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Advocacy Update: October 2022

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

Executive Branch Activities

APA Supports the Administration in Strengthening of Nondiscrimination Section 1557

On October 3, APA responded to the US Department of Health and Human Services proposed rule Nondiscrimination in Health Programs and Activities, supporting the Agency’s commitment to clarify and broaden nondiscrimination protections to include sexual orientation and gender identity in access to covered health programs and activities, including pregnancy or related conditions. The proposed rule also includes nondiscrimination in the delivery of health programs and activities through telehealth services, including but not limited to Limited English Proficiency individuals and individuals with disabilities. APA previously responded to changes to Section 1557, and will continue to support vulnerable populations' access to and coverage of mental health, substance use, and other health care services.

APA Supports Increased Funding and Access to Evidence-Based Treatment for Mental Health and Substance Use Disorders in Proposed Rule on the 2023 Medicare Physician Fee Schedule and Quality Payment Programs

APA’s September 6 comments to CMS on the 2023 Medicare Physician Fee Schedule and Quality Payment Program focused on ensuring access to mental health and substance use disorder (SUD) treatment through continuing support for coverage and appropriate reimbursement of services, including those provided via telehealth (including audio-only). APA expressed concerns about the impending reduction in payments which will require congressional action to restore. The comments also provided feedback on expanding access and reducing barriers to care, while ensuring that care is safe and effective through appropriate supervision. APA applauded CMS’s development of coding and payment updates that support new services, such as general behavioral health integration and Intensive Outpatient Programs, while also facilitating the implementation of measurement-based care (MBC) and improved care coordination. Finally, the letter urged CMS to increase access and quality of care by incentivizing the Collaborative Care Model and measurement-based care, and provided input on efforts to improve collection of data on social risk factors and disparities in order to ensure quality and health equity across populations.

Congressional Activities

APA Urges Senate to Extend Telehealth Flexibilities

On September 13, APA joined a letter to Senate Majority Leader Chuck Schumer (D-NY) and Minority Leader Mitch McConnell (R-KY) urging them to act to ensure certainty for telehealth services. The COVID-19 public health emergency (PHE) provides telehealth flexibilities for the duration of the emergency and for 5 months following the termination of the emergency. Virtual care is now a fundamental part of the U.S. health care system and APA supports continuing these telehealth flexibilities so patients have continued access to care. The letter urges the Senate to take up H.R. 4040, the Advancing Telehealth Beyond COVID-19 Act, which would provide a two-year extension of telehealth flexibilities beyond the pandemic. The House overwhelmingly passed H.R. 4040 earlier this year.

APA Supports Prior Authorization Bill to Improve Access to Care

On September 14, the House passed by voice vote H.R. 3173, the Improving Seniors Timely Access to Care Act, APA-endorsed legislation which seeks to streamline the approval of prior authorization in Medicare Advantage plans. APA signed a letter of support for the bill earlier this year, to improve the process for prior authorization by requiring Medicare Advantage plans to accept requests electronically and provide "real-time" decisions for services that are routinely approved. Despite enjoying broad bi-partisan support, prospects for passage in the Senate remain unclear, in part due to costs associated with the legislation. The Congressional Budget Office (CBO) on Wednesday projected that the streamlined process for authorizations would increase the use of health services and cause Medicare Advantage plans to raise their bids to include the additional costs, resulting in roughly $16.2 billion in higher Medicare payments over a decade. APA is continuing to advocate for Senate passage.

APA Thanks Lead Sponsors of Physician Fee Schedule Bill

On September 30, APA joined a letter to thank Reps. Ami Bera, M.D. (D-CA) and Larry Bucshon, M.D. (R-IN) for introducing H.R. 8800, the Supporting Medicare Providers Act of 2022. This bill provides a 4.42% positive adjustment to the Medicare Physician Fee Schedule (MPFS) conversion factor for Calendar Year 2023. The adjustment would mitigate payment cuts within the MPFS that are anticipated to take place on January 1, 2023. Absent action from Congress, the Medicare conversion factor, which is used to calculate billing codes into payment rates, will see a 4.5 percent cut, amounting to about $3 billion or $4 billion less for providers in 2023. APA sees H.R. 8800 as a necessary step toward providing clinicians with financial stability and ensuring patients have access to critical services that clinicians provide. The final Medicare payment rule is expected in November.

Congress Passes Continuing Resolution to Fund Government

On September 30, the House passed a short-term government funding bill, known as a continuing resolution (CR), keeping the government funded through December 16. The bill includes a five-year reauthorization of user fee authorities that the Food and Drug Administration uses to fund programs that review medical devices and pharmaceuticals. The CR also provides $62 million in appropriations to the Substance Abuse and Mental Health Services Administration (SAMHSA) to support the 988 Suicide Lifeline and maintains the increased federal medical assistance percentage (FMAP) for U.S. territories. The CR was passed to keep programs functioning and to avoid a government shutdown, but Congress still needs to pass the 12 appropriations bills to fully fund the government. After the election, Congress will reconvene to finalize and look to pass the 12 bills, including the Labor, Health and Human Services, and Education bill, which includes most of APA’s priorities. Further, it is possible that other APA priorities will be attached to the package, including provisions to extend telehealth flexibilities and the Medicare program, as well as other mental health legislation. APA is continuing to monitor what will be included in the final appropriation bills.

State Activities

California Signs 988 Legislation into Law

On September 30, California’s Governor Newsom signed AB 988, the Miles Hall Lifeline and Suicide Prevention Act, into law. The legislation supports the 988 crisis continuum of care in the state and enacts fees to support the system’s structure. Additionally, the new law requires commercial insurance coverage of medically necessary crisis services. In his letter to the California State Assembly, Governor Newsom called on the California Health and Human Services Agency to ensure the 988 system will not fall short of necessary resources to “establish a comprehensive suicide and behavioral health crisis response system.” APA and California District Branches have supported the passage of AB 988 throughout the legislative process.

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