These are challenging times for practicing psychologists. Insurance reimbursement stagnation along with increased paperwork (documentation, billing, required continuing education, etc.) have made the business of practice more difficult. At the same time, keeping up with changing state & federal regulations (Health Insurance Portability and Accountability Act [HIPAA] privacy rules, HIPAA security rules, Medicare, mandated reporting, disposition of records) can also be a full-time job. Clinically, our patients are often more ill, more anxious, and more vulnerable to misinformation. Our patients may fear Immigration and Customs Enforcement (ICE) sweeps, loss of jobs, and loss of economic stability. Parenting is difficult in the digital age. Sandwich generation challenges increase, parenting our children while helping our parents as they age. Substance use and abuse, suicidality, dependence on our digital lives, insomnia, and health issues are all on the rise.

I write this column on an airplane heading for Washington DC to attend the Practice & State, Provincial & Territorial Associations (SPTA) Leaders Conference (PSLC) and an all-day meeting with the Directors of Professional Affairs from other states, along with American Psychological Association practice and legal experts. We will be talking about state legislative efforts to regulate Artificial Intelligence (AI; especially chat bots pretending to be mental health professionals, as well as insurers using AI to automatically down code our insurance claims despite clinical documentation), to limit insurance company clawback audits going back years and for vague documentation standards, the rise of equity-fund driven healthcare platforms, and efforts to provide the highest quality behavioral healthcare to our most vulnerable children and adults in our states. We will also be discussing the rapidly changing federal environment, including Medicare telehealth waivers; ICE and Department of Justice (DOJ) intrusion into hospitals, clinics, and previously privileged chart notes regarding immigration status; gender affirming treatment; reproductive choice; and loss of scientific grant funding.

As OPA’s Director of Professional Affairs, I also sit on the OPA Legislative Committee and we have embarked on a wild short legislative session with many bills we are tracking closely, advocating, and testifying on behalf of OPA. We are working in coalition with other professional organizations to safeguard professional regulation, limit insurance clawback audits, and ensure that Oregonians receive high quality clinical services from licensed professionals within their legal scope of practice. The OPA Legislative Committee is a large committee of dedicated psychologists from many arenas, willing to read bills and amendments, identify areas of concern for our members, and work with our lobbyists to advocate and testify in front of the Oregon Legislature.

I have been OPA’s Director of Professional Affairs since 2018, and I have learned how state and federal legislation takes shape. We must be very careful not to be knee-jerk reactive, nor to let perfect get in the way of good enough when working in legislative spheres. By that I mean that, sometimes, APA’s or OPA’s legislative efforts might engender anger that the legislation isn’t perfect, but leaving those bills to fail completely is not an option either. Legislative and administrative change (some things are done by administrative rule, not by laws passed by legislators) happens slowly and through relationships forged over time. Mental health parity is a good example: hen first introduced (in both the state and Congress), these bills had flaws but once passed, we were able to shape the dialog and close some of the loopholes. It’s not perfect, and the legal framework that governs self-funded plans under the federal Employee Retirement Income Security Act (ERISA) statute makes it impossible to regulate those plans under state law. The regional offices of the Federal Department of Labor, which regulates ERISA plans, were decimated in the first year of this administration, so we lost a valuable route of advocacy. Many of you have asked about the Psychology Interjurisdictional Compact (PSYPACT), which requires resolution of some significant constitutional and privacy issues, as well as passage by the Oregon Legislature. The PSYPACT bill did not pass last year’s regular legislative session and will not be introduced in the short session (there are only a limited number of bills allowed from each legislator in the short session) but may well come back up in the 2027s regular legislative session.

As I write this today, knowing you will read it weeks from when I wrote it, I wish desperately that I could give you unqualified answers about whether and how psychologists can respond when ICE shows up demanding patient records (this has begun to happen), or about whether Oregon’s legislature will keep unregulated providers or AI-bots from harming our residents. I can report that the Medicare telehealth in-person requirements have been delayed by TWO YEARS (until 12/31/2027) and that APA will be working with the Centers for Medicaid and Medicare Services (CMS) and Congress to have this requirement eliminated altogether. But at least we don’t have to ping pong every 4 months on this.

I will be presenting at the OPA Spring Conference, and that usually includes specifics because I am presenting in real time (much to the chagrin of conference organizers who want my slides in advance!) I hope to revive the Professional Affairs Committee at OPA so that we can provide real-time updates on our website about issues relevant to professional practice. Right now, I am just one person, working 4 hours a week for OPA. If any of this seems interesting to you, please reach out to me or to the OPA office and indicate your interest in professional affairs. I welcome students, early career professionals, and seasoned psychologists alike, working in institutions, group clinics, solo practice, or consulting. Each of you see practice through a different valuable lens. Please join me.

Your OPA Director of Professional Affairs,

Susan Rosenzweig, PsyD

*SPTA = State, Provincial & Territorial Associations