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Advocacy Update: August 2022

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

APA-Led Activities

Interested In Becoming A Stronger Advocate? Join Us at the 2022 APA State Advocacy Conference!

The American Psychiatric Association (APA) will hold its 2022 State Advocacy Conference this year in person in Minneapolis, Minnesota on October 15-16, 2022. At this year’s conference, attendees will take a deep dive into advocacy topics like the Collaborative Care Model and Prior Authorization and learn how to successfully engage with state legislators to help APA District Branches and State Associations reach their advocacy goals. Attendees will hear from political pundits on the upcoming election, meet other members from around the country, and have the chance to mingle with state legislators and other invited guests. Please visit the American Psychiatric Association 2022 State Advocacy Conference registration page to learn more, or contact [email protected].

Executive Branch Activities

Telehealth: Transitioning out of the COVID-19 Public Health Emergency Designation

The Public Health Emergency (PHE) was extended again until October 15. The Administration has all but guaranteed they would give a 60-day notice before ending the PHE, which would be coming up in the next week. If there is no notice of ending the PHE, we can expect it to be extended until the beginning of 2023. Under the current regulations once it ends, practices will have five months to take action required to continue to provide telehealth to patients. However, for clinicians seeing patients across state lines, states have already removed some of the flexibilities seen early on during the pandemic and are requiring all clinicians to meet the requirements to practice in the state. APA is working on educational materials to provide more in-depth information on federal telehealth regulations post-PHE to be released this fall. In the meantime, please check out the following telehealth comparison chart for more information.

APA Highlights the Collaborative Care Model (CoCM) as a way to Strengthen Primary Care

APA submitted a letter on August 1 in response to a Health and Human Services request for information on ways to strengthen primary care, which they acknowledge is under-resourced. Implementation of CoCM provides an evidence-based population-based approach that improves access and quality of care, and has been shown to reduce long-term costs. Primary care physicians that have implemented the model have reported an increased sense of well being and feel better prepared to provide care to patients with mental health and substance use disorders. APA asked HHS to incentivize adoption of the model and reduce existing barriers to encourage primary care practices to implement the model.

Congressional Activities

APA Supports REDI Act to Defer Student Loans for Physicians and Dentists

On July 15, APA joined a letter of support that was sent to the Chairs and Ranking Members of the House Education and Labor Committee and the Senate Help, Education, Labor, and Pensions Committee for H.R. 4122 / S. 3658, the Resident Education Deferred Interest (REDI) Act. This bill would allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental internship or residency program. This legislation promotes workforce development and retention by preventing medical and dental residents from accruing thousands of dollars in interest on their student loans while completing their residency programs. APA staff will continue to monitor the progress of this bill.

Reimagine Crisis Response Celebrates 9-8-8 Launch

On July 16, APA joined other partner organizations from Reimagine Crisis Response to celebrate the launch of the new 9-8-8 Suicide and Crisis Lifeline. The Lifeline, which was previously a 10-digit number, was officially converted to a new, easy-to-remember three-digit number for people to call for support during a mental health, substance use or suicide crisis (the 10-digit number also remains available). The crisis system is equipped with call, text, and chat functions where individuals will be connected to trained crisis counselors in the network. The Lifeline is now available across the US, but coverage gaps and additional crisis services will continue to be developed. APA has supported additional federal funding for the implementation of the Lifeline as well as funding for public education and communications campaigns to ensure that patients and communities are aware of the new help number. Additional information on implementation of the new Lifeline number can be found here. The 9-8-8 advertisement that was featured in The Washington Post can be viewed here.

Increased Medicare Support for GME Requested in Budget Reconciliation

On July 18, APA joined the Graduate Medical Education (GME) Advocacy Coalition in signing a letter sent to Senate Majority Leader Schumer (D-NY) and House Speaker Pelosi (D-CA) requesting increased Medicare support for GME in the Fiscal Year 2022 Budget Reconciliation bill. Though Congress increased Medicare GME positions by 1,000 positions in the 2021 Consolidated Appropriations Act, letter signers agree that in order to address the current workforce shortage, Congress must continue to expand GME-funded Medicare slots. By 2034, the United States will face a shortage of 124,000 physicians, which will be exacerbated by the aging physician population, rates of physician burnout, and early retirement due to the COVID-19 pandemic. To meet the needs of the diverse and growing nation, the letter urges Congress to continue investing in the physician workforce by again increasing the number of Medicare-supported GME positions. APA will continue to advocate for additional GME slots to help replenish the physician workforce.

APA Supports Prior Authorization Reform Bill to Improve Access to Care

On July 22, APA joined the Group of 6 in sending a letter of support for H.R. 3173, the bipartisan Improving Seniors’ Timely Access to Care Act. Prior authorization delays care for patients and imposes significant administrative burdens on physicians. In response to this issue, this legislation would streamline and standardize the prior authorization process within the Medicare Advantage program. On July 27, the House Ways and Means Committee held a markup of the bill and voted to favorably send the legislation to the floor for a full-House vote. The letter requests that House Speaker Pelosi (D-CA) and Minority Leader McCarthy (R-CA) bring the bill to the House floor for a vote. Further, the legislation has reached the 290-cosponsor threshold, entitling it to be considered on the House Consensus Calendar after the next 25 legislative days. APA still will continue to monitor the progress of this bill.

APA Supports Medicare Physician Fee Schedule Adjustments

On July 27, APA joined the Conversion Factor Coalition in a letter to the Chairs and Ranking Members of the House Ways and Means Committee, House Energy and Commerce Committee, and the Senate Finance Committee thanking them for providing a 3 percent positive adjustment to the Medicare Physician Fee Schedule (MPFS) conversion factor (CF). This adjustment was used to partially offset a scheduled fee schedule reduction and averted an additional 4 percent Medicare payment reduction, ensuring financial stability for Medicare clinicians and continued access to high quality care for our nation’s seniors. However, Medicare providers face another round of payment cuts on January 1, 2023. The letter requests that Congress again pass legislation that provides at least a 4.5 percent CF for 2023 and waives the 4 percent statutory pay-as-you-go (PAYGO) requirement. In addition to these provisions, the letter requests that any legislatislative fix include a one-year inflationary update based on the Medicare Economic Index. APA staff will continue to engage with Congress as it considers these Medicare payment reforms.

APA Leads MHLG Letter in Support of Mental Health Parity

In July, APA led a sign on letter to Rep. Katie Porter (D-CA), Rep. Tony Cárdenas (D-CA), and Sen. Elizabeth Warren (D-MA) in support of H.R. 8512 / S. 4616, the Behavioral Health Coverage Transparency Act. The letter, which garnered support from 48 organizations, expresses support for the bill, which would strengthen enforcement of rules required by the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). MHPAEA requires insurers to provide coverage for mental health and substance use disorder treatments at parity with other physical health benefits. Among other provisions, the new bill would require most plans and issuers to submit the analyses they perform in making parity determinations to federal agencies. Additionally, the bill would create an online portal so that consumers can easily access publicly available information related to parity, such as their parity rights, guidance to submit complaints, and information insurers submit about how they make parity decisions. The legislation was introduced on July 26 with 14 original cosponsors in the House and 13 original cosponsors in the Senate. APA staff will continue to monitor the progress of this bill.

APA Weighing in on HHS Rule to Strengthen Nondiscrimination Protections in Health Care

The U.S. Department of Health and Human Services (HHS) announced a proposed rule implementing Section 1557 of the Affordable Care Act which prohibits discrimination on the basis of race, color, national origin, sex (including sexual orientation and gender identity), age, and disability in certain health programs and activities. The proposed rule restores and strengthens civil rights protections for patients and consumers in federally funded health programs and HHS programs, after the 2020 version of the rule limited its scope and power to cover fewer programs and services. In 2019, APA opposed the proposed rule Nondiscrimination in Health and Health Education Programs or Activities, citing the unnecessary barriers to care the rule would impose and the associated costs in allowing for discrimination in healthcare.

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