Psychologists warn Congress of access cliff for patients who rely on telehealth

Impact as of October 2021

Additional legislation to preserve access to audio-only telehealth has been introduced in the House and Senate and the Biden administration has announced grants to expand access to broadband and telehealth training for providers and technical assistance to improve access.

The House Appropriations Committees are starting to release their annual appropriations bills. On July 15, the Committee released the second largest of the 12 funding bills (PDF, 465KB), the Labor, Health, and Human Services, Education, and Related Agencies (Labor-HHS), which included $25 million for graduate psychology education (GPE), a $6 million increase over FY21’s enacted level. It also provided $20.3 for the MFP currently funded at $16.2M. The president’s budget requested $17.1 million for FY 2022. The House passed this legislation on July 29, so advocacy efforts are now focused on the Senate.

More than 400 psychologists met with congressional leaders as part of the Advocacy Summit on Telehealth and Health Equity hosted by APA Services, Inc. (APASI). Participants attended to preserve Medicare and private insurance coverage of critical telemental health services and increase support for psychology workforce training programs to increase health equity of underserved communities. The Hill day follows recent congressional testimony of APA CEO Arthur C. Evans Jr., PhD, who called for a population health approach to addressing the mental health and substance use disorder crisis of the COVID-19 pandemic. 

As APA’s Stress in America polling has shown, individuals are not only reporting rising mental health concerns during the pandemic, but the prolonged stress reported by Americans is seriously impacting their physical health, including changes to weight, sleep, and alcohol use. 

Last year, in response to the COVID-19 public health emergency, APA successfully advocated for expanded support for telehealth and the Centers for Medicare and Medicaid Services temporarily lifted some in-person requirements to ensure patient access to health care services, including coverage of audio-only telemental and behavioral health services. Research shows telehealth services delivery is effective, and coverage expansions have provided a lifeline for patients living in rural areas without reliable internet coverage or populations who may have difficulties accessing the required technology, such as older adults or those with disabilities. Over 41,000 messages were sent by psychologists to Congress to fight for Medicare reimbursement for telehealth services, as well as 11,000 regulatory comments opposing proposed cuts for psychologists under the Proposed Physician Fee Schedule. 

To preserve patient access to psychological services and advance health equity, psychologists are now advocating for congressional support for two key telehealth issues: expanding access to telehealth services—including audio-only services—for the provision of mental health care for Medicare patients, and extending telebehavioral health reimbursement parity in ERISA self-insured group health plans. Participants are also urging Congress to support increased funding for key psychology workforce programs: the Graduate Psychology Education program, which supports the interprofessional training and placement of psychologists who specialize in working with underserved populations or in communities with shortages of mental and behavioral health providers; and the Minority Fellowship Program, which supports training for psychologists to improve mental and behavioral health outcomes for people from diverse cultural and ethnic backgrounds.

To add your voice to their efforts, join APASI’s Call for Congressional Telehealth Service Coverage Protections.

APA President Jennifer F. Kelly, PhD, ABPP, and APA Chief Advocacy Officer Katherine McGuire opened the Advocacy Summit calling on all participants to share their personal stories of how their patients were utilizing telemental services and to develop relationships with bipartisan congressional offices.

To prepare for their visits during an evenly divided Senate, McGuire hosted and moderated the political plenary with former Senate Majority Leaders Tom Daschle (D-S.D.) and Trent Lott (R-Miss.) who were the last Senate leaders to govern a 50-50 chamber. Daschle and Lott shared wisdom and insights into how they productively worked together, despite their ideological differences, to lead the country through challenging times as members of the Bipartisan Policy Center. They agreed that psychologists are uniquely qualified to help bridge the political divide and encouraged psychologists to share their personal stories and inform their congressional delegation about the needs in the community.

To assist participants in having productive conversations in the current polarized political climate, Chuck Hollister, PhD, chief executive officer of the Missouri Psychological Association, chaired a panel discussion with McGuire and psychologists Kirk Schneider, PhD, and Tania Israel, PhD. The panelists reminded attendees to cultivate the skills psychologists already have and to approach meetings with open-mindedness, curiosity, and respect for those willing to engage in conversations. Israel shared some of her recommendations on reducing political conflict from her Beyond Your Bubble project, including the Flow Chart that Will Resolve All Political Conflict in our Country (PDF, 367KB). Participants were also encouraged to consider guidance from groups such as Braver Angels, which Schneider works with to support cross-partisan dialogue and restore civic trust in communities across the country.

To make lasting change and increase the impact of psychology in society, APA is also encouraging a continuous “every day” engagement approach at the state, local, or global level. Kathleen S. Brown, PhD, chair of APASI’s Advocacy Coordinating Committee, chaired a panel discussion of dynamic and diverse colleagues who each shared their unique experiences, challenges, and advice for others to integrate advocacy into their daily lives. The panel included Maysa Akbar, PhD, ABPP, APA chief diversity officer; Arlene Noriega, PhD, Div. 44 (Society for the Psychology of Sexual Orientation and Gender Diversity) representative to APA Council of Representatives; and Nadika Paranamana, MA, chair of APASI Advocacy Coordinating Committee’s APAGS Advocacy Coordinating Team.

APA Advocacy staff provided an informative issue briefing and role-play demonstration to prepare advocates for their meetings the following day. State delegations were then able to practice in their teams to strategize how to make their key points and tailor their messages for different offices.

The summit also featured eight additional Advocacy Skills Labs—mini trainings on a range of issues, including state advocacy efforts to expand PsyPACT and RxP, building relationships with legislators, coalition building, adding social media to amplify advocacy efforts, and the role of the Psychology PAC.

During the Summit, APA also honored three congressional leaders who have prominently championed the goals of the discipline and profession of psychology in the past year.

In presenting Rep. Bonnie Watson Coleman (D-N.J.) with the APA Congressional Champion award, Kelly highlighted Watson Coleman’s leadership in Congress to address mental health disparities. The Pursuing Equity in Mental Health Act, which she reintroduced this month, would authorize $805 million in grants and other funding to support research, improve the pipeline of culturally competent providers, build outreach programs that reduce stigma, and develop a training program for providers to effectively manage disparities. The COVID-19 pandemic has illuminated the breadth of mental health disparities and the toll on the mental health of Americans and seeks to address the suicide crisis among Black youth in particular.  

APA also honored Sens. Angus King (I-Maine) and Todd Young (R-Ind.) for their work in introducing the Mental and Behavioral Health Connectivity Act (S.3999) in the last Congress. This legislation would have permanently expanded Medicare coverage of telehealth services—beyond the COVID-19 public health emergency—to make it possible for Medicare beneficiaries to receive care in their homes and to receive audio-only services for mental and behavioral health care.

McGuire honored several leading psychologist advocates whose dedicated state leadership during the pandemic was critical to increasing our advocacy impact for the profession of psychology. This year’s honorees included: 

JoAnna Romero Cartaya, PhD, the federal advocacy coordinator for the Iowa Psychological Association, for spearheading our outreach to Sen. Charles Grassley’s (R-Iowa) office regarding APA's priorities during the first COVID relief legislation; helping to organize a roundtable held in the state by Sen. Joni Ernst (R-Iowa) in August; and generating congressional outreach and regulatory comments to the Medicare physician fee schedule proposed rule.

Paul T. Korte, PhD, the federal advocacy coordinator for the Missouri Psychological Association, who succeeded in gaining four members of the Missouri delegation as cosponsors of the Medicare Mental Health Access Act (H.R. 884), and gathered examples of the need for this legislation for our use with the Energy and Commerce Committee’s hearing; and sent letters to the entire Missouri congressional delegation urging waiver of budget neutrality rules for implementation of the new Medicare evaluation and management codes.

Shahana Koslofsky, PhD, federal advocacy coordinator for the Oregon Psychological Association, for her outreach efforts to Oregon’s congressional delegation urging their support of a waiver of budget neutrality requirements for implementation of new reimbursement codes in the Medicare Physician Fee Schedule, and garnering 160 comments submitted to the state’s congressional delegation on the CMS Proposed Rule on the Medicare fee schedule; led a district office meeting with Rep. Kurt Schrader’s (D-Ore.) staff in September on the Medicare Mental Health Access Act (H.R. 884); gathered personal stories on the impact of Medicare’s physician oversight requirements for sharing with Schrader and Rep. Greg Walden (R-Ore.); and participated in a Psychology PAC event for Sen. Ron Wyden (D-Ore.) along with APA staff.

The Oklahoma Psychological Association (OPA) has had recent success at both the state and federal level under the leadership of J’Dene Rogers, PhD, past president, Jennifer Steber, PhD, president, Danna Fowble, executive director, and Tim Doty, PhD, federal advocacy coordinator. Among their accomplishments, OPA secured 80% of the Oklahoma House delegation, including all of the Oklahoma House Republican members of Congress, as cosponsors of the Medicare Mental Health Access Act (H.R. 884), generated 87 comments to CMS last year on the Medicare Physician Fee Schedule proposed rule and its effects on psychologists' reimbursement rates, and is working with APA to provide psychological pain management training to Oklahoma psychologists and a briefing for policymakers during 2021.

For more information, contact Karen Studwell.