KPA SPEARHEADS ADVOCACY FOR MASTER’S-LEVEL PSYCHOLOGICAL PROVIDERS AND THE FEDERAL GOVERNMENT LISTENS!!

By Sheila A. Schuster, Ph.D., Federal Advocacy Coordinator & Legislative Liaison

In late April of 2013, the KPA office was contacted by a number of Certified Psychologists with Autonomous Functioning (CPAFs) and Licensed Psychological Practitioners (LPPs) about a letter they had just received from the Kentucky Social Security Office of Disability Determination Services telling them that they would no longer be able to provide examination services as had been the case for nearly thirty years.  Instead, they would have to have a co-signature by a Licensed Psychologist on all examination reports, even though that is not a legal requirement in Kentucky.

As it has done on numerous other advocacy issues, KPA immediately sprang into action.   We initiated communications with the Kentucky office to seek clarification of the reason for the change (review by offices nationally who do not have Master’s-level providers) and discussed the possibility and rationale of “work-arounds” as a temporary “fix”.  KPA also immediately contacted the KY Board of Examiners of Psychology and requested that they issue a letter clarifying that the providers were practicing entirely within the legal structure in Kentucky in providing these examinations.  That letter was sent on May 15th and has been an important piece of our advocacy materials.

Several of the affected providers had reached out to both the Kentucky Congressional delegation and to their Kentucky state legislators, seeking their help in advocating for a reversal of the policy.  KPA took on a leadership and coordinating role in pulling together information from the providers and in communicating with congressional offices and with the Legislative Research Commission.  In the latter case, we worked with LRC staff to explain the situation and to point out that the remedy needed to happen at the federal, and not at the state level.

Our collective contacts were able to generate both interest and response from several of the Congressional offices, most notably that of Senator Mitch McConnell and of Congressman Thomas Massie.  Despite numerous requests for assistance made to the Atlanta regional Social Security office, that office informed the Kentucky office that the co-signature of reports was not acceptable.  In turn, the Kentucky office issued a letter on September 10, 2013 which actually made the situation worse for our providers.  It required that the Licensed (doctoral-level) Psychologist actually be in the examining room, co-administering the testing instruments with the CPAF, LPP or with the Licensed Psychological Associate (LPA).  Furthermore, the letter gave a 90-day deadline, after which none of the Master’s-prepared psychological providers would be authorized to do any of the examinations.

We redoubled our efforts in focusing on contacts in Washington with key Congressional staff members.   A comprehensive letter from KPA was sent with numerous attachments, spelling out the legal status of the providers, summarizing the history of our licensing law, sharing data gathered on the number of examinations and the counties in which they were done over the previous 12-month period, and making a very specific “ask” to have Kentucky exempted in the Social Security regulations from the doctoral requirement, as had been done for Vermont, West Virginia and Puerto Rico. 

Progress was being made, resulting in the Atlanta regional office actually scheduling a meeting with Sen. McConnell’s staff…until the government shutdown occurred.  All communications with the Atlanta and Baltimore offices came back unanswered as SSA staff was furloughed during the shutdown.  Meanwhile, the clock was ticking on the 90-day deadline set for early December.  Behind the scenes, I was in almost constant communication with staff in Sen. McConnell’s office to be ready for a (hopefully) rescheduled meeting once the government was again open for business.

Those affected and their colleagues were also hard at work, contacting their members of Congress both in DC and back at home, as well as the offices of Sens. McConnell and Paul.  They pointed out not only the effect on their livelihood and practices, but also in creating significant barriers for Kentuckians, particularly in rural communities, in accessing these examination services.

And our collective advocacy paid off!  The Baltimore office was in contact with
Sen. McConnell’s staff once the shutdown was over and agreed to modify the SSA Program Operations Manual System (POMS) in order to make the policy change effective immediately!  That has been officially done and the CPAFs and LPPs have received a letter from the KY SSA-DDS office, notifying them that the contract cancellation has been rescinded and that they are now recognized officially as being added to the list of “acceptable medical sources”!  Not only does this return these providers to “business as usual”, it gives them the protection of a formal change of policy made by SSA.

The status of the LPAs as examiners has also now been clarified by Atlanta and by the Kentucky SSA-DDS office.  LPAs may administer the testing instruments as part of the consultative examinations, with the Licensed Psychologist conducting the interview, observation and diagnostic assessment and taking responsibility for the report.  This maintains a role for the LPAs as part of the assessment team…and perhaps gives additional incentive for them to move on to LPP status when their five years of supervised experience are completed and the appropriate examinations passed.  [NOTE: It was KPA’s leadership and advocacy that created this path to autonomous functioning for Master’s-level psychological providers by revising the statute in 2001.]

Some of the 29 individuals with whom and for whom KPA advocated on this issue were not KPA members.  During this process, I have consistently urged them to join KPA and a number of them have done so.  It is through KPA dues that I am supported to spend the time and to utilize the resources of KPA support staff including our Executive Director, Dr. Lisa Willner, in successfully carrying out this advocacy campaign.  All benefit from our success, but it seems to me only fair that those who have benefited – and those who will benefit in the future – make a contribution to the effort through their membership in KPA.

It should also be instructive for all of us to be reminded that everyone has a voice and that a democracy depends on the voice of the people being spoken…and heard.  Advocacy does work, especially advocacy with a consistent message and coordinated voices.  We have collectively moved the federal ship of state to do the right thing.  And that is a victory to be savored!