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Advocacy Update: March 2024

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

APA-Led Activities

APA to Host Advocacy Town Hall

APA works every day with policymakers on Capitol Hill, in the Administration, and at the state level to shape legislation and regulations to advance psychiatry and promote the highest quality of care for our patients and their families. As an APA member, you play a critical role in furthering our advocacy priorities and policy agenda.

Come join APA President, Dr. Petros Levounis, and the Division of Advocacy, Policy, and Practice Advancement on Wednesday, March 27 from 12:00-12:45 Eastern, in an interactive setting to learn more about our advocacy agenda, the current state of play, ask your questions, and begin your journey as an advocate. Click here to register.

Executive Branch Activities

APA Submits Response to SAMHSA Maternal Mental Health RFI

On February 8, APA sent a letter to SAMHSA’s Task Force on Maternal Mental Health (.pdf) concerning the prevention and treatment of maternal mental health conditions and substance use disorders. In our response, APA shared evidenced-based interventions and treatment models, such as the Massachusetts Child Psychiatry Access Program, Transforming Maternal Health Model, and the Collaborative Care Model, that can be implemented broadly to help access in order to address maternal mental health and substance use. The letter also highlights opportunities in outcomes for pregnant and postpartum individuals with substance use disorders and/or mental health conditions as well as opportunities in prevention, screening, and diagnosis.

APA Joins White House Conversation Against Use of Conversion Therapy

On February 7, APA joined the United States Joint Statement (USJS) in a conversation with the White House Domestic Policy Council on policies against the use of conversion therapy. APA joined the USJS, and its partners, supporting LGBTQ individuals' healthcare. APA, along with USJS voiced our continued support to the Administration in developing equitable policies to advance care for LGBTQ individuals.

HHS Issues Final Rule on 42 CFR Part 2

On February 16, the U.S. Department of Health and Human Services (HHS), through the Office of Civil Rights (OCR) in coordination with the Substance Abuse and Mental Health Administration (SAMHSA), issued a final rule to revise the Confidentiality of Substance Use Disorder Patient Records regulations (42 CFR Part 2) (.pdf). Part 2 protects “records of the identity, diagnosis, prognosis, or treatment of any patient which are maintained in connection with the performance of any program or activity relating to substance abuse education prevention, training, treatment rehabilitation, or research.” The updates to Part 2, many of which APA supported, better align the rule with HIPAA, improve care coordination between health professionals, and help eliminate the stigma patients experience in receiving substance use disorder care.

APA Provides Telehealth Recommendations for CMS

APA discussed with the Center for Medicaid and Medicare leadership and submitted a letter regarding the need for pay parity for telehealth services, and as well as the need to continue access to virtual supervision of residents.

APA Provides Feedback to CMS on MIPS Value Payment Program

APA, AMA, and several other medical-specialty societies met with CMS on February 26, 2024, to provide feedback to CMS regarding the MIPS Value Payment Program (MVP). Concerns focused on the choice of quality measures included in the MVP and new cost-measures that have the potential to impact future payments negatively.

Congressional Activities

APA Fiscal Year 2024 Priorities

On February 9, APA sent our FY 2024 priorities to House and Senate Leadership to provide policy recommendations for inclusion in a forthcoming health package. In our letter, we highlight APA’s priority legislation H.R. 5819/S.1378, the COMPLETE Care Act, which would provide temporary Medicare reimbursement increases to support the integration of primary care and behavioral health. Other highlights include support for addressing the Medicare Physician Fee Schedule, bolstering the physician workforce, extending current telehealth flexibilities, and reauthorizing the 2018 SUPPORT Act.

CAMH Children’s Priorities for Fiscal Year 2024

On February 8, APA joined the Child and Adolescent Mental Health (CAMH) Coalition in a letter to House and Senate Leadership expressing the coalition’s support for children’s programs in Fiscal Year 2024. In the letter, we highlight several programs, including support for SAMHSA’s Community Mental Health Services Block Grant as well as Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment benefit. Finally, the letter includes support for S. 2556, the Improving Coordination and Access to Resources Equitably (CARE) for Youth Act, which would increase access to mental and behavioral health care by reducing barriers related to Medicaid billing of services furnished on the same day.

Friends of AHRQ Fiscal Year 2025 Priorities

On February 26, APA joined the Friends of AHRQ coalition in a letter to the House and Senate Chairs and Ranking Members of the Labor, Health and Human Services, Education, and Related Agencies Appropriations Subcommittee. In the letter, the coalition expresses support for the Agency for Healthcare Research and Quality (AHRQ) in FY2025, which supports research to improve healthcare quality, reduce costs, advance patient safety, decrease medical errors, and broaden access to essential services.

APA Supports Lorna Breen Healthcare Provider Protection Act

On February 15, APA joined other healthcare organizations in a letter of support for H.R. 7153/S.3679, the Dr. Lorna Breen Health Care Provider Protection Act. The letter expresses that health care professionals are facing increasing rates of mental and behavioral health conditions, suicide, and burnout than other professions. In order to ensure an environment where every health care professional always has access to the necessary mental health care services, we urged Congress to reauthorize this legislation.

APA Supports the Healthcare Workforce Resilience Act

On February 27, APA joined two letters of support for H.R. 6205, the Healthcare Workforce Resilience Act, which would help recapture up to 40,000 unused employment-based visas so foreign-born physicians and nurses can continue working and providing care in the United States. This legislation would increase the number of highly trained nurses in America by expediting the visa authorization process for qualified international nurses. Additionally, this measure would allow for thousands of international physicians who are currently working in America on temporary visas with approved immigrant petitions to adjust their status so they can continue serving in underserved communities. The House and Senate letters can be found here.

State Advocacy Activities

Florida Psychiatric Society Defeats Several Unsafe Prescribing Bills

The Florida Psychiatric Society (FPS) is celebrating several wins after a very successful lobbying effort during the 2024 state legislative session. FPS, in close collaboration with the APA, opposed several bills, including psychologist prescribing, autonomous practice for certified psychiatric nurses, and the lack of adequate education, training, and physician supervision for the practice of naturopathy. The bills all died in committee.

APA Collaborative Care Model Campaign Continues to Expand

APA is collaborating with several district branches and state associations in pursuing legislation requiring commercial insurers and/or Medicaid to reimburse for the Collaborative Care Model codes and/ or appropriate funding for grants. Louisiana and Minnesota district branches are lobbying for legislation requiring Medicaid coverage of the codes, after they succeeded in enacting laws requiring insurers to cover the codes. In South Carolina, the Department of Health and Human Services budget request includes $2.98 million to establish reimbursement rates for pediatric collaborative care services. The South Carolina Psychiatric Association has been working with legislators to turn on all of the collaborative care codes, but stressed the importance in pediatrics given the ongoing foster home crisis in the state. Illinois, which was the first state to enact APA model legislation requiring both insurers and Medicaid to reimburse for the codes, is now seeking a $5 million state-based appropriation for implementation grants.

APA Pursuing Prior Authorization Reform

Several District Branches are initiating APA state prior authorization reform legislation (.pdf) or supporting bills containing its key provisions this session. The model language 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. It 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. Contact APA government affairs for more information.

Utah Enacts Psychologist Prescribing Legislation

The Utah Legislature passed a large behavioral health care bill into law which includes establishing prescriptive authority for psychologists. The Utah Psychiatric Association (UPA), in collaboration with the American Psychiatric Association and Utah Medical Association, lobbied in opposition to the psychologist prescribing provision. In consideration of the Governor’s strong support for the proposal and the political climate, UPA negotiated stronger patient protections. The Governor is expected to sign the legislation into law.

As enacted, the law will require applicants for prescribing psychologist licenses to obtain a master’s degree in psychopharmacology which includes 30 credit hours in specific core areas; complete at least 4,000 hours of clinical training; and hold liability insurance. To prescribe to those 17 years of age and under, 65 years of age or older; or those with comorbid conditions, they must complete one year of clinical training specific to those populations and be supervised by a physician.

The law requires collaboration with a health care practitioner, which must be a physician or a psychiatric health nurse practitioner. Prescribing psychologists may prescribe selective serotonin reuptake inhibitors (SSRIs) and other medications recognized in or customarily used to treat psychiatric, mental, cognitive, nervous, emotional, developmental, or behavioral disorders. They are prohibited from prescribing narcotics or controlled substances.

The American Psychiatric Association continues to partner with its district branches and state associations throughout the country to advocate for safe prescribing. Please contact [email protected] for more information.

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