70 MONITOR ON PSYCHOLOGY • DECEMBER 2013
Practice PERSPECTIVE ON
Tracking issues with
health insurance exchanges
BY DR. KATHERINE C. NORDAL • EXECUTIVE DIRECTOR FOR PROFESSIONAL PRACTICE
When health insurance exchanges went live on Oct. 1, the healthcare.gov
website drew five times more visitors than predicted. Like any major new
product, the site experienced glitches with its rollout, and implementation
will continue to be a work in progress. The exchanges are a centerpiece of the
Affordable Care Act, designed to provide coverage for uninsured Americans
beginning Jan. 1. They will bring mental health care access —
and access to mental health care at parity — to millions who
didn’t have it before.
While the exchanges are intended to improve Americans’
access to health care, there are issues related to their development
and implementation that will affect psychologists and other
health-care providers. For example, as part of our early advocacy
efforts to influence the process, the APA Practice Organization
(APAPO) is collaborating with the Connecticut Psychological
Association and the Inter Organizational Practice Committee to
address a situation that recently arose in that state.
Under one plan in Connecticut’s exchange, only physicians and
advanced practice registered nurses are reimbursed for neuropsychological assessment. Neuropsychologists — the predominant
providers of neuropsychological services — are excluded from reimbursement, a situation that could dramatically limit access to
neuropsychological services for that plan’s participants.
We are also concerned by some health plans’ narrow
networks. All health plans offered through the exchanges must
be certified by federally recognized accreditors as qualified
health plans, or QHPs. To be accredited as QHPs, plans must
meet certain criteria as defined by the Department of Health
and Human Services.
Companies that seek certification as QHPs must
demonstrate that their plan maintains a network with a
sufficient number and type of health-care providers, including
those providers specializing in mental health and substance
abuse services. This is to ensure that the plan offers benefits
under all 10 identified essential health benefits categories, one
of which is mental health and substance use services. However,
the Affordable Care Act does not specify what providers, or how
many, must be included in a provider network.
Insurers seem to be building narrower networks with fewer
providers than are typically found in commercial health plan
provider networks. It remains to be seen whether these smaller
networks, which may have a limited number of psychologists,
will satisfy the Affordable Care Act’s network adequacy criterion.
What does this mean for you? Psychologists should research
plans offered through the exchange in their states to determine
if they are in-network for any of those plans. It is also important
to understand how your state defines the scope of mental health
and substance abuse services and to regularly check and review
your patients’ coverage.
Most states have been working with local stakeholders to
design and implement the health insurance exchanges. You can
check with your state psychological association to find out how
it is involved in your state’s exchange implementation process.
Also, if you know of issues or concerns for practicing
psychologists regarding participation in the exchanges or QHP
payment policies, contact APAPO and your state psychological
association. To report an issue to APAPO, email the Office of Legal
and Regulatory Affairs at firstname.lastname@example.org or call (202) 336-5886.
For more information about health insurance exchanges,
read the four-part series on APAPO’s Practice Central website
Also look for the article “Health Insurance Exchanges: An
Overview for Psychologists” in the fall 2013 issue of Good
Practice magazine, available to APAPO members online at
Psychologists are advised to understand how
your state defines the scope of mental health
and substance abuse services and to regularly
check and review your patients’ coverage.