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Advocacy Update: April 2019

April 2, 2019

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

APA Members Visit Capitol Hill

One hundred psychiatrists from across the country converged on Washington, DC, this month to lobby Congress during APA’s 2019 Federal Advocacy Conference. Attendees received hands-on advocacy training before they engaged in face-to-face meetings with their elected lawmakers. Through their efforts, APA was able to educate 135 congressional offices on issues vital to the practice of psychiatry including achieving true mental health parity, ways to address the physician workforce shortage and increasing federal investments in public mental health programs. Other highlights of the conference included the presentation of the Jacob K. Javits award to Rep. Doris Matsui (D-CA) for her work on the Excellence in Mental Health Act and the 21st Century Cures Act as well as the APAPAC Reception, which was attended by several members of Congress.

APA President Testifies Against Family Separations at the Border

As a part of APA’s continuous efforts to address the administration’s policy of separating immigrant children from their families, APA President Dr. Altha Stewart testified before the U.S. House of Representatives Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies. As the only physician witness, Dr. Stewart highlighted how traumatic these experiences can be for children and how exposure to “toxic stress” often leads to an increased risk of mental illness later in life. She also reiterated APA’s opposition to family separation at the border and the need for staff at detention centers to be trained in trauma-informed care.

Read more in Psych News.

APA Surveys Members on Evaluation and Management Services

A random sample of APA members recently received a request to complete an AMA/Specialty Society RVS Update Committee (RUC) survey on select evaluation and management services. Responses to this survey will help the APA, in concert with the RUC, recommend accurate relative values for physician work and direct practice expense to the Centers for Medicare and Medicaid Services.

APA Launches New Telepsychiatry Vlog

The APA’s Committee on Telepsychiatry has recently expanded upon its regular blog series by launching a new Telepsychiatry Video Blog (“Vlog”). In addition to Blog content, the Vlog will regularly feature members of the Committee discussing research, practice, and policy issues in telepsychiatry. To receive email notices about updates to the Vlog, members can sign-up for the Telepsychiatry Newsletter.

APA Provides HHS with Recommendations to Improve HIPAA

APA responded to the Department of Health and Human Services’ Request for Information on how the Health Insurance Portability and Accountability Act (HIPAA) Rules could be modified to promote coordinated value based care. APA recommended HHS:

  1. share scenarios in which information sharing is allowed,
  2. “hold harmless” providers who release information to other providers for treatment-related purposes,
  3. require providers who decline to share information to send a notice to the requesting provider of the denial,
  4. encourage information sharing with family members and caregivers as appropriate, and
  5. align requirements for substance use disorder patient records with HIPAA to the extent possible.

APA Responds to Proposed Changes to Medicare Part C and D

APA sent its formal comments to the CMS, regarding the 2020 Call Letter to Medicare Advantage (Part C) and Medicare Prescription Drug Plan (Part D). The call letter is CMS’s request for comments from the Parts C and D sponsor plans and from the medical provider community. APA’s comments thanked CMS for expanding the set of mental health and substance use disorder treatment quality measures and recommended that CMS include more of the (NQF) National Quality Forum-endorsed measures that could be used to assess the quality of care provided by health plans.

APA Provides HELP Committee Recommendations to Lower Health Care Costs

Earlier this year, Senate HELP Committee Chair Lamar Alexander (R-TN) asked stakeholders for their proposals to lower health care costs. On February 28th, APA responded by highlighting the need for improved access to MH/SUD services, greater parity enforcement, reduced barriers to telepsychiatry, and greater adoption of the collaborative care model, among other proposals.

Court Rules United Behavioral Health Wrongfully Denied SUD Benefits

In an opinion issued on Tuesday, March 5, 2019, District Court Judge Joseph C. Spero of the Northern District of California, found that United Behavioral Health (UBH), violated its fiduciary duty and wrongfully denied benefits to patient seeking substance use disorder care. The court also found that:

  • “many mental health and substance use disorders are long-term and chronic” and “it is generally accepted in the behavioral health community that effective treatment of individuals with mental health or substance use disorders is not limited to the alleviation of the current symptoms.”
  • UBH misled regulators about its guidelines being consistent with the American Society of Addiction Medicine (ASAM) criteria, which insurers must otherwise use in certain states such as Connecticut, Illinois, and Rhode Island.
  • UBH failed to apply Texas-mandated substance use criteria for at least a portion of the class period.

The court was particularly troubled by UBH’s lack of coverage criteria specific to children and adolescents. Although this case did not involve allegations of MHPAEA violations and was not decided on the basis of the parity law, the findings provide significant evidence that UBH created and used internal policies and guidelines to deliberately avoid complying with MHPAEA’s prohibition against discrimination. Nonetheless, the case is significant and serves as a bright red flag that federal and state regulators need to enhance their oversight of MHPAEA compliance.

State Update: Scope of Practice

State legislative sessions are in full swing, with 43 states and DC currently in regular session. So far this year, legislators in ten states have introduced psychologist prescribing legislation. Additionally, nurse practitioners are seeking to expand their scope of practice in at least 17 states, and there are at least 10 states that have legislation expanding scope of practice for physician assistants, with one of those states considering independent practice for physician assistants. We expect more scope of practice legislation to be introduced this year; APA has submitted letters in opposition to psychologist prescribing bills and sent grassroots alerts in several states at the DB/SA’s request. APA continues to work with District Branches (DBs) and State Associations (SAs) who are facing various types of scope expansion bills.

State Update: Parity Enforcement

APA’s model parity enforcement legislation has been introduced in eight states, with introduction of this legislation expected in several other states. APA has provided letters of support in these states and assisted with testimony.

State Update: Clinical Practice

APA model legislation requiring private insurance coverage of the Psychiatric Collaborative Care Model codes has been introduced in Illinois, and several other states are also considering this legislation. Positive legislation regarding telemedicine and medication assisted treatment (MAT) has been introduced in several states. APA submitted a letter in favor of ending prior authorization requirements for MAT in Kentucky, and APA wrote letters in opposition to legislation in North Dakota that would require prior authorization for ADD and ADHD medications.

State Update: Additional Issues

APA is also working with states who wish to delink Maintenance of Certification from licensure, credentialing, and reimbursement, and wrote a letter in support of legislation and sent a grassroots alert in Rhode Island. Bans on conversion therapy have been introduced in several states, and APA sent a letter of support for such legislation in Colorado. For more information about how to get involved in advocacy in your state, please contact [email protected].

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