crane, Ph.D. Lori J. Stark, Ph.D. Jerry R. Grammer, Ph.D. Robert B. Doyle, Ph.D. Michael J. Sullivan, Ph.D. Ronald J. Gannellen, Ph.D. Raymond D. Fowler, Ph.D. John A. Zarske, Ed.D. Steven G. Gray, Ph.D. Robert G. Frank, Ph.D. David O. Hill, Ph.D. Susan Graysen, Ph.D. PRESORTED STANDARD U.S. POSTAGE PAID PERMIT NO. 1 OKLAHOMA CITY, OK 731 Association for the Advancement of Psychology P.O. Box 38129 Colorado Springs, Colorado 80937 800/869-6595 ADDRESS SERVICE REQUESTED.
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