A strategic push by APA and its partners is bolstering the mental health workforce and making psychological treatment more accessible. At the heart of advancing care are efforts to make sure insurers, both private and public, cover the cost of mental health treatment. On one front, APA is working to increase the public’s understanding of why their insurance may offer poor coverage for mental health and about insurance barriers that keep psychologists and other professionals from practicing in-network. The hope is that public understanding can yield public support for policies to expand access.
“It’s one thing to go talk with payers to say, ‘you need to reimburse people better,’” said Stephen Gillaspy, PhD, director of health and health care at the APA Center for Psychology and Health. “It’s something else if someone in the state legislature reads an article and goes to the health care commissioner.”
To this end, APA has worked with reporters at ProPublica to provide expertise on complex issues and connect them with clinicians for a series of articles they are reporting on about patients and accessing mental health coverage that has exposed insurance barriers that keep psychologists and other mental health professionals from practicing in-network. More than 500 mental health professionals shared their experiences with ProPublica about the ways insurance companies dodge paying for mental health treatment for an article copublished with NPR in Augustopens in new window. A more recent follow-up article focuses on the insurer UnitedHealth and its strategies for denying mental health claimsopens in new window.
APA is also lending expertise to independent organizations drawing attention to insurance coverage gaps. APA helped fund the nonprofit RTI International to look at in-network and out-of-network coverage of mental and behavioral health. Their reportopens in new window, released in April, found that patients went out of their health care network 10.6 times more often to see a licensed psychologist than to see a medical or surgical clinician. APA also contributed psychology expertise to a National Academies of Sciences, Engineering, and Medicine reportopens in new window on expanding access to behavioral health care through Medicare and Medicaid.
These articles and reports give state psychological associations the tools and resources they need to fight for state-level regulatory changes. “Partnering with psychologists in the states is a force multiplier for our advocacy efforts,” said Katherine McGuire, APA’s chief advocacy officer. McGuire noted that APA Services’ advocacy staff frequently enlist psychologists to share their perspectives in targeted, one-on-one meetings with congressional offices, in order to both share their front-line expertise and ensure that members of Congress know how their constituents are affected by the issue being discussed.
In the postelection climate, many states are also considering new policies to either restrict or protect access to health care for LGBTQ+ populations. APA will continue to support state psychological associations to protect the practice of psychology and will also provide expertise and resources on other policy areas, including reproductive health, immigration, equity, diversity, and inclusion in education, and the mental health impacts of climate policy.
Another avenue is federal-level lobbying. Medicare provider payments have failed to keep pace with inflation on a decades-long scale. One major goal is to push for an increase in the Medicare Conversion Factor for mental health services. Conversion factors are monetary values on medical services that act as a multiplier for the value of specific services. If, for example, the value for service for 60 minutes of psychotherapy is set at 3.5, the payment would be 3.5 times that year’s conversion factor.
As of 2023, the conversion factor sat at $33.89, barely above the 1992 factor of $31.00. APA Services supports the Strengthening Medicare for Patients and Providers Act (H.R. 2474), which would build in an inflationary index to the conversion factor. That bill was introduced by Representative Raul Ruiz, MD, (D-California) in April and is also supported by other professional organizations, such as the American Medical Association. APA is also advocating for new legislation known as the Medicare Patient Access and Practice Stabilization Act (H.R. 10073), which focuses more narrowly on preventing the 2.8% cut to the Medicare conversion factor scheduled to take effect in January. APA Services is asking psychologists to call on their members of Congress to support the legislation and is meeting with congressional offices to urge their support for the legislation.
“There is a really good chance that discussions across all these fronts lead to progress next year,” said Scott Barstow, APA’s senior director of congressional and federal affairs for practice-related issues.
APA efforts have already led to big wins in digital therapeutics, with new U.S. Food and Drug Administration (FDA) approvals for digital interventions that treat chronic insomnia and generalized anxiety disorder (SleepioRx and DaylightRx). The clearance of these tools is an important step for psychologists because the developer of these interventions, Big Health, specified that these interventions can be ordered by psychologists and other licensed professionals, rather than limiting access solely to providers with prescriptive authority.
In addition, on November 6 the Centers for Medicare & Medicaid Services (CMS) finalized three new reimbursement codes for digital mental health therapeutics. CMS also extended a pandemic-era rule permitting practitioners to use enrolled practice locations rather than home addresses when providing telehealth services from home, an important safeguard for privacy and security.
The office is also lobbying in support of evidence-based integration of behavioral health services into integrated care models that deliver mental health services in primary care settings. Policymakers are increasingly focusing on integrated care as well as shifting to value-based payment systems and establishing new models of paying for primary care. APA Services is working to ensure patients served by new payment models get the behavioral or mental health services they need.
To bolster the mental health workforce, APA Services has been working all year to increase mental health options for Medicare beneficiaries by supporting reimbursements to doctoral interns and postdoctoral residents practicing under supervision. Both the Accelerating the Development of Advanced Psychology Trainees (ADAPT) Act (S. 2511/H.R. 9138) and Increasing Mental Health Options Act (S. 669/H.R. 8458) have been introduced in the Senate and House with bipartisan support in committees with jurisdiction over Medicare, a “critical step forward,” said Barstow.
In addition, APA Services helped draft the ACCESS in Mental Health Act (H.R. 7924), which was introduced to Congress in March 2024. The bill would provide grants to minority-serving institutions to create or expand graduate programs in mental health fields and would provide grants to students attending these graduate programs. APA Services will be working with a new lead sponsor in Congress in 2025 to push the legislation forward.
Looking forward, APA Services will continue working to maintain the telehealth access expansions that were first established during the Covid-19 pandemic to allow providers to deliver therapy online. These expansions include the relaxation of geographical restrictions on where telehealth services originate as well as rules allowing adaptations such as audio-only communication platforms. Another goal is to build momentum for school-based mental health services, said Kenneth Polishchuk, APA’s senior director for congressional and federal relations, and education policy lead. “We can’t only legislate in response to an emergency,” he said. “We are telling Congress they need to invest rather than cut.”