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Advocacy Update: December 2022

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

APA-Led Activities

APA Survey on Stimulant Prescriptions

APA has heard from members across the country that their patients were having trouble getting prescriptions for stimulants filled at pharmacies. APA is using multiple channels to get member feedback in order to have informed discussions with partners and Agencies. Please continue to provide feedback via the survey or via the practice management helpline at [email protected] or 800-343-4671.

Executive Branch Activities

APA Urges HRSA to Support Access to Telemental Health Care

APA has responded to a Policy Information Notice regarding telehealth released by the Health Resources and Services Administration (HRSA), the federal agency that administers programs to improve access to care including federally-qualified health centers (FQHCs) and rural health centers (RHCs). Access to high-quality mental health care has emerged from the pandemic as a key population health and health equity priority, and we applaud HRSA’s commitment to continuity of care through telehealth once the public health emergency ends. APA has provided HRSA with policy recommendations to more fully achieve this objective, including relaxing requirements that the patient be physically located within the health center’s service area for each telehealth encounter and collaborating with other federal agencies to address barriers to telemental health care.

APA Joins Partners to Advance Rules on Special Registration for Telemedicine

APA joined 114 other organizations urging the Department of Justice and the Drug Enforcement Administration (DEA) to advance the rules on the Special Registration for Telemedicine. The November 11th letter is a follow-up to previous letters sent to ensure that prescribing via telehealth technologies can continue in a safe and equitable manner following the end of the COVID-19 public health emergency (PHE), which is expected to happen in 2023. Specifically, APA urges the DEA to waive the in-person requirement for the duration of the ongoing opioid epidemic PHE, propose solutions for patients who have established a valid provider-patient relationship via telemedicine during the COVID-19 PHE, and continue to allow physicians who have at least one valid, active DEA license to prescribe controlled substances to patients until the special registration is finalized.

APA Urges CMS to Consider Psychiatrists’ Unique Concerns Regarding the Administrative Burden of Providing Good Faith Estimates

APA responded to a Request for Information regarding the good faith estimate and advanced explanation of benefits for individuals with insurance coverage and expressed concern that the requirements pose unique concerns to psychiatrists and may have the unintended consequence of further restricting access to care. APA urged CMS to provide an exception to MH/SUD clinicians from the requirements of providing GFE/AEOBs; an exception to small, solo and safety net practices from data interoperability requirements; and require a uniform platform to submit data needed to create AEOBs.

APA Aligns with the Administration to Promote Equity and Efficiency in CMS Programs

The Centers for Medicare and Medicaid Services (CMS) requested information on promoting equity and efficiency in CMS programs. APA recommended CMS ensure that measurement of disparities is based on reliable, accurate, and actionable data that allows providers to implement concrete solutions and to reduce burden and increase incentives for psychiatrists to expand their practices accepting more Medicare patients. APA also urged CMS to make flexibilities permanent following the public health emergency, meeting beneficiaries needs and increasing access.

APA Joins Coalition Seeking White House Action on Emergency Patient Boarding

APA joined the American College of Emergency Physicians (ACEP) and other organizations in a letter requesting President Biden’s administration to hold a summit addressing emergency patient boarding. Emergency departments have recently reached a crisis point. As the nation enters into the winter months facing a “triple threat” of COVID, flu, and respiratory illnesses such as RSV, a long-term solution is needed to this urgent problem. At the state level, APA will be working with ACEP in the coming legislative session to address these concerns with state legislators.

APA Supports but Cautions CMS in Creating a Directory of Healthcare Providers & Services

The Centers for Medicare and Medicaid Services (CMS) requested information on the creation of a national directory of healthcare providers and services. CMS would like to alleviate burdens and improve the state of provider directories through a CMS developed and maintained, Application Programming Interface (API)-enabled national directory. APA responded by recommending frequent updates to keep information updated and accurate but also to take into account that psychiatrists may work in multiple settings, accepting new patients may change more frequently than on an annual basis, and participation in networks can vary. Moreover, APA suggested that information such as participation in a Collaborative Care model can help patients select a primary care provider in order to access the care necessary when searching for a physician.

Congressional Activities

APA Supports Funding for 988 Crisis Care in Fiscal Year 2023

On November 4, APA signed a letter of support to the Chairs and Ranking Members of the House and Senate Labor, Health and Human Services, and Education Appropriations Subcommittees urging the inclusion of 988 crisis care services into the Fiscal Year (FY) 2023 appropriations bill. In the letter, we express support for current and new funding accounts for mental health and suicide prevention services, including the Community Mental Health Block Grant, the 988 Suicide & Crisis Lifeline, and for Certified Community Behavioral Health Clinics. APA will continue to support investments into the nation’s suicide prevention services.

APA Supports Extension of Medicaid Postpartum Coverage

On November 14, APA joined a letter to House and Senate leadership in support of including language in a year-end legislative package to establish permanent, nationwide 12-month postpartum Medicaid coverage. Currently, states have the option to extend Medicaid coverage and this expansion has proven to reduce disparities in racial inequities and maternal health outcomes. More congressional action is needed to continue this reduction in disparities. We urge Congress to make this coverage permanent to address the maternal health crisis.

APA Requests House-Level Funding for Minority Fellowship Program

On November 17, APA joined the Minority Fellowship Program (MFP) Coalition in a letter of support for the MFP. In the letter, we request that the Senate Labor, Health and Human Services, and Education Appropriations Subcommittee include the House funding level of $25 million for the MFP that was proposed in the Senate’s draft appropriations bill. This program increases the number of minority behavioral health professionals in the health care system so patients can receive culturally competent services. MFP fellowships are awarded to professionals in the fields of psychiatry, psychology, social work, nursing, marriage and family therapy, counseling, and addictions.

APA Applauds House Passage of the VIPER Act

On November 17, the House passed H.R. 5721, the VA Infrastructure Powers Exceptional Research (VIPER) Act. This bipartisan bill, which APA has endorsed, would improve the VA Medical and Prosthetic Research program by providing additional authority and resources for VA research. If enacted, the bill would exempt the VA from the Paperwork Reduction Act requirements when it enters certain contracts or agreements for research activities. It would also establish the Office of Research and Development within title 38 of the United States Code to ensure that the VA maintains its commitment to a robust research endeavor within the department. Finally, it would allow some scarce research professionals engaged in mission-critical work to accept compensation from other sources for off-hours work outside of their VA duties.

APA Supports the Investing in Kids’ Mental Health Now Act

On November 29, APA joined a letter to Sens. Bob Casey (D-PA) and Rob Portman (R-OH) to thank them for introducing S. 4747, the Investing in Kids’ Mental Health Now Act. This legislation would incentivize states to increase Medicaid reimbursement services for pediatric mental health care and substance use disorder treatment services. Low reimbursement rates often translate into delayed access to mental health services for children covered by Medicaid. APA supports this bill, which would provide an increased federal reimbursement match to states that increase reimbursement for pediatric mental health services.

APA Partners with Group of 6 in Letter on Year-End Priorities

On December 2, APA signed a letter with the Group of 6, the six main primary care primary care associations representing frontline physicians, to House and Senate leadership on our year-end priorities. In the letter, we named several urgent issues that need congressional action, including ensuring continuous coverage for Medicaid and CHIP, extending Medicare telehealth flexibilities, and extending funding for the Teaching Health Centers Graduate Medical Education program. We also expressed support for mental health and substance use disorder services and access, including resources to enforce the parity law,promote the integration of behavioral health services with primary care, and fund additional Graduate Medical Education (GME) slots for psychiatry. Finally, the letter includes support for H.R. 3173, the Improving Seniors’ Timely Access to Care Act, a bill that will remove prior authorization burdens for seniors, as well as our supports congressional action on averting the impending cuts Medicare physician payments under the Medicare Physician Fee Schedule.

State Activities

Prior Authorization

APA’s State Advocacy Conference took place on October 15-16 in Minneapolis, Minnesota. 100 APA members attended, as well as 4 District Branch Executive Directors and Lobbyists and an additional 13 speakers. Participants included many APA members who were new to advocacy, who benefitted from a variety of presentations on important advocacy topics, had the opportunity to network with their colleagues, worked to build their skills, and contacted their state legislators. The participants will have the opportunity to further refine their skills and engage with the Department of Government Relations in APA’s advocacy over the coming months and years.

APA Opposes Proposals to Criminalize Medicine

The APA has voiced strong opposition to state legislative proposals to restrict or prohibit physicians’ ability to deliver safe and necessary medical care through criminal penalties. The APA anticipates bills to restrict gender-affirming care and reproductive freedom will continue to be introduced in many states. Most recently, the Florida Board of Medicine voted to ban gender-affirming care for many transgender youth, which was the first decision of its kind by a state board of medicine. APA State Government Relations is available to assist APA district branches and state associations in opposing such proposals. Please contact [email protected] for more information.

States Consider How to Spend Opioid Settlement Monies

The Pennsylvania Psychiatric Society (PaPS) met with staff from Shatterproof to hear about their tracking of the settlement monies this month. While states are each approaching the funding allocation in many ways, PaPS will recommend that the state allocate funding to cover Collaborative Care Model start-up costs and workforce expansion programs.

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