Good afternoon, everyone. Welcome to this IHS webinar. This is the first in a series of webinars that the Government Affairs team will be presenting over the year. I'm Peter Mihalik, IHS's Health Policy and Advocacy Director. But before we get into it, I just wanted to share a few housekeeping items. Note that we are recording today's webinar so it can be offered on demand through our e-learning portal. An email will be sent out next week when the recording is available. Closed captioning is also available and can be turned on using the Zoom toolbar as shown on the screen. The slides for today's presentation can also be downloaded on the webinar web page. If you want to follow along, feel free to go ahead and download that and stay up to date with what we're talking about. At the end of today's presentation, we'll also have... Today's webinar is a bit informal. If you've seen one of my webinars before, you know that I enjoy sort of interacting with the participants. So at any time during today's presentation, feel free to raise your hand. If you have any questions virtually, we will call on those with hands raised and you'll receive a prompt on the screen to unmute yourself. As you can see, we have a pretty in-depth agenda. We want to talk about why IHS is doing this, why it's important, how to directly communicate with congressional offices, some local initiatives that you might undertake, and finally, answer any kind of questions. So why is IHS doing this? We are currently working on a piece of legislation to support our fit-to-serve initiative that has been going on for nearly a decade. Over time, the Veterans Affairs Administration has been ordered by Congress to bring hearing aid specialists into the fold, their various health care programs, first at the individual facilities, also giving them the authority to include them in the community care program, which veterans can utilize in their hometowns and communities to get the health care that they need. But to date, the VA hasn't necessarily been the most proactive and engaging in any of this. So we want to target some legislation on making sure that in the community care program, hearing aid specialists are definitely included. And we'll be revealing more of that a little bit later. But what we need to do is build support for that legislation. And we'll talk a little bit more about it in a few slides. Also, you know, just kind of things tend to pop up, whether that's an amendment on, you know, appropriations bill, some kind of bill that might be negative for our membership. So we just want to kind of build that institutional knowledge, both here at the staff and also amongst all of you, that you know when the bell needs to be rung, that you're ready to go. And finally, you know, anytime that you have the opportunity to kind of talk with a member of Congress or staff, that's just building, you know, long term relationships and, you know, opportunities for future engagement on other initiatives. So the importance of grassroots. Grassroots matters. I'm coming from this, having worked in a congressional office for a few members of Congress. Congressional offices definitely pay attention to the issues being raised by the folks that they serve. This can vary a little bit by office, obviously. There's a lot of considerations that go into supporting or not supporting, you know, individual pieces of legislation. But in any given Congress, there are about 8000 bills introduced. So what can kind of draw some attention to a particular bill? What can kind of get something on a staffer's radar? You know, having those conversations, sending in those emails, calling the office, letting them know that this is important to you and therefore important to them. So one of the things that, you know, an office might understand or take into consideration is incoming communications, how many emails, phone calls, things like that they get about a particular issue and how important it is to their district. In addition to that, you know, building out that grassroots support also means that we bring something to the table when we're engaging in coalition building with other organizations. We can trade shits on supporting different bills, knowing that we have a robust membership and that we can utilize them to support different initiatives. So the first, this is going to be a lot of kind of variations on the theme. We'll kind of go through, you know, the pros and cons of each of these sort of ways to communicate with an office. And I'll provide a little bit of kind of a sample that you might want to expand upon. The first is direct phone calls. So you just pick up the phone, call the office. If you don't know what your, you know, congressman's office, house.gov or the senate.gov directory can help you. You can also call the switchboard and I'll have that number in a few slides. Phone calls can kind of be scripted or unscripted. Sometimes if like if you're in a chapter and you want to do like a phone bank or a thing like that where everybody calls at the same time, it might be helpful to have something scripted so that members can just sort of, you know, for lack of a better word, kind of regurgitate that information back to the staff. But if you're just, you know, yourself, pick up the phone, dial your congressman, say, hey, I'm a constituent and I would like you to support XYZ. One of the pros is that sort of the passion about the industry, your knowledge, how you can kind of talk about how important it is, can really sort of resonate with the staff who are kind of making those decisions about what to support and what not to support. And, you know, if you pick up the phone and you're just like, eh, whatever, that doesn't necessarily lead to results as much as being really passionate and enthused about something. One of the other benefits of, you know, engaging in sort of a phone call or a phone bank is that it's immediate. You don't have to wait for a staffer to read it. You don't have to wait for the mail to get there. You don't have to wait for any of that. It's, you know, right there, you're talking to a staffer. One of the cons, though, and I think this is a big con, is it's really difficult to track a response. So staff is responsible for entering all the phone calls and communications into a database system for the office. Usually that task is left up to interns or junior staff, and it can be a little bit kind of like haphazard. Not that they don't want to do it or anything like that, but they don't always have the right information. They don't always take down your name. They don't have your address. It can be really difficult to figure out, like, how to get back to a particular constituent once a decision is made, whether to support or not support something. So all that has to be kind of taken into consideration when you kind of engage in phone calls. But the other kind of sort of drawback is, like I said, you're probably talking to an intern or junior staff. It's not getting communicated necessarily directly to the member or chief of staff or legislative director or anything like that, that are going to be responsible for making those types of decisions on policy. So it's got to go through a few levels to get there, and it might not get there at all. So that can be really kind of a big drawback, but it's something to consider. So as you can see, you can look up your house member, house.gov, you can look up the senator, senate.gov, and if all else fails, call the capital switchboard and they'll direct you to where you need to go and connect you to the office. And here is an example of a phone script, you know, you're calling on the congressman to support HR XXX. A little bit about, you know, who you are and what you do and why it's important to the community and, you know, why this legislation will fix the problem that you are looking to address. So we'll kind of get back to this a little bit in a few slides and emails and things like that, but it's all just a way to communicate with a congressional office. So in a similar fashion, you can do email and mail. So email is obviously immediate, it gets delivered, it might not get read, but it gets delivered almost immediately. Traditional mail takes several weeks. The reason for that is that all the mail is collected and sent to a facility to be irradiated. So if you write a letter today, it probably won't get to the office that you intend it to before March 30th or so, about a month. So, you know, five, six weeks. So, you know, if you're expecting kind of something to be moving relatively quickly, if you're expecting something to happen relatively soon, that that's not the way to go. Just as, you know, in my experience, I had, I fielded a few phone calls from people that would say like, hey, I sent a letter. Why haven't you responded to that? And the answer is, is we haven't gotten it yet. So that can obviously be an issue. Additionally, with sort of email and traditional mail, you can use a form letter. We'll talk a little bit about that in a few slides when we talk about voter voice, but basically everybody sends out the same letter. You just sign your name. Get sent off to the office. Versus you could do kind of in a similar fashion to the phone call where you just kind of lay out, you know, why this issue is important to you, why this matters to the congressman, and all the information sort of required for them to make a decision about that. The benefits of this is that all this is kind of entered into the database directly. So when things get scanned, when the email comes through, it all gets populated in the database attached to your name. And basically, if somebody wasn't able to like follow up with you in a couple of weeks, you could call and say, hey, I sent an email and they'll be able to say like, yes, you did. And, you know, give you a little bit more information about like where the congressman is or what's going on related to that particular piece of legislation. So, for example, email, dear member of Congress, and kind of the same language that we had before. One thing that's really important to highlight is the HR number. It's really important. Like I said, there are over 8,000 bills introduced in a single congressional session. If you just say like, hey, I really support the hearing aid specialist in the community care program bill, the staffer is not going to really be able to like hunt that down. On your behalf. They just don't have the bandwidth to be able to do that. So it's really important to really have that HR number available. And I would, you know, tend to put that at the top of any kind of like letter, because you're just that's the thing that the office is going to look for. If you have some other information about like the original sponsor or some other kind of co-sponsor list or something like that, that can be very helpful. But as far as getting somebody to look at what you're doing or want them to be supporting, it's really important to put that at the top of any kind of like letter, because you're just that's the thing that the office is going to look for. One of the tools that we have here at IHS is VoterVoice. It's part of our package that we use to track bills. It's a great tool to be able to track bills. One of the tools that we have here at IHS is VoterVoice. It's part of our package that we use to track bills and legislation throughout the country, both at the federal and state level. And the great thing about VoterVoice is that we can preload a scripted email for you. You just kind of sign your name and click send and it will go out to who we assigned it to. So this gives us at IHS a little bit more control over the content and also the recipients. So we can direct it to, say, the chair of a committee, and everything kind of flows through that. Or we can kind of, you know, devise three or four bullet points, and those are the things that are just highlighted in the email. The problem with that is obviously, I don't know all of your individual stories about why, you know, you served a veteran, or you didn't get paid for this, or something else happened. So it's really hard to include that information in the voter voice system. But one of the benefits is, is that we can also track about, you know, click rate, open rate, letting, you know, whether that email is viewed by the staff or not. So we'll have that available. But we kind of, like, it kind of loses, it's really easy for you guys to participate in that, but it kind of loses that personal sort of, like, edge that really can kind of put something over the top and bring something to the top of the list of things for a staffer to consider. So it's an important tool, and I think really kind of something that we're looking to utilize more. As I mentioned, we're looking to introduce a piece of legislation to address the fit to serve kind of ongoing issue. We'll be actually putting together a voter voice campaign over the next week or so, contacting, allowing you to contact the chair and ranking member of the House and Senate Veterans Affairs Committees, letting them know that this is an issue that's important to you. As they kind of go through any kind of community care reforms, that you take this policy under consideration and make sure that veterans have access to everything that they need as far as hearing health is concerned. So we'll be putting that together. We'll be directing that out to the general membership as much as possible. And sort of building that, like I said, that sort of groundswell, so that anything that kind of as legislation moves affecting the community care program, we're on the top of mind of a chairman or the ranking member when those discussions are being held. So I got a little bit ahead of myself. We'll be, like I said, providing a script through VoterVoice, loading up the database, directing all that out. It's been a little while since VoterVoice has been used by HS. So like I said, wanna build that institutional knowledge, wanna build some of that programming and really make sure that membership is involved with the success in government affairs. It's really important to kind of have your voice. This is an issue that's important to you and nobody's better at expressing that than you guys. One thing that I think VoterVoice is particularly good at is sort of getting things out quickly. We've had, well, I've had success in utilizing VoterVoice or similar type of programs as far as like killing things that tend to pop up almost immediately. So sometimes on appropriations, which is the mechanism that funds a particular agency, there'll be a cut or something to a particular program. And it's really easy just to like crank out the VoterVoice, send it out to the membership with an email saying this is bad. And then you sign your name and click send, and then it's off to whatever offices you direct it to. In this case, we're directing it towards the chair and ranking members, but we could set it up where it's directed towards your individual members of Congress, but we really kind of want to focus on the chair and ranking because they're engaging in sort of negotiations about VA reform as we speak. So we want to keep this issue kind of percolating and make sure that they don't forget about us. There's other opportunities. Those are what I just talked about was sort of focused on contacting the DC office through various forms, but you can obviously engage in communications at the district office and other opportunities. One thing that I've utilized successfully in the past is the letter to the editor. A lot of offices tend to track news, particularly in kind of like the local papers, people writing in about different issues. It's not gonna be some sort of wordy book or anything like that. You're gonna have 200 to 500 words, very short and to the point. The kind of big downsides are, there's no direct contact, so you don't really get a response back from the office. The benefits are is that you bring awareness, not just to the office, but to a wide swath of people. So if this is something that really matters to a bunch of different people that maybe aren't hearing aid specialists, but say that this would be a great idea, maybe they would be motivated to do something about that. In this particular instance, talking about the VA, it might be best written by a patient, but we wanna be careful that we're protecting their privacy and anything like that. Obviously, if they're putting that information out there, that's up to them, but just kind of be aware of that. And this is a little bit of a sample letter to the editor. I've kind of framed it as a veteran, blah, blah, blah, blah. The wait time was 42 days. If we were expanding the options like HR, blah, blah, blah, we would have been able to be tested and receive my hearing aids that much quicker. The whole point of all of this is providing quicker and better access for veterans. So really kind of drills down on that particular point. The other thing that you could do is request an in-district meeting. So in-district meeting, you're either probably gonna meet with the district director or some other staff. You might meet with a member if the member is around, but that can be kind of hit or miss depending upon what's going on. Obviously, it's an immediate interaction. You're gonna be communicating directly with the staff. However, district staff, usually not empowered to make policy decisions. So a lot of kind of taking notes and then passing that off to the DC crowd to kind of figure out what makes sense for the member of Congress. It's a great opportunity though to kind of like get to know the office, build that relationship. And you can schedule all this via phone, via email. There's on all the members of Congress websites, there's like a request a meeting page or a function, and you can just kind of fill that out and you'll be on the schedule. Just some general warnings as we kind of engage in these campaigns. Don't violate HIPAA. Please do not identify any particular patients. I don't really want to kind of get into the privacy rule and all of that security rule as far as HIPAA is concerned, but just try to stay away from that as... Don't try to... Just stay away from that as far as HIPAA is concerned. Just stay away from that as much as possible. You're providing your perspective. Obviously, if a patient, like if you interact with a veteran and they seem like you mentioned this might be coming up and they want to support it, that's up to them. But what you really want to do is include your own story, include details about your practice, location. In this particular instance, proximity to the VA facility. If the VA facility in your community is like 50 miles away, it might be helpful for the member of Congress to know that. And also all the details that I talked about before about sort of bill information, most particularly the HR number. So, kind of move through that a little quicker than I thought, but I'm available to take questions. It would be great to hear if there was anything that is on top of the mind. All right, I see Terrence. Hi, am I on? Yeah. Okay, wasn't a bill passed a few years ago due to the post-war complications of hearing loss and tinnitus or tinnitus that a president was allowing veterans to take their VA benefits to any hearing office? I know it's, and that's what we're building on. The timeframe and the paperwork is what is following everything up. But wasn't that an initial bill that allowed all this to happen? Well, the community care program was initiated back when I was on the Hill in like 2016 or so based upon a lot of issues with the institution of sort of the VA health facilities as independent operations. So, there was a big push to allow veterans to be included in that program and involved in contract with providers in a particular community. So, in general, yes, but they, for whatever reason, the VA did not include hearing aid specialists as sort of part of that contracting process. So, there are currently, we've directed the VA to hire hearing aid specialists in facility. They've hired, that happened like three or four years ago. Over the course of time, they've hired like 12. There's a whole lot of issues with sort of their hiring practices and what's going on with sort of their requirements as it affects, they're looking at different like education levels and things like that. But there's no sort of direct direction from Congress that hearing aid specialists need to be included in sort of the broader community care program. They do have the discretionary authority, but no mandatory authority. So, what we're gonna be doing is telling Congress, well, Congress is gonna be telling them, you need to do this as these sort of, it gets into like a little bit of how the VA runs the community care program through third-party vendors and things like that. But to make sure that hearing aid specialists are definitely included in all of this, and there's no questions asked. All right, I see a couple of questions come in on the chat. All right, JC, question about the Florida bill. That is obviously sort of a state level issue. I'm more than happy to get Christine, who works with me in the government affairs office to make sure that we follow up with you on that, because there's a lot kind of going back and forth on that. Let me see, question from Carol. Important is my words, if I'm not right. I think, any kind of support is beneficial. So, just because you're, have kind of an inclusion through another means, because you're an audiologist versus just being a hearing aid specialist, doesn't mean that you can't be supportive. It doesn't mean that you can't write in. I would encourage everybody that's participating today and all of our membership to write in as possible. Question from Sue about, what is the HR number? Unfortunately, I was hoping that we would have that information today. However, the committee of jurisdiction is taking a little bit longer to kind of get its wheels turning. We're working with them very closely on sort of finalizing language and getting it introduced. So, I don't have an HR number today to give you. I was hoping that we would, but stay tuned because it's really coming kind of to the impetus of being introduced. We're looking forward to getting it dropped as soon as possible. It's just, we have to kind of wait for the internal gears of the committee to kind of grind through and figure out how to best kind of accommodate what we're looking for. If there's any questions from before. Would this be an opportunity to highlight the value of closer care for veterans compared to a two-hour drive if the VA facility is located that far? The answer is yes. I believe in one of my examples, I did include some information about sort of the wait time and the proximity. So one thing that you want to highlight is maybe that that facility is a significant distance and that hearing aid specialists would be well served in sort of providing that care in their communities. It's, I think, one thing that is very sort of beneficial as far as highlighting that is just, you know, being able to kind of point that out to the member, being able to point that out to the staff. Do we have a guideline on how to set up an advocacy day at the state level? From Monica. The answer to that question is yes. In fact, there was a webinar in November about that very topic. So I encourage you to take a look at the e-learning portal and download that webinar. Take a look at it. And Christine and I would be more than helpful, happy to be helpful in kind of setting that up. And I think just for a brief aside, obviously, I focus at the federal level. That's kind of my experience. That's what we're talking about as far as legislation. But I think a lot of sort of the general kind of tenets of communicating with a particular office, you know, held at the state level. So if you want to write if there's something going on at the state level and you want to write your member, obviously, you need to look that up and things like that. But as far as making sure that you're communicating directly about the policy or whatever bill that you want them to support or not support and why that sort of matters to you and therefore matters to them can be effective at the state level as well. So somebody asked what my most kind of effective grassroots campaign was. There was an amendment to an appropriations bill a few years ago in another organization that I was working for, and we were able to effectively kill it. It would have cut a program that our members relied on pretty significantly and prevent sort of limitations of rules from a particular part of the government. And we were able to get the voter voice sort of campaign up and running, get it out the door, and our members sent in close to 1,500 to 2,000 emails to various offices and, you know, making sure that they were, you know, it was really easy for them to set that up and sign on to that and get it out the door. Like I said, voter voice is really good about sort of being able to kind of like all of, you know, having me preset it for all of you. But unfortunately, kind of, like I said, loses that personalization that can really kind of draw attention from a member or staff. So, just food for thought. Any other questions for me? I see that there's a little bit of a robust discussion about audiologists in the community care program. Just checking to see if I missed anything. Deadline on this. We'll be putting out the voter voice, like I said, next week. However, until a bill gets marked up, until a particular piece of legislation is either moved or decided not to be moved, there could be grassroots support sent in about it. It would be great if we could get all that coordinated, but recognizing that that's not necessarily always the case, we'll be reminding members through our various communications that we have related to government affairs that you have the opportunity to do that if you choose. So I'm gonna wrap it up a little bit. Obviously, like I said, this is the first in a series of webinars coming this year related to government affairs. Feel free to send us any questions at advocacy at ihsinfo.org. If you want to obtain half a CE credit for attending this webinar, please visit the webpage. I want to thank everybody for participating, for asking some great questions, and for being interested on these topics. So really excited to kind of put this all together. Really excited to have all of you involved. Like I said, I think it's really important that members kind of bring their experiences, their perspectives to the Hill. It's not just sort of myself or Christine talking about from a lobbyist perspective with somebody that lives and breathes these issues every day. So feel free to reach out with any kind of questions. Thank you for attending. And if there's anything else, it was great seeing you. Thank you.

IHS webinar

advocacy efforts

fit-to-serve initiative

hearing aid specialists

Veterans Affairs

VoterVoice

grassroots involvement