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Advocacy Update: June 2022

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

Executive Branch Activities

Inpatient Psychiatric Facility Quality Reporting Program Proposed Rule

On April 4, 2022, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule regarding 2023 policies for the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program. APA submitted comments on the proposed rule, supporting positive payment updates and providing input on future payment methodologies and billing policies. In addition, APA provided feedback on a CMS Request for Information (RFI) regarding approaches to collection of data on social disparities of health.

Pharmacy Benefit Managers’ Business Practices

The Federal Trade Commission solicited comments on the business practices of pharmacy benefit managers and their impact on patients and their physicians. APA submitted comments highlighting the administrative burdens that contribute to physician burnout and reduces clinical time available for patient care and quantity requirements that pose dangers to some patients. APA also addressed changes to prescription-tiering that apply to inexpensive generics and other medications that are widely used to treat psychiatric conditions and cannot be quickly or easily changed due to the nature of these medications and result in increased costs to patients and/or disruptions to their care.

APA Expresses Concerns About Lack of Parity Enforcement in Letter to DOL Secretary

In a May 25, 2022 letter to Department of Labor (DOL) Secretary Martin Walsh, APA urged the administration to employ its new powers to investigate and sanction plans that are non-compliant with Mental Health Parity and Addiction Equity Act (MHPAEA). APA highlighted the DOL’s report to Congress (.pdf) that not a single health plan had submitted a compliant parity analysis and the Government Accountability Office’s report that consumers continue to be unable to access mental health care. Clearly, the promises of MHPAEA remain unfulfilled, and in the words of one APA member, “a cruel joke in that insurance companies treat mental health providers and our patients as if it does not exist.” APA will be meeting with the DOL regarding this letter and member complaints in the near future. APA members are encouraged to contact the Practice Management Helpline for assistance with claims issues at [email protected] and (800) 343-4671.

APA and Other Behavioral Health Organization Continue to Work with CMS for Clarifications of No Surprises Act Regulations

APA, the American Psychological Association, and the National Association of Social Workers met with CMS to express member concerns about the administrative burden of the good faith estimate requirements and to seek clarification of the regulations. APA anticipates ongoing meetings with CMS as the agency refines guidance and releases additional regulations and will update the membership accordingly.

Congressional Activities

APA Engages with Energy and Commerce as Mental Health Package Moves Forward

On May 18, the House Energy and Commerce Committee held a markup to consider several bills, including H.R. 7666, the Restoring Hope for Mental Health and Well-Being Act of 2022. The legislation includes several provisions APA has prioritized, including: elimination of the federal opt-out for non-federal governmental health plans within the Mental Health Parity and Addiction Equity Act (MPHEA), further funding for crisis services in advance of the July launch of 988, reauthorizing funds for maternal mental health and substance use disorder screening programs, and the authorization of funding to incentivize uptake of the collaborative care model. These provisions align with APA priorities that were highlighted in APA President Dr. Rebecca Brendel’s testimony (.pdf) before the committee in April. We will continue to monitor the progress of this package as it goes to the House floor for consideration and will work with Senate committees as they begin to consider a companion measure.

APA Stands in Support of Reproductive Rights

On May 10, APA joined a coalition of medical organizations in a letter of support (.pdf) for S. 4132, the Women’s Health Protection Act, which would make abortion rights a law rather than precedent set by the landmark Roe v. Wade (1973) case. Regrettably, the Senate voted against the bill, which had previously passed the House. The bill was voted down in the wake of a leaked Supreme Court draft opinion that would overturn Roe and allow states to decide whether to allow or ban abortion. Currently as many as 28 states could ban abortion if Roe is overturned. While the leaked opinion is not final and SCOTUS Justices can change their vote, the final opinion is expected to be released by the end of June. Moving forward, APA will continue to work with Congress to ensure reproductive rights.

APA Urges Congress to Act on Gun Violence Prevention Legislation

In response to the recent mass shootings in Buffalo, Uvalde, and Tulsa, the APA has joined several letters urging Congress to pass bipartisan, common-sense gun control legislation. In the first letter (.pdf), we express concern about the attempts to link mental illness and gun violence, as well as how the trauma of mass shootings has worsened Americans’ mental health. The second letter (.pdf) urges the Chairs and Ranking Members of the House and Senate Commerce, Justice, and Science Appropriations Subcommittees to include funding for the implementation of extreme risk protection orders (ERPOs). In the meantime, on June 8 the House passed both the Protecting Our Kids Act, an omnibus package of eight bills broadly aimed at promoting gun safety, and the Federal ERPO Act, which would allow federal courts to issue these protection orders. In the Senate, a bipartisan group of lawmakers have convened to negotiate issues such as tightening background checks and providing incentives for states to take up ERPO legislation. APA will continue to monitor the progress of the House package and Senate negotiations.

APA Submits Appropriations Requests for Fiscal Year 2023

On April 26, APA wrote to Chair DeLauro and Ranking Member Cole of the House Labor, Health and Human Services, Education, and Related Agencies (LHHS) Appropriations Subcommittee which details our Fiscal Year (FY) 2023 funding requests. In the letter, we highlighted our support for various mental health and substance use disorder programs, including grant funding to states for mental health parity compliance, program funding to prepare for the implementation of the new three-digit National Suicide Prevention Lifeline, and funding for the Centers for Disease Control and Prevention and the National Institute of Mental Health for gun violence prevention research. Additionally, on June 6, we wrote to Chair Murray and Ranking Member Blunt of the Senate LHHS Appropriations Subcommittee. This letter included many of the same requests as the House letter. APA will continue to engage with Congress as lawmakers begin to consider the FY 2023 Appropriations bills this month.

State Activities

Colorado and Connecticut Sign Collaborative Care Legislation into Law; Other States Pursue Legislation

On May 18, Colorado’s Governor Polis signed HB 1302 and HB 1325 into law. This legislation will increase access to evidence-based, quality care across Colorado by providing American Rescue Plan Act (ARPA) funding to primary care settings to implement the Collaborative Care Model (integrated care) in their offices. The Colorado Psychiatric Society said Collaborative Care will “normalize and de-stigmatize treatment for mental health and substance use disorders and expand the capacity of our current workforce without compromising quality of care, including for rural and traditionally underserved communities.”

Connecticut’s Governor Lamont signed HB 5001 into law on May 23

The legislation was a sweeping mental health package which included coverage for Collaborative Care codes. The Connecticut DB worked closely with NASW-Connecticut in support of the legislation. Louisiana’s HB 278, requiring insurance coverage for Collaborative Care, is awaiting gubernatorial signature, and several other states like Pennsylvania and New Jersey are awaiting further action on Collaborative Care bills. For more information on how your state can pursue coverage or funding for Collaborative Care, contact [email protected].

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