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Advocacy Update: February 2022

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

Executive Branch Activities

Organizations Express Concern with Administrative Burden of NSA Good Faith Estimates

APA signed onto a letter with a coalition of other behavioral health associations, including the American Psychological Association, expressing concern to CMS that the No Surprises Act’s requirements that patients be provided with a good faith estimate (GFE) add to providers’ administrative burden. The coalition points out that psychiatrists/therapists have a longstanding practice of reviewing costs of care with patients upfront, as required by their professional ethics, and are requesting an exemption. In late January, CMS invited APA and the other signatories to a listening session to gain a better understanding of how the GFE requirements impact the delivery of MH/SUD care. CMS anticipates hosting more sessions with the behavioral health community.

CMS Field Tests Psychiatry Cost Measures, Invites Comments

The Centers for Medicare & Medicaid Services (CMS) is conducting field testing for five episode-based cost measures for the Merit-based Incentive Payment System (MIPS). The goal is to learn about collecting feedback on these cost measures for major depressive disorder and psychoses/related conditions. Testing will include assessment of the measures’ importance, scientific acceptability, and clinical validity. Clinicians and clinician groups with at least 20 episodes for at least one measure will receive a Field Test Report with information about their cost performance; feedback will be used to consider potential measure refinements. Draft specifications for each measure are available on the CMS website. The field testing ends Thursday, February 25.

APA is interested in reviewing Field Test Reports with APA members to inform our feedback to CMS. If you have received a cost report and are open to discussing it with APA staff, please contact [email protected]. Also, reach out if you have any questions, comments, or input on episode-based cost measures or the field testing process.

HHS Announces a Standard Clinical Definition for Opioid Withdrawal in Infants

The Department of Health and Human Services (HHS), together with leading clinicians, researchers, and policy experts led the development of a standard clinical definition for opioid withdrawal in infants. As described in a press release, the definition is accompanied with a set of foundational principles that outlines bioethical uses for the definition, distinctly centering around identifying clinical and supportive care needs of mothers and their infants, using an evidence-based, compassionate, and equitable approach. The announcement builds on a recent study from HHS researchers that highlighted data collection challenges, including lack of a standard definition.

Register for NIDA’s National Drug and Alcohol Facts Week

The National Institute on Drug Abuse (NIDA) announced their upcoming National Drug and Alcohol Facts Week (NDAFW) from March 21st through March 27th. NDAFW is a week-long national health observance highlighting the science-based facts about drugs, alcohol, and addiction. The website includes lesson plans and other materials for educators, counselors, and prevention specialists. In addition, teens, teachers, and parents can register to hold an NDAFW event. For more information, click here.

FDA Releases Warning on Dental Issues Associated with Buprenorphine

The Food and Drug Administration (FDA) is warning patients and prescribers about the potential for dental problems associated with buprenorphine medications dissolved in the mouth to treat opioid use disorder (OUD) and pain. FDA is taking several measures to protect public health and will require that a new warning about the risk of dental problems be added to the prescribing information and the patient Medication Guide for all buprenorphine-containing medicines that are dissolved in the mouth. Prescribers should advise patients to see a dentist soon after starting the medicine and during treatment. Patients may lessen their risk of dental problems by taking certain preventative measures.

HRSA Releases Grants to Improve Retention of Healthcare Workers and Respond to Burnout

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced $103 million in awards to improve the retention of healthcare workers and help respond to the nation’s critical staffing needs by reducing burnout and promoting mental health and wellness among the healthcare workforce. These awards will fund evidence-informed programs, practices and training, with a specific focus on providers in underserved and rural communities. The funds, secured through the Biden-Harris Administration’s American Rescue Plan, will be disbursed to 45 grantees.

Congressional Activities

APA Joins Letters to Congress on FDA REMS Concerns

On January 27, APA signed onto two letters to House Energy and Commerce Committee Chairman Frank Pallone (D-NJ) and Ranking Member Cathy McMorris Rogers (R-WA) as well as to Senate Health, Education, Labor and Pensions (HELP) Chairwoman Patty Murray (D-WA) and Ranking Member Richard Burr (R-NC) to express concerns about the recent Food and Drug Administration (FDA) modifications of the Risk Evaluation and Mitigation Strategies (REMS) for clozapine and isotretinoin. The letters express concerns that changes to these REMS creates unnecessary disruptions to patient care and could result in relapse with devastating effects, including hospitalization, suicide attempts, and even violent acts. The letters urge Congress to request that the FDA halt the REMS program changes until a thorough review of the programs is completed to reduce disruptions to treatment. Further, the letters request that the Committees hold hearings to discuss these issues and identify how the REMS process may be improved and whether Congressional changes are needed. APA will continue to engage regarding how the FDA and Congress respond to this issue.

APA Joins Letter to Congress on Establishing a Pathway to Telehealth Reform

On January 31, APA joined a letter to House and Senate leadership on how Congress can best support healthcare providers and patients by continuing and expanding access to telehealth services. Telehealth flexibilities that were created as a response to the current public health emergency have improved patient access to care and have impacted both public health programs and private health coverage, so continuing these services will provide certainty to beneficiaries and providers. The letter asks for the continuation of all telehealth waivers through December 31, 2024, that the Department of Health and Human Services evaluate telehealth and create an aggregate report on their findings for Congress, and to consider permanent telehealth legislation in 2024.

APA’s MH/SUD Parity Stance Validated by Agencies’ 2022 Report to Congress

On January 25, the Departments of Labor, Health and Human Services, and the Treasury issued the 2022 Mental Health and Addiction Equity Act Report to Congress. The report described health plans and insurers' compliance with the amendments made to the federal parity law by the Consolidated Appropriations Act (CAA) in December of 2020. APA drafted and lobbied for the amendments contained in the CAA. The CAA required all health plans and insurers to perform comparative analyses demonstrating their compliance with the existing provisions of the federal parity law and submit them to federal and state regulators upon request. Combined, the agencies requested 171 comparative analyses, which far exceeded the minimum threshold required by the CAA. Upon initial examination, the agencies found that not a single analysis contained sufficient information. Additionally, when collecting supplemental information, the agencies found numerous parity violations potentially affecting millions of beneficiaries. The report validates APA’s position that plans and insurers generally are not complying with the federal parity law and more transparency and accountability is needed.

APA Responds to the Healthy Futures Task Force Security Subcommittee RFI

On January 31, APA sent a letter to Representatives Richard Hudson (R-NC) Jim Banks (R-IN) and Tom Cole (R-OK) of the Healthy Futures Task Force Security Subcommittee in response to their Request for Information (RFI) regarding how Congress can improve access to effective, evidence-based mental health and substance use disorder (MH/SUD) care and services. In the letter, APA submitted multiple recommendations on how to address the current MH/SUD crisis, including continuing current COVID-19 telehealth flexibilities, supporting and expanding our healthcare workforce, enforcing proper parity compliance, and integrating primary and behavioral healthcare through H.R. 5218, the Collaborate in an Orderly and Cohesive Manner Act.

APA Members Attend Senator Stabenow’s Stakeholder Meeting on the Youth MH Crisis

On February 3, Drs. Michele Reid and Gabrielle Shapiro represented the APA at a virtual meeting of mental health stakeholders hosted by Senator Debbie Stabenow (D-MI). The primary focus of the discussion was the youth mental health crisis and the growing role that Certified Community Behavioral Health Clinics (CCBHCs) can have in providing high-quality, comprehensive care around the country. Senator Stabenow was joined by former APA President Dr. Anita Everett who currently serves as SAMHSA Director of the Center for Mental Health Services, and who discussed the impact of these programs and opportunities to expand access to School-Based Health Centers (SBHCs). Drs. Reid and Shapiro detailed the need for additional flexibility with regards to how CCBHC funds can be utilized to expand access, as well as the need to develop sustainable long term funding streams to support new and existing CCBHCs. Both Drs. Reid and Shapiro also noted the need to align CCBHC services with the launch of the national 9-8-8 crisis line this July. Senator Stabenow and her staff noted that the conversation is likely to inform forthcoming efforts by the Senate Finance Committee to address gaps in mental health access. APA will continue to engage with Congress and various Committees work toward a larger mental health legislative package.

State Activities

APA Assists States with Legislation Addressing Coordinated Specialty Care for First Episode Psychosis

APA members and staff have worked together to develop state legislative language addressing coverage of coordinated specialty care (CSC) for the treatment of first episode psychosis (FEP). CSC is an evidence-based, team-based approach that includes all the following components: case management, family support and education, pharmacology and medication management; psychotherapy, supported education and employment, and coordination with primary care. Early intervention in FEP is key to improving a patient’s long-term recovery. If CSC were utilized and covered in a uniform manner, more patients will have better chances at long term recovery, which positively impacts that patient’s life, their family’s life, and the society around them. APA’s California District Branches are working to have APA-drafted CSC legislation introduced by California state legislators in the coming weeks. For more information about APA’s CSC legislation, contact [email protected].

States Continue to Pursue Legislation Supporting 9-8-8

In July of this year, 9-8-8 will go “live” as the new nationwide number for mental health and suicidal crises. While federal legislation designated the three-digit number and authorized states to collect fees and set up infrastructure, much work is needed at both the state and federal levels to ensure 9-8-8 is successfully implemented to fully transform mental health crisis response and services. APA belongs to Reimagine Crisis Response, a coalition seeking to assist states with implementing 9-8-8 infrastructure. Last year, 8 states passed laws enacting 9-8-8 infrastructure (4 states included fees and 4 did not). There are still 12 states with pending 9-8-8 legislation, and APA is working closely with APA District Branches and coalition partners to assist these and other states reach their legislative goals.

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