Texas Psychological Association 2013 Annual Review
A message from the
President
by Ray H. Brown, PhD
Early in my year as your President-Elect, I was asked to write an article addressing what I perceived to be before us at TPA as we prepared for yet another legislative session. Now, near the end of my term as President, and with the legislative session behind us, I am to write this article in which I review this past year spanning my term as TPA President. On a personal note, this year has been one of those very special opportunities of a professional lifetime, an experience I shall never forget, and an experience for which I will always be grateful. I have stated in earnest my motive behind wanting to serve TPA, a motive that is seated in a desire to give something back to a profession that has been very good to me.
Ray H. Brown , PhD President
You will likely recall that, as this year began, much was said of the concerns facing our profession. We recognized and addressed multiple challenges facing psychology, particularly the erosion of the psychology provider base secondary to the proliferation of master level providers, decreased fees from insurance companies, challenges toward the doctoral standard, continued efforts to carve out specialty certifications deemed unnecessary at our level of training, and much more. TPA addressed these and other topics, carving out a legislative agenda even before my term in office began and we came prepared for the challenges before us as we faced the 2013 legislative session. TPA’s commitment has been to our profession, but also to the public, this being reflected in our efforts to improve access to care, to improve quality of care, and to enhance the continuity of care for those whom we serve.
We entered this year having, at our last TPA Convention, celebrated the 65th “birthday” of TPA. We recognized the work of valiant leaders before us who created this professional foundation for us and gave us an organization that has consistently provided the necessary support to protect, to grow, and to nurture the practice of psychology and also you, the psychologists of Texas. We left that special commemorative convention and began both our offensive and our defensive work within the legislative arena. We put into motion what I believe has proven to be the best possible organizational structure from which to do our legislative work. That involves our Executive Director, David White, assuming the primary role as legislative coordinator and the in-house “lobbyist” for our organization. We found that we can enrich the coordination and “lobbying’ of our Executive Director through the temporary employment of a legislative consultant and we were able to do that without creating a financial burden for TPA. The effort also involved a dedicated group of our peers who served on the Legislative Committee and reviewed every bill introduced that gave the appearance of relating to our field. We also learned (what we really always knew) that the value of relationships is critical, and fortunately we had put much effort into that, largely out of the preliminary work done by David White in meeting with, educating, and supporting legislators and legislative staffs and building relationships that those of us in elected positions with TPA would later draw upon as we traveled to the Capital, gave testimony, and met, hour after hour, as we presented our legislative agendas to the law-makers. This resulted in success through the passage of two bills, HB 807 and HB 808. This year was, hands down, the most successful year in the last 30 plus years and second only to the likes of early accomplishments including the passage of our licensure law and adding us as qualified recipients of insurance claims! You likely know by now that HB 807 brings us much-needed protection of the doctoral standard for psychology. No longer can there be random and casual use of the term “psychology” or “psychologist” for job titles in state agencies (excluding institutes of higher learning). HB 808 extends, for the purpose of insurance billing, the list of individuals who are nearing the end of their training and the newly licensed psychologists, all under supervision, who can now be compensated financially. A more difficult to measure type of success came in the form of helping to prevent the passage of bills that would not be good for psychology and/or for consumers. This includes at least one successful effort to prevent yet another subspecialty certification bill that can only burden psychologists with unnecessary additional training while opening new doors for minimally trained individuals from other mental health fields. I think that we learned a lesson that perhaps we already knew, but we saw it come together this year. That lesson is one of patience, following up on the remarkable efforts and hard work that TPA put into the previous legislative session, learning to progress in incremental fashion without rolling the proverbial die in an “all or nothing” fashion with our bill proposals. This leaves us with good relationships at the Capital, relationships with legislators who actually called upon us for advice and direction during the session, and it leaves us with a starting point for the next legislative session. And I would add that, even as I write this article, the Legislative Committee and the Grassroots Committee already have a draft for the 2015 legislative session. That draft will be honed and then presented for approval at the board meeting in November. By definition and in function, TPA is a legislative organization that is committed to protecting and promoting the field of psychology in Texas. In a legislative year, the lion’s share of energy certainly goes into our legislative agendas. That is not to say, however, that other important works did not occur during this recent legislative session. Certainly, the Business of Practice Committee did much this year to protect psychologists through monitoring the various hearings and monitoring the activities of those entities that control the purse strings related to reimbursement within the governmental domains of Medicare and Medicaid and private insurance companies as well. In this difficult time of healthcare transition, great uncertainty and many unknown factors are present and are difficult to deal with effectively. We do not fully know where all of this is going, but we witnessed the work of TPA in successfully overturning some of the plans to decrease our rates and in so doing protect the public in areas where reduced rates would almost certainly reduce the number of providers and thus restrict services to individuals who perhaps are in the greatest need of our care. TPA made this happen and every Texas psychologist, in one way or another, benefited from our efforts, members and non-members alike. Some unbelievable work by your Convention Committee is coming to fruition in just weeks and you will have the opportunity to experience accessible and financially reasonable continuing education opportunities of the highest quality possible. Please take note of the convention theme as well, Honoring Our Traditions-Expanding Our Horizons, and know that this theme is purposeful in view of the changes before us. We can fear and/or resist the changes before us and those that we anticipate with reorganized healthcare, but we should also look beyond our traditional roles. This convention will highlight a variety of traditional clinical themes, current themes that reflect the changes about us, and also you will find opportunities to be oriented regarding new practice arenas wherein our skills are needed. Tremendous strides have been made through TPA committee efforts to stay connected with our licensing board and to establish a meaningful liaison between the two boards, that is the TSBEP and TPA boards. Dr. Paul Andrews has led the way in this and, I believe, has established a standard for what is needed from this point forward in dealing with licensing issues and making sure that TPA members are informed at all times.
A year of success for
Texas Psychological Association...
TPA
In this past year, some powerful things have occurred related to membership and the financial status of our professional organization. In general, professional organizations have waned and psychology has not been excluded from this. Much of this can be attributed to a vibrant Financial Committee within TPA. For several years now, unselfish and dedicated members of this committee have committed to a true retreat type weekend event, at their own expense, and some great ideas have emerged, in a collegial and relaxing atmosphere wherein little clutter gets in the way of doing the work before us. A real turning point occurred about a year and a half ago during our retreat to Utopia, Texas. At that time, Dr. Paul Burney and Dr. Ron Cohorn, both former TPA Presidents, were rallying the committee and from that retreat, the seeds of thought emerged that eventually left us with a plan that developed into the Platinum Advantage level of membership. This is a totally voluntary, clearly more expensive, but benefit rich plan through which more could be given as a reward for membership and greater income could be realized for TPA. It took most of another year to put this in order as we worked out the kinks and we set a budget in place projecting that maybe nine generous and bold TPA members might join at this level. After only one year of offering this membership category, our Platinum Advantage membership, exceeded all of our expectations. Today we stand at 90 Platinum Advantage members! This has positively impacted our cash flow and along with the refinancing of our office space, working to pay the mortgage off early, increasing overall membership, and carefully managing our monies, TPA may well be in the best financial condition ever! This does not mean that we are at a point of relaxing and being smug about our condition as we are certainly not there. We have to maintain this and to be prepared to put monies into our legislative activities including our going through Sunset Review in just two more sessions. We are on track! We are headed in the right direction! But the challenges are still there and we are still in need of educating our peers and bringing them into the fold of TPA membership. That has been my challenge to you for this entire year and some of you have taken it seriously. That will be our task for years to come if we are to preserve our profession as we know it. Inn summarizing this year, 2013, I believe that we can clearly claim the following accomplishments: • • • • • • • • • •
We identified and implemented the structure under which our legislative efforts work best. We had the best legislative year, perhaps ever, certainly in the last 30 years. We have developed relationships with legislative staff and we have created legislative momentum. We have reaped the benefits of accepting small legislative victories and building upon them. In very difficult and changing times of healthcare, TPA has helped to curb significant third-party fee reductions. Financial stability has increased notably and the Platinum Advantage membership category experienced success while boosting the benefits to members and enhancing the cash flow of TPA. Legislative planning is already in place for the next session and focal issues can potentially benefit those delivering clinical services while expanding forensic services, and benefitting specialty groups such as neuropsychologists. Innovative ideas continue such as providing a “Psychologist of the Day” in the Capital during the legislative session. We have enhanced and sophisticated our efforts at staying connected with our licensing board, TSBEP, and the effectiveness of an ongoing liaison is obvious. Our Convention theme this year clearly communicates an effort to move TPA members through the 21st century as new and creative points of delivery for psychology are identified and nourished. This involves the identification of new points of service delivery, but it also involves the evolving world wherein technology is changing our profession, particularly in terms of our transition to electronic records and other creative plans such as “teletherapy” (with much to be done in terms of legal issues regarding licensure across state lines).
In closing, allow me to quote two individuals who have worked tirelessly for TPA as long as I can remember. Each, across time, helped bring TPA to this point of legislative success. Both are heroes among our ranks. They have effectively summed up my sentiments and they have done it more eloquently and in better fashion than I could hope to do. Both unselfishly commented on the success of our legislative year as indicated below: “One of the best parts of this year’s long experience has been the great collaboration of efforts from so many. It creates such a sense of kinship with all of you that transcends any point in time. It is a part of the ‘glow’.” -- Dr. Rob Mehl— “This is a moment unlike any that I can recall for TPA in our efforts with the legislature. We are reaping the benefits of literally years of grassroots and legislative contacts. I hope we can continue to nurture them and find ways to ride this positive relationship into Sunset review.” -- Dr. Paul Andrews--
I thank you for this opportunity of service and I think every one of you who worked in committed, collegial fashion to make this a banner year for the Texas Psychological Association.
TPA update on
TSBEP Supervision Rules
by Paul Andrews, PhD
More than a year ago, TPA appointed a task force under the leadership of Dr. Rob Mehl to develop supervision rules for post doctoral training supervision. The work document submitted by that task force was presented to Texas State Board of Examiners of Psychologists (TSBEP) which eventually decided to look at all the rules about supervision that were contained in Rules and Regulations of the licensure board. TSBEP Rules Committee and staff members along with a newly appointed Rules Advisory Committee comprised of representatives of the major licensure groups and two TSBEP Board members have been working on integrating and updating supervision rules. Some changes have been submitted back to TSBEP Board for approval, and others are still in progress. Here is a synopsis of the submitted proposed changes to supervision rules...
Paul Andrews , PhD Psychologist
Section 463.8: A change for LPA (Licensed Psychological Associate) training would require that the 450 hours of supervised practice take place within a course of study in a recognized training institution or facility. Under current rules, it is possible to obtain the required hours of supervision apart from a training program (e.g. with someone in private practice or in an agency) so that a person’s clinical training and skills may never come under review of anyone other than one supervisor.
Section 463.11: A change in supervision requirements for Licensed Psychologist would specify that the internship year of training must be pre-doctoral. There would also be an expectation for the year of post doctoral training to be completed with the person being Provisionally Licensed Psychologist (PLP) and expectation that this year of training would be completed within two years of graduating from a doctoral training program. Appeal is possible for extenuating circumstances that prevent such a timely completion, but the emphasis is to move persons on to Licensed Psychologist and not allow a prolonged use of PLP status. There remain some problems in attempting to integrate these changes in light of HB808, when one may take the EPPP exam, when one may take Jurisprudence exam, and when one may apply for PLP. Section 465.2: LSSP’s would have to be fully licensed for three years before being able to supervise. The year of internship could not count as one of those years of licensure. Other rules having to do with the nature of supervision are also currently under review but have not been worked out in final form to submit to TSBEP. One of these matters has to do with expectations regarding training of supervisors. Psychologists are expected to have proficiency in areas of practice, but few of us have much specific training in supervision. (In contrast, Licensed Professional Counselors in Texas now must complete a forty hour course of study before being able to supervise.) There are issues related to how long one must have been licensed before being able to supervise. While most jurisdictions do not specify this post-licensure qualification, several require two or three years of independent practice before psychologists are able to supervise. How often and for how long should supervisor meet with supervisee? What elements should be addressed in a supervisor-supervisee contract? In what manner and on what specific matters should the supervisee expect to receive feedback? How many supervisees should a supervisor be able to carry under his/her license? What parameters define accessibility of supervisee to supervisor—geography, time, employment or affiliation status with an agency or practice, electronic connection? If you want more resources for thinking about supervision, Association of State and Provincial Boards of Psychology (http://www.asppb.net) has supervision guidelines and is now in process of revising those guidelines. Also, APA has recently released proposed Guidelines for Competency-based Clinical Supervision in Health Service Psychology Education and Training Programs (http://apa.org) which details many issues related to supervision.
Change in Renewal Fees and CE requirements
David White, CAE/Sherry Reisman, Assistant Executive Director
Beginning October 1, 2013, annual renewal fees for some licensees will increase slightly. The new fees will be as follows: Psychological Associate - $121 (remains $16 for those over the age of 70) Provisionally Licensed Psychologist - $116 (remains $16 for those over 70) Psychologist - $212 (remains $16 for those over 70) Health Service Provider status - $20 Licensed Specialist in School Psychology - $64 (remains $14 for those over 70)
Upcoming Changes to Professional Development Requirements:
Sherry Reisman Assistant Executive Director
Beginning October 1, 2014, all licensees renewing their license will be required to show completion of 20 hours of professional development (formerly continuing education). Of these 20 hours, 3 hours must be in the areas of ethics, Board rules, or professional responsibility, and 3 hours must be in the area of cultural diversity. Furthermore, at least half of the required 20 hours of professional development must be obtained from or endorsed by national, regional, state, or local psychological associations, public school districts, regional service centers for public school districts, or psychology programs at regionally accredited institutions of higher education. TPA will be an approved associaiton that will grant CE sponsorships to groups and individuals. If you would like to get approval for your Local Aarea Societies (LAS) workshops or any other CE workshop, please contact Sherry Reisman, TPA’s Assistant Executive Director at (512) 528-8400.
A New Law for Psychologists
by David White, CAE
Supervising and billing for services provided by extenders By now you have heard about the new law that was passed allowing psychologists to bill for services provided by extenders. TPA was instrumental in passing this law (HB 808), however , there have been many questions about how to implement this new law into your practice and the impact it will have for your clients. First and most importantly, this new law expands your ability to provide mental health services to your clients by supervising and billing, for services rendered by certain extenders. This law which went into effect on September 1, 2013, allows you to hire a post-doc or a provisionally licensed psychologist and bill for services they render under your supervision. For many years TPA members were uncertain whether this practice was permissible but with the passage of HB 808 in now explicitly state you have that authority. *
David White, CAE Executive Director
This bill does not allow you to bill for services provided by interns or practicum students and many members have asked me if it applies to License Psychological Associates (LPA’s) The bill does not actually state LPA’s and there is nothing in the current law or rules that explicitly state you have that authority to bill for their services. But the law has ALWAYS implied that you have that authority.
The practice of supervising ones services implies you have the authority to bill for those services. You are taking on all the liability just as you would if you were seeing that client face-to-face. The question is not if you have the authority to bill for services rendered by LPA’s but rather will insurance companies accept, per you contractual arrangements, services provided by a supervised mental health professional. Even with this implied authority, many TPA members are skeptical in engaging in this type of practice with LPA’s. With the approval of TPA’s Board of Trustees, TPA will be asking TSBEP for a formal opinion on this matter so we can get a final determination if this practice is permissible. If you are interesting in expanding your practice, now is the time. The landscape of how mental health services are being provided is changing. You must prepare your practice to be competitive in this ever-changing health care environment. Come to TPA’s Annual Business meeting in Galleria I - II on Saturday, November 16, 2013 from 8:30 AM - 9:00 AM and hear more about HB 808 and other laws that were passed that will affect your practice. * Please note that HB 808 does not apply to Medicaid or Medicare. You must have a provider number issued by Medicare and Medicaid to be reimbursed for services your provided to this population. Current rules permit PLP’s to provide services to Medicaid clients.
TPA Electronic health records task force
by Michael Ratheal, PhD
The TPA Board appointed a Task Force to address the impact of electronic health records (EHR) on psychologists in Texas covering federal and state regulations, current EHR systems, security/confidentiality, and EHR integration with Health Information Exchanges (HIE). Since psychologists were not covered in the incentive payments for transitioning to EHR, it appears that the “meaningful use” criteria and associated penalties do not apply however use of EHR provides an opportunity for advocacy for patients and the field.
Michael Rathael, PhD Board Member
APA and SAMHSA are actively working to redress the lack of parity for mental health in this area. In Texas, regional centers are available toprovide support in selecting an EHR on a fee basis. A county-‐level map of regional HIE coverage in Texas can be found at the following website: http://hietexas.org/local-‐hies/hie-‐service-‐areas-‐and-‐ info. The Tas Force reported on areas related to privacy concerns with EHR and other forms of electronic medical records. The Task Force included Karin Price, Ph.D.; Andrea Bradford, Ph.D.; Collette Miesse, Ph.D.; Mike McFarland, Ph.D.; and Michael Ratheal, Ed.D. (chair). Don’t forget to visit the Special Event during convention on November 15th from 10:15 AM - 11:45 AM in Plaza I. Michael Ratheal will be the speaker for this panel discussion. This discussion is also worth 1.5 CE/PD hrs. See description below for further information:
The Patient Protection and Affordable Care Act included incentives for eligible practitioners to participate in electronic health records (EHR) for patients. The EHR is a long-term record of a patient’s accumulated health information across care-delivery systems. This record is produced by individual providers and through a Health Information Exchange (HIE) providers will have access to the patient’s record with some exceptions. This session will explain the federal and state statutes related to electronic health records (EHR) and what components of these apply to psychologists under what conditions. The presentation will address the security and confidentiality issues psychologists must consider when implementing an EHR and the special issues around behavioral health information. Additionally, it will cover privacy issues related to electronic patient information in any form and the penalties for a breach. There will be information about resources for making decisions about whether or not to use an EHR system. -Michael Ratheal, PhD, Gujs van Oort
A message from the
President-elect
by Marcia Laviage, PhD
How lucky am I? Recently my mom and I were reminiscing about my childhood and adolescence and she reminded me that I was somehow gifted with the talent of having “perfect timing.” I grew up in southwest Louisiana (proudly referred to as Cajun Country) and we had so much fun – maybe way too much fun! But right when the fun was about to be broken up by responsible adults (or perhaps the occasional law enforcement), I seemed to just “know” and leave just in time. My mom looked at me and asked, “How did you do it?” I looked at her, shrugged and said simply, “I guess I got lucky.”
Marcia Laviage , PhD President - Elect
Here I am again and my timing is, if I do say so myself, nothing short of stellar. Just one year ago at this time, I recall the message sent by then TPA President, Dr. Lane Ogden and TPA President-Elect, Dr. Ray Brown calling all psychologists to action because of the threats felt to our profession. They were absolutely right and the response (your response!) to their message was inspirational. Those threats still exists – we continue protecting and defending the doctoral level standard in mental health treatment, fighting the continuing lowered insurance reimbursements, and so forth – but, this past year, under their continued leadership, we had such great successes! Instead of stopping in the face of despair, we acted and propelled our profession forward. We cleared pathways for our post-doctoral fellows and early career psychologists to find potentially more positions by obtaining reimbursements under supervising psychologists; we protected the title of psychologists to avoid the perpetual confusion in the public; we maintained standards for custody evaluations and much more.
Overall, we stood up; we spoke out; and we made ourselves known among the legislators and other mental health organizations! And I get to ride on the tail end of this successful year! I realize that with my fortunate positioning and timing, also comes some pressure. Of course we want to keep the momentum, the excitement, the optimism, and the hope that the profession we so dearly believe in continues to be viewed as critical and relevant in these times of changing healthcare. This responsibility is not one I take lightly. I feel the burden and I welcome the challenge of devising a strategy to continue the energy. I will lay out my vision for what TPA in 2014 will look like during the TPA luncheon on Friday, November 15th. from 12:00 PM to 1:30 PM. But for now, here is a visual cue: We cannot do it alone. The TPA executive committee cannot do it. The TPA Board of Trustees cannot do it. The various TPA committees and task forces cannot do it. Even our famed executive director – who seems to be able to do just about anything we ask of him – cannot do it. We need you, the members of TPA. We need other psychologists who are not (yet) members of TPA. We need attorneys and judges who understand our skill set. We need legislators who understand the differences of educational backgrounds among mental health provider groups. We need physicians to recognize we deserve a seat at the table…at their table. We need these relationships. For me, this past year has been about strengthening my relationships within TPA. Dr. Brown has been a distinguished mentor and the ease with which I can pick up the phone for a late night call is so comforting. Past President, Dr. Ogden, and President before him, Dr. Rob Mehl are so gracious in their repeated gestures and comments of support to me. We have an incredibly hard-working and diligent board that I look forward to seeing at each meeting, whichever city it may be in! Working with David White for the past several years as we both await my tenure as President has allowed us to form a resilient relationship being able to have the hard discussions often needed when critical issues arise. The year ahead will be more about these and other, newer relationships being formed and strengthened which I so eagerly anticipate. So, as my mom and I sat around reminiscing, we also agreed - it’s all about the timing. And this is the best time ever for TPA to start making these connections. You should feel proud to be a psychologist, for doing what you do and want to share that message with others with whom we often work so collaboratively. Please join me in sending this message. I hope you are able to attend convention. If you are not already involved in TPA but want to be, please do not hesitate to contact me. We have so many hard-working committees, task forces and other opportunities such as continuing education get-aways and legislative days, to be a part of. I really hope to see you soon.
TPA Telepsychology TASK FORCE
by Gregory Simonsen, PhD
In 2013, Ray Brown, the president of TPA, asked that a task force be formed to investigate the happenings in the area of Telepsychology as this is a growing area of interest for many psychologists. This information was reported to the TPA BOT. Telepsychology is defined as the provision of psychological services using telecommunication technologies. Telecommunication technologies include but are not limited to telephone, mobile devices, interactive videoconferencing, email, chat, text, and Internet (e.g., self-help websites, blogs, and social media). During this year, a national task force made up of members from The American Psychological Association (APA), the Association of State and Provincial Psychology Boards (ASPPB) and the APA Insurance Trust (APAIT) developed ethical and practice guidelines. To view the recommended guidlelines visit http://apa.org/search.aspx?query=guidelines. There are many areas of Telepsychology practice that remain uncertain as the jurisdictional issues of practicing across state lines create difficult licensing and oversight issues. At the APA State Leadership Conference in March of this year, the Telepsychology Task Force provided information about the possible use of an “e-passport” which would allow psychologists to work with states in which they were not licensed if their patients lived in those jurisdictions. This remains a developing issue. There will be several presentations throughout the convention regarding Telepsychology to help psychologists stay abreast of this fast paced and growing area of psychological services. Be sure to follow the guidebook app as well as your convention program for the schedule of events. If you have any questions on locating where these presentations on Telepsychology will be, just visit TPA’s registration desk at any point during convention, and TPA staff may help direct you to where you need to go.