GCS VP discusses a notable shift in bills focused on mental health and substance use disorder, even before the COVID19 pandemic.
Women in Government Relations recognized Sarah Corcoran, Vice President of Government Relations at Guide Consulting Services, as a nominee and finalist for Excellence in a Federal Issue Campaign.
Ahead of the launch for the new 9-8-8 suicide hotline, GCS’s Sarah Corcoran comments on the likelihood of a Senate mental health bill before November.
Following a quick passage of the Bipartisan Safer Communities Act by Congress, President Joe Biden signed the mental health and gun safety reform package into law over this past weekend. GCS offers a rundown of key mental health provisions in the 80-page Bipartisan Safer Communities Act, signed into law over this past weekend.
An analysis from Guide Consulting Service’s VP on what’s in the bill, which has been endorsed by Senate Minority Leader Mitch McConnell and should attract the 60 votes needed to overcome a Republican filibuster.
As midterms loom, urgency for mental health action brings forward opportunities.
Sarah Corcoran, vice president of government relations at Guide Consulting Services, said a package would "need to be fairly substantial to really transform the system from where we are to what it needs to be to meet that current level of need."
Bloomberg Government looked at the 2,118 registered lobbying firms that filed Lobbying Disclosure Act reports with the Senate during 2021. For the seventh consecutive year, Bloomberg Government identified top-performing firms, measured by critical performance metrics.
View report here.
Every day that ticks by toward the July 4th recess reduces the chances of passing a budget reconciliation package, thereby putting a stunning array of Biden Administration mental health policy goals (too numerous to detail here) in jeopardy. But, perhaps surprisingly, there are bipartisan opportunities for legislating in the health care space even in a midterm election year.
Mental health care and substance use may finally have achieved parity with primary care and specialty medicine – at least in terms of congressional interest. What’s not as clear is what this level of attention may mean for federal behavioral health policy and funding.
Congress tends to be motivated by deadlines, especially when faced with the prospect of working into the holiday recess. Learn how major mental health financing is moving on Capitol Hill in early December.
For health care interests represented in our nation’s capital, the next 60 to 90 days may be the most consequential since the creation of the Medicaid and Medicare programs back in 1965. The counsel of Guide Consulting Services (GCS) is: buckle up and make sure your tray tables are in their full upright and locked positions.
Sarah Corcoran, vice president of government relations for Guide Consulting Services, said recent funding from the March COVID-19 relief law was a good sign that [the crisis hotline] is a priority. That law offered an enhanced 85 percent federal match for three years for states to cover mobile crisis intervention services and provided $15 million in grants to states for crisis services and $20 million for youth suicide prevention.
“We’re just looking to build on that and to make sure that the focus doesn’t come off of this,” she said, via Roll Call.
Guide Consulting Services’ President & CEO, Al Guida, recently joined the McBee CareThreads Podcast to discuss the view from DC on Post-Acute care. Have a listen to the episode here: https://bit.ly/37ndr7G
Al Guida, President and CEO of Guide Consulting Services was quoted in an April 9, 2020 Politico article discussing the urgency behind creating access to behavioral health telehealth services during the COVID-19 pandemic. GCS is proud to help our clients in navigating these challenging times.
America’s having a nervous breakdown. Can telemedicine fix it?
By Mohana Ravindranath
04/09/2020 12:29 PM EDT
Locked-down America has become a country desperately in need of virtual therapy, but the health care system has been left scrambling to use telemedicine to help connect people with mental health professionals.
Years of restrictive federal and state policies kept America’s therapists from embracing telemedicine, and now behavioral health providers are rushing to move online — often with little guidance on best practices or assurances that the care will continue after the coronavirus fades.
"Everybody is struggling with this issue,” said Lynn Linde of the American Counseling Association, which represents licensed professional counselors.
The Trump administration, amid the crisis, has temporarily eased some restrictions to make it easier for therapists to video chat with patients across the country, and states and insurers have followed suit. President Donald Trump, who will meet with mental health providers Thursday afternoon, acknowledged the stresses Americans are feeling at one of his task force briefings this week.
“They need help,” Trump said Tuesday. “It’s a big problem."
The health care industry was notoriously slow to move online, but behavioral health providers are especially hustling to catch up to the new socially distanced reality after they were overlooked in previous efforts to expand digital health. Congress over a decade ago excluded them from a $30 billion investment toward putting electronic health records systems in physician offices and hospitals. Medicare payment for telehealth has been typically spotty, and uneven state licensing rules have made it difficult to expand the technology across the country.
"There's been a huge potential for this move for a long time, but ... regulatory and reimbursement barriers have prevented it from happening," said Chuck Ingoglia, president and CEO of the National Council for Behavioral Health.
Even with the new flexibility to practice remotely, mental health providers are still struggling on multiple levels. They are trying to adapt to telehealth visits without sacrificing the personal connection to the people they help. They are trying to navigate a maze of licensing rules while figuring out what the emergency flexibility really means. And they are trying to accommodate growing numbers of online patients facing depression, fear, panic, grief, isolation and economic distress — often on top of mental health conditions they had before the pandemic.
“There is a mad scramble to shift mental health and addiction treatment services online,” said Al Guida, a lobbyist representing behavorial health providers. “The question becomes: during a period extreme economic challenge, how do we invest heavily in tele-mental health?”
There are a lot of unanswered questions, including what the rapid changes may mean for patient privacy over the long term, whether in one-on-one teletherapy or in group sessions after digital Alcoholics Anonymous meetings were crashed by online trolls.
Providers are “kind of trying everything right now and seeing what can work,” said John Torous, director of the digital psychiatry division at Beth Israel Deaconess Medical Center. That includes meeting patients virtually on popular video chat apps like Google Hangouts and Skype after the Trump administration temporarily relaxed rules that long restricted health care’s use of these platforms over privacy concerns.
In addition to the people who were already receiving therapy or treatment for behavioral health, many more are now confronting isolation and anxiety because of the health and financial crisis. Nearly half of Americans say the pandemic is already affecting their mental health, according to a recent Kaiser Family Foundation poll.
"I would expect with these kinds of deprivations or stressors that those numbers would only increase," said Elinore McCance-Katz, Trump’s top mental health official. The agency she runs, the federal Substance Abuse and Mental Health Services Administration, has been hosting calls with behavioral health providers to walk through conducting virtual care during the pandemic.
Adopting telehealth will be a massive paradigm shift for behavioral health providers, an expansive category that includes psychologists, psychiatrists, licensed clinical social workers and licensed practicing counselors, among others. The field has been typically slower to embrace telehealth compared with other disciplines, according to a 2018 study from the University of Michigan's Behavioral Health Workforce Research Center.
Today's complicated patchwork of payment rules determining who can provide online counseling services may be holding back even broader adoption of telehealth. State regulators are generally relaxing restrictions on telehealth , at least temporarily, though some haven’t yet. Some private insurers are paying for online therapy visits at the same rate as in-person, though others still pay less.
Mental health professionals may still feel pressure to treat clients in person, putting themselves at risk, without stronger encouragement from health care payers, like state and federal governments and insurers, said Robert Caudill, a psychiatry professor at the University of Louisville. "Until we get clarification that says, 'Yes, absolutely do this, you're going to be fine,'" the shift toward telehealth may be restrained, he said.
Medicare during the crisis has relaxed federal rules to expand telehealth, including mental health, and HHS Secretary Alex Azar has urged states to loosen licensing requirements to allow out-of-state providers where there are shortages.
There are still some limits. Medicare still generally requires that telehealth visits have both audio and visual elements — so it typically won’t pay for phone calls — which could disadvantage those without internet access. Medicare says it will for pay for virtual visits with psychiatrists, clinical psychologists and licensed clinical social workers, but won't for licensed professional counselors — even though they often do similar work — because of what some behavioral trade groups called a quirk in federal law.
And while Medicaid tends to provide better coverage for mental health services than private insurers, access to telehealth services more broadly during the national emergency varies across the states. In California, telehealth companies employing out-of-state doctors can get approval to treat new patients within two to four days; temporary rules in Florida allow interns to lead more remote mental health sessions during the pandemic. Mississippi sets a much higher bar, only allowing out-of-state doctors to treat existing patients virtually.
There are already signs the practically nationwide lock-in is driving more mental health services online. Doctor on Demand, a well-known telehealth company, said it’s seen a 130 percent increase in behavioral health visits compared with the same time last year, as well as a significant uptick in the weeks since President Donald Trump formally declared the coronavirus a national emergency. NOCD, an app-based provider specializing in obsessive-compulsive disorder, said virtual visits have more than doubled since the beginning of March. Multiple behavioral health clinics tell POLITICO they've had to take 100 percent of their visits online during the pandemic, compared with a tiny fraction just weeks before.
The virtual shift hasn’t been without drawbacks, though. Reports about harassment of digital AA meetings could make people wary of seeking mental health care online.
"There's always a concern about confidentiality," said McCance-Katz, the federal mental health chief. "An individual just needs to decide the risk [of online therapy] versus gain ... If they're more concerned about something revealed about them that they don't want to be revealed, then they probably won't use the service."
For therapists, there’s an added challenge of building trust with their patients when there’s a digital barrier between them.
“So much of counseling has to do with body language, being physically present in the room, intonation,” Linde said. “Sometimes, that's lost when you don't have good internet connection, or one of you starts getting garbled.”
And other barriers appear poised to challenge the demand for mental health care. Lower-income Americans bearing the brunt of the country’s rapid financial collapse might not have access to phones or the internet, while the rolls of uninsured Americans seem bound to explode.
Some think the pandemic will force patients and providers to get more comfortable with using telehealth for behavioral care, even after the disruption to daily life ends. The crisis could be a "tipping point for the way we practice," said Peter Yellowlees, a professor of clinical psychiatry at the University of California, Davis and former president of the American Telemedicine Association.
Telehealth advocates say a further embrace of technology can prove to be an invaluable tool, giving providers deeper insight into their patients’ well-being. Beth Israel Deaconess psychiatric patients are now using an app that tracks sleep, step count and other biometric markers, for instance.
"This could be a really important testing case for telehealth," Torous said.
Senator Harris joins a number of her fellow presidential candidates in offering a plan to address the shortage of mental health and addiction care providers across the country. However, Senator Harris takes her plan a step further with demanding a reclassification of Schizophrenia.
“We need to act. As president, Kamala will make sure we deliver mental health on demand—that is, she will provide services to all Americans who need it, whenever they need it, and wherever they need it,” her proposal reads.
Senator Harris supports an effort that GCS has been championing. Her plan supports reclassifying schizophrenia and other serious mental illnesses as a neurological condition instead of a behavioral condition. The new designation would unlock more funding for research, advocates say.
Groups lobbying for reclassification have argued they want schizophrenia included in the CDC surveillance in order to convince researchers and the public the condition is biologically based with probable causes.
Politico Covered the newly debuted House Democratic funding patch to keep the government running for four more weeks once the current stopgap expires Thursday night. A major program that GCS has championed was included in the bill:
“A mental health demonstration program providing funding for clinics in eight states was extended for another month. The program launched in 2017 and has been temporarily extended several times since funding was slated to expire last March. It provides mental health and addiction treatment services to an estimated 300,000 people.” -Politico Pro, November 18, 2019
Politico recently covered the programs that are funded in the draft Senate Health and Human Services appropriations bill for FY2020. Several programs GCS champions were included in their coverage:
“The draft contains $3.9 billion to respond to the addiction crisis, including $1.5 billion in state response grants and $200 million for community health centers that provide behavioral health services and treat substance abuse disorder.
The $3.7 billion in spending to expand access to mental health services includes $200 million for certified community behavioral health clinics and $103 million for efforts by schools and state agencies to increase awareness of mental health among kids and train school personnel on detecting and responding to mental health issues.” – Politico Pro, September 18, 2019
On Politico’s Morning eHealth edition on May 6, 2019, a briefing in cooperation with the House of Representatives Mental Health Caucus’ May is Mental Health month was featured.
— “Other events: Myriad Genetics will hold a briefing Thursday on medication choices for depression.”
New year brings new push to overhaul patient privacy rule
By Darius Tahir
02/21/2019 04:44 PM EDT
Advocates for a privacy rule overhaul that would make it easier to share a patient's substance use treatment records are hoping the Trump administration will take action where Congress failed.
The advocates — including a cross-section of health groups, from the American Hospital Association to the American Society of Addiction Medicine — want to change 42 CFR Part 2, a 1970s-era law mandating explicit patient consent each time the records are shared with anyone.
The groups believe the law is cumbersome and ineffective at protecting patient privacy. Changing it could make it easier to detect and coordinate care for patients suffering in the enormous opioid epidemic, they say.
A legislative effort to change Part 2 fell short in the previous Congress. The bill (H.R. 6082 (115)) passed the House by a comfortable margin, but was never considered by the Senate. Advocates for the bill felt the intervention of the AMA, and persistent concerns from some powerful congressional Democrats, stymied the effort.
This year they're hoping to win changes at the administrative level. "We feel pretty confident that this administration is frustrated with the barriers to coordination for patients suffering with substance use disorder," said Duanne Pearson, senior director of federal affairs at Premier. "They are looking at every avenue to tackle care coordination."
"HHS has indicated that Part 2 reform is the final part of the regulatory sprint," agreed Rebecca Klein, director of government affairs at the Association for Behavioral Health and Wellness, which represents insurers.
HHS is expected soon to issue a request for information, which could lead to a rulemaking, Klein indicated during a press call held by the Partnership to Amend 42 CFR Part 2, an umbrella group.
Members of Congress have joined the effort. West Virginia's senators are circulating a "Dear Colleague" letter urging HHS to initiate rulemaking on Part 2, saying its provisions are "not compatible with the way health care is delivered currently." A spokesperson for Sen. Joe Manchin (D-W. Va.) said the letter is expected to go out next week with a list of co-signers.
In recent years, the department has twice conducted Part 2 rulemakings. Those efforts produced only minor changes, Klein said. But the department may have further room for maneuver.
While rulemakers "can't entirely abandon the idea of the statute," said Kirk Nahra, a privacy lawyer at Wiley Rein, "there are enormous parts of the existing regulations that didn't have to be written the way they're written."
Nahra argues that the substance use treatment data has special status: no other type of health care information receives such protection.
Privacy hawks believe the rule's protections are justified, given the stigma and societal penalties associated with substance use. But there are other, less protected medical conditions with stigma, such as sexually transmitted infections.
"It is a very tricky balance," said Lucia Savage, chief privacy and regulatory officer for Omada Health. "The opioid crisis is severe, but the rationale behind the statute's guarantee of confidentiality unless the individual consents, remains: people who are in recovery or who suffer from substance use disorder want to control who knows about this to protect their families, their jobs, their finances, and their very lives from health status discrimination or being criminalized for addiction."
Pearson argues that treating substance use data the same as other medical records, while still banning its use in criminal or civil proceedings, would be the best solution. Enforcement of violations of Part 2 have been minimal. By contrast, the HHS Office for Civil Rights' enforcement of HIPAA violations has been comparatively robust.
Advocates of Part 2 reform also say it would make it easier for medical systems to expand into addiction treatment by making data sharing easier. "Part 2 is unimplementable in an integrated setting," said Corey Waller, chair of the American Society for Addiction Medicine's legislative committee.
Whatever the results of rulemaking, "the best avenue forward would be the legislation," Pearson said.
The flip of the House makes that less likely, however. Rep. Frank Pallone, the new chairman of the House Energy and Commerce Committee, which has jurisdiction over the bill, voted against it last year. A spokesperson for the committee had no update on Pallone's position.
A spokesperson for Rep. Markwayne Mullin (R-Okla.), a legislative ringleader of Part 2 overhaul, said he would wait for any HHS rulemaking before deciding on a legislative strategy.
"If the administration drops a new rule" with significant changes in it, "I think people will come to the table on legislation," Pearson said.