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Advocacy Update: June 2023

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

APA-Led Activities

The Washington Post Interviews DC Psychiatrist on Prior Authorization

Following the DC City Council’s hearing on a prior authorization reform bill in early June, Dr. Jacob Swartz was interviewed by the Washington Post for a story on the issue. Dr. Swartz shared how patients are negatively impacted by onerous prior authorizations and discussed the Washington Psychiatric Society’s support for the bill.

Call for Applications for APA's 2024 Psychiatric Services Achievement Awards

Since 1949, the Psychiatric Services Achievement Awards have recognized creative models of service delivery and innovative programs for persons with mental illness or disabilities. We are looking for programs that have made a significant contribution to the mental health field and provide an innovative model for others to follow. Each award recipient will be presented with a monetary award, a plaque, recognition at the 2024 Annual Meeting, and coverage in two APA publications. 

Apply here by Monday, July 31, 2023.

The nomination requirements, the full application, and additional information can be found on the APA’s Awards website. For any specific questions, feel free to reach out to Agathe Farrage at [email protected].

Executive Branch Activities

Telepsychiatry Practices Inform Importance of Maintaining Reimbursement Rates for Telehealth in the CMS 2024 Medicare Physician Fee Schedule

On June 8, 2023, APA sent a letter to CMS sharing the results of APA’s 2023 Telepsychiatry Survey. The survey provided key data points that underscore the importance of maintaining reimbursement for telehealth at equivalent rates to in-person care in the Medicare Physician Fee Schedule. Among other insights, survey results indicated that most psychiatrists (85 percent) maintain at least one physical practice location, thus offering hybrid care, and most telepsychiatry (82 percent) is delivered via audio/video technology.

SAMHSA Convening on Measurement-Based Care

APA and the Association for Behavioral Health and Wellness worked with SAMHSA to convene an expert panel meeting regarding Measurement-Based Care (MBC) on June 5 – 6. The meeting sought to bring together stakeholders from a variety of settings including payors, consumers, clinical service providers, Electronic Health Record (EHR) vendors, advocacy groups, accreditors, and federal leadership. The focus of the meeting was to better understand successes and challenges in implementing measurement-based care which is aligned with the work of the Inter-Departmental Serious Mental Illness Coordinating Committee (ISMICC) workgroup on data and evaluation.

Letter to FDA Requesting Meeting on Stimulant Shortages

On May 1, APA along with the American Academy of Child and Adolescent Psychiatry (AACAP) sent a letter to the Food and Drug Administration (FDA) Commissioner requesting a meeting to discuss the stimulant shortage that is continuing to impact patient care across the country. The disruption in the supply chain has deeply impacted APA and AACAP members, their patients, and the families of patients our members treat. It has also caused a tremendous burden on psychiatrists and pharmacies to fill patient medications. APA and AACAP are working with the FDA to set up a meeting in order to discuss this important issue.

Congressional Activities

Group of Six Statement on Republican Debt Limit Medicaid Requirements

On April 24, the Group of Six issued a statement (.pdf) in opposition to the Medicaid work requirements in the House Republicans’ initial debt limit proposal, which proposed mandatory work requirements for Medicaid beneficiaries. The final agreement passed by Congress and signed by the President excluded any Medicaid work requirements. Such requirements have been demonstrated to be ineffective at improving employment rates and to lead to higher program administrative costs for states, increased medical debt for patients, and barriers to care.

APA Supports Pediatric Subspecialty Loan Repayment Program

On May 24, APA signed a letter supporting fiscal year 2024 funding for the Pediatric Subspecialty Loan Repayment Program (PSLRP). This program provides an award of up to $100,000 to eligible health professionals in exchange for a three-year, full-time service commitment to either working in a health professional shortage area or medically underserved area, or providing care to a medically underserved population. The PSLRP helps expand the pool of pediatric providers, including medical specialists, surgical specialists, child and adolescent behavioral health care specialists, and mental health and substance use disorder prevention and treatment service providers.

APA Supports Pursuing Equity in Mental Health Act

On May 18, APA signed a letter of support for H.R. 3548, the Pursuing Equity in Mental Health Act. This legislation was reintroduced by Rep. Bonnie Watson Coleman (D-NJ) and Rep. Grace Napolitano (D-CA) and would authorize increased data collection and funding for integrated care models to ensure that youth of color have greater access to mental health services. The bill would authorize $995 million in grants and other funding to support research, build a culturally competent workforce, support outreach programs that reduce stigma and develop training programs for healthcare professionals to manage health disparities. The bill also promotes efforts to integrate mental health and primary care in an effort to ensure underserved populations have greater access to mental health care. APA CEO and Medical Director Saul Levin, M.D., M.P.A., provided a quote in the press release for the bill, which can be read here.

APA Supports the Helping Kids Cope Act

In June, APA signed a letter of support for H.R. 2412, the Helping Kids Cope Act. This legislation, which was introduced by Rep. Lisa Blunt Rochester (D-DE) and Rep. Brian Fitzpatrick (R-PA), would improve children’s access to a full spectrum of mental and behavioral health services when they need them. Specifically, the bill would expand the availability of pediatric mental health services and make targeted investments in the pediatric mental and behavioral health workforce. Additionally, this bill supports innovative solutions to increase care coordination and integration, as well as facilitate early intervention services.

State Activities

Montana Enacts APA Model Prior Authorization Reform Legislation Into Law

Montana Governor Gianforte recently signed SB 380, based on APA model prior authorization legislation initiated by the Montana Psychiatric Association, into law. APA state model legislation on prior authorization reform (.pdf), the product of a work group of APA members and staff, would prohibit prior authorization in certain circumstances, including for generic prescription drugs, on any drugs that have been prescribed without interruption for six months, and on any long-acting injectable medication. Among other topics, the language also requires that any denial of coverage be made by a physician in the same specialty as the prescriber, requires that all denials be eligible for an expedited internal appeal process, and requires the insurer to render a decision within 48 hours of the requested expedited appeal process. If your APA district branch or state association is interested in pursuing prior authorization reform, please contact APA State Government Affairs Director Erin Philp.

APA Collaborative Care Model Legislation Enacted in Additional States

Approximately ten states have now enacted laws based on APA’s Collaborative Care Model legislation, requiring insurance companies to reimburse for the Collaborative Care Model (CoCM) codes. CoCM is an evidence-based solution to safely increase access to mental healthcare through the state. CoCM is effective and efficient, resulting in healthcare cost savings. This session Minnesota and Wyoming enacted legislation initiated by the Minnesota Psychiatric Society and Wyoming Association of Psychiatric Physicians respectively into law.

APA State Government Affairs continues to support its district branches and state associations in advocating for coverage of CoCM. For more information or to view model legislation adapted specifically for your state, visit our website.

Montana Law Prohibits Non-Competes For Psychiatrists and Behavioral Health Professionals

The Montana Psychiatric Association (MPA) is celebrating a victory after Governor Gianforte signed MPA-initiated legislation (SB 451) into law, prohibiting non-competes for psychiatrists and behavioral health professionals, including psychologists, social workers, professional counselors, addiction counselors, marriage and family therapists, and behavioral health peer support specialists. APA assisted MPA by drafting the legislation and partnered closely with them throughout the process. If your APA district branch or state association is interested in similar legislation, please contact [email protected].

Ensuring Medical Licensure Application Questions Comply With The ADA

Several medical students and physicians live or have lived with some form of mental illness. Medical licensure boards in several states have asked physician medical licensure applicants with medical degrees intrusive questions about whether they have any psychiatric history, discouraging those who need psychiatric treatment from seeking it. The United States Department of Justice has established that such questions violate the Americans with Disabilities Act (ADA).

After lobbying for reform for several years, the Illinois Psychiatric Society (IPS) scored a victory this session when Governor JB Pritzker signed IPS-initiated legislation (HB 3109) into law, which amends the Illinois Medical Practice Act regarding provisions concerning application for medical licensure, requiring that the Illinois State Medical Board, in determining mental capacity, must ensure questions concerning mental health are compliant with the guidelines of the Americans with Disabilities Act.

Massachusetts Psychiatric Society Testifies in Support of Prior Authorization Reform

Last month, the Massachusetts Joint Committee on Financial Services held a hearing on SB 677/HB 941, the APA-drafted prior authorization reform bill. Dr. Amy Harrington testified on behalf of the Massachusetts Psychiatric Society in support of the bill. Among the many provisions of the bill, it streamlines the approval and denial process and eliminates prior authorization for a number of drugs, antipsychotic long-acting injectables, and OUD treatment.

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