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Advocacy Update: October 2021

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

APA-Led Activities

Draft APA Practice Guideline for Eating Disorders

The public comment period for the draft “Practice Guideline for the Treatment of Patients with Eating Disorders” is underway through November 12, 2021. APA invites you to review and submit feedback on the draft here.

The APA’s Guideline Writing Group drafted the guideline based on a systematic review of the available evidence on pharmacological and psychosocial treatments for patients with eating disorders. Each statement (recommendation or suggestion) is separately rated according to the strength of the supporting research evidence and the balance of possible benefits and harms of the recommended or suggested actions. In addition, the draft guideline includes a review of strategies and caveats when implementing the guideline statements and a discussion of their relevance quality improvement activities.

For questions about this draft or the comment process, contact Jennifer Medicus, APA Practice Guidelines, at [email protected].

Help Pass APA’s Signature Legislation to Increase Access to MH/SUD Treatment

APA's signature legislation was recently introduced that seeks to facilitate greater uptake of the Collaborative Care Model (CoCM) by providing grants to primary care practices to help defray the startup costs associated with implementing CoCM, creating national and regional technical assistance centers to train providers on CoCM and authorizing further research into other potentially promising integrated care models. Use APA’s online tool to tell your Representative to cosponsor H.R. 5218, the Collaborate in an Orderly and Cohesive Manner Act today!

APA Participates in Reviewing Quality Measures for Geriatric Neurology

In partnership with APA, the American Academy of Neurology (AAN) is forming a Standing Work Group to review, update, and develop new quality measures for geriatric neurology. The Work Group includes two APA experts, and APA will be working closely with AAN in the development of these measures, which will address dementia and mild cognitive impairment, among other issues.

Executive Branch Activities

Measures on Measurement-Based Care Submitted to CMS for Approval

Under a cooperative agreement with CMS, APA has been developing a suite of quality measures focused on measurement-based care (MBC); in September, these measures were submitted for CMS’s Qualified Clinical Data Registry (QCDR) program. If approved, the measures will be available for clinicians to collect and report data for the Merit-Based Incentive Payment System (MIPS) through APA’s PsychPRO registry. More information on the measures is available here.

APA Engages with CMS to Review Inpatient Psychiatric Facility Quality Reporting

On September 29, APA participated in a stakeholder meeting convened by CMS to review measures in the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program, identifying gaps and priorities for future measure development. APA will continue to engage with CMS to improve the IPFQR program and ensure that it is aligned with the needs and priorities of APA’s membership.

APA Representatives Selected to Serve on Technical Expert Panels

APA representatives have been selected to serve on two Technical Expert Panels (TEPs) convened by CMS and its contractors to advise on the development of cost measures related to Major Depressive Disorder (MDD) and Psychoses/Other Conditions. CMS has a legislative mandate to develop cost measures for potential implementation in the MIPS program; APA will be actively engaging with CMS to ensure that efforts to measure costs in psychiatric care are valid, appropriate, and do not create unintended consequences or negative outcomes for patients and clinicians.

Proposed Rule on the Hospital Outpatient Prospective Payment and Quality Reporting Programs

In comments on the CMS proposed rule on the Hospital Outpatient Prospective Payment and Quality Reporting Programs, APA thanked CMS for quickly extending temporary emergency waivers during the public health emergency that enabled CMHCs and other facilities to continue to provide partial hospitalization services through the use of telehealth, and without regard to payer and urged CMS to maintain the flexibilities for the foreseeable future until there is an opportunity to understand the impact of these changes on patient outcomes. APA also supported CMS’ proposal to use 2019 claims as the basis for rate setting methodology, and requested CMS clarify payment policies related to Collaborative Care services provided in hospital outpatient and off-campus hospital provider-based departments.

Congressional Activities

Physician Leaders Call on Congressional Leadership to Support Frontline Physicians

APA President Dr. Vivian Pender joined leaders from other frontline physician organizations to meet with Congressional leadership and leaders on key Congressional committees to encourage congressional action on policies that will strengthen access to care and improve our health care infrastructure. She and her colleagues specifically called on Congress to: (1) pass APA’s signature legislation that will facilitate the integration of behavioral health and primary care, (2) advance Medicaid payment parity for primary care and behavioral health, (3) promote maternal health, and (4) avert physician reimbursement cuts.

Mental Health Organizations Call for Enhanced MH Parity Enforcement

APA and 49 other mental health advocacy organizations asked the Senate HELP Committee Chair, Senator Patty Murray (D-WA), to support efforts already underway to enforce the federal mental health parity law. Specifically, the organizations suggested that Congress should provide the U.S. Department of Labor with the authority to fine health plans and third party administrators that violate federal parity laws and include $195 million to the Employee Benefits Security Administration for enforcement. Earlier in September, the House Education and Labor Committee included similar language in legislation it passed.

APA Highlights Important Proposals in the 2021 Build Back Better Agenda

As Congress continues its efforts to legislate the president’s Build Back Better agenda, APA wrote congressional leadership to highlight important provisions that will improve access to mental health care. APA endorsed several provisions that will either make health insurance more accessible or affordable, as well as provisions that would improve Medicaid coverage and strengthen the Children's Health Insurance Program (CHIP). APA also applauded provisions that address the healthcare workforce shortage and other provisions that support health equity.

State Activities

State Collaborative Care Legislation

The Council on Advocacy and Government Relations and APA staff recently held a District Branch Legislative Representatives Forum on the Collaborative Care Model. Over 75 members attended, representing more than half of the District Branches. During the Forum, members heard from District Branches that have enacted APA’s model legislation, and also learned more about the APA’s federal Collaborative Care legislation. To view a recording of the Forum meeting, please contact [email protected]. Several states are interested in pursuing Collaborative Care legislation in the next legislative session, and APA staff are working closely with them to develop sound strategy in those states.

State Plans for National Crisis and Suicide Prevention Hotline

Last year, Congress established 988 as a new nationwide telephone hotline for crisis and suicide prevention and gave states two years to implement the line. APA is working with a coalition of other mental health organizations to support the passage of 988 implementation legislation in each state. So far, there are seven states that have enacted 988 legislation (Colorado, Indiana, Nebraska, Nevada, Oregon, Virginia, and Washington). The American Medical Association has invited APA to help educate state medical associations across the country about 988. To get involved in 988 coalition activity in your state, please contact [email protected].

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