EDITOR'S NOTE
PROGRESS NOTES' readers are aware of the ongoing
efforts of your Editor to bring the concerns of CPA members to NHIC, the
Medicare intermediary for California. The concerns revolve around
frequent and ongoing requests for the records of Medicare patients who are
receiving a frequency of service that is greater than 26 psychotherapy
sessions per month. In a singular experience for your editor, we received a
personal telephone call from the NHIC Medical Director asking us to a lunch
between the two of us. While the expectations for what can be
accomplished in a single meeting should be modest, it is clear
that NHIC has heard the voice of CPA's membership. Now is the time to recruit
colleagues to join or re-join CPA so our voices can be even louder.
Charles Faltz, Ph.D., Editor
cpadpa@pacbell.net
LCSW’S FAIL IN ATTEMPT TO EXPAND SCOPE OF PRACTICE
LCSW'S bill which would have added the diagnosis of mental
disorders to their scope of practice lost by a large margin in the closing
hours of the 2003-04 legislative session.
In its final vote on the floor of the 80 member State
Assembly, SB 1853 was only able to register a total of 10 votes in favor. A
total of 32 votes of opposition were recorded. The remaining members of
the Assembly who did not vote demonstrated that they were
unwilling to support the bill, which would have required 41 aye votes to pass
the Assembly.
Social workers argued that the bill did not really expand
what they were already doing in practice. On the Assembly
floor social workers' acknowledged that LCSWs were
already being compensated for their services. In Committee they
had argued that the bill was necessary for them to continue to be
reimbursed for services.
In taking a position of opposition to the bill, CPA
research revealed that (a) there was no evidence to support the claim that
Medicare reimbursement for social workers was threatened and (b) the social
worker testimony that social worker training in diagnosis is comparable to
psychologists was not borne out by a review of the required coursework for a
social work master's degree. Although the strong grassroots response by
psychologists showed overwhelming opposition to the bill, there were a small
number of psychologists who took the position that CPA should support the
social workers' scope of practice bill.
Error in Medicare’s Processing of Health and Behavior Claims
Many psychologists complained that the Medicare
intermediary, NHIC, began denying their claims for Health and Behavior
services. When we first questioned NHIC about the denials, we were told that
Health and Behavior services were not a Medicare benefit until the NHIC Local
Coverage Determination policy for those services was adopted. After
we reminded NHIC that Health and Behavior services were indeed a
Medicare benefit, we were then told that the problem was actually an NHIC "system
error". According to NHIC, any providers with denials for these
procedures will not
have to resubmit claims. A "mass adjustment" is in
process for those claims that were wrongfully rejected.
Mixing Treating and Forensic Roles
One of the most common questions your editor answers for
CPA members concern how to respond to requests to add a forensic role to a
treating relationship with a patient. When a patient is in a custody battle
or involved in a lawsuit, patients' attorneys often turn to the treating
psychologist for expert recommendations and/or testimony. The
attorneys' rationale is that the treating psychologist knows the patient
best. What is not often acknowledged is that attorneys often believe treating
psychologists will move into a sympathetic advocacy role for their patients.
What is almost never acknowledged is that the attorney and patient also want
the treating psychologist to provide expert services at little or no cost. If
a treating psychologist agrees to multiple roles, the cost of obtaining an
independent expert can be avoided.
It is clear that a treating role is separate from a
forensic role as an expert. Combining both roles will likely involve
conflicts because of the multiple relationships to the patient/client. It is
also the case that often a treating psychologist has little information
other than the statements from the patient or the patient's attorney. A
cogent, useful discussion of the potential problems of combining a
treating role with a role as an expert can be found at:
http://pn.psychiatryonline.org/cgi/content/full/39/16/16-a?etoc
Antidepressant Chart
A quick reference chart for practitioners that includes
the most commonly used antidepressants is available online in a PDF file at:
http://www.psychoanalysis.net/~KRudy/anti_Card2.pdf
2005-2006 APA Fellowship Programs
APA Congressional Fellowship Programs
APA will sponsor up to six postdoctoral-level
psychologists who demonstrate exceptional competence in scientific and/or
professional psychology to spend one year working as a special legislative
assistants on the staff of a member of Congress or congressional committee.
APA Science Policy Fellowship Program
This Fellowship sponsors a psychologist to serve as a
special assistant in the executive branch. The prospective Science
Policy Fellow must demonstrate competence in scientific psychology, display
sensitivity toward policy issues, and have a strong interest in applying
psychological knowledge to national science policy issues.
The application deadline is January 3, 2005.
Descriptions of the APA Fellowship programs can be obtained from APA’s
website:
http://www.apa.org/ppo/funding/homepage.html#fellows
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