Challenges to Psychological Assessment: DPA, …...Protocol, expensive instruments, supervision time...
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Challenges to Psychological Assessment: DPA, …...Protocol, expensive instruments, supervision time – not financially viable ESP if add in personnel time to deal with denials, \
Challenges to Psychological Assessment:Stories from the States
Laurie Mount Grimes, PhD, MPHDPA, Kentucky
• Scope of Practice
• Reimbursement
• Practice Issues
• Parity
Scope of Practice
Encroachment from other professions on psychological testing (mental health counselors, licensed professional counselors)
Terminology• Use of term “psychological”• Define testing vs assessment vs screening measure vs soc-
emo report vs testing summary
Kentucky – wrestled with defining psych tests and limited tester to those licensed under psychology board
Ohio – psychologists cannot own psych testing; MSWs and clinical counselors can do psych testing
New York – LMHCs can test; training unspecified; “diagnose”
Maryland – LCPCs can test if training comparable to PhD
Presenter
Presentation Notes
KY – in response to other groups saying KBEP exceeded bounds of statutory authority by limitig others’ use of testing, work group Delineated the areas of memory and attention Achievement testing not exclusively psych Removed terms “objective” and “projective” No section on forensic testing Mississippi – SW with no psychologist in practice doing psych testing for pre-surg evals
Outside threats:
Testing companies marketing to broader market:• don’t require psychology license to purchase
instruments • “Assessment Catalogues”
Pearson encouraging physicians to use their test as pre-surgical psych eval instead of patient seeing psychologist
ReimbursementLow rates
Authorization
No reimbursement for “surveys” (normed scales like BDI, MMPI
No reimbursement for specific diagnoses
Presenter
Presentation Notes
Protocol, expensive instruments, supervision time – not financially viable ESP if add in personnel time to deal with denials, resubmissions, etc Difficulty getting approval, reduced time authorized, can’t get done in time allotted or so little time its useless Normed scales such as the MMPI, Millon, BASC, PAI redefined as rating scales and expected to be administered as part of diagnostic interview (i.e., unreimbursed) no regard to normed standards, complex results, interpretation time required, Carved out measures and diagnoses that erodes battery and risks no reimb after testing completed (forces financial risk) texas - These have been viewed as incidental questionnaires akin to the consent form and intake demographic forms and therefore not billable. Texas (multi-state) insurer (Amerigroup) redefines psychological tests as "rating scales" and views them as part of the normal intake procedure. Therefore, it is not authorizing testing. Medicaid MCOs in Texas (Amerigroup and Superior/Cenpatico) are no longer paying for psychological tests that are considered “rating scales.”
Practice Issues
Definition of Medical Necessity
Test battery diminished, trivializes complicated diagnostic rule-out,
Refusals for specific diagnoses, ID, learning/academic
Presenter
Presentation Notes
Med nec – inconsistent, hard to get def – MA extensive work and forms for auth Battery – no rating scales, no projective “Not “real” test), no cognitive!, no learning/academic ADHD - ADHD denials simplify or trivialize diagnostic rule out process – reducing it to just qnairres for what can be complicated neuro pic. Parents and prescribing docs often want/need more before starting a trial of meds on young child. Feeding into to overdiagnosis/overprescribing fever in US? ID – medical diagnosis ID diagnosis because it’s a “medical diagnosis” – even when pointed out that psychologists are the ones who test for ID. (North Carolina) Learning – domain of school system no learning component allowed – ties hands for thorough look at child and for considering what can be significant confound to child’s presentation and diagnostic profile. Says learning issues are completely the domain of the school system. Totally unrealistic! They are backlogged years, can only get to the “squeaky wheels” which leaves many children underserved
Parity
Questions limits placed on testing (hours, measures, diagnoses) – are there comparable restrictions in other medical/surgical testing?
Washington state – meeting with AG, urging complaints to be filed
Presenter
Presentation Notes
WPA and other mental health provider associations in Washington met recently with AG and his consumer protection staff & have urged our members to file complaints of this nature now with both the AG's office and our state Insurance Commissioner. Their offices don't get many complaints & we are trying to get our members to assist clients with filing complaints. There were other reasons given as well: Inpatient SUD admission was denied because the patient had not had outpatient treatment first; Inpatient MH admission was denied because it was not the “least restrictive” treatment…although the provider pointed out that in the particular geographic area, hospitalization was the only treatment available! Psychological Testing is being denied or so limited that a comprehensive evaluation cannot be completed. 96150 is being denied and a psychiatric diagnosis required, although it is a code for health-related evaluation of a patient.
Thank you!
Laurie Mount Grimes, Phd, MPH
Director of Professional AffairsKentucky Psychological Association
