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Advocacy Update: November 2022

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

APA-Led Activities

APA President Dr. Brendel Joins Briefing on Psychology Prescribing

On October 27, APA President Rebecca Brendel, MD, JD, joined a panel hosted by the CATO Institute entitled, “Can Prescribing Psychologists Help Solve the National Mental Health Crisis?” The panel discussed whether lawmakers should expand psychologists’ scope of practice to allow them to prescribe medication. The panel included two psychologists and a psychiatrist who supervises prescribing psychologist students in Illinois. Dr. Brendel discussed the lack of data on safety and efficacy of psychologists prescribing and encouraged support for access improvements like telemedicine and the collaborative care model. The briefing can be watched in full here.

Evaluation, Management Coding, and Documentation - What All Psychiatrists in Clinical Practice Need to Know

On December 8, APA will be hosting a webinar on the changes to how physicians select, and document evaluation and management services continue. Beginning in January 2023, all evaluation and management (E/M) services in all settings (including hospital, and nursing facility settings) will use the same billing rules in place currently for outpatient services -- all E/M’s will be billed on the basis of medical decision making, rather than history or exam OR by time, when psychotherapy is not being provided. The webinar will review the medical decision table, and rules around time. The discussion includes how to select the appropriate level of E/M service and how to document care for billing purposes. While the changes for 2023 are focused on facility-based care, there will be a review of proper coding and documentation for outpatient services as well.

Executive Branch Activities

Final 2023 Physician Fee Schedule

On September 6, 2022, APA sent a letter to Centers for Medicare & Medicaid Services (CMS) administrator Chiquita Brooks-LaSure supporting increased funding and access to evidence-based treatment for mental health and substance use disorders in the 2023 Medicare Physician Fee Schedule. On November 1, 2022, the Centers for Medicare & Medicaid Services (CMS) released the final CY 2023 Physician Fee Schedule, effective January 1, 2023. CMS adopted several of APA’s recommendations in the final rule, including maintaining audio-only billing capabilities for Medicare mental health services, allowing initiation of buprenorphine via telehealth, increasing payment for evaluation and management (E/M) services in facility settings (hospital, nursing facility) and services provided in the home/residence, and expanding the definition of a “high-priority measure” in the QPP to include health equity-related quality measures.

For additional information on the telemental health provisions in the CY2023 Physician Fee Schedule, please see the Telepsychiatry Blog.

APA Responds to SAMHSA RFI on Addressing Mental Health in the Context of Climate Change and Equity

APA’s comments to SAMHSA’s Request for Information on Possible Agency Actions Regarding Mental Health and Substance Use Wellbeing in the Context of Climate Change and Health Equity address pressing issues the agency faces while developing priorities. APA recommended priorities for SAMHSA to ensure behavioral health equity across all populations, but with a focus on those most vulnerable to climate change and natural disasters. As a leader on mental health impacts of climate change and natural disasters, APA has offered support to partner with SAMHSA to address the inequities in care as the intensity and frequency of climate events increase.

Screening and Intervention Highlighted in Comments to U.S. Preventive Services Task Force

Comments submitted by APA to the U.S. Preventive Services Task Force (USPSTF) supported the recommendations of screening for depression, suicide risk and anxiety in conjunction with brief interventions, as opposed to screening alone. This includes screening for individuals over the age of 65. APA expressed concern about the potential negative interpretation of statements regarding the use of pharmacologic agents during the perinatal period, which are safe and effective treatment options.

APA Meets with Office of Management and Budget to Discuss Confidentiality of Substance Use Disorder Patient Records

APA, along with its partners working to amend 42 CFR Part 2: confidentiality of substance use disorder patient records, met with the United States Office of Management and Budget to share recommendations about changes to the rule. The recommendations include administrative simplification, language to address the conflict with Part 2’s disclosure, segregation of a patient’s Part 2 data from the rest of a HIPAA database, and rules for the revocation of consent. APA continues to monitor the federal register for the release of the rule.

APA Supports Call for National Emergency on Youth Mental Health

October marks the one year anniversary of the Sound the Alarm for Kids initiative. Last year, APA joined Sound the Alarm as a partner organization to declare a National State of Emergency in Children's Mental Health. To commemorate the anniversary, APA joined over 130 organizations in a letter to President Biden urging him to declare a federal National Emergency for children's mental health. The letter expresses support for the mental health reforms outlined in the administration's unity agenda. However, it also calls on the President to declare a National Emergency for the youth mental health crisis. The letter to the President is attached to this email. APA will continue to engage in the effort to support children's mental health.

Congressional Activities

APA Joins NDAA Letter in Support of Military Billets in FY 2023 Appropriations

On October 12, APA joined a letter to the House and Senate Chairs and Ranking Members of the Armed Services Committees in support of military billets in the Fiscal Year (FY) 2023 National Defense Authorization Act (NDAA). Currently, there is a pause in reductions in medical billets, but there is concern that military branches, particularly the Navy and Air Force, are moving forward with a reduction in military medical billets over the next several years. Continued proposals to eliminate uniformed medical billets could result in reduced medical training, which could further strain an already understaffed military medical system. In order to maintain a proper medical system, we urge Congress to include language in the FY 2023 NDAA that will prevent a reduction in medical billets until further analysis can be conducted.

APA Responds to RFI on Medicare Access and CHIP Reauthorization Act

On October 31, APA responded to a request from House legislators, led by Reps. Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN), to identify strategies to strengthen and stabilize the Medicare payment system. The request for information (RFI) specifically sought feedback on potential action Congress should take to promote a more affordable, sustainable, and patient-centered health care system, with a focus on avoiding dramatic spending increases and ensuring successful value-based care incentives are in place. In the response, APA provided insight on the effectiveness of the Medicare Access and CHIP Reauthorization Act for psychiatrists and their patients, how to improve participation amongst psychiatrists in value-based payment models, and specific recommendations to improve the Medicare Merit-Based Incentive Payment System and Alternative Payment Model programs.

State Activities

State Advocacy Conference

APA’s State Advocacy Conference took place on October 15-16 in Minneapolis, Minnesota. 100 APA members attended, as well as 4 District Branch Executive Directors and Lobbyists and an additional 13 speakers. Participants included many APA members who were new to advocacy, who benefitted from a variety of presentations on important advocacy topics, had the opportunity to network with their colleagues, worked to build their skills, and contacted their state legislators. The participants will have the opportunity to further refine their skills and engage with the Department of Government Relations in APA’s advocacy over the coming months and years.

Prior Authorization Reform

During the State Advocacy Conference in October, APA’s state model legislation on prior authorization reform was shared with members for the first time. The model language, which was 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. APA staff have already heard from 25 different states who are interested in pursuing some version of prior authorization reform legislation next year.

Engaging Members in Advocacy Visits in State Capitols

Visits to the state capitol are a great opportunity for all members to learn more about APA district branch and state associations’ legislative agendas, meet with their legislators and staff, and make their voices heard. The Michigan Psychiatric Society (MPS) recently held a successful Day at the Capitol, with over 30 residents participating. Residents participated in an orientation led by MPS’ executive director and lobbyist, where they learned the best ways to form relationships with their legislators. Advocates also attended a House Health Policy Committee Hearing to witness debates and bill revisions firsthand. Contact APA at [email protected] if you are interested in learning more about state advocacy days.

New Mexico Mental Health Parity Enforcement Listening Session

On October 18, New Mexico State Senator Martin Hickey, MD held a joint listening session on mental health parity with the Department of Insurance. During the meeting, Senator Hickey announced his plan to file legislation to enforce mental health parity within New Mexico. He will also seek to increase reimbursement for mental health services delivered through Medicaid, decrease the burdens of prior authorization, and define medical necessity. The District Branch supports this initiative and plans to meet further with the Senator to offer their assistance.

California Nurse Practitioner Scope of Practice

In California, the proposed regulations for AB 890, the 2020 bill that expands scope of practice for NPs, have been released for comment. The California Medical Association’s comment letter recommends supplemental examinations for independent practice NPs, a transition process for independent practice, and explicit patient communications on NPs’ role in the healthcare team. The California State Association of Psychiatrists will likely respond with similar recommendations.

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