Pencil It In… CEs Are Coming!

We don't have confirmed dates quite yet, but we know you're planning ahead for 2016. Stay tuned for the following CE offerings that we hope to make official SOON!

  • The Practitioner's Tightrope:  A consideration of our dual duties to the client and to the general public.  In this workshop we will consider such topics as:  Is our duty to warn, or to protect?  To whom is that duty owed?  When is it triggered?  How do we balance conflicting duties? This workshop will qualify for 6 hours of ethics, coming in January
  • “Daring Therapists Healing Shame in the Therapy Room,” with Marianne Marlow in February
  • “Creativity in the Counseling Process: Exploring Metaphor and Meaning through Music and Art, with Ellen Carruth in March
  • TBA: Workshop with WMHCA President Thom Field in April
  • “Suicide Assessment, Management, and Treatment,” with WMHCA President Thom Field in May

Two Updates from Coalition Regarding Regence

The 25% reimbursement cut to 90837 by Regence starts today. The Coalition is tracking the number of clinicians that decide to drop off the panel. OIC has said that they will step in if the network is depleted to the point where it is inadequate.

Please take this short survey so that this data can be provided to OIC.


Yesterday we heard from the Office of the Insurance Commissioner (OIC) as follows:

"The lowering of a reimbursement rate for a procedure, by itself, is not a violation of mental health parity. Many, many providers are experiencing this same sort of reduction, sometimes across the board, sometimes on a particular set of CPT codes or sometimes on just one.  OIC will be looking very closely at how this reduction impacts network adequacy, as this change goes into effect on October 1, 2015.

The issue of access to mental health services is a priority for Commissioner Kreidler and the staff here at OIC. We will continue to look for ways that access can be protected and improved, within the current scope of our legal authority."

Other routes to stop the 25% cut to 90837 are being explored.  A group of mental health advocates will be meeting with the state Attorney General Bob Ferguson in the next couple weeks to see if he can be of assistance; the federal parity laws delegate parity implementation of the ERISA plans to state attorneys general.

The Coalition has developed a position paper that will be distributed widely. I will start contacting legislators about this issue.
There is the law suit filed by Karen Hansen against Group Health which will be wending its way through the courts.
The response from OIC is disappointing but we will continue to fight this battle.
Regards,

Rule making on minimum standards for suicide prevention training meetings

Certain health care professionals are required to complete training in suicide prevention. In 2015 the legislature passed Engrossed Substitute House Bill (ESHB) 1424. The new law requires the Department of Health (department) to develop minimum standards for the suicide prevention training programs.  The department has started the rule making process to develop the minimum standards by filing a CR-101.  Two stakeholder meetings are scheduled to gather input on definitions of terms, content standards and quality standards to include in the rules.
The first stakeholder meeting will be on Monday, October 19 from 1:00 to 4:00 PM in room 307 at the Department of Health’s office in Kent, WA (20425 72nd Avenue S, Building 2). This meeting is open to the public.  Attendees will work in small groups to discuss a series of questions related to suicide prevention training program standards.  The questions are attached.  The department will use the input provided to develop draft rules.

The second stakeholder meeting will be at the same Kent location on Wednesday, November 4 from 1:00 to 4:00 PM. At this meeting attendees will review draft rules and to provide additional input to the department.  This meeting is also open to the public.

Please pass this news on to colleagues who may have an interest in participating in the rule making process.  Click here for a one-page flyer to post. If you are not able to attend the meeting, you can email your input to the department at SuicidePreventionCE@doh.wa.gov.

--From Karen Brownson, MSW, Project Manager, WA State Department of Health

Request for Nominations – Social Emotional Learning Benchmarks Workgroup

The Office of Superintendent of Public Instruction (OSPI) is taking nominations for a mental health counselor to the Social Emotional Learning (SEL) Benchmarks Workgroup. This Workgroup is charged by ESSB 6052 Sec 201 (34) “to recommend comprehensive benchmarks for developmentally appropriate interpersonal and decision-making knowledge and skills of social and emotional learning for grades kindergarten through high school that build upon what is being done in early learning.”

OSPI will hold meetings for the Workgroup at least once a month October 2015 through October 2016 to develop these recommendations. OSPI will submit a report to the education and fiscal committees of the legislature by October 1, 2016. To the greatest extent possible, the members of the Workgroup must reflect the cultural, racial, ethnic, gender, and geographic diversity of Washington state.

Please send nominations, including a resume and a cover letter which includes a brief description of their qualifications and desire to serve on this task force to jenny.plaja@k12.wa.us by September 21, 2015. The complete membership of the Social Emotional Learning (SEL) Benchmarks Workgroup will be announced September 22, 2015.

The Workgroup’s first meeting is scheduled for Friday, October 23, 2015, from 9 a.m.– 4 p.m. in the Brouillet Conference Room at the Office of Superintendent of Public Instruction. The Workgroup will establish regular meeting times and locations for subsequent meetings at its first meeting.

If you have any questions regarding the Workgroup you can contact Special Programs Director Maria Flores at 360-725-6359 or maria.flores@k12.wa.us.

Licensed Counselor’s Advisory Committee meeting, June 12, 2015

On June 12, 2015 the Washington State Mental Health Counselors, Marriage and Family Therapists, and Social Workers Advisory Committee (committee) met at the Department of Health (department), 111 Israel Road, Room 145, Tumwater, WA. In accordance with the Open Public Meetings Act, the meeting agenda was emailed to members of the licensed counselors’ professional Listserv and posted to the professions’ webpages.

You can find the minutes by clicking here.

Regence Slashes Reimbursement for Mental Health Providers Again

Seattle, WA (September 3, 2015) Regence BlueShield continues to cut reimbursements to mental health providers. While Regence’s original scheme to cut reimbursement by 30% on October 1, 2015 was rescinded on August 28, a letter went out to providers on August 31 saying that reimbursement for the most commonly used mental health procedure code will be cut by approximately 25% on December 1. This is a huge decrease in compensation for a group of providers that are now earning $.80 less an hour from Regence in real dollars than they were in 2002.

For the most commonly billed psychotherapy service, Regence’s proposed compensation for psychologists and licensed Master’s mental health clinicians would be slashed by nearly 30%, to levels not seen since 2002. Further, the compensation reduction is intended to force MH providers to offer shorter sessions to patients, regardless of patient need.

In a Washington State Coalition of Mental Health Professionals and Consumers survey of mental health clinicians, 75% of 300 clinicians responding said they would or might leave the Regence panel if the original plan had been implemented; the new decrease in reimbursement will likely have the same impact. Many concerns have been expressed by clinicians, the Office of the Insurance Commissioner (OIC), the Washington Psychological Association (WSPA), the Wellspring EAP program and insurance broker Sean Corry about the negative impact this kind of cut would have on access to patients and mental health services.

OIC has already responded to a complaint from WSPA about Regence’s plan to merge two distinct psychotherapy codes into one for reimbursement purposes and in response to OIC’s actions, Regence withdrew its proposed plan. Since the new Regence plan would also lower the most common psychotherapy rate significantly, there is still a likelihood that there will be a large number of mental health clinicians who leave the Regence panel. OIC will be tracking the network adequacy of Regence carefully to make sure that Regence has an adequate mental health network if this plan goes forward.

Kevin Host, Director of Wellspring Employee EAP (Employee Assistance Program), which provides service to nearly 200 employers and covers over 180,000 people, is worried. “Regence’s behavioral health panel is thin already. It is difficult to find paneled licensed clinicians to see patients who need EAP services. It is likely that the most experienced practitioners will leave the Regence panel if a cut of this magnitude goes into effect. We will have an even bigger problem finding qualified practitioners to take cases.”

Sean Corry, a veteran of the mental health parity wars and President of Sprague Israel Giles, an insurance brokerage firm, expresses similar concerns.

“As an insurance broker, my job is to make sure the health plans that clients offer to their employees actually deliver the care that is promised. When a health plan restricts access by severely limiting the number of available mental health providers, that health plan does not get recommended by our firm.”

Regence continues to refuse to meet with mental health clinicians to discuss how their continued effort to reduce payments to clinicians is harming access to mental health care.

Bad News from WCMHPC

As many of you know, Regence did not waste any time coming up with another way to limit reimbursement to paneled mental health clinicians after they rescinded their initial plan to 'combine' rates for 90834 and 90837 by severely lowering the 90837 rate.

A letter sent to paneled clinicians yesterday said that starting December 1, 2015, Regence will lower 90837 claims by about 25%. The rate for 90834 will remain the same.

This is comparable to the 30% cut that Regence tried to put in place on October 1.

The Coalition and other mental health groups, including NPSI, will continue to fight these unfair practices, which may be parity violations.

Please join the committees that the Coalition has set up to fight this continuing effort by Regence. Thanks to all who have agreed to participate in the committees set up by the Washington State Coalition of Mental Health Professionals and Consumers: Social Media; Publicity; Legal/Legislative; Position Papers; Liaison with other mental health groups; and Liaison with consumer groups. You can email me or Sue Wiedenfeld, PhD, Coalition Chair at swiedenfeld@me.com.

This fight is not over yet.
Laura W. Groshong, LICSW, Mental Health Advocate
206-524-3690
lwgroshong@comcast.net

Big News from Regence

I am happy to inform you that Regence has decided not to implement the plan to change the reimbursement rates for CPT codes 90834 and 90837. In a letter written to OIC today, a representative of Regence’s legal department said the following:

 

Regence has carefully reviewed this matter, and has taken all concerns into account, including the feedback we have received from providers. We recognize that the description of the 90834 and 90837 codes create a gap in the time duration for treatment between 45 and 60 minutes. Therefore, a decision has been made that instead of creating a single rate for both procedure codes (90834 and 90837), differential rates will apply. This means that an upcoming revision will be made to the allowable rate concerning procedure code 90837.

Regence announced on One Health Port that the new rate for 90837 will go into effect on December 1, 2015, not October 1. The Coalition will continue to track the ways that Regence changes their reimbursement policies and make sure that their decisions are fair to mental health clinicians.

Laura W. Groshong, LICSW, Mental Health Advocate
206-524-3690
lwgroshong@comcast.net

 

Press Release from The Coalition on Regence

REGENCE SLASHES MENTAL HEALTH REIMBURSEMENT RATES;

75% OF SURVEYED PROFESSIONALS INDICATE THEY MAY OR

WILL LEAVE THE REGENCE NETWORK;

PRACTITIONERS AND CONSUMERS ADVERSELY AFFECTED.

Seattle, WA (August 26, 2015) – On July 1, Regence Blue Shield sent notice to its network of mental health providers that they would be combining payment for the two most-used mental health procedure codes, effectively cutting the reimbursement rate for their most commonly used mental health code by almost 30%. This decision has practitioners indicating a willingness to drop off of insurance panels, with consumers paying the price.

The Washington State Coalition of Mental Health Professionals and Consumers, a consumer advocate group, recently conducted a survey of mental health practitioners in Washington State that asked, “If the proposed policy of equalizing the reimbursement for [the procedure codes] was put in place, would you leave the Regence panel?”

Three-quarters of the 300 respondents paneled by Regence answered “Yes” or “Maybe.”

Sue Wiedenfeld, Ph.D., a licensed psychologist and President of the Coalition, states that, “Seventy-five percent is a very high percentage of practitioners who are considering leaving the panel, and those most likely to leave are our more experienced practitioners. This will lead to Regence having a preponderance of inexperienced practitioners, severely limiting the types of mental health problems that can be addressed.”

“In psychotherapy procedure, codes are time-based codes,” notes Wiedenfeld, “The average length of the shorter code is 45 minutes, and the average length of the longer code is 55 minutes. What Regence did was to say it doesn’t matter whether you see someone for 45 or 55 minutes, we’re going to pay the same for both codes.”

Wiedenfeld concludes that this decision was an excuse by Regence to cut reimbursement rates and increase their profits. “They raised the rate for the shorter code by 4% and cut the rate for the longer code by 30%. This is a direct hit on the income of practitioners.”

Kevin Host, Director of Wellspring Employee EAP (Employee Assistance Program), which provides service to nearly 200 companies and covers over 180,000 people, is also worried.

“People use their EAP benefit when issues in their personal lives start affecting their work life. To best serve our corporate clients, we refer their covered employees to highly capable professionals. If the most experienced practitioners leave the Regence panel, we will have real problems finding qualified practitioners to take cases. This is a big deal since some of our largest client companies use Regence for their major medical benefit.”

Sean Corry, a veteran of the mental health parity wars and President of Sprague Israel Giles, an insurance brokerage firm, expresses different concerns.

“As an insurance broker, my job is to make sure the health plans that clients offer to their employees actually deliver the care that is promised. When a health plan restricts access by severely limiting the number of available mental health providers, that health plan does not get recommended by our firm.”

Each medical procedure code carries what is known as a “relative value unit” or RVU. The RVUs indicate the degree of difficulty that a given procedure has. A higher RVU indicates a more complex procedure requiring more effort and training. The higher the RVU, the higher the reimbursement for the procedure.

According to Laura Groshong, LICSW, a licensed independent clinical social worker and mental health advocate, “The 55-minute procedure code carries with it about a 50% higher RVU than the 45-minute code. It goes against standard practice in medicine to pay the same amount for two different codes.” She adds, “Mental health clinicians have had positive interactions with Regence over the years when we have disagreement. This ultimatum from Regence is a disappointment after all the time we have worked together collaboratively. This is the first time that Regence has refused to respond to mental health groups at all, and it’s been going on since July 1.”

Psychologists are also concerned. The Washington State Psychological Association sent a letter to Regence asking them to identify what medical procedure codes with different RVUs Regence has collapsed into one reimbursement rate.

This issue points to state and national mental health parity laws that require mental health and physical health be treated the same by insurance companies. Collapsing codes for mental health without doing the same for medical codes would be in direct violation of parity laws.

The Office of Insurance Commissioner (OIC) is also curious to learn the answer to this question. They, too, sent a letter to Regence asking them to identify which medical procedure codes they’ve done this with.

Regence was required to respond by August 25.

Corry, who understands insurance from the insurer’s point of view, says, “This is yet another example of some insurance companies taking the decisions about mental health treatment out of the hands of the practitioners and patients, an ongoing issue for years. Some insurers look for hidden treatment limitations. Many insurance companies interfere with the doctor-patient relationship, through the use of proprietary review criteria, to determine what mental health treatments will be approved or denied. Patients are routinely forced through bureaucratic review procedures to get authorization for treatment, and are often subject to arbitrary limits on diagnostic work and therapeutic care.”

In the meantime, mental health groups and practitioners are busy marshalling their members and resources. Practitioners have sent letters to the Insurance Commissioner’s office complaining about this change. The OIC wants to hear directly from clients that might be affected by this decision.

“Practitioners are often hesitant to ask their clients to advocate on their behalf,” says Wiedenfeld. “But Regence’s decision may lead to our doing just that to avoid having to leave the Regence panel to make a living.”

The people who will bear the brunt of Regence’s decision are mental health practitioners, who will take a 26% cut in income and clients who will have less access to qualified clinicians. Both parties can let their voice be heard:

Contact the Office of Insurance Commissioner
Write a letter to the Insurance Commissioner (a template that enrollees can use may be found at the Coalition website).

Contacts:

Sue Wiedenfeld, PhD, swiedenfeld@me.com, 206-930-2343

Laura Groshong, LICSW, lwgroshong@comcast.net, 206-524-3690

Sean Corry, sean.corry@SIGinsures.com, 206-957-7070