2020 saw psychiatrists, the House of Medicine and other health care providers on the frontline in the fight against the novel coronavirus pandemic. To support your efforts, APA work closely with the Administration, Congress and state leaders to ensure that you have the resources you need to provide vital care to your patients and their families.
Many of APA’s regulatory activities and work with the Administration revolved around COVID-19 responses and changes. Early efforts included calling on the Administration concerning the shortage of PPE for health professionals in residential mental health and substance use disorder treatment facilities and urging action to ensure safer working conditions for frontline physicians and healthcare professionals. Further advocacy efforts focused on supporting clinician health in the COVID-19 and post-pandemic era, underscoring that physicians and other clinicians must be able to safely secure treatment for mental or other health issues. Aside from frontline physicians, numerous reports showed the disproportionate impact of the pandemic on minority populations. APA sent a letter to HHS requesting the collection and publication of comprehensive data on COVID-19’s impact on vulnerable populations. Last month APA, along with several District Branches and ACROSS members, expressed concern regarding proposed rules affecting IMGs. Specifically, these proposed rules would eliminate the duration of status as an authorized period of stay for J-1 visa holders and increase the minimum required salaries that hospitals and practice must pay physicians with H-1B visas. These rules adversely affect the medical and psychiatric work forces, creating barriers to patients’ access to care.
Other access to care issues and disparities came to the forefront as a result of the COVID-19 public health emergency (PHE). Early in the year, APA advocated to eased telehealth restrictions and reimbursement for telephone appointments. Once CMS took action on regulatory relief during the PHE, APA advocated for the Administration to maintain newly implemented telehealth flexibilities. Such flexibilities include: removing limitations around originating site and geographical restrictions, maintaining coverage and increased payment for the telephone evaluation and management services, allowing for the use of audio only communications, and removing frequency limitations for telehealth services. In October, the Office of the National Coordinator (ONC) released its long-awaited Final Rule around Interoperability and Information Blocking, which impacts the methods in which patient information is shared between patients, providers, software developers, and Health Information Exchanges/Networks. APA developed several member resources to help understand how this rule will impact their practices.
Over the year, APA’s policy division created several other member resources, including releasing a billing guide and patient pamphlet to provide guidance to psychiatrists and their patients on the use of newly reimbursable non-face-to-face consultation codes (“curbside consults”). APA, in conjunction with AAAP and ASAM, also hosted a webinar focused on recent federal regulatory and legislative changes to 42 CFR Part 2 regarding confidentiality of substance use disorder patient records, to allow for better alignment with HIPAA.
All too often in our nation’s history, mental health and addiction care has been ignored during times of crisis. To keep history from repeating itself, APA worked to ensure that the mental health care needs of communities across America were being met and that no patients were left behind. As a result, APA was able to advance policies that expanded access to mental health care, provided psychiatrists with the tools they needed to practice safely, protected patient safety and addressed health care disparities.
Access to Care
In 2019, APA was pleased to work with Representatives Katie Porter (D-CA) and Gus Bilirakis (R-FL) as well as Senators Chris Murphy (D-CT) and William Cassidy (R-LA) to introduce the Mental Health Parity Compliance Act (HR 3165/S 1737). This bipartisan legislation seeks to address the unnecessary and discriminatory barriers patients face when trying to access mental health care or substance use disorder treatment by enhancing insurers’ transparency and accountability regarding the coverage of mental health and substance use disorder services.
Throughout 2020, APA and its congressional allies continued to identify opportunities to advance this legislation. For example, APA President, Dr. Jeffrey Geller, testified about the legislation’s importance before the House of Representatives Energy and Commerce Committee in June. As a result, the amended legislation has passed out of committee in the House and awaits consideration on the floor. In addition, APA worked with the Senate Health, Education, Labor and Pensions (HELP) Committee to ensure that the bill language was added to the Senate’s surprise billing package. Given the bipartisan, bicameral support for the legislation, APA is working hard to ensure the bill’s inclusion in end-of-year legislation.
Additionally, on October 17, 2020, President Trump signed the National Suicide Hotline Designation Act into law. This legislation, which APA supported, establishes 9-8-8 as a national phone number that individuals can call when they are experiencing a suicidal emergency. It also instructs the Department of Health and Human Services and the Department of Veterans Affairs to work together to implement the phone number and to ensure that the number provides culturally competent services to high-risk populations like LGBTQ youth, communities of color and rural individuals.
Congress initially responded to the pandemic by passing the Coronavirus Preparedness and Response Supplemental Appropriations Act, H.R. 6074, which was signed into law on March 6. Among its many provisions, this law allowed the U.S. Department of Health and Human Services (HHS) to temporarily lift restrictions on telehealth services provided to Medicare patients. Throughout the year, APA has remained focused on securing psychiatrists’ continued ability to delivery services via telehealth by working to lift further restrictions on its usage beyond the pandemic public health emergency. In addition to sweeping changes made by HHS, the House considered APA-supported legislation, the Telemental Health Expansion Act, H.R. 5201, which would permanently remove geographic and site of service restrictions for mental health or substance use disorder services as well as allow care provided over the phone. This legislation passed out of the House of Representatives Energy and Commerce Committee in July 2020 and currently awaits consideration on the House floor.
The Coronavirus Aid, Relief, and Economic Security (CARES) Act, which was signed into law on March 27, included language to that modernized patient privacy regulations (42 CFR Part 2) so that an individual’s history of substance use disorder can be included in their medical records. APA had been advocating for this legislation’s passage for several years and applauded its passage.
Additionally, in the latter half of 2020, APA lead the opposition to two efforts to expand psychologists’ scope of practice in federal health programs:
- In July, the Energy and Commerce Health Subcommittee considered legislation to address the mental health care crisis, including a bill that is ardently opposed by APA, H.R. 884. This legislation would have changed Medicare’s definition of physician to include psychologists. APA worked closely with Representatives Michael Burgess, MD (R-TX), Larry Bucshon (R-IN) and Raul Ruiz, MD (D-CA) to educate their colleagues on the committee on the inherent dangers of this legislation. In addition, APA’s President, Jeffrey Geller, MD, voiced his concerns when testifying before the subcommittee. Ultimately, the subcommittee did not include HR 884 in their final legislative package; however, APA fully anticipates that this bill will be re-introduced in the new Congress come January.
- Similarly, in September, the U.S. House of Representatives Veteran’s Affairs Committee was considering S. 785, the Commander John Scott Hannon Veterans Mental Health Care Improvement Act, which seeks to prevent Veteran suicide. During their deliberations, Committee members considered adding an experimental pilot program that APA opposed which would have allowed clinical psychologists to prescribe and manage medications in the Veteran Administration health system. While APA worked with our champions on the Committee, over 1,100 psychiatrists sent 3,600 letters in opposition to this pilot program and reached nearly every member of Congress. Ultimately, the Committee heard APA’s concerns and removed the pilot program from the legislative package. President Trump signed the Commander John Scott Hannon Veterans Mental Health Care Improvement Act, S. 785 into law on October 17.
Health Care Disparities
APA’s DGR has engaged with Congress in providing assistance to House and Senate offices as they work on legislation to address social determinants of health, health disparities, structural racism, and community trauma. APA’s latest COVID-19 legislative priority letter included requests for inclusion of legislation that collects data, increases funding for policies addressing health disparities and increases funding for the Minority Fellowship Program. DGR also worked with APA’s member Committees and Councils to submit comments to a House Ways and Means Committee Request For Information (RFI) in October on the misuse and misapplication of race and ethnicity in clinical algorithms and research, and how it impacts the delivery of health including care for patients with mental illness and substance use disorders.
The APA is also lobbying in support of H.R. 5469 / S. 4388, the Pursing Equity in Mental Health Act, introduced by Rep. Watson-Coleman (D-NJ) in the House and Senator Menendez (D-NJ) in the Senate. The legislation increases funding for the National Institute on Minority Health and Health Disparities (NIMHD) to study mental health disparities in racial and ethnic minority groups. In addition, the bill also reauthorizes the Minority Fellowship Program that trains a diverse mental health workforce to serve in underserved areas – the bill also doubles funding for the program. At the end of September, H.R. 5469 passed the House and was referred to the Senate where it awaits consideration.
In addition, APA is supporting H.R. 7078, introduced by Rep. Robin Kelly (D-IL) which direct HHS to oversee a telehealth study during COVID-19 and H.R. 7077, which would establish and expand programs to improve health equity as they pertain to COVID-19. APA continues to provide House and Senate staff with technical assistance as they draft health disparity legislation.
Mental Health Funding
In July, the House of Representatives passed HR 7617, a seven-bill spending package that included the Labor, Health and Human Services Education (Labor HHS) FY2021 appropriations bill that contained important programs related to APA priorities. The Labor HHS bill included $96.4 billion for the Department of Health and Human Services and increased funding for several APA supported priorities including $6 billion for the Substance Abuse and Mental Health Services Administration (SAMHSA) and more than $2 billion to the National Institute of Mental Health. The Centers for Disease Control and Prevention and National Institute of Health also received increased funding including for firearm injury and mortality prevention research as well as for the Minority Fellowship Program and loan repayment program for the Substance Use Disorder Treatment Workforce Program. The bill also included new funding for an APA led initiative to improve mental health crisis systems and suicide prevention ($35 million) and new funding for the national suicide prevention lifeline ($25 million).
Unfortunately, the APA does not anticipate the Senate to take up the House Labor HHS bill by the end of the year given large discrepancies between the House and Senate on government funding levels. Instead, Congress will most likely pass multiple short-term continuing resolutions (CR) or an omnibus spending bill at the end of the year that will keep Federal programs funded at current levels for several months until after the new year.
2020 Advocacy Highlights
Advocacy is a team effort, and APA could not have achieved it’s legislative victories on behalf of psychiatry and your patients without the efforts of our advocates and APAPAC members.
In the 2020 election cycle, APAPAC contributed $459,000 towards 163 congressional races to help elect and reelect champions for mental health, which represented a 50% increase from our support in the 2018 election cycle. 61% of APAPAC contributions went to democratic candidates and committees while 39% went to republican candidates or committees. Indeed, 91% of APAPAC-supported candidates won their election or re-election, which means that mental health champions like Representatives Katie Porter (D-CA) and Gus Bilirakis (R-FL) or Senators Tammie Baldwin and William Cassidy, MD will be returning to Washington, DC, in January. These lawmakers played a valuable role in introducing and championing APA’s Mental Health Parity Compliance Act (H.R. 3165 / S. 1737).
In fact, we saw an overall increase in advocacy efforts from our membership as well. Over 5,584 psychiatrists answered APA's call to action during the 116th Congress which resulted in nearly 20,000 letters, tweets or phone calls to lawmakers - that's a 106% percent increase in activity from the 115h Congress! Additionally, our Congressional Advocacy Network members played a critical role in APA’s opposition to two federal efforts to expand psychologists’ scope of practice.
In January, we will be welcoming about 60 new members of Congress as well as several state lawmakers. APA will need resources to start building those new relationships. Here’s how you can help:
- You are our boots on the ground – Do you know someone who was just elected to public office? Your insights on whether this person would be a champion for mental health will inform our federal and state legislative strategies.
- Join CAN – CAN members build a relationship with their members of Congress so that when an important issue arises, APA can quickly get its message directly to lawmakers.
- Become a 2021 APAPAC member early – APA will need to make certain that psychiatry hasa seat at the table on January 3rd when the new Congress begins. Now more than ever, we need you to become a 2021 APAPAC member early this year!