Does Your Representative Know About S.448/H.R.1173?

Do you live in the States? Ever feel like all this mental health activism isn't bringing about nearly enough change? Don't worry--there's something very easy you can do to change that.

Contact your representatives in congress about S.448/H.R.1173!

That is, you should contact your Senators about S.448 and your House Representative about H.R.1173. They are the same bill, just originating from different chambers in congress (S for Senator, H.R. for House of Representatives), and both chambers need to pass their own "version" of the bill before it can get closer to reality.

But what is S.448/H.R.1173?

These two bills are called the Medicare Mental Health Access Act. They're sponsored by Senator Sherrod Brown of Ohio in the Senate and by Representative Kristi L. Noem of South Dakota in the House of Representatives. The bill "would remove a roadblock to mental health treatment for Medicare beneficiaries in certain treatment facilities. Although psychologists are licensed to practice independently in all U.S. states and jurisdictions, Medicare still requires unnecessary physician sign-off and oversight of their services in some settings, hampering or even preventing delivery of needed care. H.R. 1173 and S. 448 would remove this barrier" (Source: APA Practice Organization).

This is super important, because right now, not nearly enough people have access to the mental health treatment they need.

Image from APA Practice Organization, citing Petterson S, Miller BF, Payne-Murphy JC, Phillips RL Jr. Mental health treatment in the primary care setting: Patterns and pathways. Fam Syst Health 2014;32:157– 66

Can I have more facts?

Yes! Check out the following excerpt from the APA Practice Organization, and read their whole article about this to learn even more:

"Medicare beneficiaries desperately need better, faster access to psychologists:

• Only 1 in 3 older adults with a mental disorder receives any mental health treatment. The Institute of Medicine reports that the situation “borders on a crisis.”

• Making patients wait for mental health treatment worsens outcomes and increases costs. For Medicare beneficiaries with a chronic condition like diabetes or congestive heart failure, comorbid depression doubles the rate of hospitalization and emergency room use.

• Physicians — and especially psychiatrists — are often in short supply, particularly in rural and underserved areas, and thus not available to oversee psychologists’ services, oversight which is unnecessary in the first place. In 2015 an executive with a leading physician search and consulting firm stated that “finding a psychiatrist willing to practice in an inpatient setting is like looking for a needle in a haystack.” Psychiatrists are more than 30 percent less likely than other physicians to accept Medicare.

• Physician oversight is usually provided by general practitioners, who have very little training in treating mental disorders. Primary care physicians detect and adequately treat or refer only 40-50 percent of patients with mental health problems.

• Behavioral health services are an essential component of treatment for many mental disorders, and psychologists provide more than 70 percent of these services in facilities.

• Psychologists are not currently eligible for the same mental health professional shortage area (MHPSA) bonus payments Medicare pays to psychiatrists and other physicians. These 10 percent bonus payments are an important incentive to provide services in rural and underserved areas. Psychologists were also excluded from receiving Medicare electronic health records (EHR) incentive payments, limited to physicians.

The Medicare Mental Health Access Act removes the unnecessary physician oversight requirement by adding clinical psychologists to the list of providers in Medicare’s definition of a “physician,” which already includes podiatrists, chiropractors, optometrists and dentists. Psychologists are the only doctoral-level provider not included.

H.R. 1173/S. 448 would not change state licensure laws, and would not add coverage for any new services for which psychologists could bill Medicare." In other words, the Act takes into account the state's rights and limited government concerns some conservatives may bring up, thereby making the Act something that both parties should be able to agree on passing.

OK, sounds great! So what should I do now?

Contact your representatives! Right now, there are 13 co-sponsors of the bill in the House of Representatives and only 3 co-sponsors in the Senate. Co-sponsors are Representatives or Senators who are essentially "endorsing" the piece of legislation. The more co-sponsors there are for a bill, the likelier it is that the bill will be moved to debate on the House/Senate floor, because it means that it has a likelier chance of passing and not being a general "waste of time" since there is more interest in it. If we want this Act to pass, then, we should first signal to congress that people do care about the Medicare Mental Health Access Act and want it to succeed.

So: the bills have been referred to their respective congressional committees for now, but it is not too late yet for other congressional members to sign on as additional co-sponsors. The more congress people who endorse the Act, the closer we get to making real change happen.

How do I tell my representatives to sign on as additional co-sponsors for S.448/H.R.1173?

Visit this handy-dandy website to find out who your representatives are! The website will tell you both your Senators and your Representative in the House. Type in your zip code and hit "submit" next to that box instead of using the "Search by State" function. This is because no matter where you live in a state, your two Senators are the same. BUT! Depending on where in the state you live, you may fall under a certain Representative's district or another Representative's. So if you type in your zip code, you will be more likely to figure out which specific House member represents you.

Once you finish the "search" process, you can click on the name of each result to find out more details about that congressional member. This should open up a new page with the congress person's website, phone number, and, often times, address. You can contact the congressional member directly through their website, or write an email to them using the email address listed on their website. HOWEVER - a phone call during their office opening hours and/or a hand-written letter (hey, L2S vibes, anyone?) mailed to their office (address should be on their website if you can't find it anywhere else) will be most effective.

If you get multiple House of Representative answers (some zip codes are covered by multiple Representatives), go to the Representatives' websites. They will typically have a link on their website that explains which cities comprise their "district." See which one includes your city in their district--that's the one you should contact. Alternatively, you can always just Google.

Sounds great and easy! Anything else I should know?

To find out more information about the Medicare Mental Health Access Act and to stay-up-to-date on its progress in congress, visit the S.448 link on our congress.gov here and the H.R.1173 link here. Thanks for joining us in making mental health matter. :) Do share this news with your friends and family if you can, and encourage them to take action. The more people who contact their representatives, the more congress will listen to us.

In the meantime, if you're looking for other ways to help, get involved with Letters to Strangers! We'd love to have you on board.