ACA Members on Capitol Hill During the 2019 Institute for Leadership Training
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August 10, 2020
Congressional Task Force Exams the Benefits of Telebehavioral Health
The House Ways & Means Committee’s Rural and Underserved Communities Health Task Force held its first roundtable discussion titled “Examining the Role of Telehealth During COVID-19 and Beyond.”
The following individuals participated as panelists:
- Tearsanee Carlisle Davis, DNP, FNP-BC, FAANP: Director of Clinical and Advanced Practice Operations, University of Mississippi Medical Center’s Center for Telehealth; Assistant Professor, UMMC School of Nursing.
- Ateev Mehrotra, MD, MPH: Associate Professor of Health Care Policy, Department of Health Care Policy, Harvard Medical School; Associate Professor of Medicine and Hospitalist, Beth Israel Deaconess Medical Center.
- Keris Myrick, MBA: Chief of Peer and Allied Health Professions, Los Angeles County Department of Mental Health.
- Jason Tibbels, MD: Chief Quality Officer, Teladoc Health; President, The Institute of Patient Safety and Quality of Virtual Care.
In her opening statement, Rural and Underserved Communities Health Task Force Co-Chair Terri Sewell (D-AL-7) stated that the task force’s policy areas of focus will be: (1) addressing social determinants of health; (2) enacting payment system reforms; (3) strengthening technology and infrastructure; and (4) reinforcing the U.S. health workforce.
Please find below a summary of the relevant discussions:
All panelists agreed that certain telehealth flexibilities which have been granted during the COVID-19 public health emergency should be made permanent in order to continue expanding telehealth services in the U.S. Panelist Tearsanee Davis stated the “loosened [telehealth] restrictions for sites of service and enhanced reimbursement structure” have significantly improved patient experience and should be made permanent even after the COVID-19 pandemic ends. Panelist Jason Tibbels added that patient geographic restrictions and originating site restrictions should be permanently removed in order to modernize telehealth in the Medicare program.
Telehealth Payment Methods
Several Republican members on the task force discussed how telehealth services should be paid for while minimizing telehealth overuse. Co-chair Brad Wenstrup (R-OH-2) discussed various types of value-based alternative payment models and how these models could be incorporated for telehealth services. Panelist Ateev Mehrotra noted that the overall costs for furnishing telehealth services would be lower in the long-term and therefore should have a lower Medicare reimbursement rate or should be subject to alternative payment methods. Dr. Tibbels also noted that the Department of Health and Human Services (HHS) already has “extensive program integrity policies and procedures in place to fight fraud, waste, and abuse.”
Mental Health Services
Several panelists and task force members emphasized how telehealth could improve access to mental health services. Panelist Keris Myrick noted that the COVID-19 pandemic has exacerbated the negative mental health outcomes for patients who already suffered from depression or isolation before mandatory quarantine efforts began. Rep. Mike Thompson (D-CA-5) discussed how one mental health provider in his district increased their average telehealth visits from 300 a month to 3,000 a month.
In her opening statement, Co-Chair Sewell noted that an investment in technology infrastructure would be necessary in order to continue expanding telehealth access. Dr. Tibbels stated that Congress should invest in creating a “broader penetration of smartphone use and data plans among underserved populations” in order to maximize the benefits of telehealth expansion.
The Task Force did not indicate when it would meet next. We will continue to monitor and update.
August 5, 2020
Trump Administration Proposes to Expand Telehealth Benefits Permanently for Medicare Beneficiaries Beyond the COVID-19 Public Health Emergency
The American Counseling Association (ACA) has been tirelessly advocating for the extension of the national health emergency declaration, which would allow licensed professional counselors to engage in telebehavioral health services for those outside of the counselor's practice jurisdiction (i.e. state lines). Our short term goal had been to extend the emergency declarations for another 90 days and we were successful in that endeavor. Our long term goal is to have the telebehavioral health flexibilities available under the declaration made permanent.
In response to the value telehealth has shown during the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) has proposed to permanently extend Medicare coverage of telebehavioral health services, as well as implement other flexibilities so that Medicare beneficiaries living in all areas of the country can receive convenient, high-quality care from the comfort of their home. Comments on the proposed regulations are due October 5, 2020. If you would like to submit comments regarding the proposed regulation, we have provided you with some talking points to help craft your message. Although bullets points are provided, you are encouraged to share your personal story.
While we are optimistic about the proposed rule, we would like to emphasize that this is a proposal and that nothing has become permanent. As ACA continues to push for full inclusion of professional counselors as Medicare providers, this would be an additional benefit and the first step towards what we hope will be even greater opportunities for our members and other professional counselors.
Here is the information from CMS who is now advocating for our goal to have the emergency declarations made permanent! ACA will continue to monitor the proposal and we will keep you updated on its progress.
If you would like to become involved in ACA’s advocacy efforts, please contact us at email@example.com
Senate Republicans Unveil HEALS Act
On Monday evening, Senate Republicans released a series of bills, collectively titled the HEALS (Health, Economic Assistance, Liability Protection, and Schools) Act. The package of bills represent Senate Republicans’ first negotiation position with House and Senate Democrats for the next COVID-19 relief package. The suite of bills includes the following:
- From the Senate Appropriations Committee, the Coronavirus Response Additional Supplemental Appropriations Act, 2020.
- From the Senate Finance Committee, the American Workers, Families, and Employers Assistance Act.
- From the Senate HELP Committee, the Safely Back to School and Back to Work Act.
- From the Senate Judiciary Committee, the Restoring Critical Supply Chains and Intellectual Property Act and the SAFE TO WORK Act
- From the Senate Small Business Committee, the Continuing Small Business Recovery and Paycheck Protection Program Act.
Provisions of note:
The Coronavirus Response Additional Supplemental Appropriations Act, 2020.
National Institute of Mental Health: The bill appropriates $200 million, to remain available until September 30, 2024, to prevent, prepare for, and respond to coronavirus, domestically or internationally.
National Institute on Minority Health and Health Disparities: The bill appropriates $64.3 million, to remain available until September 30, 2024, to prevent, prepare for, and respond to coronavirus, domestically or internationally.
Substance Abuse and Mental Health Services Administration: The bill appropriates $4.5 billion for Health Surveillance and Program Support, to remain available until September 30, 2021, to prevent, prepare for, and respond to coronavirus, domestically or internationally. This sum includes $1.5 billion for substance abuse prevention and treatment block grants, and $2 billion for grants for community mental health services block grants. This sum includes $600 million for Certified Community Behavior Health Clinic Expansion grants. This sum includes $50 million for suicide prevention programs. This sum includes $100 million for activities and services under Project AWARE.
The American Workers, Families, and Employers Assistance Act.
Sec. 303. Authority to Extend Medicare Telehealth Waivers: The bill extends the Secretary of HHS’ authority to waive or modify requirements with respect to telehealth services through December 31, 2021, even if the public health emergency has ended before that time. The Secretary of HHS must post information describing the requirements applicable to telehealth services and other virtual services under Medicare Parts A and B and the Medicare Advantage program within three months of enactment of the bill, and prior to waiving or modifying such requirements. The Secretary of HHS must also conduct a study on the impact of telehealth and other virtual services furnished under the Medicare program and issue such report within 15 months of the date of enactment of the bill. The bill also requires the Medicare Payment Advisory Commission (MedPAC) to conduct an evaluation by June 15, 2021 of telehealth services under Medicare Part B related to the COVID-19 public health emergency and the appropriate treatment of such expansions after the expiration of the public health emergency. Section 303 extends the telehealth coverage waivers provided by the CARES Act.
Sec. 304. Extending Medicare Telehealth Flexibilities for Federally Qualified Health Centers and Rural Health Clinics: The bill extends Medicare telehealth flexibilities for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) for five years beyond the end of the COVID-19 public health emergency. Section 3704 of the CARES Act authorized RHCs and FQHCs to furnish distant site telehealth services to Medicare beneficiaries only during the COVID-19 public health emergency.
The Safely Back to School and Back to Work Act.
Sec. 108. Telehealth Plans: The bill allows employers to offer telehealth as an accepted benefit to employees who are not full-time or do not qualify for their employer’s coverage during the declared COVID-19 public health emergency until the later of January 1, 2022 or the date on which the COVID-19 public health emergency ends.
The HEALS Act is still undergoing the negotiation process and some of the legislative language may change. The ACA Government Affairs and Public Policy team will monitor the bills’ process and will keep you updated as things progress.
Senate Democrats Introduce the Economic Justice Act
Senate Democrats have recently unveiled a proposal known as the Economic Justice Act that would infuse $350 billion in immediate and long-term investments into communities of color to help offset racial inequality. Lead by Senator Chuck Schumer (D-NY), the proposal also seeks to deliver ten financial investments over a period of five years to communities of color to support various initiatives such as child care, mental health, and job development.
The American Counseling Association will continue to monitor the progress of this legislation.
House Energy & Commerce Committee Markup Information
The House Energy & Commerce Committee held a markup of 30 health-related bills. Of note, the Committee favorably reported the following bills out of the Committee and to the full House of Representatives.
- Strengthening Behavioral Parity Act (H.R. 7539), with technical amendments. The legislation would increase parity in mental health and substance use disorder by limiting aggregate lifetime limits on mental health and substance use disorder benefits to better ensure coverage. The legislation would require that the financial requirements for mental health or substance use disorder benefits be no more restrictive than the financial requirements for medical or surgical benefits, requiring availability of certain plan information, and more.
- Suicide Prevention Lifeline Improvement Act of 2019 (H.R. 4564). The legislation would ensure the provision of high-quality service through the Suicide Prevention Lifeline by clearly defining and measuring performance indicators and objectives to improve the responsiveness and performance of the hotline and quantifying time frames to track the progress of the hotline in meeting such performance indicators and objectives, as well as setting other standards that crisis centers and backup centers must meet. This legislation also appropriates $5,000,000 to establish a pilot program to research, analyze, and employ technologies and platforms of communication for suicide prevention. Lastly, this legislation requires an HHS study and report on the implementation of this bill and a GAO study and report on the Suicide Prevention Lifeline.
- Campaign to Prevent Suicide Act (H.R. 4585), as amended. The legislation would require the Director of the Centers for Disease Control and Prevention (CDC) to conduct a national prevention media campaign to prevent suicide in the U.S., educating families, friends, and communities on how to address suicide and suicidal thoughts, and increasing suicide prevention resources of the CDC and the Substance Abuse and Mental Health Services Administration (SAMSA).
- Suicide Prevention Act (H.R. 5619), as amended. The legislation would authorize a pilot program to expand and intensify surveillance of self-harm in partnership with state and local public health departments and would provide suicide prevention services in hospital emergency departments. This legislation would appropriate $30,000,000 to establish a grant program to provide self-harm and suicide prevention services.
- National Suicide Hotline Designation Act of 2019, (H.R. 4194), as amended. This legislation would direct the Federal Communications Commission to designate ‘9-8-8’ as the universal telephone number for the national suicide prevention and mental health crisis hotline system operating through the National Suicide Prevention Lifeline and through the Veterans Crisis Line.
The Committee stated there will not be another markup until September. We will continue to monitor and provide updates.
ACA Urges HHS to Extend Public Health Emergency
The American Counseling Association (ACA) recently sent a letter to the Department of Health and Human Services (HHS) secretary Alex Azar requesting that HHS extend the public health emergency beyond its current July 25, 2020 expiration date so that licensed professional counselors can continue to offer the highest quality care and provide greater access to behavioral health services for millions of Americans through the COVID-19 pandemic.
July 15, 2020
The Trump Administration Rescinded ICE Rule for International Students
The Trump administration has rolled back its rule for international students!
On July 10, 2020, the American Counseling Association (ACA) and the Association for Counselor Education and Supervision’s (ACES) issued a statement opposing the U.S. Immigration and Customs Enforcement (ICE) regulation that stated international students must take at least some education in person for their F-1 and M-1 visas to remain valid.
This regulation would have caused 360,000 international students (as of 2019) enrolled at American institutions (which include students in counselor education) to leave the US or find an institution with in-person instruction.
The Trump administration has rescinded the ICE regulation that would have required international students to transfer or leave the country if their schools held classes entirely online as a result of the national health emergency. Federal immigration authorities agreed to pull the July 6 directive and “return to the status quo.”
The announcement brings relief to thousands of foreign students who had been at risk of being deported, along with colleges and universities that would have needed to act quickly and reassess their plans for the fall in light of the policy.
ACA is grateful to its membership for activating its grassroots networks so quickly. We are also grateful to ACES for their partnership on this matter. If you have questions or would like to become involved in ACA’s advocacy efforts, ACA’s Government Affairs and Public Policy team is happy to help. You can contact them at firstname.lastname@example.org.
July 9, 2020
Expiration of COVID-19 National Emergency Declaration
On July 25th, 2020, the provisions supporting Licensed Professional Counselors (LPCs) within the National Emergency Declaration are set to expire. These provisions allow LPCs to provide mental health services while waiving certain telebehavioral health restrictions due to the coronavirus pandemic.
The American Counseling Association is aware of our members’ concerns, and in collaboration with our colleagues within the mental health profession, we have supported actions to request an extension to the national emergency. We expect a renewal of the public health emergency which would allow LPCs to continuing practice during the pandemic.
Public health emergencies must be renewed by Health and Human Services every 90 days, and the coronavirus declaration is set to expire July 25. The emergency was first issued in January, and was renewed previously in late April. The expected extension would last until late October.
Secretary Alex Azar of Health and Human Services (HHS) recently informed the public that he expects a renewal of the National Emergency. “I don’t know of any circumstance — I can’t imagine why that wouldn’t be renewed. I’d be quite surprised if that were not renewed,” said Secretary Azar.
States and lobbying groups representing a wide swath of health care interests have been imploring the White House administration for an extension, though last week HHS spokesperson Michael Caputo sought to sway away those concerns.
The American Counseling Association’s Government Affairs team is keeping a close eye on the progress of this extension. For questions or to take action on this issue, please email the ACA team at email@example.com.
June 30, 2020
ACA Sends H.R. 945 Support Letter to House Energy & Commerce
The American Counseling Association recently sent a support letter to the House Energy & Commerce subcommittee on Health in advance of the subcommittee’s hearing on "High Anxiety and Stress: Legislation to Improve Mental Health During Crisis.” The letter details the need for the inclusion of licensed professional counselors (LPCs) as Medicare providers.
H.R. 945, the Mental Health Access Improvement Act, will be one of a handful of bills discussed during the hearing. The Energy & Commerce subcommittee’s jurisdiction includes, among other things, public health and quarantine, mental health, public health insurance (Medicare, Medicaid), and private health insurance.
May 11, 2020
Medicare Bill Sponsor Sends Letter of Support to Congressional Leaders
The American Counseling Association recently requested stories from our members about the way COVID-19 has affected you and your clients. We took those stories, along with additional data, to the sponsor of the Mental Health Access Improvement Act (H.R. 945), Representative Mike Thompson (D-CA).
Rep. Thompson has been in talks with congressional leadership about the possible inclusion of our Medicare bill (H.R. 945) in one of the upcoming COVID-19 stimulus packages. Thompson’s office was able to submit a letter to congressional leaders on ACA’s behalf, detailing the need for the inclusion of licensed professional counselors (LPCs) as Medicare providers.
As Members of Congress continue to negotiate legislation responding to the COVID-19 pandemic, it is very important that you urge lawmakers to expand access to critical behavioral health services for Medicare beneficiaries. This is particularly vital during this time of uncertainty.
ACA is grateful to Rep. Thompson and his staff for all of their hard work and for supporting ACA’s advocacy efforts for professional counselors.
May, 4, 2020
Rural LPC’s Provide Telebehavioral Health Services under Medicare during Pandemic
On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) was signed into law. Section 3704 of the CARES Act authorizes Rural Health Clinics (RHCs) and Federally Qualified Health Clinics (FQHCs) to provide telebehavioral health services to Medicare beneficiaries during the COVID-19 health emergency.
Medicare telehealth services generally require an interactive audio and video telecommunications system that permits real-time communication between the practitioner and the patient. RHCs and FQHCs with this capability can immediately provide and receive payment for telehealth services to patients covered by Medicare for the duration of the COVID-19 health emergency.
Remote telebehavioral health services can now be provided by any health care practitioner working for the RHC or the FQHC within their scope of practice. This includes licensed professional counselors (LPCs), working under the supervision of an RHC practitioner, and within their state’s scope of practice. The RHC or FQHC are eligible to bill for these services, NOT LPCs individually. Please take a look at the telehealth language, from the Center for Medicaid and Medicare services (CMS).
If you have questions or need additional information, please contact the ACA Government Affairs and Public Policy team at firstname.lastname@example.org.