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For the past 17 years, the Washington State Coalition of Mental Health Professionals and Consumers  (the Coalition) has worked to maintain access to ethical mental health treatment; prevent insurers from intruding into the treatment process or unfairly restricting mental health treatment; elect legislators who support access to ethical mental health treatment; and keep clinical mental health judgment in the hands of clinicians.  This summary will outline the activity and successes of the Coalition over the past 18 years.

Beginnings of the Coalition

In 1994, several mental health practitioners became very concerned about the evolution of Managed Care and formed two groups, one the precursor to the Coalition, led by Dick Miller, Sue Wiedenfeld, and Mel Knight, and the other, founded by Ken King and Laura Groshong, the Consortium of mental health practitioners.  Both were multidisciplinary efforts to make a difference in protecting the values that underlie effective psychotherapy.

The Coalition and Consortium merged and began the advocacy work on behalf of all mental health clinicians and consumers that continues today.  That year there were testimonials all over the state on the need for adequate protection of client rights and the elements of effective psychotherapy.  Coalition meetings were well attended as people looked for ways to cope and survive in an evolving managed care environment.


    The Coalition took a lead role in responding to the Volk Decision made by the Supreme Court in December 2016. The Coalition has sought to investigate, clarify, and to eventually recommend actions related to 'duty to warn' and 'duty to protect'. The Coalition worked and will continue to work to encourage the legislature to pass a bill that will correct the possibly increased liability for clinicians and to make clarifications and define options to discharge one's duty. This matters to every clinician in practice; because of its complexity, it will likely be a central issue for the Coalition in 2018 and hopefully corrected by 2019.

    We offered a well-attended program on Interruptions and Endings in one's practice, which was well received by all who attended.


    Regence -- The Coalition went from working collaboratively with Regence early in 2014 as Regence opened its panel for the first time in decades and raised reimbursement rates for psychotherapy to lowering rates for the 90837 code by 30% in June of 2015.  The Coalition sprang into action, holding a meeting in the Swedish Auditorium for 80 clinicians and consumers.  We developed 5 committees to educate the public and mental health community about the way that Regence was demeaning mental health treatment, violating mental health parity laws, and causing clinicians to leave the Regence panel in droves.  We also contacted the Office of the Insurance Commissioner and the Attorney General’s Office and have been working with them for over a year to find ways to stop the “bait and switch” tactics of Regence.  Finally, we have been working with the Washington Association of Mental Health Treatment Protection which is exploring legal actions to stop the ways that Regence (and Group Health) has attempted to make clinical decisions for mental health clinicians, a trend that is increasing.  The Coalition is attempting to find legislative support for a bill that would stop these damaging practices.   We received excellent response from the press, including an article in the Puget Sound Business Journal. (July 2015-present)

    Chemical Dependency Professionals -- The Legislature passed a bill in 2014 allowing licensed mental health clinicians to have an “alternative path” to becoming CDPs, or chemical dependency professionals.  The divide between mental health clinicians and chemical dependency professionals is one of the worst in the country, thanks mostly to the way that the CDP programs were first established with staff being recovering alcoholics who only supported abstinence programs.  In fact, the DOH rule on this prohibits any form of treatment such as harm reduction, a much more humane way to help people with substance disorders.  DOH put the CDP Advisory Committee in charge of creating an alternative path with predictably unworkable results.  The Coalition is working to create a bill that will prevent DOH from defining the method treatment that can be used to treat substance disorders.  This is a major challenge that will likely take a couple of years to implement. (January 2015-present)

    Continuing Education -- The Coalition has continued to offer well-attended, reasonably priced continuing education programs to the mental health community in suicide prevention, HIPAA, and ICD-10, with a new program on retirement practices this fall, Endings and Interruptions in Clinical Mental Health Practice. (January 2015-present)

    MH-PAC -- After 15 years as the political action committee (MH-PAC) Chair, Laura Groshong has finally relinquished the reins to Madeleine Lewis, LICSW, who is doing a great job with Laura’s help.  Deborah Jordan has stepped into the Treasurer role, relieving long-time Treasurer Barbara Sardarov, and Sue Westmoreland has joined the PAC Board as well. The PAC has already distributed $2500 to candidates who support Coalition goals in the primary election and will now be supporting more candidates who support these goals in general election. (January 2015-present)


    Regence contacted the Coalition to let them know that they had decided to open their mental health panel, after years of refusing to accept new clinicians, to all eligible clinicians.  The Coalition’s ongoing discussions with Regence were a factor in this decision.

    In addition to continuing suicide prevention trainings, the Coalition sponsored a training on the change to ICD-10 codes in October by Laura Groshong, LICSW, Coalition lobbyist, and Tanya Ranchigoda, LICSW.

    The Coalition worked with WAMHTP to develop the class action lawsuit to prevent restriction of mental health treatment by insurers, which was filed in June.

    The Coalition began working with psychologists and LICSWs to find another way to create alternative paths to CDP certification.


    The Coalition offered four Suicide Prevention trainings and became a major organization in providing training to the community with Robin Shapiro, LMFT, LICSW, an expert in this area.  Physicians and nurses were included in the groups that were required to receive this training.

    The Coalition worked with WAMHTP to shift the focus of a class action lawsuit to stop violation of mental health parity laws from having a patient as the representative to having a clinician be the plaintiff.

    The Coalition also carried out ongoing discussions with Group Health and Regence to discuss restrictions on mental health treatment, with varying degrees of success.

    The Coalition continued to work for an alternative path for licensed clinicians to become CDPs, with increasing opposition from CDPs through the Department of Health.


    The Coalition supported the Matt Adler Suicide Prevention Act, requiring six hours of training in suicide assessment for all mental health clinicians every four years.  Work began on providing this training to the mental health community through the Coalition.

    Changes to the health care delivery system started to occur with the new CPT codes and the implementation of electronic health records, partly spurred by the ACA, and the Coalition gave several presentations on the changes.

    The Coalition met with staff at the Office of the Insurance Commissioner to discuss restrictions on mental health treatment by insurers.  The Insurance Commissioner subsequently held a hearing to begin implementing rules to enforce the mental health parity law.

    The legislature passed a bill requiring “alternative paths” to allow licensed mental health clinicians to become chemical dependency professionals (CDPs), which created turmoil in the CDP community.


    The Coalition became a founding member of the Washington Association for Mental Health Treatment Protection (WAMHTP), which superseded the WMHTTF.  The goal of the organization expanded to include templates for filing appeals, consultation with attorneys to explore legal means to prevent restriction of mental health treatment coverage.  Committees were formed to develop a summary of ethical psychotherapy concepts; outcome studies which confirm the value of psychotherapy; and outcome tools to verify treatment progress.

    The Coalition worked in the legislature to promote the passage of the prohibition of “conversion therapy,” the so-called therapy that attempts to change the sexual orientation of minors.  The damage caused by this process is extensive, often conducted by religious groups.  The opposition to this bill, HB 1882, was extensive and prevented passage.


    The Coalition tracked the way that the Uniform Medical Plan was implemented and began receiving complaints from members in April that payments were not being made.  The monthly conference calls that the Coalition had with Regence administrators became increasingly difficult as the number of unpaid mental health claims climbed to 7,000.  Finally, Regence was able to resolve the problem with its computer system that prevented claims from being paid when Regence was a secondary insurer to Medicare, and most claims were paid by November.

    A new problem arose in the form of the Regence decision to begin using Milliman Guidelines as the basis for mental health treatment coverage.  The Coalition investigated the way that these Guidelines were constructed by an actuarial firm and mobilized the mental health community to confront the lack of sound clinical judgment behind the way that the Guidelines viewed mental health treatment.  The Coalition was a leader in forming the Washington Mental Health Treatment Task Force, a group that intends to create a clinical alternative to the Milliman Guidelines in discussions with insurers and legislators.  The target date for this alternative is February 2012.


    The Coalition continued to work on the way that the Uniform Medical Plan would be administered, meeting with Director Steve Hill of the Health Care Authority to discuss the way that mental health should be included in a balanced plan.  The contract was awarded to Regence BlueShield and the Coalition, which had already been meeting with Regence regularly, increased our contact with Regence to discuss the way that the UMP mental health benefit would be implemented.  Regence planned to cover the UMP the same way that other mental health benefits were covered, resulting in hardships for clinicians and their patients.


    The Coalition began working with the Health Care Authority on the Uniform Medical Plan administration.  This plan had one of the best mental health benefits in the state, but as our state revenue decreased sharply, it was clear that the benefits and reimbursement rates would have to be lowered.  The Coalition met with Aetna executives when the contract was awarded to this insurer.  Shortly after this, the contract was revoked for failure to follow state laws on contract procedures, and a new round of contract proposals had to be started.

    The Coalition also tracked the national changes to health care through the Affordable Care Act (ACA) which would begin to change the way that health care was delivered.


    The Coalition worked diligently to elect candidates who supported the right to ethical mental health services.  MH-PAC had seven members who sent questionnaires to all 250 candidates.  Of the 75 candidates who were endorsed, 90% were elected.

    Additionally, the Coalition carefully tracked the reorganization of the Registered Counselors, a category with more than 19,000 members who were not required to have any clinical degree or training.  This contentious process led to higher standards for mental health clinicians and better protection of Washington citizens who needed mental health treatment.


    Expanded parity success!  HB 1460 was signed into law in March, giving mental health parity to all non-ERISA plans (the small business and individual market) for the first time.  A monumental legislative year for mental health, SB 1088, the Children's Mental Health bill, provided $12 million in new funding for children in Medicaid programs and foster care.


    The Coalition met with Regence executives to discuss their intent to cover only “evidence-based practice.”  We began discussions with Regence on the problems inherent in requiring all treatment meet this limited standard.  MH-PAC continued to win with 98% of endorsed candidates successful.


    Success!  The first part of mental health parity, HB 1828, a mandated benefit for companies with more than 50 employees, passed the legislature.  The Coalition had been a member of the Washington Coalition for Insurance Parity since its inception in 1998.

    Rep. Eileen Cody created the Joint Executive Legislative Task Force to review our state’s public mental health systems, and the Coalition was one of only 5 groups asked to submit recommendations.


    The Coalition Board expanded talks with Rotary Clubs.  In defensive mode, we worked with other groups to prevent the Department of Health from seizing clinical records without due process.  We continued to work with the WCIP to pass mental health parity.  HB 1828, our mental health parity bill, passed the House for the first time.


    Coalition Board member Jane Palmer created a Provider Satisfaction Survey, identifying which insurers were the easiest for clinicians to work with.  Laura Groshong and Sue Wiedenfeld were appointed to the Regence Behavioral Health Advisory Panel with 8 other clinicians.  The MH-PAC took in $4000 and endorsed 35 candidates, 90% of whom won their races.


    A big step for the Coalition—joining forces with seven other mental health groups to form MH-PAC, a mental health political action committee.  We held a Patients’ Rights Conference in association with the Washington State Labor Council and Commissioner Senn.


    The work with Commissioner Senn became the Insurance Commissioner’s Mental Health Task Force.  The Coalition played a major role in passing SB 5587, the Patient Bill of Rights, protecting insurance enrollees’ access to benefits.  The Coalition became actively involved with the Washington Coalition for Insurance Parity, with Laura Groshong as a WCIP Board member.



Washington State Coalition of Mental Health Professionals & Consumers
Mailing Address:  P. O. Box 30087  Seattle, WA 98113   Phone:  206-444-4304