aap_fall_2002 by suchenfz


									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
  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

                                                                                                      ADVANCE • FALL 2002

 RACES TO WATCH                              FROM THE DESK OF THE CHAIR

  Connie Morella (R-MD-8) –                Ronald E. Fox, Ph.D.
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
  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
                                           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
              CONTINUED ON PAGE 14

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

                                                                                                            ADVANCE • FALL 2002


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)
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

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

                                                                                                ADVANCE • FALL 2002

                                            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

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-
                                            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

                                                                                         ADVANCE • FALL 2002

                                         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-
   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


   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).

                                                                                  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

                                                                   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
                                                       Rudy Nydegger, New York State Psychological Assn.
                                                       President, June Feder, NYSPA Disaster Response
                                                       Coordinator and Gayle O’Brien, NYSPA Executive

            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
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                                                                                                           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


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
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

                                                                                                          ADVANCE • FALL 2002


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

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


                                                                                                          ADVANCE • FALL 2002


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
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

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


                                                                                                               ADVANCE • FALL 2002

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

                                         CONTRIBUTORS HONOR ROLL
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
                                                                                                              PERMIT NO. 1
                                                                                                          OKLAHOMA CITY, OK 731
          Association for the Advancement of Psychology

             P.O. Box 38129
     Colorado Springs, Colorado 80937


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