Legislative Updates

June 23, 2020

Telehealth Survey Results

Thanks to so many of you who took the time to complete the survey on telehealth use so as to provide us with data for ongoing planning. We had a total of 878 respondents of which 76% were psychologists. We wanted to share some of the results of the survey for your interest, and to assist you in advocacy of continuance of recent telehealth services coverage. Thirty percent of you are in solo practice, with 22% in group practices, 10% working primarily in outpatient hospital settings, and 9.6% in community clinics. Here are some of the takeaways:

Psychologists embraced the use of telehealth.

Some 76% of you provided most or almost all of your services by telehealth over the last three months. You found telehealth of great assistance with continuity of care (73%) and felt that it significantly improved access to care for your clients (74%). Sixty-three percent of you indicated that the use of telehealth improved client attendance. Not only was the quantity of telehealth use significant, respondents also felt that videoconferencing maintained and sometimes exceeded the quality of care of in person services (87%).

Clients were satisfied with telehealth provided.

Eighty-seven percent of you felt that, on the whole, clients were satisfied with the telehealth services they received.

New ways of providing service helps to address access concerns.

Videoconferencing was the dominant type of service provided, typically from the provider’s residence to the patient’s home was most common with 84% of you providing such service. Such interactions were allowed with Medical Assistance and Medicaid due to the changes to telehealth allowing the originating site to be in the patient’s home and removing distance and geography restrictions. Only 5% of you provided services clinic to clinic under what had been the previous requirements. About half of you also provided service from a clinic setting to a client’s home. Of particular note, audio-only services provided by telephone played a huge part in serving clients.

Kinds of services provided through telehealth.

The primary service provided by this sample of providers was psychotherapy (93%) with 71% providing diagnostic assessments. Twelve percent of providers reported competing psychological testing using telehealth.

Telephone services are crucial in addressing access to care issues. Every effort needs to be made to preserve these services.

Fully 80% of you provided at least some services using the telephone, with 10% providing three-quarters or more of services provided by audio-only means. Most of you (62%) provided such services to at least a fifth of your clients in this way. And most of you (67%)  found that services provided by telephone met your standards for competent and effective care. Access to care was much improved with the ability to provide phone services, with 66% of you reporting telephone services provided improved or much improved access. Clearly these services met a critical need. Should these services no longer be covered, dire consequences might ensue with providers anticipating more missed sessions (53%), delays in service provision (43%), and with an alarming 63% of providers reporting that some clients would go without service if this avenue is removed.

Efficiencies in care occurred because of telehealth.

Seventy-four percent reported that continuity of care had increased as a consequence of the use of telehealth and 63% of you noting increased attendance to sessions. Cost efficiencies as a result of better attendance and greater continuity should be heralded to payers. Additional efficiencies and savings likely occurred because of reduced travel expense and time for those providing in-home services. Nineteen percent of providers report decreased costs.

Previously poorly served populations received care.

Forty-four percent of providers reported giving care to individuals in rural areas and 60% to underserved communities. Of those reporting, 53% of providers indicated they were serving individuals with serious mental illness.

Adjustments were required in order to provide telehealth service.

Some new investments were required in order to provide telehealth. Sixty-two percent of providers had to purchase access to a video platform. Costs for technical support services were required by 44% of providers, 24% being required to purchase cameras and the purchase of additional hardware was also frequent (30%). The fiscal impact of providing telehealth services varied, with 36% of providers seeing no fiscal impact while others saw increased costs (16%), and 21% with decreased earning. On the flip side, 19% experienced decreased costs and 21% reported increased earnings.

Deeper dives into the data reveal increased concerns for underserved populations.

Of providers giving care to individuals in rural areas, their perception of the impact of ending telephone coverage were more dire, with 60% expecting more missed sessions, 53% reporting delays in service, and 70% of providers anticipating that some clients would be unable to access care. Individuals working with underserved communities were more likely to work in outpatient hospital (13%) and community clinic settings (12%) and anticipated similar effects of curtailing telephone coverage. Providers of DBT services anticipate a greater reduction in access to care if telephone services are discontinued with 75% anticipating loss of access and 70% anticipating more missed sessions; only 3% anticipate the same rate of attendance. DBT providers estimate a satisfaction rate with telehealth of 92%. For individuals providing substance use disorder and dual diagnosis disorder treatment, 40% provided initial sessions using audio-only services, and had higher rates of reported improved access to services with telehealth. Individuals serving seniors estimated a satisfaction rate of 90% with the provision of telehealth services.

Again, thank you for your participation in the telehealth survey. We hope that the results are thought provoking and will encourage advocacy for maintenance of change in telehealth services.

March 24, 2020

MPA 2020 Legislative Update

Our legislative efforts are rightly overshadowed by the current challenges. The legislature passed a bill to address some of the issues related to the COVID-19. An emergency order by the Governor has loosened restrictions on Medical Assistance such that first sessions can be provided by telehealth and telephone service will be reimbursed.

Many thanks to our Legislator of the year, several times over, Senator Jim Abeler, who has been advocating for this bill and order to address the needs of the disability community. Thanks also to Deb Kiel, one of our previous legislators of the year who helped on this front.

Prior to this emergency, which halted the Legislative session for the time being, the Minnesota Psychological Association (MPA) was making some important strides, which we hope will continue if a special legislative session is called for next session. Most importantly, both the MPA and the Minnesota Board of Psychology voted to support the PSYPACT legislation (HF3823 (Morrison), SF3762 (Matthews) that would assist with oversight and easing of licensure restrictions for telepsychology services across state lines. The bill was poised to be heard in the Health and Human Services Finance and Policy committee in the Minnesota Senate. Unfortunately, meetings had to be cancelled and other pressing issues took precedence. We received widespread support for the bill as we talked with legislators. MPA will continue to provide leadership for the PSYPACT bill. Thanks to Dr. Bruce Bobbitt for his assistance with PSYPACT and the behavior analyst licensing bill.

An additional priority is the behavior analyst licensing bill, which MPA and the Board of Psychology also both supported. This bill HF 3213 (Edelson), SF3279 (Jensen) had a hearing in the Senate Health and Human Services Finance and Policy Committee where it received unanimous and welcome support. The bill, which would license behavior analysts and assistant behavior analysts under the oversight of the Board of Psychology, is important for public protection and so that families using these services have a path to a complaint process if needed. Many thanks to the psychologists who worked with the behavior analysts to fashion a bill that does not negatively impact psychology’s scope of practice, including supervision of trainees and assistant behavior analysts.

Unfortunately, a bill that MPA opposed, which would allow Physician Assistants to practice with less oversight, was passed in the Senate Health and Human Services Finance and Policy Committee. The mental health community, including MPA, expressed our concerns with Physician Assistants providing care to individuals with mental illness without sufficient oversight. As a function of the delays at the legislature, moving forward, MPA will work with community partners to add limiting language that would protect individuals with serious and persistent mental illness.

While no additional hearings had been scheduled for MPA’s bill that would extend the Medical Assistance 23.7% increase to all providers, significant efforts have been underway to address a larger restructuring of rates for outpatient mental health services. MPA has been working in partnership with other community organizations (Minnesota Association of Community Mental Health Centers, Minnesota Psychiatric Society, Minnesota Association of Resources for Recovery of Chemical Health, and Aspire, Minnesota.) It is hoped that legislation for 2021 will be coming forth from these community efforts.

Also interrupted by the COVID-19 crisis was a press conference regarding the Conversion Therapy bill Dr. Marge Charmoli was to speak at the press conference and has played an important role in leadership for this key effort.

Many thanks to the MPA members, including Dr. Steve Girardeau and Dr. Matt Syzdek for their active participation in the Uniform Standards discussion with DHS, which is moving to update and modernize Minnesota’s outpatient mental health rules (Rule 47 and Rule 29) by creating standardized policies and definitions.

MPA will continue to keep you apprised of our legislative efforts. Thanks to all of you who have been contacting your legislators. Please take action when it is requested and stay safe and engage in self-care in these challenging times.

March 10, 2020

APA Federal Advocacy Coordinator of the Year Award

Dr. Trisha Stark, MPA's Federal Advocacy Coordinator, was awarded the Federal Advocacy Coordinator of the Year Award at the APA Practice Leadership Conference in Washington DC. This award is given by APA for leadership in advancing the profession of psychology through federal advocacy. MPA would like to congratulate and thank Dr. Stark for all that she does for MPA and for psychologists in Minnesota!

Left photo: Pictured left to right (Arthur C. Evans Jr., APA CEO; Trisha Stark; Sandra Shullman, APA President)
Right photo: Pictured left to right (Erika Brink, Susan McPherson, Trisha Stark, Willie Garrett, Robin McLeod, Talee Vang)

February 7, 2020

Help Minnesota be the First State to Have Complete Endorsement of the Medicare Mental Health Access Act

We are asking that you contact your Congressional Representative and Senators to ask that they support a bill (HR884 in the House and S2772 for the Senate) that would allow psychologists to be categorized just like all other doctoral level health professionals (dentists, chiropractors, podiatrists), in the “physician” category. Five of our 10 Congresspeople currently support the bill because they know it will ease access, especially in settings such as day treatment, partial hospitalization, and in skilled nursing facilities. Help us be the first state to be wholly in support of this important bill. We are providing model language for you to use in an email.

• First, you need to know who represents you. You can find their contacts here: https://www.house.gov/representatives/find-your-representative
• If your Congressional Representative is listed below, send them a thank you email because they have already signed on to the bill. If they are not on the list, and for both of our Senators, please send an email asking them to sign on to the bill.
• Congresspeople who have already signed on to the bill:
  • Angie Craig https://craig.house.gov
  • Tom Emmer https://emmer.house.gov/contact
  • Betty McCollum https://mccollum.house.gov/contact/email
  • Collin Peterson https://collinpeterson.house.gov/zip-code-lookup?form=/contact/email-me
  • Dean Phillips https://phillips.house.gov/zip-code-lookup?form=/contact/email-me

Send them an email saying,

Dear Congressperson ____________:

“I am a psychologist and your constituent. Thank you for supporting HR884, the Medicare Mental Health Access Act. Your support means that Minnesotans will have greater access to needed mental health services. Thank you for all of your efforts to support quality mental health services.”

Sincerely,

Name

Street Address

City, State, Zip

Email address

• Congresspeople who have not yet signed on include:
  • Jim Hagedorn https://hagedorn.house.gov/zip-code-lookup?form=/contact/email-me
  • Ilhan Omar https://omar.house.gov/zip-code-lookup?form=/contact/email-me
  • Pete Stauber https://stauber.house.gov/contact/email-me

Send them an email saying,

“Dear Congressperson _______________:

I am a psychologist and your constituent. I am contacting you to ask that you sign on in support of HR884, the Medicare Mental Health Access Act. This bill would allow psychologists providing Medicare services to be more accurately categorized, along with all of the other doctoral level health professions (dentists, chiropractors, podiatrists), in the “physician” category. This recategorization would not change scope of practice or infringe on any other profession. The recategorization will increase much needed access to mental health services for individuals covered by Medicare in Minnesota. Passage of this bill is crucial to secure adequate access to mental health services for Minnesotans.”

Sincerely,

Name

Street Address

City, State, Zip

Email address

Neither of Minnesota’s Senators have signed on as cosponsors to the Senate version of the bill, S2772. Please send the following email to both of our Senators,

Amy Klobuchar  www.klobuchar.senate.gov/public/index.cfm/contact

Tina Smith  www.smith.senate.gov/contact-tina

“Dear Senator (Klobuchar/Smith):

I am a psychologist and your constituent. I am contacting you to ask that you sign on in support of S2772, the Medicare Mental Health Access Act. This bill would allow psychologists providing Medicare services to be more accurately categorized, along with all of the other doctoral level health professions (dentists, chiropractors, podiatrists), in the “physician” category. This recategorization would not change scope of practice or infringe on any other profession. This recategorization would increase access to much needed mental health services in Minnesota. You have been a great champion for mental health concerns in the past and I’m asking you to cosponsor S2772. Please support this bill so that my training can be used to its maximum capacity for the good of Minnesotans.”

Sincerely,

Name

Street Address

City, State, Zip

Email address

We Need Your Help to Preserve Psychology’s Scope of Practice

Two urgent legislative issues threaten our scope of practice. They would allow unqualified individuals to provide key services and endanger the public.

First, licensed clinical social workers (LICSWs) are bringing a bill to allow them to diagnose Attention Deficit Disorder (ADD) for something called 504 plans for schools. Why is this a problem? 504 plans are based on a disability determination based on a medical condition in order to provide accommodations for students. Currently only physicians, nurse practitioners, and psychologists can diagnose ADD to initiate a 504 process. Psychologists make a diagnosis of ADD based on neuropsychological factors, whereas other mental health professionals diagnose on the basis of behavior. ADD is a medical condition, not a behavioral disorder. If  LICSWs are able to diagnose ADD for purposes of initiating a 504 plan in a school, many children will  inappropriately be given a disability diagnosis that is based on a behavioral disturbance rather than a medical condition. As psychologists know, ADD is a complicated diagnosis to make, with many competing factors that must be ruled out. LICSWs do not have the skills to accurately address these multiple factors and will inappropriately give a disability diagnosis to a child based purely on behavioral manifestations. This puts children at risk. It is especially problematic as African American boys are inappropriately over-diagnosed with ADHD by community providers.

Second, Occupational Therapists (OTs) are bringing a bill that would allow them to be classified as mental health professionals. Mental health professionals are able to diagnose and treat mental health disorders. OTs have no training in mental health and should not be allowed to diagnose or treat mental health concerns using our billing codes. OTs provide an important service in assisting individuals in improving their Activities of Daily Living. That is not a mental health service. OT services should be billed as what they are, occupational therapy services.

WHAT CAN YOU DO?

Send an email to your state legislators. Call your legislators and let them know of these urgent concerns that threaten public safety. You can use the example below in your email and on your call. To find out who represents you click here https://www.gis.leg.mn/iMaps/districts/ Let MPA know that you have reached out to your legislators by sending an email to [email protected] If legislators have further questions that you feel you cannot answer, please email and MPA can respond for you.

Dear Representative or Senator _______________,

I am a constituent and psychologist contacting you about two critical issues that threaten public safety.

First, Licensed Independent Clinical Social Workers are attempting to change statute so that they can diagnose for purposes of initiating a 504 plan for schools. I ask you to oppose this proposal. Such a disability diagnosis is a matter of considerable weight with significant implications for a child’s life. Physicians and psychologists currently diagnose Attention Deficit Disorder for a 504 plan from a medical, neuropsychological perspective. Social workers diagnose based on behavioral manifestations, which leads to many inaccurate diagnoses that harm children. Please prevent more children from being inappropriately labeled with a disability diagnosis by opposing social work efforts to diagnose this complex condition.

Second, Occupational Therapists are seeking to be included in statute as mental health professionals. Again, I ask that you oppose this proposal. They have no training in mental health. They do work with individuals with serious mental illness, assisting with Activities of Daily Living. Help with such activities is not a mental health treatment and should not inappropriately be billed as such. Occupational Therapists cannot diagnose or treat mental illness, key features in the definition of a mental health professional. Please oppose this attempt to provide services without appropriate training that endangers the public.

Thank you for your attention to these important matters.

Name

Street address

City, MN zip code

Phone number

Email address

IF YOU WOULD LIKE TO CALL YOUR SENATOR AND REPRESENTATIVE, YOU CAN USE THIS SCRIPT:

Hello (Senator/Representative _____________:

My name is _________________ and I am your constituent and a licensed psychologist. I am calling today with two concerns. First Licensed Independent Clinical Social Workers are attempting to change statute to allow them to diagnose attention deficit disorder to initiate 504 plans for schools. ADD is a complicated neuropsychological condition that requires skills social workers do not have. Please oppose any efforts to allow social workers to give this weighty disability diagnosis without proper training. Additionally, Occupational Therapists are seeking to be classified as mental health professionals. They do not have the training to provide mental health services. Their interventions should be limited to the interventions covered by their licensing board. Please oppose any efforts to allow Occupational therapists to become mental health professionals. Thank you. If you have any questions feel free to contact me at (phone number).

January 22, 2020

Many thanks to Minnesota’s Congress members who are supporting HR 884, the Medicare Mental Health Access Act. Thanks to these representatives for supporting crucial access to mental health services in Minnesota.

Angie Craig
Tom Emmer
Betty McCollum
Collin Peterson
Dean Phillips

Congressman Emmer (middle) with Dr. Scott Palmer (right), Behavioral Health Specialist and Jeri Mehr (left), Supervisor for Psychotherapy of Clara's House Mental Health Services in St. Cloud, Minnesota.

Click here to read more about Congressman Emmer's visit to Clara's House with MPA member Dr. Scott Palmer.

Click here to view archived 2019 MPA Legislative Updates

Click here to view archived 2018 MPA Legislative Updates

Click here to view archived 2017 MPA Legislative Updates