Illinois Downcoding, an FDA First, and Teen Screening

Each week brings new conversations about mental health, technology, and care. Between Sessions gathers what's worth your attention - so you can stay informed without adding to your workload.

Blue Cross Blue Shield of Illinois has been downcoding mental health and pediatric claims since July, cutting payments for codes practices have billed unchanged for years, without reviewing records or explanation.

👉 Why it matters: Illinois passed a law against this practice, but it doesn't take effect until 2028, leaving clinicians to absorb lower payments or drop insurance for now.

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HHS settled its 55th Right of Access enforcement action this week, after a California provider failed to give a patient access to her own health records within the required 30 days.

👉 Why it matters: Every practice, including solo therapists, must fulfill records requests within 30 days, and OCR continues actively enforcing this rule regardless of practice size.

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A new report in The Journal of Pediatrics found that adding anxiety and suicide screening to routine depression screening identified one more at-risk teen for every 13 patients screened in primary care.

👉 Why it matters: This adds evidence that depression screening alone may miss a meaningful share of anxious or at-risk teens, worth flagging with referring pediatric practices.

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Limbic became the first AI-led mental health company chosen for the FDA's TEMPO pilot, launching supervised CBT sessions for Medicare patients with depression or anxiety through a voice AI agent.

👉 Why it matters: A licensed clinician still reviews every session and can take over care, an early look at how regulators are structuring supervised AI use in therapy.

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As the school year begins, therapist Shala Staple, LSW, shares the ordinary signs of back-to-school anxiety she sees in session, and how to tell normal adjustment from a pattern needing more support.

👉 Why it matters: With school anxiety cases likely rising in caseloads this month, her referral threshold offers a quick, defensible way to counsel families on when to seek additional support.

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A psychiatrist and literary scholar's essay comparing the "odd speech" of schizophrenia with the odd speech of poetry is a quiet reminder of how differently language can break, and how closely it rewards listening.

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This week, Berries shared a podcast on what actually eases the pressure clinicians carry, plus a blog on a pattern worth watching for behind a well-put-together presentation.

Podcast: Kym Tolson is joined by Kristine Hoestermann, LICSW, founder of RARE., for a candid conversation on disclosure with clients, spoon theory in session planning, and where AI actually reduces cognitive load without replacing clinical judgment.

→ Listen to our podcast

Blog: A look at ADHD masking, the compensating habits that let symptoms hide behind anxiety, perfectionism, or burnout, with guidance on spotting it in session and building the kind of safety that lets patients stop performing.

→ Read our blog

The details change every week, but the thing that doesn't is the quiet, steady work you do in the room - that's still the part no policy or pilot program can replace.

As always, thank you for your truly important work.

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This newsletter is intended for informational and educational purposes only. It does not constitute clinical, legal, or regulatory guidance. Clinicians should rely on their professional judgment and applicable standards of care when integrating any technology into practice.