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Advocacy Update: January 2023

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

APA-Led Activities

Emerging Topics Webinar Series

Hundreds of APA members joined member experts for webinars on Evaluation and Management (E/M) Coding and Documentation and Telepsychiatry (December 2022) and Hybrid Practice Post-PHE (January 2023) as part of APA’s Emerging Topics Webinar series. The December webinar highlighted changes to E/M coding and documentation for facility-based and in-home services set to take effect beginning in January 2023. It also included a review of the coding and documentation rules for care in outpatient settings, which remain unchanged. The January webinar discussed telehealth flexibilities that were intended to facilitate access to care during the COVID-19 public health emergency (PHE) and rules and regulations that will be back in place once the PHE ends. APA member experts discussed what is needed to operate successfully in a hybrid environment and to continue to practice in a way that meets the needs of patients within rules and regulations. Click below for the recordings.

APA Supports Quality Measures and Raises Concerns About Cost Measures up for Endorsement

APA supported APA-developed quality measures related to functioning, suicide safety planning, and reduction in suicidal thoughts and behaviors, as well as measures related to screening for social determinents of health. However, we did not support proposed cost-measures for the MIPS program, repeating our concerns about the patient population and attribution methodology. These cost-measures, if not applied appropriately, could have unintended consequences by emphasizing cost-reduction which could place patients at risk and have the potential to exacerbate problems with access to care.

Executive Branch Activities

APA Supports FDA’s Efforts to Increase Access to Naloxone

APA responded to a request for comments from the Food and Drug Administration (FDA) supporting FDA’s efforts to increase access to Naloxone, the opioid overdose reversal agent, by making it available as an over-the-counter medication. APA applauds this effort to help reduce overdose mortality, while suggesting several strategies to help mitigate any unintended consequences to changing Naloxone from a prescription to a non-prescription product, such as providing adequate end-user education, adding intranasal naloxone to the list of FDA Essential Medications, and encouraging collaborations with CMS to keep costs low.

Congressional Activities

APA Priorities Included in Fiscal Year 2023 Omnibus Bill

In December 2022, Congress passed and the President signed a $1.7 trillion Omnibus spending package which included significant funding and policy provisions that APA championed and supported. The legislation funded an unprecedented 100 new Medicare Graduate Medical Education residency slots dedicated for psychiatry and psychiatric subspecialties. It also included APA’s legislation authorizing new grants to boost the uptake of the collaborative care model and APA’s proposal to authorize grants to assist states in enforcing the mental health and substance use disorder parity law. In addition, the funding package included a two-year extension of Medicare telehealth flexibilities and delayed the in-person requirements for telehealth services for mental health until December 31, 2024. These and many other APA priorities were highlighted in our press release issued when the bill passed. Several of APA’s requests included in the package were also priorities were outlined in a year-end letter calling for congressional action. Also included in the bill was the VA Infrastructure Powers Exceptional Research (VIPER) Act, which APA also supported. Unfortunately, Congress did not fully eliminate the cuts proposed by CMS under the Medicare Physician Fee Schedule (MFPS), which were implemented January 1, 2023, despite the efforts of the House of Medicine, including in a joint letter to Congress.

APA Supports Due Process Continuity of Care Act

On December 7, APA joined the Coalition to Stop Opioid Overdose (CSOO) in a letter of support for the Due Process Continuity of Care Act. This bill would amend the Medicaid Inmate Exclusion Policy (MIEP) to allow states the option to provide pretrial detainees with full Medicaid benefits while awaiting the disposition of charges against them. Individuals who are incarcerated have higher rates of chronic disease, substance use, and mental health disorders. However, the current MIEP severely limits Medicaid from paying for healthcare services for individuals who are incarcerated, particularly for pretrial detainees.

State Activities

APA State Government Affairs Is Here To Help

State legislatures across the country are convening new sessions. APA State Government Affairs provides assistance to District Branches/State Associations on state legislative and regulatory affairs, offering model legislation, tracking legislation, providing guidance on best lobbying practices, offering advocacy training, and more. To find out when your state legislature goes into session, check out this 2023 State Legislative Session Calendar. For more information on how APA can team with your DB/SA, please contact [email protected].

Unsafe Prescribing

On December 9, 2022, the New Mexico Medical Board held a hearing regarding proposed changes to the existing psychology prescribing laws passed in 2002. Prescribing psychologists are seeking the title “medical psychologists,” want to be moved under the supervision of the medical board, and are seeking to expand their formulary to include drugs that counteract the side effects of psychotropic medications. Psychologists are also seeking to eliminate the 2-year supervision by a physician or nurse practitioner and replace that with supervision by another prescribing psychologist. APA President Rebecca Brendel, M.D., J.D., spoke in opposition to the proposal during the hearing. The Medical Board opposed the title change but supported the other requests. The psychologists will now seek those changes via legislation in the 2023 session, and the APA will be working with the Psychiatric Medical Association of New Mexico to oppose the legislation.

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