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Advocacy Update: July 2023

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

Congressional Activities

APA Supports Mental Health Services for Students Act

On May 25, APA signed a letter of support for H.R. 3713, the Mental Health Services for Students Act. This bill, reintroduced by Reps. Grace Napolitano (D-CA) and Brian Fitzpatrick (R-PA), provides on-site school and community-based mental health services to public school students, helping schools and families identify students who need mental health services and connect them with the care they need. The bill provides funding for schools to build partnerships with health care providers, child welfare agencies, and other community-based services, as well as training for teachers to identify the signs and symptoms of mental disorders, risk of suicide, and trauma exposure. APA has also signed a letter of support for the Senate version of this bill that was reintroduced by Sens. Tina Smith (D-MN) and Chris Murphy (D-CT).

APA Participates in House Call on the Mall

On June 6, APA President Petros Levounis, M.D., M.A., and APAPAC Board Chair Brian Hart, M.D., took part in the National Republican Campaign Committee’s (NRCC) annual lobbying event with the congressional Doctors Caucus. During the event, Dr. Hart joined meetings with several members of Congress to lobby on behalf of the collaborative care model and key mental health/substance use disorder legislative priorities. Both Dr. Hart and President Levounis attended the NRCC’s evening reception hosted on the rooftop of APA headquarters with several congressional leaders.

APA Sends Workforce Letter of Support to HELP Committee

On June 27, APA sent a letter to the Chair and Ranking Member of the Senate Health, Education, Labor, and Pensions (HELP) Committee in support of the Committee’s continued efforts to address the healthcare workforce shortage. The letter expressed APA’s support for several initiatives, including strengthening workforce building programs, expanding access to tele-behavioral health services, and supporting evidence-based integrated care models.

Executive Branch Activities

APA Responds to ONC’s Health Data, Technology, and Interoperability (HTI-1) Proposed Rule

On June 20, APA sent a letter to the Office of the National Coordinator for Health Information Technology (ONC) applauding the office’s efforts to improve the accountability and transparency of health IT products to customers, regulators, and policymakers. These proposed approaches include additions to certification standards for health IT developers to document the usability and interoperability of certified products. APA urged ONC to take additional steps to further these objectives, including expanding the governance and oversight of ONC efforts to include non-subject matter expert patients and clinicians, providing technical assistance to mental health-specific health IT firms in achieving interoperability objectives, and partnering with APA to offer the expertise of psychiatrists to support mental health clinicians in adopting health IT to advance mental health outcomes and equity.

Enhanced HIPAA Protections for Sensitive Data

APA sent a letter to the U.S. Department of Health and Human Services (HHS), Office for Civil Rights supporting the strong privacy protections for patients, clinicians, and those facilitating lawful reproductive health care, further encouraging HHS to expand the proposed rule to other types of highly sensitive protected health information (PHI) including gender affirming and sexual health care. APA has long supported strong privacy protections for patients given the sensitivity of certain health information, and all highly sensitive PHI should be used to encourage quality and safe healthcare rather than used punitively for seeking lawful services.

Support for Expansion of SUD Treatment and Recovery Loan Repayment

On June 16, APA responded to an Information Collection Request (ICR) from the Health Resources and Services Administration regarding the Substance Use Disorder Treatment and Recovery Loan Repayment Program (STAR LRP) and the Pediatric Speciality Loan Repayment Program. The STAR LRP is an important tool in incentivizing more physicians to enter the mental health and substance use treatment workforce. APA recommended HRSA consider additional information that should be used to assess an applicant’s eligibility and qualifications including automatic designation of substance use disorder (SUD) treatment facilities and incorporation of Medicaid and Medicare payer mix. APA will continue to advocate for a robust workforce trained to meet the country’s current and future mental health and SUD needs.

Biden Administration Continues Efforts to Address Medicaid Access Challenges

APA submitted comment letters in response to a pair of proposed rules intended to improve quality and address challenges Medicaid beneficiaries face when accessing care. APA supported proposals to add appointment wait times standards, secret shopper studies, enrollee experience surveys and improved transparency requirements, among other things. APA urged CMS to look more closely at in network rates and their impact on access, take steps to encourage the adoption of the Collaborative Care Model and support increased funding for research into social determinants affect on mental illness and recovery, and to develop and disseminate evidence-based interventions to promote mental health equity and improve the social and mental health needs of patients and their families.

APA Urges CMS to Adopt Policies to Increase Reimbursement for Care in Inpatient Psychiatric and Acute Care Hospitals

APA responded to two CMS proposals regarding payment and quality measurement in the inpatient setting. In both instances APA urged CMS to refine their policies to ensure that payments made were sufficient to cover the increasing cost to provide care in inpatient settings. Recommendations include changes to the methodology (i.e., rebasing the market basket payments, changes in the severity classifications of conditions, adoption of add-on payments for new technology), and reduction of costly administrative burdens. APA urged delaying the implementation of measures related to social drivers of health until they could be tested.

State Activities

Ohio Patient Safety Victory

The Ohio Psychiatric Physicians Association (OPPA), in conjunction with the Ohio State Medical Association, lobbied throughout this year’s legislative session against legislation that would have created a new health care practitioner license for “Certified Mental Health Assistants” (CMHAs). American Psychiatric Association staff researched this issue, and CMHA licenses do not exist in any other state. The bill concerned OPPA, as it would have authorized prescriptive authority up to and including controlled substances for a practitioner without adequate education and training. Further, no national organization or credentialing body exists to oversee CMHAs. At the last minute, enacting language was added to Ohio’s budget bill. The Governor issued a line-item veto of the budget to remove CMHA licensure language.

Oregon’s Psilocybin Policy Implementation Highlights Gaps in Evidence

In 2020, Oregon became the first state to decriminalize the manufacturing and administration of psilocybin at licensed facilities. A recent editorial in the Journal of the American Academy of Psychiatry and the Law summarized the risks to patient safety the current implementation is exposing. The author highlights that current research efforts on psilocybin often exclude patients with a history of psychotic, bipolar, and substance use disorders. Per Oregon’s policy, psilocybin facilitators are not able to diagnose psychiatric disorders and do not require any mental health training, so individuals who have never been represented in psilocybin research can easily receive the drug without understanding how it may impact them. The author warns that lacking research on safety and efficacy of psilocybin, lawsuits will likely drive standards of care, rather than science. Both the Oregon Psychiatric Physicians Association and the American Psychiatric Association’s opposition to the ballot measure legalizing the medical use of psilocybin are cited in the article.

Oklahoma Governor Signs Collaborative Care Legislation Into Law

Governor Stitt signed SB 444 into law on June 9. SB 444 requires insurers to reimburse Collaborative Care codes for both private insurance and Medicaid. The American Psychiatric Association and the Oklahoma Psychiatric Physicians Association (OPPA) joined a coalition led by Healthy Minds Policy Initiative, a policy leader in Oklahoma, to support and testify in favor of the legislation. Healthy Minds and OPPA are now supporting the regulatory implementation of the law.

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