Resources - Information and Tools to
Fight for Quality Mental Health

Psychologist Drafts “Therapists’ Insurer Profiling” (“Tip”) Scale, Invites Mental Health Therapists To Grade Insurance Companies And Report Fees They Reimburse

In an effort to help “TIP” the balance in the war being waged by “managed care” against individuals seeking mental health care and the therapists providing that care, Dr. Gordon Herz, a Madison, Wisconsin psychologist has constructed a five-item grading scale and is offering mental health clinicians the opportunity to inform each other and their clients about their experiences with insurance companies.

The “Therapists’ Insurer Profiling” (“TIP” Scale©) allows therapists to grade insurance companies on five dimensions: Credentialing process, Paperwork, Intrusiveness of case management, Consideration of patient needs, and Speed of reimbursement. In addition, masters and doctoral level psychotherapists who are licensed for independent practice are invited to report fees they have been offered by “managed care” and other insurers.

“The scale is rough and undergoing continuous quality improvement, but may be useful even in its present form,” states Dr. Herz. “Therapists talk all the time about their experiences with insurance companies. This allows us the opportunity to report those experiences in a standardized way, and to have access to a large data base of information other therapists have reported. Insurers profile our practices all the time. It’s time to “TIP” the balance, run our own Quality Assurance, and Information System. We can draw our own conclusions as long as we have good information.”

Grades and fees reported by clinicians are posted online, categorized by insurance company and region of fee coverage. Since going ‘live’ toward the end of September, reports have been posted from all regions of the country. Some intriguing patterns have begun to emerge. For example, one managed care company reimburses therapists lower fees in New York than in the Pacific Northwest. Many managed care fees are substantially lower than Medicare rates. Other information posted of possible interest is an estimate of annual compensation a therapist might expect if all his or her clients were covered by a particular insurance company.

Therapists who submit grades and fees will be provided free reports twice per year summarizing the data collected. Other licensed mental health practitioners who do not provide information may request those reports for a nominal fee. Annual “Report Cards” are planned.

Therapists may grade insurance companies online at Rate the Insurer  or request a ‘hard copy’ of the report form by sending an SASE to Dr. Gordon Herz, Mental Health Associates, (608) 256-4848, 20 S. Park Street, Suite 408, Madison, Wisconsin 53715.

Hastings Center Addresses the Ethics of Managed Mental Health Care

Mental Health Managed Care: The Ethics of Resource Utilization Building on the Center’s recently completed work on priorities in mental health services; this project continues to examine critical features of the ethics of managed mental health resource utilization. It focuses on two separate areas: the ethical issues of resource utilization tied to mental health managed care and the moral puzzles embedded in mental health resource utilization.

                The project aims to identify more precisely the ethical facets of the mechanisms that are being used for resource utilization, who is making the decision to implement the resource utilization, and what criteria are being employed for resource utilization. For this aspect of the project we are working with mental health providers at Cornell Medical School, Westchester Division. This work is supported by: The John D. and Catherine T. MacArthur Foundation Project Director: Philip J. Boyle For additional information click here or go to: http://www.cpn.org/sections/affiliates/hastings_center.html

Medicaid Managed Care and Due Process Reports

Two new reports produced by the National Health Law Program, through funding from the Center for Health Care Strategies, serve as helpful tools for implementing the legal rights of Medicaid managed care beneficiaries and provide a single-source summary of the federal legal requirements.

The first report, Medicaid Managed Care and Due Process: The Law, Its Implementation, and Recommendations (November 2000), is intended to serve as a comprehensive resource for health attorneys, policymakers, and other stakeholders.

The second report, Medicaid Managed Care and Due Process: A Guide for Health Plans and State Administrators (November 2000), provides quick access to legal requirements, gives examples of “real world” problems that have occurred in practice, and offers recommendations.

Order the reports online at http://www.chcs.org/publications or by calling the Center for Health Care Strategies, Inc., at (609) 279-0700. Ask for publication number #056. Publications are free of charge, but you are limited to only one copy of each publication. Both executive summaries and the full reports are available upon request.

This notice was posted by Brendan McTaggart, Communications Director, National Health Law Program, 1101 14th St NW, Ste 405, Washington, DC 20005, Ph (202) 289-7661, Fax (202) 289-7724, e-mail: brendan@healthlaw.org, web site: http://www.healthlaw.org

The Judge Bazelon Center for Mental Health Law

The Judge David L. Bazelon Center for Mental Health Law is a nonprofit legal advocacy organization based in Washington D.C. Our name honors the federal appeals court judge whose landmark decisions pioneered the field of mental health law, and our advocacy is based on the principle that every individual is entitled to choice and dignity. For many people with mental disabilities, this means something as basic as having a decent place to live, supportive services and equality of opportunity.

Since 1972, we have successfully challenged many barriers. Our precedent-setting litigation has outlawed institutional abuse and won protections against arbitrary confinement. In the courts and in Congress, our advocacy has opened up public schools, workplaces, housing and other opportunities for community life.

Bazelon Center attorneys provide technical support for and co-counsel selected lawsuits with private lawyers, legal services programs, ACLU chapters and state protection and advocacy systems (P&As).

We collaborate with local, regional and national advocacy and consumer organizations to reform public systems and promote consumer participation in the design and operation of service programs.

We’re active in national policy coalitions working to preserve and expand programs that assure children and adults with mental disabilities of choice and dignity.

We publish handbooks, manuals, issue papers and reports explaining key legal and policy issues in everyday terms.

Bazelon Center for Mental Health Law
1101 15th Street, NW, Suite 1212
Washington, DC 20005-5002
Phone: 202-467-5730
Fax: 202-223-0409
TDD: 202-467-4232
e-mail: webmaster@bazelon.org

Read the Privacy Regulations and See for Yourself

The Special Section on HIPAA’s Privacy Rules continues in this issue with additional reflections by a number of contributors. Clearly, there are many different perspectives as many members feel the regulations are barely sufficient and many others supporting this as an important first step. At the same time, Coalition members may also wish to examine those rules and come to their own decision.

A complete abstract of the HHS Privacy Rule’s provisions relating to “Psychotherapy Notes,” with all relevant text included, is now available from a link on the page <http://jaffee-redmond.org>. Look under the heading marked “Recent Developments.” This document also includes the Federal Register page numbers of all mentions of “psychotherapy notes” and of “Jaffee v. Redmond,” so it can serve as a guide to those who wish to see the quoted passages in context within the printed version of the rules.

Request for Help

       Julie Savacool, an assistant writer for Self Magazine, wants to speak to women who have been impeded from getting what they need from their mental health plan by MC.  If you want to speak to her (or if any of you know any women, ages about 20-45 who have a gripe against MC as a patient and would speak to her) call her at 212-286-6647.  She would be willing to call you back so that the majority of the phone bill is hers.

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Click here to view our PRIVACY policy