The last few months have seen significant movement across a broad array of issues.
Some Psychiatrists Experience Increased Audits
APA is in communication with private payers following an increase in calls to APA’s Practice Management Helpline from members who are experiencing coding and documentation audits by these payers. As was highlighted in a May 2022 Psychiatric News article, members have seen an increase in scrutiny of their claims including the use of prepayment claims review and post-payment claw-backs. In an effort to ensure that APA understand the breadth of the issue, we encourage members experiencing delays or adjustments to their claims to send an email describing your experience to our Helpline at [email protected]. Include your name, contact information, and the payer in question. The Helpline is a free resource that assists APA members with practice management issues.
Executive Branch Activities
Federal Trade Commission Opens Inquiry Into Pharmacy Benefit Managers’ Practices
The Federal Trade Commission (FTC) has opened an inquiry of pharmacy benefit managers’ business practices, including those of CVS Caremark; Express Scripts, Inc.; OptumRx, Inc.; Humana Inc.; Prime Therapeutics LLC; and MedImpact Healthcare Systems, Inc. This inquiry comes as a result of over 24,000 comments made in response to FTC’s request for information regarding how these middlemen are impacting prescription cost and access. Furthermore, the largest pharmacy benefits managers are now vertically integrated with the largest health insurance companies and wholly owned mail order and specialty pharmacies. APA’s comments can be found here.
APA Comments on Patient Experience Survey for Mental Health Settings
The Agency for Healthcare Research and Quality (AHRQ) is looking to develop a version of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, a tool for assessing patients’ experiences with healthcare, for use in inpatient mental health settings. Versions of the CAHPS survey are currently used in a variety of other healthcare settings, and have been incorporated into federal quality and payment programs, such as CMS’s Merit-Based Incentive Payment System (MIPS) and Hospital Value-Based Purchasing (VBP) programs. APA responded to a Request for Information released by AHRQ, providing input on development of a patient experience survey for inpatient mental health settings, noting potential benefits and limitations of such a survey, and making recommendations for AHRQ to consider as development of the tool moves forward.
Executive Order on Protecting Access to Reproductive Healthcare Services
Two weeks after the Supreme Court issued a decision on Dobbs v Jackson Women’s Health Organization, President Biden issued an Executive Order (EO) on Protecting Access to Reproductive Healthcare Services. The EO defines the term “reproductive healthcare services” to mean medical, surgical, counseling, or referral services relating to the human reproductive system, including services relating to pregnancy or the termination of a pregnancy. APA will continue to support the Agencies in their work under the EO as well as shape the policy discussion to ensure that all people have access to the full range of reproductive healthcare services.
APA Submits Testimony in Support of Bill to Fight Veteran Suicide
The House Veterans Affairs Health Subcommittee in June held a legislative hearing to consider several bills related to veterans’ health care. Among the legislation considered was the APA endorsed VA Zero Suicide Demonstration Project Act of 2022, which aims to eliminate veterans suicide deaths via promotion of the Zero Suicide model. The Zero Suicide model utilizes a system-wide approach to mental and substance use disorder services and aims to improve outcomes and close gaps in care. On June 9, APA submitted testimony in support of the bill and will continue to monitor the progress of the legislation.
APA Supports Enactment of Bipartisan Safer Communities Act
In response to the recent mass shootings in Buffalo, Uvalde, and Tulsa, Congress passed and President Biden signed the Bipartisan Safer Communities Act, S.2938 – the first major federal gun violence prevention legislation to successfully clear both the House and Senate in nearly three decades. The bill would provide states with grants to create, implement, and improve Extreme Risk Protection Orders (ERPOs) or red flag laws; require additional background checks for purchasers of guns who are under 21, including consideration of juvenile criminal records; and fund community-based violence prevention initiatives, as well as a series of other items. The bill also provides significant mental health resources for select programs, including: almost $8 billion for the Medicaid Certified Community Behavioral Health Clinics program; $150 million in state funding to support the implementation of the 9-8-8 lifeline and to improve their crisis response and prevention programs; $500 million through the School-Based Mental Health Services program under Medicaid; $250 million to states through the Community Mental Health Services Block Grant; $80 million for the Pediatric Mental Health Care Access grant program; $60 million to support Mental Health Training for Primary Care Providers; and assistance to states on how to increase access to telehealth services, among other items. APA supported enactment of S.2938 and 396 APA members engaged through APA’s action alerts to contact their congressional representatives in support of the legislation.
APA Priorities Included in House-Passed Mental Health Reauthorization Package
On June 22, the House overwhelmingly passed H.R. 7666, the Restoring Hope for Mental Health and Well-Being Act of 2022, by a vote of 402 to 20. The legislation includes several provisions APA has prioritized, including: language from APA’s legislation to encourage uptake of the Collaborative Care Model; authorize federal grants to states to enhance parity enforcement; eliminates the federal opt-out for non-federal governmental health plans from requirements of the Mental Health Parity and Addiction Equity Act (MPHEA); boost authorized funding for crisis services including the launch of the 9-8-8 Lifeline; and reauthorize funding for maternal mental health and substance use disorder screening programs. Additionally, the package extends the funding authorization for Project AWARE and reauthorizes the Minority Fellowship Program at $25 million for Fiscal Years 2023 through 2027. These provisions align with APA priorities that were highlighted in APA President Dr. Rebecca Brendel’s testimony before the Health Subcommittee of the House Energy & Commerce Committee in April. More than three hundred APA members engaged with their legislators via APA’s grassroots engagements and wrote to their Representatives asking them to support the bill. APA continues to encourage Senate action on this bill and other mental health / substance use disorder-related legislation pending in that chamber.
APA Continues to Support Reproductive Rights
On May 10, APA joined a coalition of medical organizations in a letter of support for S. 4132, the Women’s Health Protection Act, which would protect access to abortion and other reproductive health care under federal law, rather than leave reproductive rights dependent on whether the U.S. Supreme Court would continue to adhere to the precedent set by the Roe v. Wade (1973) case. Though the legislation passed the House of Representatives last year, a vote on the legislation failed in the Senate this spring. Further, on June 24, the U.S. Supreme Court voted 6-3 to overturn Roe, allowing states to decide whether to allow or ban abortion services in its ruling in Dobbs v. Jackson Women’s Health Organization. In response to the Supreme Court ruling, APA issued its own statement, joined its physician colleagues from the Group of Six denouncing the ruling for jeopardizing women’s access to health care services, partnered with other mental health organizations in issuing a statement decrying the ruling, and also joined over 75 individual organizations including the American Medical Association in issuing another statement condemning legislative interference into the patient physician relationship. APA previously joined our Group of Six colleagues in issuing statements opposing legislation that threatens access to reproductive health care, opposing the criminalization of physicians for providing medically necessary, scientifically based care, and opposing legislation that interferes with or penalizes patient-care.
Wisconsin Medicaid to Reimburse for the Collaborative Care Model
The Wisconsin Department of Health Services will now reimburse through Medicaid for the Collaborative Care Model (CoCM) codes as a direct result of the Wisconsin Psychiatric Association’s (WPA) successful advocacy efforts. WPA met with the Department, explaining CoCM is an evidence-based solution to safely increase access to mental healthcare through the state. CoCM is effective and efficient, resulting in healthcare cost savings.
APA State Government Affairs continues to support its district branches and state associations, such as the WPA, in advocating for coverage of CoCM. APA model legislation provides that commercial insurers must reimburse for the CoCM codes. For more information or to view model legislation adapted specifically for your state, visit our website.
State Legislators Seek to Strengthen Red Flag Laws
State legislators are introducing legislation to establish or strengthen extreme risk protection order laws in several states in light of recent mass shootings, and incentives provided in the recently enacted federal Bipartisan Safer Communities Act. Currently 19 states and the District of Columbia have what are commonly referred to as “red flag laws,” that allow certain citizens or law enforcement to petition a court to remove firearm access from a person believed capable of committing homicide or suicide. Research shows that when appropriately implemented, red flag laws are effective in preventing gun violence.
Illinois legislators are analyzing their red flag law following the tragic mass shooting in Highland Park at a Fourth of July parade. At the age of 18, the alleged shooter was able to obtain a Firearm Owners Identification (FOID) card and legally purchase an AR-15 style weapon, just three months after police visited his home for threatening to kill his family. In response, Representative Conroy filed HB 5766, which seeks to amend the FOID Card Act to provide that a minor who causes or attempts to cause physical self-harm or harm to another is subject to the denial of an application or revocation and seizure of a FOID Card. The Conroy proposal also provides that until 24 years of age, such a person is presumed to have a mental condition of such a nature that it poses a clear and present danger.
Arizona Passes Rules to Implement Jake’s Law
On July 6th, Governor Ducey's Regulatory Reform Council passed the Department of Insurance and Financial Institutions' (DIFI) proposed rules to implement Jake's Law creating mental health parity in the State. Jake's Law originally passed in 2020 and will become effective 60 days after DIFI submits it to the Secretary of State's Office for publication in the Arizona Register, likely in early to mid-September. This is a significant advocacy achievement for the District Branch.