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Sandy on Board Certification, Mental Health Parity, and Neuropsychology

Question 1. How do you view specialty/subspecialty psychology practice and board certification in professional psychology?

The APA Ethics Code notes that all psychologists can practice within their area of competence, thus allowing each psychologist to describe their own scope of practice. However, training in a recognized specialty and the board certification in that specialty acknowledges that the practitioner has been recognized by their peers as following the expected guidelines of that specialty and thus recognized as competent beyond the broad and general skills of our generic license.

Question 2. What role should specialties, like neuropsychology, play in the changing health care marketplace to remain relevant?

In today’s healthcare system both consumers of healthcare services (patients and their families) and organized healthcare systems (hospitals, Accountable Care Organizations) expect their providers to practice at the highest level of competence. Being board certified is designed to assure the patient and the organization that a provider has achieved that status. In fact, most hospitals require their doctoral level providers to be board certified to have privileges, and, as the quality oriented-consumer based system evolves, this will include psychology and psychologists. Psychology’s recognized specialties will lead the way for our field in this evolution.

Specialty and subspecialty practice will become a significant aspect of defining the role of health service psychology in the next decade, particularly as integrated behavioral healthcare becomes more of a norm than an exception. Health Service Psychologists will increasingly face the need to board certify through APA-recognized credentialing organizations, after completing education and training to develop competencies within a given specialty. Specialties, like Clinical Neuropsychology, should be active in advising APA about relevant policy on issues of specialization, specialty practice, and credentialing within healthcare settings (both hospital and primary care settings as well as medical specialty practices).

Question 3. How would you support mental health parity and the possibility of professional psychology becoming recognized as a physician by CMS/healthcare systems and payors?

As President, I would continue my support for the work of the practice organization and APA broadly in advocating with Medicare for the recognition of psychologists as physicians. We are not currently recognized because APA leadership decided, many years ago, to not pursue this recognition when presented with the opportunity. In recent years, we have been vigorously pursuing physician recognition, and I believe it will happen, guaranteeing proper and ongoing reimbursement for our services.

As you may well know, mental health parity has been an ongoing advocacy and regulatory emphasis for APA. There are repeated threats to implementation of existing laws and rules on parity. Parity is hard to implement when psychologists are not listed in the CMS physician definition. The problem created by this omission extends beyond just CMS and Medicare. Certainly, the damage is clear to patients unnecessarily awaiting neuropsychological evaluations solely because of a physician sign-off requirement that delays the process. Further, the perception that psychologists are not equivalent, independent doctoral providers, due to not being recognized as physicians under CMS/healthcare systems, migrates into commercial carrier policies and state rules (e.g., Medicaid). That unintended outcome unfairly limits psychology’s scope of practice and harms patients.

As President, I would continue to support APA’s Government Relations focus on advocacy for this change in our recognition as physicians. I would also ask our Legal and Regulatory Office to further efforts to establish independence for psychologists in states within systems like Medicaid and commercial insurance. To this point, in my own state, Ohio, our SPTA, the Ohio Psychological Association, fought for, and secured, rule changes that eliminated onerous supervision requirements for interns and post-doctoral residents in psychology, previously having made it all but impossible to be reimbursed under Ohio Medicaid. That effort led to replication of the same rules in other states. As President, I would be looking for such successes at state levels and replicating them systematically through APA’s strategic advocacy efforts.

Question 4. What do you perceive as avenues to encourage funding for evidence-based research to enhance clinical psychological science and practice?

As APA works on its new membership model to ensure adequate funding for advocacy efforts, we must include increased advocacy for psychological science. This work is not just within the scope of the APA Science Directorate but cuts across all the directorates.

The avenue to successful funding for evidence-based treatment is through adequately funded advocacy—advocacy that brings data forward to both NIH and Congress to ensure that funding sources understand that we are a science-based profession, with outcome data that is as strong, or stronger than other health care professions. We need strong advocacy efforts enhanced across APA that are targeted toward legal, regulatory and organizational groups. We also need strong advocacy for research funding on health disparities to ensure cultural competence in the delivery of psychological services. Further, we need to place psychologists into decision-making roles. This will require networking with legislators and the administration. Well-placed clinically oriented researchers/practitioners can help secure increased funding for our science. Division 40 voices are critical in our new process for setting priorities for advocacy and ensuring APA best serves its clinical science and practice membership.

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