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Advocacy Update: April 2023

The last few months have seen significant movement across a broad array of issues.

Executive Branch Activities

APA Recommends Significant Revisions in DEA Proposed Rules on Telemedicine Prescribing of Controlled Substances, Including Removal of In-person Requirements for Buprenorphine Initiation

APA submitted comments to the Drug Enforcement Agency (DEA) on a package of proposed rules around telemedicine prescribing of controlled substances. If finalized, these rules would modify longstanding regulation to slightly increase flexibility of DEA-registered practitioners to prescribe controlled substances without having seen the patient in person first after the end of the COVID-19 public health emergency (PHE). In response to the buprenorphine rule, which addresses the prescribing of buprenorphine for opioid use disorder, APA recommended that the DEA remove in-person visit requirements for buprenorphine, at a minimum for the duration of the opioid public health emergency. In response to the telemedicine rule, which addresses the prescribing of Schedules III-V non-narcotic controlled substances, APA recommended significant revisions to the final rule to maintain access to clinically-indicated treatment. APA shared its recommendations widely, including with other medical societies and stakeholders and with each District Branch, to increase the reach of these recommendations.

APA and AACAP Request Action from DEA About Shortages of Prescribed Stimulant Medications

APA joined the American Academy of Child and Adolescent Psychiatry in a letter to the Drug Enforcement Agency (DEA) highlighting the crisis of the widespread shortage of prescribed stimulants. AACAP and APA requested information from the DEA about their actions to address the shortage and requested a meeting to discuss potential solutions as soon as possible. AACAP and APA also shared case studies of the effect of this shortage on our members and their patients to demonstrate to DEA the importance of mitigating and communicating its cause and solutions to the public.

APA Urges CMS To Maintain Access to Telemental Health in the 2024 Medicare Physician Fee Schedule

APA sent a letter to the Centers for Medicare & Medicaid Services (CMS) urging action in the 2024 Medicare Physician Fee Schedule and other pertinent rulemaking to maintain critical access to mental health care through telehealth as the COVID-19 public health emergency (PHE) comes to an end. These recommendations included: 1. Maintaining standardized coding for telehealth rather than delineating CPT codes by modality; 2. Maintaining reimbursement for telehealth services at the same rate as in-person care; 3. Permanently removing in-person visit requirements for mental health care; and 4. Maintaining the virtual supervision of residents delivering telehealth services. CMS has taken significant strides toward maintaining access to telehealth services for Medicare beneficiaries, and these steps would help codify remaining areas of opportunity for clinicians to deliver high-quality, technology-enabled mental health care.

APA Responds to Rule Modifying Regulations Governing Various Medicare Plans

APA commented on a proposed rule to modify regulations governing Medicare Advantage (MA or Part C), the Medicare Prescription Drug Benefit (Part D), Medicare cost plans and Programs of All-Inclusive Care for the Elderly (PACE). APA supported many of the proposals, including when and how Medicare Advantage plans develop and use coverage criteria and utilization management policies to ensure that MA enrollees receive the same access to medically necessary care they would receive in traditional Medicare. APA supported proposals that would streamline prior authorization requirements, including adding continuity of care requirements and reducing disruption in ongoing care for beneficiaries by requiring that when an enrollee is granted prior authorization approval it will remain valid for the full course of treatment. APA also supported marketing proposals intended to protect MA and Part D enrollees and people shopping for Medicare coverage, advance health equities and improve access to behavioral health care.

APA Supports the Veterans Health Administration Supporting Expanding Eligibility for Crisis Care to Veterans

APA commented on the interim final rule to expand Veterans access to emergent suicide care. APA supported the Veterans Health Administration (VA) in expanding eligibility for care to individuals who previously were not eligible to receive stabilizing care and offering additional benefits at no cost to the individual, including no copays and coverage of emergency transportation to receive care. APA supports the removal of unnecessary barriers to care, while encouraging the VA to provide additional clarifications and education to prevent confusion in the time of crisis.

Congressional Activities

APA Submits Response to Senate HELP Workforce RFI

On March 20, APA submitted a response to the Senate Health, Education, Labor, and Pensions (HELP) Committee’s Request for Information (RFI) on how best to bolster the health care workforce amid the ongoing shortage. In the letter, APA highlights various programs that should receive continued or increased funding to address the current and foreseeable workforce shortages brought on by the COVID-19 pandemic. We also note how use of the collaborative care model, proper enforcement of parity laws, continued access to tele-behavioral care, and a culturally competent workforce can strengthen the health care workforce.

APA Supports Programs in Fiscal Year 2024

On March 24, APA submitted our Fiscal Year 2024 requests for the House Labor, Health and Human Services, Education, and Related Agencies Appropriations Subcommittee to Chair Robert Aderholt (R-AL) and Ranking Member Rosa DeLauro (D-CT). Priorities included funding for mental health parity enforcement grants to states as well as grants to support the implementation of the Collaborative Care Model–two new authorizations APA led in enacting last year. APA also worked with our congressional champions to secure additional support through two Dear Colleague letters encouraging Members of Congress to support parity and CoCM grant funding this year.

APA also joined with other organizations in a number of requests, including:

  • Mental Health Liaison Group (MHLG) Fiscal Year (FY) 2024 Appropriations Request – APA joined more than 50 partner members of the MHLG in submitting many of the same mental health priorities as APA’s FY24 letter to the House Appropriations Committee, including funding for the National Institutes of Health, the Community Mental Health Services Block Grant, Certified Community Behavioral Health Clinic Expansion Grants, and suicide prevention and crisis hotline-related programs.
  • Children’s Hospital Graduate Medical Education (CHGME) Supporters – The CHGME program supports children’s hospitals efforts to increase pediatric physician training to increase the number of pediatricians and pediatric specialists who care for the nation’s children.
  • Friends of VA Medical Care and Health Research (FOVA) Coalition – The FOVA letter recommended $980 million for VA research to ensure that research progress can keep pace with the increasing health needs of veterans.
  • Friends of Title V – The Title V Maternal and Child Health (MCH) Services Block Grant is used to address the most critical needs of maternal and child health populations across the nation through a wide range of statewide and community-level maternal and child health programs.
  • Friends of the Agency for Healthcare Research and Quality (AHRQ) – The AHRQ supports research to improve health care quality, reduce costs, advance patients’ safety, decrease medical errors, and broaden access to essential services.
  • HRSA Pediatric Mental Health Care Access Program (PMHCA) Supporters – The HRSA PMHCA Program supports pediatric primary care practices with telehealth consultation by child mental health teams, which increases access to mental health services for children. This program also enhances the capacity of pediatric primary care to screen, treat, and refer children with mental health conditions.
  • CDC, NIH, and NIJ Gun Violence Prevention Research Supporters – A coalition of organizations in support of gun violence prevention requested $35 million for the Centers of Disease Control and Prevention (CDC), $25 million for the National Institutes of Health (NIH), and $1 million for the National Institute of Justice (NIJ) to conduct public health research into firearm morbidity and mortality prevention in Fiscal Year 2024.

APA Supports Mental Health Services for Students Act

In March, APA joined a letter of support for the Mental Health Services for Students Act. This bill is being reintroduced by Rep. Grace Napolitano (D-CA) and would provide on-site school and community-based mental health services to public school students, to help schools and families identify students who need mental health services and connect them with treatment. Specifically, the bill provides funding for schools to partner with health care providers, child welfare agencies, and other community-based system services. The bill also supports training for teachers to identify the signs and symptoms of mental disorders, risk of suicide, and trauma exposure.

State Activities

Montana Legislation Seeks To Limit Non-Compete Agreements for Psychiatrists

Montana has the third highest suicide rate in the nation. In order to address concerns about continuity of mental health care, the Montana Psychiatric Association initiated legislation (SB 451) to limit non-compete agreements. This legislation will help ensure Montanans’ uninterrupted access to clinicians providing mental health and substance use disorder treatment. SB 451 will prohibit non-compete agreements that restrict practice for psychiatrists, addiction medicine physicians, psychologists, social workers, professional counselors, addiction counselors, marriage and family therapists, and behavioral health peer support specialists. The bill passed both chambers and is expected to be sent to the Governor for his signature.

North Carolina Becomes 40th State to Expand Medicaid

On March 27, North Carolina Governor Roy Cooper signed House Bill 76 into law, which expands Medicaid coverage to more than 600,000 low-income adults. APA member and State Representative Kristin Baker, MD, chairs the House Health Committee and was key in facilitating the bill’s passage. Governor Cooper invited the North Carolina Psychiatric Association to the bill signing and thanked them for supporting this effort that was a decade in the making.

Mississippi Legalizes Fentanyl Testing Strips

On March 14, Mississippi legislation legalizing fentanyl testing strips (SB 2336) was signed into law by Governor Tate Reeves. Historically, these strips were categorized as illegal drug paraphernalia, but they are an important tool in detecting the presence of fentanyl in other drugs, which can lead to a lethal overdose. APA member and Mississippi Psychiatric Association’s Council on Legislation Chair Katherine Pannel, DO, FAPA, testified in support of the legislation.

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