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Advocacy Update: September 2022

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

APA-Led Activities

APA Sends Cease and Desist Letter to CareDash

APA has sent a letter to CareDash, a health care provider review and referral website, demanding that they remove from their platform all profiles of psychiatrists who have not provided consent to display their profile due to member concerns that the company’s business practices were deceptive and misleading. APA Members listed on CareDash without their consent are encouraged to consider taking action by: filing individual complaints with 1) the Federal Trade Commission; 2) their State's consumer protection office (state contact information can be found in the dropdown menu); and/or 3) the Better Business Bureau by selecting "File a Complaint."

Executive Branch Activities

President Biden Signs Inflation Reduction Act into Law

On August 16, President Biden signed H.R. 5376, the Inflation Reduction Act, into law. The bill includes significant tax incentives for clean energy technologies along with modifications to the tax code meant to reduce the federal budget deficit. The bill will also allow Medicare to negotiate prescription drug prices and extend the expanded Affordable Care Act insurance premium assistance program for three years, through 2025. A breakdown of the Inflation Reduction Act can be found here, and the White House press release with the President’s remarks on the bill can be found here.

APA Provides Feedback on Medicare Advantage

APA responded to a federal request for information on the Medicare Advantage (MA) program, in which CMS sought input on approaches to advancing health equity and ensuring that MA enrollees have access to high-quality care. APA’s comments provided input on capturing data related to social determinants of health (SDOH), guidance on MA marketing activities, use of telehealth to improve patient outcomes, and enhancing network access to behavioral health services. In addition, APA urged CMS to incentivize use of the collaborative care model and adoption of measurement-based care as part of the MA program.

APA President Rebecca Brendel Discusses Mental Health with Secretary of Labor

APA President Rebecca Brendel met for a roundtable with Secretary of Labor Marty Walsh and Acting Assistant Secretary Ali Khawar to discuss what areas need focused parity enforcement and how to address workforce shortages and employee/workplace mental health. Dr. Brendel highlighted APA members' concerns regarding concurrent reviews in facilities, retroactive reviews and clawbacks in the outpatient setting, and reimbursement rates. Dr. Brendel also discussed the collaborative care model and the evidence supporting the model’s ability to be a workforce multiplier, improve outcomes and contribute to physicians’ satisfaction. Dr. Brendel also highlighted work being done by the APA Foundation’s Center for Workplace Mental Health, including Notice, Talk, Act, and pointed out that access to mental health is not only a health issue, but a significant economic issue. Both Secretaries emphasized that parity enforcement remains a high priority for the Department, as does the mental health and well being of the nation’s labor force.

APA Supports Efforts to Expand Access to Care to Rural Communities

On August 31, APA responded to the Centers for Medicare and Medicaid Services Proposed Rule on Conditions of Participation (COP) for Rural Emergency Hospitals and Critical Access Hospital COP Updates. APA supports the expansion of healthcare access in rural communities, while encouraging CMS to further support access to mental health and substance use treatment through these facilities. The APA report “The Psychiatric Bed Crisis in the U.S.” was highlighted to urge CMS to reconsider an exemption for patients needing inpatient psychiatric care until a bed in a facility that most mees the needs of a patient is available. APA also used this opportunity to encourage the coverage and reimbursement of mental health and substance use outpatient treatment services out of the REH to increase the availability of quality services in rural health communities.

APA Supports Increased Funding and Access to Evidence-Based Treatment for Mental Health and Substance Use Disorders

APA submitted comments on the CMS proposed rule on the 2023 Physician Fee Schedule and Quality Payment Programs. Our comments focused on ensuring access to mental health and substance use disorder (SUD) treatment through continuing support for coverage and reimbursement of services via telehealth (including audio-only); reducing the barriers to care; support for new services (general behavioral health integration, Intensive Outpatient Programs); increased payments for facility-based E/M services; increasing access and quality of care through incentivizing the Collaborative Care Model and measurement-based care; and ensuring quality and health equity. The proposed rule forecasts a roughly 4.4% reduction in the 2023 conversion factor used by Medicare to calculate payments. APA will work with other physician stakeholders over the coming months to advocate for Congressional action to stop the proposed cuts.

Congressional Activities

APA Joins Letter of Support for Telehealth Expansion Bill

On September 2, APA joined a letter in support of H.R. 4040, the Advancing Telehealth Beyond COVID-19 Act of 2021. The legislation, which passed 416-12, would ensure the extension remains in place at least through 2024. Currently, Medicare telehealth coverage, which was temporarily expanded during the COVID-19 pandemic, is slated to expire 151 days after the end of the public health emergency (PHE). The current PHE is scheduled to end on October 15, but is expected to be extended by the Biden administration for another 90 days. because the administration did not provide the 60-day notification to states and localities it has promised before allowing the emergency to end. Of particular interest to psychiatry, H.R. 4040 would specifically expand Medicare coverage to include audio-only telehealth in certain circumstances, including for behavioral health services, and delay the implementation of the 6-month in person requirement for coverage of behavioral health services. APA will continue to monitor the progress of this legislation and support the removal of the 6-month in person requirement.

APA Supports Bill to Issue Civil Monetary Penalties for Mental Health Parity Violations

On September 8, Senators Chris Murphy (D-CT), Tina Smith (D-MN), and Ben Ray Luján (D-NM) introduced S.4804, the Parity Enforcement Act of 2022, which would allow the Secretary of the Department of Labor to issue civil monetary penalties against insurers and health plans who are not in compliance with mental health parity laws. This bill further responds to issues highlighted in the 2022 Mental Health and Addiction Equity Act Report, which found that many health plans and insurance companies are not in compliance with federal mental health parity laws laid out in the Consolidated Appropriations Act of 2020. APA CEO and Medical Director Saul Levin, M.D., M.P.A, provided a quote in support of the bill. APA will continue to support the proper enforcement of mental health parity laws.

State Activities

APA Joins Letter Urging Governor Newsom to Sign 988 Legislation

On September 1, APA joined twenty other organizations in a letter urging Governor Newsom to sign AB 988 into law. AB 988 would coordinate implementation of the 988 system throughout California and provide sustainable funding mechanisms similar to 911. Under the legislation, insurers would be required to cover behavioral health crises to the same extent they cover physical medical emergencies. Governor Newsom has until September 30 to sign the legislation into law. For up-to-date information on state 988 legislation, please visit the Reimagine Crisis website. APA participates in this coalition to transform crisis response in our nation.

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