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Relevant legislation
anticipated
(May 2003
Issue)
By Dexter Van Zile
State legislatures across New England are gearing up for some important
battles for psychologists in the next fiscal year. Lawmakers will
address issues including carve-outs, parity and the right of practitioners
to deal with insurance companies collectively, rather than relying
on state regulators for protection.
In Rhode Island, a shrinking state budget and an unpredictable
political environment could make it impossible for lawmakers to
do anything other than pass a budget, says Peter Oppenheimer, Ph.D.,
chairperson of the Legislative Committee for the Rhode Island Psychological
Association. A downsizing of House of Representatives from 100 representatives
to 50 and a reduction in the number of senators from 75 to 38 could
result in extensive political wrangling. "I will be pleasantly surprised
if something constructive happens on our end this year," he says.
Nevertheless, Oppenheimer hopes the legislature will give psychologists
an exemption from the state's anti-trust laws that make it difficult
for practitioners to negotiate as a group with insurance providers
regarding compensation. Allowing practitioners to create a bargaining
group that would be closely watched by the attorney general would
create a mechanism capable of standing up to Blue Cross of Rhode
Island and United Health Care, which control 90 percent of the business
in the state, Oppenheimer says. In recent years, practitioners have
been forced to provide services without pay as carve-outs created
by insurance companies have filed for bankruptcy. If practitioners
obtained negotiating rights, they could insist companies post bonds
to ensure psychologists get paid, Oppenheimer says.
"We see the anti-trust exemption as the only way we can fight back,"
he says.
Carve-outs are a big issue in Connecticut as well, according to
Dan Abrahamson, Ph.D., director of Professional Affairs for Connecticut
Psychological Association. In that state, lawmakers are considering
bills that would require carve-outs to adhere to the same standards
of financial solvency as the insurance companies that hire them
to manage mental health services, Abrahamson says. As in Rhode Island,
practitioners in Connecticut have been left in the lurch as carve-outs
have filed for bankruptcy.
"Many hospitals and practitioners were not paid for six months
or longer," he says. "It resulted in many practitioners and hospitals
not being willing to take on new subscribers. It took a tremendous
amount of effort to resolve the problem."
Legislation that would regulate carve-outs was filed last year,
but blocked by the insurance industry, Abrahamson says, but he is
hoping it will pass this year. "I would be surprised and flabbergasted
if the legislation didn't pass," he says.
The Vermont Psychological Association (VPA) is considering asking
legislators to enact "any willing provider" legislation that would
require managed care companies to allow all qualified practitioners
to provide services to patients in the network, says Alexandra Forbes,
M.A., legislative chairperson.
A similar law was passed in Kentucky (see
related story), Forbes says. She adds that VPA is still thinking
about whether or not to make the proposal to lawmakers because once
the law is passed, the onus would be on practitioners to sign on
with managed care companies and agree to their rules and regulations.
In Maine, psychologists will be paying close attention to how the
legislature addresses parity, says Sheila Comerford, executive director
for the Maine Psychological Association. A bill was passed in the
last legislative session, but was vetoed by then-governor Angus
King.
"We have a new governor [John E. Baldacci] who says he'll sign
it if it gets to his desk," Comerford says.
In New Hampshire, psychologists are considering a proposal to give
psychologists the authority to prescribe medications to patients.
Kirsten Singleton, executive director of the New Hampshire Psychological
Association, says it's unlikely the bill will pass this year, but
promises it will be introduced.
"We look at this as the first step in a long process," she says.
"We'll keep working with legislators on it."
In Massachusetts, the primary battles will be over the budget,
says Elena Eisman, Ph.D., executive director of the Massachusetts
Psychological Association.
"The budget is horrible for Medicaid," she says. "We don't know
what's going to happen. There's been a 3.3 percent decrease for
all providers. It's not going to get any better."
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