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Advocacy Update: February 2024

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

APA-Led Activities

APA Webinar on Clozapine REMS

On January 17, APA’s Division of Advocacy, Policy, and Practice Advancement coordinated with the SMI advisor to host a webinar that provided updates on Clozapine REMS. Members of the SMI Adviser Clinical Expert Team along with APA staff covered an overview of the FDA’s Clozapine REMS program, highlighting current research and data from providers and patients, and sharing how APA has been advocating for change. To view this webinar or previous webinars, visit the Policy and Practice Insights Series page.

Executive Branch Activities

CMS Shortens Prior Authorization Times

In its final rule, Advancing Interoperability and Improving Prior Authorization Processes Final Rule (CMS-0057-F), CMS will require payers of Medicare Advantage (MA) and Medicare Advantage/ Medicare Part D (MA-PD) plans, state Medicaid and Children’s Health Insurance Program (CHIP) fee-for-service (FFS) programs, Medicaid managed care plans and CHIP managed care entities (“impacted payers”) to send prior authorization decisions within 72 hours for expedited (i.e., urgent) requests and seven calendar days for standard (i.e., non-urgent) requests. These rules apply to services and do not apply to prior authorization decisions for drugs. Beginning in 2026, impacted payers must provide a specific reason for denied prior authorization decisions and publicly report certain prior authorization metrics annually by posting them on their website.

The rule also adds a new measure, titled “Electronic Prior Authorization,” to the Health Information Exchange (HIE) objective for the MIPS Promoting Interoperability performance category and the Medicare Promoting Interoperability Program. MIPS eligible clinicians will report the Electronic Prior Authorization measure beginning with the Calendar Year (CY) 2027 performance period/CY 2029 MIPS payment year and eligible hospitals and CAHs beginning with the CY 2027 EHR reporting period. CMS agreed with APA’s recommendation that this be an attestation measure, for which the MIPS eligible clinician, eligible hospital, or CAH reports a yes/no response or claims an applicable exclusion, rather than the proposed numerator/denominator calculation.

The final rule also requires impacted payers to implement and maintain application programming interfaces (APIs) to improve patient access to data, to facilitate care coordination among providers and to support care continuity by January 1, 2027. The rule also provides for certain exemptions from the API and prior authorization requirements. APA’s letter to the proposed rule can be found here.

SAMHSA Finalizes Important Changes to Opioid Use Treatment

In its final rule, Medications for the Treatment of Opioid Use Disorder (.pdf), SAMHSA makes sweeping changes to Outpatient Treatment Programs (OTP) to reduce the burden on physicians while creating a patient-centered approach to care. The final rule makes the alignment needed to remove mention of the data 2000 waiver that prescribers previously needed in order to prescribe buprenorphine in order to treat an individual with opioid use disorder. Moreover, the rule removes the previously problematic regulation that required a one-year history of opioid addiction before admission into an OTP, leaving many without a place of treatment when ready to enter care.

Another area that was finalized that APA advocated for, was initiation of buprenorphine at an OTP, by an OTP practitioner, via audio-only or audio-visual telehealth technology if an adequate evaluation of the patient could happen. This COVID-19 era flexibility was made permanent, to continue to support those who do not have access to an OTP and those who face stigma in their communities preventing them from starting the life-saving treatment. SAMHSA also finalized the request to allow for medical intake and periodic medical assessments to happen via audio-visual telehealth, again allowing patients to continue in treatment while reducing disruptions in daily activities of living.

One of the most impactful changes this rule finalized is the allowance of take-home doses of methadone, again allowing patients to reduce missed doses while also limiting disruptions to employment, education, or other obligations. OTPs can now dispense up to 7 days of take- home doses of methadone during the first 14 days of treatment, up to 14 days of take-home doses from 15 days of treatment, and up to 28 take-home doses from 31 days of treatment for patients who the OTP believes can safely handle this level of take-home medication.

With the ever-changing landscape of synthetic opioids, the final rule also allows for the distribution of testing strips for drug checking where not prohibited by law. Again, signaling the Administration's commitment to harm reduction strategies to help prevent overdoses. APA’s letter to the proposed rule can be found here.

APA Meets with CMS to Discuss Telehealth Payment Parity and Support for Virtual Supervision

APA recently met with CMS on two occasions requesting CMS make permanent telehealth flexibilities currently in place. APA joined 11 organizations on a call with CMS on January 29, 2024. Speakers from APA, American College of Physicians, American Academy of Neurology, and the American Geriatrics Society, voiced support for payment parity for telehealth services, citing this as a “top priority for all our organizations to ensure that physician practices can continue providing vital care via telemedicine in 2025 and beyond.” APA met with CMS individually on February 5, to reinforce this message and request that CMS continue to pay for services as they always have by using the same codes one would use if the patient was being seen in-person. We also asked CMS to make permanent virtual supervision of residents, underscoring the value it brings to the process whether the resident is providing virtual or in-person care. APA followed up with a letter in support of these and other priorities for CMS to consider as they begin to write the proposed rule on the 2025 Medicare Physician Fee Schedule.

Congressional Activities

Medicare Physician Fee Schedule (MPFS) Cuts

On January 17, APA joined the American Medical Association and other medical organizations in a letter urging House and Senate leadership to reverse the 3.37 percent Medicare physician payment cuts that took effect on January 1, 2024. APA also supports a permanent elimination of these cuts via the Preserving Seniors’ Access to Physicians Act of 2023, which would provide a 4.6 percent payment increase for the MPFS, eliminating the cuts.

Maternal Mental Health

On January 17, APA joined a letter of support urging the Chairs and Ranking Members of the House and Senate Labor, Health and Human Services, Education, and Related Agencies (LHHS) Appropriations Subcommittee to include the PREEMIE Reauthorization Act and the Preventing Maternal Deaths Reauthorization Act in the final Fiscal Year (FY) 2024 appropriations bill. The PREEMIE Reauthorization Act would require the Department of Health and Human Services to establish an interagency work group to improve the coordination of programs to prevent preterm birth, infant mortality, and related adverse effects. The Preventing Maternal Deaths Reauthorization Act would provide support for state-based efforts to improve maternal mortality review committees, enhance surveillance of pregnancy-related deaths, and reduce disparities in maternal health outcomes.

Title VII and Title VIII HRSA Funding

On January 29, APA joined the Health Professions and Nursing Education Coalition’s letter of support urging the Chairs and Ranking Members of the House and Senate Appropriations Committees to provide the highest level of funding possible for the Health Resources and Services Administration (HRSA) Title VII health professions and Title VIII nursing workforce development programs for FY2024. Further, the letter requests that the Committees work to finalize the FY2024 spending packages as soon as possible to fortify a strong public health workforce.

NIDA Funding

On January 29, APA joined a letter to the Senate Chair and Ranking Member of the LHHS Appropriations Subcommittee requesting that Congress oppose the addition of language prohibiting the National Institute on Drug Abuse (NIDA) from funding any research related to harm reductions in the FY24 LHHS Appropriations bill.

State Advocacy Activities

APA State Government Affairs Is Here to Help

State legislatures across the country are convening new sessions. APA State Government Affairs provides assistance to District Branches/State Associations on state legislative and regulatory affairs, offering model legislation, tracking legislation, providing guidance on best lobbying practices, offering advocacy training, and more. To find out when your state legislature goes into session, check out this 2024 State Legislative Session Calendar. For more information on how APA can team with your DB/SA, please contact [email protected].

APA Testifies Against Psychologists Prescribing Bills in Hawaii and Washington

In coordination with the Hawaii and Washington district branches, Dr. Levounis testified in opposition to bills related to psychologists prescribing this January. In Washington state, SB 6144 would allow psychologists to prescribe psychotropic medications to patients and order any necessary laboratory tests or diagnostic examinations. The district branch mobilized its membership and partners to testify against the bill and due to the volume of opposition, the bill has officially been defeated for the year. In Hawaii, SB 760 and SB 2049, would establish pilot programs to give psychologists prescriptive privileges. The district branch’s leadership and APA staff continue to monitor these proposals and meet with legislators, given that both bills have strong support from the Senate leadership.

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