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Advocacy Update: August 2023

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

APA-Led Activities

Join APA at the 2023 Federal Advocacy Conference

APA is pleased to announce its 2023 Federal Advocacy Conference in Washington, D.C. This is a unique opportunity for APA members to receive training and lobby Members of Congress on issues that affect psychiatry and our patients. The conference will take place October 16-17 at the Willard Hotel in Washington, DC. Registration for the conference is now open. Please register today by visiting the APA website.

APA Hosts Maternal Health and Climate Change Briefings

On July 20, APA held a congressional briefing entitled Maternal Mortality and the Mental Health Crisis. In collaboration with the American College of Obstetricians & Gynecologists, Maternal Mental Health Leadership Alliance and Mental Health Liaison Group, the panel examined disparities in maternal mental health and potential federal policies to address the crisis. APA members Dr. Nancy Byatt and Dr. Denis Antoine moderated and served as an SUD issue expert, respectively. Reps. Lauren Underwood (D-IL) and Robin Kelly (D-IL) both participated and spoke on key maternal health legislation, including H.R. 3312, the Moms Matter Act, and, H.R. 3838, the Preventing Maternal Deaths Reauthorization Act. On the same day, APA Climate Committee Chair Dr. Joshua Wortzel participated in a virtual briefing to discuss H.R. 3073, the Community Mental Wellness and Resilience Act. The bill, which APA has endorsed, proposes funding for community-led public health approaches to prevent and heal mental health concerns caused by natural disasters, toxic stresses and environmental emergencies.

APA Seeks Nominations for Javits Award: State Public Servant

APA is seeking nominations from District Branches for the recipient of the Jacob K. Javits Public Service Award of 2023. On behalf of the APA, the Council on Advocacy and Government Relations presents the Javits Award annually to a public servant who has made a significant contribution to the support of those living with mental illness. This is the highest award conferred upon a public servant by the APA, representing more than 38,000 psychiatric physicians nationwide, and their patients. The Javits Award goes to federal and state public servants in alternating years. This year’s award will honor a state public servant (legislators, regulators, other public servants). Presenting the Javits Award gives APA the opportunity to showcase the work honorees provide on behalf of consumers and the fields of health care and mental health care.

In 1986, the APA established the Jacob K. Javits Public Service Award to honor the legacy of a U.S. Senator from New York, Jacob K. Javits. First elected in 1956, Senator Javits served for 24 years, using his position on the then-Labor and Public Welfare Committee to spearhead health-related legislation, achieving multiple successes on behalf of the mentally ill and on substance abuse issues. In the name of this great statesman, the Council on Advocacy and Government Relations confers this award to federal and state public servants, who have earned recognition for outstanding contributions to the cause of those living with mental illness.

If your APA District Branch wishes to nominate a state public servant for this honor, please complete this form (.pdf) and email it to Naomi Watson at [email protected] by August 25, 2023.

Executive Branch Activities

APA Provides Insight to HHS on Smoking Cessation Framework

APA sent a letter to the Department of Health and Human Services (HHS) in response to a Request for Information on a Smoking Cessation Framework draft, applauding the efforts taken by the Biden Administration to accelerate smoking cessation while urging HHS to consider adding details to support the goals of the framework. These additional details would include addressing e-cigarettes and vaping, providing specifics around coverage and reimbursement of over the counter Nicotine Replacement Therapy products and other smoking cessation tools, and more specific definitions around high risk populations. APA also encouraged HHS to include metrics in the framework such as the number of prescriptions related to smoking cessation, smoking cessation CPT code utilization, as well as the number of people reporting access to treatment.

APA Responds to FDA on changes to Third-Party Vendors for REMS

APA, along with partner organizations, responded to the Food and Drug Administration’s Request for Comments regarding factors the FDA should consider when it reviews a proposed risk mitigation and evaluation strategy (REMS) modification that is prompted by or related to a change in a REMS administrator. Often, drug sponsors and REMS administrators do not seek input from physicians, other prescribers, health systems, or patient/their representatives prior to developing, implementing, or modifying a REMS, which has resulted in significant disruptions in care that exposes patients to serious complications. APA recommended that the FDA include transparent and meaningful stakeholder representation with REMS administrators to ensure patients have timely and safe access to treatments.

APA Applauds FTC’s Expanded Enforcement of Health Breach Notifications

APA supports FTC’s efforts to increase consumer health data protections through enhancing the definition of “health care services or supplies” to “include any online service … that provides health-related services or tools,” including mobile applications that host “wellness” data, like sleep, fitness, or diet information. This is a critical starting point in establishing accountability and transparency for protection of health-related data by non-HIPAA-covered entities. APA urges FTC to go farther in protecting consumer data before breaches occur by strengthening rules around user consent to privacy policies and issuing the Commercial Surveillance and Data Security Proposed Rule to establish a framework enabling FTC to regulate data privacy and security protections before a breach occurs.

APA Advocacy Reflected in Recent CMS Proposed Rule on the 2024 Medicare Physician Fee Schedule and Quality Payment Program

CMS released the proposed rule on the 2024 Medicare Physician Fee Schedule and Quality Payment Program on July 13, 2023. Several CMS proposals support APA advocacy efforts including continuing to reimburse telehealth services provided to patients in their home at the same rate as in-person care; allowing virtual supervision, including virtual supervision by teaching physicians when the resident furnishes Medicare telehealth services in all residency training locations through the end of 2024. CMS has also proposed to increase reimbursement to psychiatrists providing longitudinal care of complex patients through the use of an add-on code and increased the payments for some psychotherapy services, including adding new codes to support care provided by mobile crisis teams or in crisis centers. CMS is proposing to adopt three quality measures (suicide safety planning measure, suicide outcome measure and a measure related improvment in functioning) for the ambulatory setting that were developed by APA and NCQA under a CMS cooperative agreement. CMS is seeking feedback on ways to expand access to behavioral health integration, and increase psychiatrist participation in Medicare. Finally, CMS is proposing to reduce the conversion factor used to calculate Medicare payments by 3.34% for 2024 (a reduction of $1.14 per RVU). APA has joined the larger physician community in urging Congress to take action to eliminate this payment cut. We welcome your comments on these or other proposals in this proposed rule; email them to [email protected].

Congressional Activities

APA Responds to Request for Information on National Drug Shortage

On July 7, APA sent a letter to the Chair and Ranking Member of the House Energy & Commerce and Senate Finance Committees in response to their Request for Information regarding ongoing drug shortages. Our submission called for improving prior authorization processes and transparency, increased cross-agency collaboration, greater coordination with drug manufacturers, distributors, dispensers and regulators as well as continued investment in healthcare workforce development. The response included data on patient and physician impact from a brief survey with 465 APA member respondents.

APA Supports Mental Health Programs in Fiscal Year 2024

On July 13, APA sent a letter to the Chairs and Ranking Members of the House and Senate Appropriations Committee highlighting the need to increase funding in support of mental health and substance use disorder programs in the Fiscal Year (FY) 2024 Labor, Health and Human Services, Education, and Related Agencies Appropriations bill rather than cut funding during the ongoing mental health and SUD crises. In the letter, APA and fellow organizations urge Congress to invest in the full continuum of care, research, and services devoted to mental health and addiction through continued and increased funding for SAMHSA, HRSA, NIH, CDC, and other key agencies with vital mental health programs.

APA Supports Mental Health Program Reauthorizations

On July 19, APA sent a letter to the House Energy & Commerce Committee expressing gratitude for the progress made in investing in mental health and substance use disorder (MH/SUD) care. The letter urges Congress to reauthorize SUPPORT Act programs and continue supporting legislation to enhance access, decrease stigma, and coordinate mental health care. We emphasized the need to invest in MH/SUD workforce, expand access to evidence-based addiction medications and treatment, and support vulnerable populations, including those reentering the community from incarceration. The letter also proposes amending the SUD State Plan Amendment option for the Medicaid Institutions for Mental Diseases (IMD) Exclusion to ensure adequate care for individuals with co-occurring mental health disorders.

APA sent a letter to the House Energy & Commerce Committee Chairs and Ranking Members in support of a clean reauthorization of the Children’s Hospital Graduate Medical Education (CHGME) program. We support H.R. 3841, which would ensure the availability of predictable, stable funding for children’s hospitals, and oppose H.R. 3887, a proposal that would prohibit hospitals from receiving CHGME funding if they have provided gender-affirming care to minors at any time in the preceding fiscal year. APA also joined a letter urging Congress to reject efforts to ban access to medically necessary gender-affirming care for transgender people.

State Activities

APA Facilitates Listening Sessions With Employee Benefit Services Administration

The Employee Benefit Services Administration (EBSA) division of the Department of Labor is beginning an outreach campaign to help make Americans more aware of their parity rights and gaining access to care. The EBSA is working with APA to schedule meetings with targeted District Branches during their stakeholder engagement of this campaign. APA Staff will contact those selected District Branches during the month of August.

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