Thank You for participating in APA's 2021 Telehealth and Health Equity Advocacy Summit. 
Feel free to use this page as a resource as you prepare for your virtual Hill meetings on Monday, April 26th. Using the information below, fill out this worksheet to help prepare talking points for your meetings in advance. 

If at any time you have any questions, please email Laurel Stine (telehelath requests); Karen Studwell (GPE); or Serena Davila (MFP)

Request #1: Support the permanent expansion of audio-only services and removal of the in-person service requirement under Medicare

Background:
CMS made several key changes to Medicare coverage for telehealth services during the Public Health Emergency (PHE) declared for the COVID-19 pandemic. This included audio-only services and several other temporary extensions of telehealth coverage:  

What's the Problem? 

• Unfortunately, current Medicare coverage of mental/behavioral health services via audio-only telehealth is only on a temporary basis tied to the end of the current public health emergency.
• Additionally, as part of the year-end COVID/budget package in December 2020, Congress permanently lifted certain Medicare site-of-service telehealth requirements. However, it also imposed a requirement that patients must be seen in-person by a provider at least six months prior to the telehealth appointment.  APA is concerned that this requirement serves as an unnecessary barrier to coverage, and again limits access only to those who are able to physically travel for the in-person visit.

Sample Talking Points:  

• We must avert a sudden “access cliff” at the end of the COVID-19 public health emergency, when the many Medicare patients who have relied on audio-only tele-mental and behavioral health services as a literal lifeline during the pandemic, will suddenly lose coverage of (and access to) these services.
• Audio-only MH/BH services are an especially effective tool to extend these services to underserved populations and geographic areas that have traditionally lacked access to broadband Internet services. In total, as many as 42 million Americans lack access to broadband Internet services—most frequently amongst older adults, individuals residing in rural or frontier areas, and racial and ethnic minority communities.
• Medicare coverage of MH/BH services furnished via telehealth—including by audio-only telehealth—has proven to be a model of efficiency in expanding access to evidence-based care. Periodic in-person service requirements, like the six-month requirement imposed by the 2020 year-end budget/COVID package, unnecessarily impede access to these services

FAQs: 

• Has a bill been introduced in the House or Senate to support this?
  Not yet, although we are working with our contacts in both chambers of Congress to do so.
• Are you asking for this to apply to all services or only to mental health services?
  We are only asking for a permanent authorization of Medicare to cover mental health, behavioral health, and substance use disorder services furnished via audio-only telehealth, in addition to any other services specified by the Secretary of HHS.

Additional Resources:

• Congress should enact tele-behavioral health policies that provide equitable access for all 
• Testimonials from patients and providers on the value of audio-only tele-behavioral health services

Request #2: Co-sponsor the Tele-Mental Health Improvement Act (S. 660 / H.R. 2264) 

Problems this Legislation Would Address: 

• Despite expansion in Medicare coverage of telehealth due to the COVID-19 public health emergency, there are a patchwork of inconsistent standards and protections amongst the states on whether private insurers are required to cover telehealth services, on what terms/conditions, and at what reimbursement rates.

Sample Talking Points:  

• Telehealth is a critical tool for narrowing preexisting gaps in access to mental and behavioral health services and meeting the needs of patients in traditionally underserved areas and communities-- such as older adults, individuals with disabilities, people in rural and frontier areas, lower-income families, and racial and ethnic minority communities.
• Unfortunately, providers seeing patients covered by private plans face a confusing array of conflicting state rules on whether private insurers are required to cover these services, under what conditions, and at what reimbursement rates.
• While the vast majority of states have laws referencing private insurance coverage of telehealth services, states may allow insurers to impose different conditions on coverage or restrict the providers that can offer telehealth services.
• Although mental and behavioral health services delivered via telehealth is as effective as in-person care, only 15 states currently require that insurers reimburse for telehealth services at parity with in-person services.

FAQs: 

• Does this parity provision apply to all services? Does it apply forever, or is it a time-limited bill?
  This bill would require private plans to cover mental health and substance use disorder services furnished by telehealth on the same terms and at the same reimbursement levels, as if they were furnished in person, through the entire COVID-19 public health emergency plus an additional 90 days.

Additional Resources:

• Congress should pass the Tele-mental Health Improvement Act

Request #3: Include $23 million for the Graduate Psychology Education (GPE) Program and $20.2 million for the Minority Fellowship Program (MFP) among your appropriations priorities for FY22 

Why Support GPE and MFP? 

• Because GPE and MFP are critical to addressing our nation’s treatment gap in mental and behavioral health care.
• Providing robust funding for both programs in FY22 will increase the nation’s supply of health service psychologists trained to provide culturally-competent, integrated mental and behavioral health services.
• This funding is key to reducing health disparities and improving health care outcomes for high-need, underserved populations in rural and urban communities.

Sample Talking Points for States with GPE Grants:

Please click on your state to view the grant abstracts for your GPE Programs.

• GPE is the nation’s primary federal program dedicated to the interprofessional education and training of doctoral-level health service psychologists.
• Our state currently has [number] GPE grant(s) at [institution], which is supporting integrated training for psychology doctoral students and expanding access to mental and behavioral health services for underserved populations in [region of state].
• As you may know, there is a shortage of qualified mental health providers in our state, particularly in [rural/urban] areas. GPE funding is critical to increasing our state’s capacity to reduce health disparities and improve health care outcomes for high-need, underserved populations (e.g. older adults, children, individuals with chronic illness, veterans, victims of abuse, ethnic minority populations, and victims of natural disasters).
• The GPE program is currently funded at $19 million. Increased funding for GPE to $23 million in FY22 would strengthen current efforts to expand the psychology workforce.
• Increased investments to support our nation’s psychological health and emotional well-being are needed now more than ever, as current data shows that Americans are experiencing a surge in COVID-related mental and behavioral health problems, including increases in anxiety, depression, and post-traumatic stress disorder.

Sample Talking Points for States without GPE Grants:

*Has previously had a GPE grant but does not have current funding. Please click here to see a full listing of previous GPE grants. 

• GPE is the nation’s primary federal program dedicated to the interprofessional education and training of doctoral-level health service psychologists.
• Established in 2002, GPE has the “two-for-one” benefit of supporting the interprofessional training of psychology graduate students and interns, while also expanding access to mental and behavioral health services for underserved populations in rural and urban communities.
• As you may know, there is a shortage of qualified mental health providers in our state, particularly in [rural/urban] areas. Funding for GPE provides a critical mechanism that could help increase our state’s capacity to reduce health disparities and improve health care outcomes for high-need, underserved populations (e.g. older adults, children, individuals with chronic illness, veterans, victims of abuse, ethnic minority populations, and victims of natural disasters).
• Currently funded at $19 million, increased funding for GPE to $23 million in FY22 would strengthen current efforts to expand the psychology workforce by increasing opportunities for our state to apply for GPE funding.
• Increased investments to support our nation’s psychological health and emotional well-being are needed now more than ever, as current data shows that Americans are experiencing a surge in COVID-related mental and behavioral health problems, including increases in anxiety, depression, and post-traumatic stress disorder.

Sample Talking Points for MFP: 

• The Minority Fellowship Program (MFP) aims to reduce health disparities and improve behavioral health care outcomes for racial and ethnic populations.
• MFP supports training, mentoring, and career development for psychologists and other mental health professionals to provide culturally competent, mental and behavioral health services to diverse populations.
• As you may know, there is a need to increase the number of culturally competent mental health professionals in our community. Culturally competent mental health professionals are important because [offer your own example or personal story].
• The Minority Fellowship Program is currently funded at $16.2 million. Increasing funding to $20.2 million would allow more psychologists to work with diverse populations in what are often underserved areas.
• This year especially has proven how necessary mental health care is in underserved populations.

FAQs: 

• What's the Difference Between GPE and MFP?
  • GPE is administered by the Health Resources and Services Administration (HRSA) and provides grants to accredited psychology doctoral, internship, and postdoctoral training programs. The purpose of this program is to expand the capacity of clinical training programs to prepare doctoral-level psychologists to deliver mental and behavioral health care in settings that provide integrated primary and behavioral health services to underserved and/or rural populations. There are currently 49 grantees.
  • MFP is administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), and provides grants to professional associations that represent mental/behavioral health providers. APA is one of seven grantee organizations that administers the program. The overarching purpose of MFP is to improve behavioral health care outcomes for racial and ethnic populations. APA’s MFP seeks to accomplish this by increasing the number of racial/ethnic minority psychologists, as well as the number of psychologists with expertise in racial/ethnic minority behavioral health. Individuals also apply individually to be accepted to MFP programs. This differs from the GPE programs.

Additional Resources:

• Increase Fiscal Year (FY22) appropriations for critical psychology workforce training programs 

Misc. Issue Briefing Resources:

• Combined Advocacy Summit Factsheets
• 3.14 Issue Briefing Presentation Slides 
• 116th Co-Sponsors - Physician Definition Bill 

Resources from "Using Psychological Science to Engage Across the Aisle" Panel Discussion

• Engaging Across the Aisle Panel Slides (Tania Israel, PhD)
• Tips and Reminders for Constructive Political Dialogues (Kirk Schneider, PhD)
• The Experiential Democracy Dialogue for Two (Kirk Schneider, PhD)