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Advocacy Update: March 2022

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

APA-Led Activities

Call for Applications for APA’s 2023 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 2023 Annual Meeting, and coverage in two APA publications. Each year, up to three awards are presented: Gold, Silver and Bronze.

Apply here by Friday, July 29, 2022. The nomination requirements, the full application, and additional information can be found on the APA’s Awards website.

Executive Branch Activities

CMS Field Testing of Cost Measures

APA submitted comments on episode-based cost measures being developed by CMS for use in the MIPS program. The measures under development include one focused on Major Depressive Disorder (MDD) and another focused on Psychoses and Related Conditions. CMS is conducting field testing of the measures; as part of this process, clinicians or clinician groups who have been attributed at least 20 episodes under any of the measures will receive a cost report for their review and feedback. More information can be found on CMS’s MACRA Feedback page. If you have received a cost report and would like to review it with APA staff, please contact [email protected].

APA Supports Network Access in Medicare Advantage Plans

APA submitted comments supporting a CMS proposal that plan applicants be required to demonstrate that they comply with network adequacy standards before CMS will approve an application for a new or expanded Medicare Advantage plan. APA also provided CMS with requested information regarding building an adequate network of behavioral health providers including easing administrative burdens, improving reimbursement rates, use of telehealth and wider adoption of the Collaborative Care Model. APA also supported efforts to improve health equity by requiring all Special Need Plans (SNP) (i.e., chronic condition special needs plans, D–SNPs, and institutional special needs plans) to include one or more standardized questions on the topics of housing stability, food security, and access to transportation as part of their Health Risk Assessments.

APA Advocates for DEA to Maintain Public Health Emergency Waivers

APA, in cooperation with the American Telemedicine Association (ATA), submitted a letter to the US Drug Enforcement Administration (DEA) concerning the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 (Ryan Haight). The letter, which garnered 69 signatories, highlighted the need to maintain the waivers which allowed certain controlled substances to be prescribed to patients via telemedicine without an in-person examination that should be continued at a physician’s discretion when the PHE ends.

APA Releases Statement in Support of New White House Mental Health Strategy

On March 1, the APA released a statement in support of the Biden Administration’s new strategy to address the mental health crisis. The new strategy, which the President unveiled during his State of the Union (SOTU) address, will focus on strengthening system capacity to address the MH workforce shortage, creating more healthy social environments for youth, and promoting increased access to care. We are glad to see that the Administration will be making historic investments in mental health, including training for clinicians, enforcing mental health parity, and expanding telehealth services. For more information on the Administration’s mental health strategy, please see this fact sheet. Please find the APA’s statement of support for the new strategy listed among others in a White House press release.

Congressional Activities

APA Member Meets with Rep. Tonko to Discuss Climate Change and Mental Health

On February 1, APA member Elizabeth Haase, MD, Chair of the APA Committee on Climate and Mental Health, participated in a meeting with other mental health providers and advocates and Rep Richard Tonko (D-NY) to discuss the mental health impacts of climate change. The participants spoke about how climate change can impact mental health, the potential role for research, and answered questions from the congressman on this issue. After the meeting, Rep. Tonko indicated his interest in sponsoring legislation on mental health and climate change, which is presently under development.

APA Submits Testimony to House Ways and Means Committee for Mental Health Hearing

On February 2, the House Ways and Means Committee conducted a hearing on “America’s Mental Health Crisis.” In response, the APA Administration submitted written testimony to the Committee. The APA testimony focused on several policy areas to increase access and treatment to mental health and substance use disorder services including enhancing the Collaborative Care Model (CoCM) by endorsing APA drafted legislation, H.R. 5218, that provides grants to primary care to integrate mental health with primary care through the CoCM. In addition, the APA highlighted the need to address health equity by promoting policies to address health disparities; expand the access to telehealth by extending the current flexibilities under the public health emergency (PHE) and removing the 6-month in-person requirement for mental health; expand the mental health workforce by increasing GME slots, specifically for psychiatry; and enhancing parity transparency and enforcement including authority for civil monetary penalties as well as the need to implement the parity law within Medicare.

APA Testifies Before Energy and Commerce Subcommittee on Oversight & Investigations

On February 17, the House Energy and Commerce Oversight and Investigations Subcommittee conducted a hearing entitled, “Americans in Need: Responding to the National Mental Health Crisis.” Lisa Fortuna, MD, MPH, Professor of Clinical Psychiatry at the University of California San Francisco Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, testified on behalf of the APA. Dr. Fortuna, who also serves as Vice-Chair of Psychiatry at the University of California San Francisco and the Chief of Psychiatry at the Zuckerberg San Francisco General Hospital, used the forum to address the current state of mental health in the nation, with specific focus on the impacts of the pandemic, health disparities, social determinants of health, and children’s mental health. Dr. Fortuna also focused on MHPAEA compliance, described the benefits of the Collaborative Care Model and provided recommendations related to rolling out of the new 988 Crisis line and supporting the full continuum of crisis care services.

APA Urges Congressional Leadership to Delay In-Person Telehealth Requirement

On February 17, the APA joined a coalition of telehealth advocates in a letter to congressional leadership urging the delay of implementation of the telemental health in-person requirement. This requirement is a prerequisite for coverage of telehealth services but has been suspended for the duration of the public health emergency (PHE). Once the PHE ends, the requirement will immediately go into effect. In the letter, we ask that lawmakers consider making a pathway to delay this in-person requirement at least through December 31, 2024, so providers and beneficiaries have more stability in access to care. Additionally, the letter asks Congress to consider legislation that would eliminate the in-person requirement for telehealth, as well as legislation that would enable the Department of Health and Human Services to collect data on how telehealth impacts care delivery and health outcomes for mental health conditions to inform future policy decisions.

APA Urges House and Senate Appropriations Committees to Prioritize Public Health Funding

On February 25, the APA joined the Group of 6 in a letter encouraging the Appropriations Committees to quickly finalize the Fiscal Year 2022 Appropriations process in order to bolster our overwhelmed health care system, ensure patients have access to medical care, and prepare for the next public health emergency. In justifying the need for action, the letter cited the uncertainty created by extended continuing resolutions, which will make it more difficult for health agencies to respond to COVID-19 challenges, and for providers to properly deliver care. In advocating for a long-term, multilayered medical and public health response to contain COVID-19, the letter also called for supporting recent proposals to significantly increase the funding of research and programs to address the current mental health and substance use disorder crises, as well as to address the co-occurring gun violence epidemic.

State Activities

Legislation Impacting the Physician-Patient Relationship

APA members and staff are concerned about the growing number of bills negatively impacting the ability of physicians to provide appropriate, evidence-based medical care to individuals, especially LGBTQ patients, transgender, and gender-diverse patients. APA has assisted District Branches in supporting legislation that would ban conversion therapy and has offered assistance in opposing legislation that would require teachers to report students who mention identifying as an LGBTQ individual. Such legislation or laws could be injurious to student mental health. Additionally, APA recently joined other physician organizations opposing efforts to interfere in the confidential relationship between a patient and their physician who is providing evidence-based treatment. It should not be against the law for a patient to talk to their physician about gender-affirming care.

Coordinated Specialty Care Legislation

Recently, Senate Majority Leader Senator McGuire, introduced SB 1337, APA-drafted legislation which would create uniform coverage for the evidence-based treatment of early or first-episode psychosis. Many APA members in California assisted APA in drafting this model legislation. California District Branches expect that other organizations, like the Kennedy Forum and the Steinberg Institute, will also advocate in support of the bill. Other states, including Illinois, Maine, Massachusetts, Virginia, and Washington, are considering legislation to support coordinated specialty care, either through coverage or funding of existing programs. If your District Branch is interested in discussing this legislation, please contact [email protected].

988 Legislative Update

The National Association of State Mental Health Program Directors (NASMHPD), in collaboration with the 988 State Work Group in which APA participates, released an updated version of the 988 state model legislation to help states implement 988 and support comprehensive crisis services. NASMHPD also released a section-by-section summary to explain what the model bill would do. There are currently 12 states with pending 988 legislation: Florida, Hawaii, Illinois, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Mississippi, New Jersey, Ohio, and West Virginia. Hawaii, Illinois, and Kansas recently had hearings on their 988 bills. APA continues to work with the Reimagine Crisis coalition partners and continues to assist District Branches who are involved in 988 work.

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