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Advocacy Update: March 2023

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

Executive Branch Activities

SAMHSA Proposed Rule to Modify Provisions for Access to Medications to Treat Opioid Use Disorder

APA responded to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) proposed rule to modify provisions for access to medications for the treatment of Opioid Use Disorder in Outpatient Treatment Programs. APA supported many of SAMHSA’s updates in the proposed rule, highlighting opportunities to maximize effectiveness of changes while limiting unintended consequences of expanding access to medications for opioid use disorder. These proposed updates follow evidence based research from the waivers allowed during the COVID-19 public health emergency. SAMHSA is using its authority to expand access to services through mobile medication units, telehealth, and removing barriers to admission and take home doses.

Congressional Activities

APA Joins MHLG CONNECT for Health Act Letter

On January 30, APA joined a Mental Health Liaison Group (MHLG) letter of support for the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act in the 118th Congress. The letter, which is addressed to Sen. Brian Schatz (D-HI) and Rep. Mike Thompson (D-CA), urges any reintroduction of this bill to include a provision that would eliminate the in-person requirement for telemental health services as a prerequisite for coverage. The 2023 Medicare Physician Fee Schedule issued by the Centers for Medicare and Medicaid Services extended the in-person follow ups to every 12 months after the initial 6-month in-person visits, but we are concerned that in-person requirements could become a barrier to access for patients.

APA Supports Lighting White House Green for Mental Health Awareness Month

On February 10, APA signed a letter of support requesting that the White House be lit in green in observance of Mental Health Awareness Month. The letter was sent by the Mental Health Liaison Group to the White House Social Secretary in the hope that the White House will commemorate the month which is used to educate the public about mental health conditions and underscore the Administration’s commitment to addressing the ongoing crisis.

APA Supports REDI Act in 118th Congress

On February 27, APA signed a letter of support for the reintroduction of the Resident Education Deferred Interest (REDI) Act in the 118th Congress. This bill would allow borrowers to qualify for interest-free deferment on their student loans while serving in a medical or dental interest internship or residency program. The REDI Act prevents physicians and dentists from being penalized during a residency by precluding the government from charging them interest on their loans during a time when they are unable to afford payments on the principal. While this bill would not provide loan forgiveness or reduce a borrower’s original loan balance, it supports the health care workforce by preventing interest accrual on existing loans.

APA Urges Legislation to Support DACA Recipients

In February, APA signed a letter urging lawmakers to enact legislation to provide permanent protections for “Dreamers'' who were brought to the United States as children and who built their lives here. Dreamers contribute to the health care workforce but are threatened by judicial uncertainty and regulatory impermanence because of their immigration status. Currently, there are 34,000 Deferred Action for Childhood Arrivals (DACA) recipients who provide health care to patients across the nation. In light of the nationwide health workforce shortages, DACA recipients are critical to retaining and expanding our nation’s health workforce and health care capacity. In the letter, we urge Congress to pass S. 365, the Dream Act of 2023, a bipartisan bill introduced by Sens. Dick Durbin (D-IL) and Lindsey Graham (R-SC) to provide Dreamers a permanent pathway to citizenship.

State Activities

Wyoming Becomes the 8th State To Enact APA Collaborative Care Model Legislation Into Law

Eight states have now enacted legislation into law requiring insurers and/ or Medicaid to reimburse for the Collaborative Care Model (CoCM), based on the American Psychiatric Association’s model legislation. Most recently, Wyoming Governor Gordon signed HB 140 into law, requiring insurers to reimburse for the CoCM codes. If you are interested in learning more about CoCM, please visit the APA website or contact [email protected].

Colorado Governor Signs Psychologist Prescribing Bill Into Law

On March 3, Colorado Governor Polis signed HB23-1071 into law. This law authorizes psychologists to prescribe if they have received a psychopharmacology degree and fulfilled other requirements of Colorado psychologist prescribing law. The Colorado Psychiatric Society (CPS), along with the American Psychiatric Association, worked diligently to oppose this legislation which was strongly supported by Governor Polis. Thankfully, the strong relationships CPS has developed with many legislators produced important limitations to the bill. State Senator Kyle Mullica, an ER nurse and ally of the House of Medicine, led negotiations to include strong physician involvement and require prescribing psychologists to have education and training standards similar to nurse practitioners and physician assistants. Under the new law, prescribing psychologists must undergo a supervised practicum which must be in person and 1:1 with patients. The practicum must be at least 750 hours long and include seeing at least 150 patients, all under the supervision of a physician. The prescribing psychologist may only prescribe with a collaborative relationship with a physician who oversees the patient’s general medical care. Before prescribing, the prescribing psychologist must communicate to the patient’s primary treating physician the intent to prescribe and must receive an electronic written agreement from the physician that the medication is appropriate. The prescribing psychologist must keep the primary treating physician apprised of all lab tests. The new law also includes Truth in Advertising language to require prescribing psychologists to tell their patients they are not physicians prior to treatment. Prescribing psychologists in the state of Colorado must submit to a peer review process approved by the Colorado Medical Board and carry malpractice insurance of $1 million per claim and $3 million per year. The education and certification standards must also be approved by the Colorado Medical Board. For more information on this new law, please contact Erin Philp, APA Director of State Government Relations, at [email protected].

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