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Advocacy Update: November 2021

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

APA-Led Activities

APA Hosts Health Equity Congressional Briefing

APA hosted a virtual congressional briefing to highlight the mental health disparities experienced by diverse communities and how the COVID-19 pandemic has exacerbated these disparities. The briefing was moderated by APA President, Dr. Vivian Pender, and included presentations and insight from expert panelists Dr. Bernardo Ng and Dr. Glenda Wrenn, who are APA Members, as well as Dr. Lisa Cooper of John Hopkins University. The panelists answered questions from the audience regarding topics like cultural competency in medicine, social determinants' relation to mortality, and how Congress can reduce disparities experienced by diverse populations. The recorded briefing can be accessed here.

Executive Branch Activities

2022 Medicare Physician Fee Schedule/Quality Payment Program

CMS released a Final Rule on Tuesday, November 2nd, laying out changes to the Medicare Physician Fee Schedule and Quality Payment Program that will take effect on January 1, 2022. The focus of APA’s advocacy efforts has been on maintaining flexibilities put in place during the public health emergency and CMS appears to have listened. They have modified the regulations to include coverage for audio-only care for patients with mental health and substance use disorders, enabling psychiatrists to bill for E/M and other telehealth approved services using the same CPT codes as if it were a telehealth visit. Patients with mental illness can now be seen in the home, which is now in line with the SUPPORT Act which allowed for this for those patients with substance use disorders (and co-occurring mental health disorders). While CMS adhered to the statutory requirement that new patients with mental illness be seen in-person within 6 months of a telehealth visit (including audio-only), they did modify their original proposal for follow-up care, now requiring an in-person visit every 12 months (instead of every 6 months) for established patients and allowing for exceptions based on the patient’s condition. Finally, CMS finalized a reduction to the conversion factor (the dollar figure applied to the RVUs that determines the payment) of $1.30 (from $34.89 to $33.59) based on overall changes to payments within the Medicare physician fee schedule. APA, along with other physician groups, will continue to lobby Congress to stop those cuts.

HHS Secretary announces release of Overdose Prevention Strategy

Health and Human Services (HHS) Secretary Xavier Becerra announced the release of the new HHS Overdose Prevention Strategy. The new strategy focuses on the multiple substances involved in overdose and various treatment approaches for substance use disorders (SUD). As described in a press release, the new strategy prioritizes four key target areas– primary prevention, harm reduction, evidence-based treatment, and recovery support. The strategy intends to expand public awareness and education of mental and behavioral health services including the availability of services for prevention and treatment of SUD. In addition, the strategy provides coordinated, federal support for harm reduction and recovery support efforts, and places emphasis on equity and meeting the needs of underserved populations.

SAMHSA releases 2020 National Survey on Drug Use and Health

The Substance Abuse and Mental Health Services Administration recently released findings from the 2020 National Survey on Drug Use and Health (NSDUH). While the sample size for the data was smaller than in years past due to the pandemic, it supports speculations that the COVID-19 pandemic had a negative impact on the nation’s well-being. Respondents noted that COVID-19 adversely impacted their mental health, including by exacerbating use of alcohol or drugs among people who had used drugs in the past year. In particular, it is estimated that 25.9 million past-year users of alcohol and 10.9 million past-year users of drugs other than alcohol reported they were using these substances “a little more or much more” than they did before the COVID-19 pandemic began.

Congressional Activities

APA Joins Coalition in Declaration of National Emergency for Children's Mental Health

APA, the American Academy of Pediatrics, the Children's Hospital Association, and the American Academy of Child and Adolescent Psychiatry joined forces and declared a national emergency for the state of children and teen's mental health during the COVID-19 pandemic. The declaration, entitled "Sound the Alarm for Kids," calls upon Congress to take immediate action by funding emergency, preventative, and continuing services and treatment to address the current mental health crisis experienced by kids. Read APA’s press release about the partnership here.

House Passes APA Supported Legislation to Address the Opioid Crisis

In October, the U.S. House of Representatives passed several bipartisan bills broadly aimed at bolstering public health infrastructure. In addition to measures seeking to promote domestic pharmaceutical manufacturing and prepare for future public health emergencies, APA-endorsed State Opioid Response Grant Authorization Act of 2021 was also passed. Introduced by Reps. David Trone (D-MD) and Mikie Sherrill (D-NJ) in April, this bill would amend the 21st Century Cures Act to further fund the State Opioid Response (SOR) Program and harmonize the uses of these grants with funding provided by the Substance Abuse and Mental Health Services Administration (SAMHSA). The legislation, which APA had encouraged House leadership to take up in August, must now be considered by the U.S. Senate.

APA Submits Testimony in Support of Expanding a Veterans Peer Specialist Program

On October 13, the House Veterans Affairs Subcommittee on Health held a hearing on more than a dozen bills aimed at expanding access to a variety of services for veterans. The wide ranging hearing focused on legislative efforts to prevent and address veterans' suicide, with specific interest in efforts to improve the Veterans Crisis Line and extend access to VA Readjustment Counseling Service to the family members of Veterans. APA submitted testimony in support of the Veterans Peer Specialist Act (H.R. 4575), which seeks to build on the efforts in the 2018 VA MISSION Act by permanently expanding the peer specialist support program to all VA medical centers over the next five years. Additionally, the legislation prioritizes the program’s expansion to rural areas and focuses on hiring peer specialists that reflect the racial and ethnic demographics of the veteran population. The entire hearing can be viewed here.

State Activities

APA-AMA Meeting on 988 Implementation

AMA holds a regular meeting for state medical associations and medical specialty organization staff to inform them of new state legislative trends. APA developed a program for one of these meetings centered around 988 implementation to help make sure state medical associations were aware of the legislation needed in the states. Speakers were Avanti Bergquist, MD, MS, FAPA, DFAACAP Government Relations Chair for the Washington State Psychiatric Association (WSPA); ​​Laura Evans, Director of National and State Policy, Vibrant Emotional Health; Taylor Kleffel, Manager of State Policy, Americans for Suicide Prevention; and Stephanie Pasternak, Senior Manager of State Affairs, National Alliance on Mental Illness. During the call, Dr. Bergquist explained how building out the full continuum of crisis care would benefit all patients.

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