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Liaison Report from the Committee for the Advancement of Professional Practice (CAPP)

Leann Diederich, Ph.D.
Leann Diederich, Ph.D.

Liaison Report from the Committee for the Advancement of Professional Practice (CAPP)

I attended a two-day CAPP board meeting in mid-October as a liaison from our Society. The CAPP board members and fellow liaisons are a group of talented individuals who are invested in coming together as a group to advance the needs of practicing psychologists. A limited summary of the topics, actions, and updates is provided below.

There are several products due to be released next year by the APAPO (the practice organization that advocates and provides for the needs of practicing psychologists). The first is a Qualified Clinical Data Registry (QCDR). This registry has expanded the previous registry option (the APAPO PQRSPRO) available to psychologists who bill for Medicare. There are numerous benefits to an APA/APAPO‐sponsored clinical data registry: (a) APAPO can provide a real‐world view of clinical practice, patient outcomes, safety, and clinical, comparative, and cost‐effectiveness, and that can serve a number of evidence development and decision making purposes; (b) we can define, develop, and/or select the measures that are of the most interest and importance to psychology and to mental health more broadly– as opposed to letting some other health care entity do so for us; (c) we can collect actionable information that can be used to modify behaviors, processes, or systems of care; and (d) we can meet other psychologist data needs, such as licensure/CE requirements, credentialing or board certification requirements, and quality‐based, differential, and reimbursement payment programs (pay‐for‐performance). The second product to be released is the fully updated HIPAA product. The product will give members a simplified and combined compliance resource for the HIPAA Privacy, Security and Breach Notification Rules (including updating state law and preemption analysis for 51 jurisdictions). They expect this product to be given a “soft launch” at the upcoming Practice Leadership Conference in March, with a full release by the summer.

A current product that is available to APAPO members is a Guide to Innovative Practice Models available on the APAPO website at: http://www.apapracticecentral.org/business/innovation/index.aspx. This toolkit provides information and resources for psychologists about emerging trends, challenges and opportunities related to alternative practice models.

The Legal and Regulatory Affairs (LRA) office of the APAPO gave an update on topics related to parity and insurance that they have been pursuing. This includes: (a) taking a lead role in an effort by stakeholders on all sides to develop a parity accreditation system; (b) working with outside counsel and NYSPA on a parity-based class action lawsuit targeting reimbursement discrimination against psychologists and their patients; (c) collaborating with Government Relations to respond to rate cuts by two MCOs brought in to manage TRICARE; and (d) continued collaboration with state associations (GA, FL, PA, KS and MN) on 90837 and reimbursement cut issues.

The LRA and the APA Education Directorate recently celebrated a large success by overcoming a major regulatory barrier and can now move forward on a pilot project to use supervised psychology trainees to bring integrated behavioral health services to underserved Medicaid populations in Washington, DC.  The pilot project will place trainees in primary care physician (PCP) offices; help build a pipeline of highly-qualified psychologists to fill the extraordinary need for these services; and develop a model for replication in other states. The pilot program will involve supervised trainees, both interns and post-docs, providing behavioral health services in three primary care clinics in underserved areas of DC. Their services will be reimbursed by Medicaid through ACDC, a big win for the sustainability of such an integrated care program.

There are a range of other topics covered at the meeting, including a policy on integrated care, master’s level training, Government Relations updates, Clinical Practice Guidelines on PTSD, a policy on Behavior Analysts, updates on APAPO membership and finances, and comments from the current APA CEO and APA President-elect. For more detailed analysis of the meeting, please contact me directly at Leann@LeannDiederich.com.

Categories
Committee Reports

Liaison Report CAPP

Leann Diederich, Ph.D.
Leann Diederich, Ph.D.

I attended a two day CAPP board meeting in early September as a liaison from our Society. The CAPP board members and fellow liaisons are a group of talented individuals who are invested in coming together as a group to advance the needs of practicing psychologists. The focus of the board, and by extension, the American Psychological Association Practice Organization (APAPO) can be seen by examining the “four Ps”: payment, prestige, practice protection, and products.  Highlights from the September meeting, as organized by these four areas, can be found below:

Payment:

  • APAPO has been working to help develop a new CPT code which would provide better reimbursement for psychologists who use certain testing practices and assessments.
  • APAPO is going to start working on developing a Qualified Clinical Data Registry (QCDR) which will help psychologists control their own outcome measurements (to aid in reporting relevant outcomes to the Centers for Medicare and Medicaid Services). This QCDR would be a system that psychologists could use for the upcoming requirement of Merit-Based Incentive Payment System (MIPS), which will replace PQRS (as it expires on December 31st). I hope as they move forward with selecting outcome measures, that group based outcomes will be represented.
  • Legal and Regulatory Affairs (LRA) staff reported success in their fight with the New York Attorney General’s office regarding Cigna’s exclusion of neuropsychological assessment for all psychiatric disorders and autism spectrum disorders.
  • LRA is also continuing their work on advocating for intern reimbursement under Medicaid and report continued progress in several states.

Prestige:

  • The Government Relations staff of APAPO continues to advocate for psychologists inclusion in the Medicare “physician” definition (H.R. 4277/S. 2597).
  • CAPP formed a workgroup to discuss and determine if there are aspects or implications of the APA resolution on psychologists in integrated care settings. This workgroup would also focus on what CPT codes might be appropriate for telehealth within integrated care. This also ties into payment concerns for psychologists engaged in these activities.

Practice Protection:

  • Recently LRA also provided input to the Texas State Board regarding the Serafine decision by the 5th Circuit US Court of Appeals decision invalidating parts of the licensing law.
  • APAPO and LRA consistently tackle issues relating to mental health parity. They recently met with Federal Parity Enforcement officials to review key issues and concerns. They are actively involved in cases regarding parity issues with several insurance companies, including Regence BCBS and Independence Blue Cross in Philadelphia.

Products:

  • As was described above, a product in development is the QCDR. However, another product that was strongly supported at the CAPP meeting was for APAPO to update the HIPAA product. This is especially salient in light of upcoming Phase 3 HIPAA audits from HHS.

I am honored to represent Division 49 as a liaison to the Committee for the Advancement of Professional Practice. Due to budget constraints, CAPP will only meet once in person next year, currently scheduled for October 2017. However, if there are significant updates that are provided to liaisons via electronic meetings, those will be included in future issues of TGP.

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Committee Reports

Summary of CAPP Board Meeting

Leann Diederich, Ph.D.
Leann Diederich, Ph.D.

Summary of CAPP Board Meeting

April 29-May 1, 2016

These are a selected compilation of meeting notes, as they might be relevant to the Division 49 Board of Directors and Members. For full details of the meeting, please request them from Dr. Leann Diederich.

Legal Risk Management (presentation by APA Office of General Counsel Ann Springer, JD)

CAPP members were briefed on the fiduciary duty that Board members have. This includes duty of care, duty of loyalty, and duty of confidentiality. If you represent multiple groups, you have a duty to clarify which group you are speaking on behalf of. For instance, a conflict may exist when a Board member has professional business or a volunteer interest that could predispose the member one way or another regarding an issue. A conflict of interest should be disclosed to the Board and the appropriate steps can be taken (e.g., recusal or abstention on voting). Conflicts of interest are to be expected when professionals are involved and carry multiple roles and aren’t inherently negative or something to be ashamed of.

Updates on Government Relations and Legal and Regulatory Initiatives

Government Relations: CAPP members were briefed by Government Relations staff on legislative efforts that followed the 2016 State Leadership Conference, including the following: (1) the Medicare Mental Health Access Act to include psychologists in the Medicare physician definition (H.R. 4277/S. 2597), and (2) legislation to reform federal mental health funding, specifically the Helping Families in Mental Health Crisis Act (H.R. 2646) and the Mental Health Reform Act (S. 1945). In addition, a new government relations initiative that engages psychology students in advocacy was outlined by staff: the TEAM Project.

Legal and Regulatory: Legal and Regulatory affairs are working on the following: collaborative Summits with state psychological associations to educate members on alternative practice models; advocacy approaches to insurance and parity; and advocacy in coordination with the education directorate to expand opportunities and reimbursement in Medicaid systems for psychologists, including managed Medicaid. One specific example that was highlighted was the fight to get a higher reimbursement rate for the CPT code 90837 (as in Washington state it was being paid at the same level as 90834, despite being a longer therapy session). If you know of instances where there is little to no difference in the rates being paid for these two codes, please contact Legal and Regulatory Affairs.

Committee on Divisions:

Beginning in 2016, CAPP combined its various committees that oversee outreach to the various APA Divisions into one committee, entitled the CAPP Committee on Divisions, which will now oversee and make recommendations related to outreach to the Divisions. Dr. BraVada Garrett-Akinsanya, Chair of the CAPP Committee on Divisions provided an update on the discussions to-date of the Committee, including discussions defining the mission of the Committee, and initiatives that are focused on developing and creating alliances with specific Divisions and creating value-added products for divisions that will encourage membership in APAPO. Also, discussed was the possibility of surveying current members of APAPO in regards to their Division memberships and roles within the Divisions.

Updates on Initiatives Impacting Practitioners:

Council of Specialties Summit: CAPP members received a report on the upcoming Specialties Summit that will focus on the continuum from generalist to specialty training and practice, in addition to, issues related to licensure, scope of practice, competencies, specialty practice and the impact of healthcare reform on practice patterns.

APA Work Group on Test User Qualifications:

Dr. Toni Zeiss, BPA Chair, provided an update on recent discussions, held during the APA Consolidated Meetings in March 2016, by the Board of Professional Affairs (BPA) and the Committee on Psychological Tests and Assessment (CPTA), related to the possible formation of a Joint Working Group on Recommended Competencies for Users of Psychological Tests. Dr. Derek Phillips, from the CAPP Assessment Workgroup will be the CAPP liaison to this group.

Psychologists and Scope of Practice:

During recent CAPP meetings, CAPP has discussed several initiatives related to developing strategies to address developments by new/or other professions advocating for inclusion of language in state legislation, in addition to, recent initiatives that included the development of a focus group of psychologists in managed care, and the development of a collaborative strategy with SPTAs to encourage psychologists involvement in medical staffs. The April-May CAPP meeting provided CAPP members an opportunity to discuss the development of a new computer based examination that will be complementary to the existing knowledge-based Examination for Professional Practice in Psychology (EPPP). The new exam, the EPPP Step 2, which was approved in January 2016 by the Association of State and Provincial Psychology Boards (ASPPB) will assess the skills necessary for entry-level licensure. It is anticipated that the exam will begin to be used in 2019.

Update on the Board of Director’s Initiative on the Master’s Degree:

In 2015, the APA/APAPO Board of Directors formed a workgroup related to addressing issues and areas of interest that have arisen in the past related to the Master’s Degree. CAPP has a liaison to this workgroup. Discussions during the CAPP meetings in the past have focused on the need to articulate the value-added aspect of doctoral level training and the need to protect the use of the title of psychologist for those trained at the doctoral level. At the present time, priority issues related to the Independent Report have taken the Board’s time and updates will be provided at future meetings.