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Advocacy Update: July 2021

July 23, 2021

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

APA-Led Activities

APA’s Signature Parity Legislation Introduced

Late last year, APA-backed legislation was enacted that gave the federal government new authority to enforce the Mental Health Parity and Addiction Equity Act law. Under this new landmark law, insurers must provide the same access to mental health and substance use disorder (MH/SUD) treatment as other medical care for patients they cover. For anyone who has struggled to find psychiatric care, or has found it too expensive, this new law, strengthening mental health parity, is a game changer.

Now, APA in partnership with its champions Senators Chris Murphy (D-CT) and William Cassidy, MD (R-LA) and Representatives Tony Cardenas (D-CA) and Brian Fitzpatrick (R-PA) are ensuring that the agency put in charge of enforcing this law, the Department of Labor, has the resources necessary to do the job right. The Parity Implementation Assistance Act, which was introduced on June 8, would provide $25 million in grants to states to support their oversight efforts. Learn more here.

Call for applications for APA’s 2022 Psychiatric Services Achievement Awards

Since 1949, the Psychiatric Services Achievement Awards have recognized creative models of service delivery and innovative programs for persons with mental illness or disabilities. We are looking for programs that have made a significant contribution to the mental health field and provide an innovative model for others to follow. Each award recipient will be presented with a monetary award, a plaque, recognition at the 2022 Annual Meeting, and coverage in two APA publications. 

Each year, up to three awards are presented: Gold, Silver and Bronze.

Apply here by Friday, July 30, 2021. The nomination requirements, the full application, and additional information can be found on the APA’s Awards website.

APA Joins Efforts to Expand Behavioral Health Integration

APA and other members of the AMA’s Behavioral Health Collaborative participated in a joint call with the American Health Insurance Plans (AHIP) and member representatives from their Behavioral Health Workgroup to identify common interests with regard to behavioral health integration, including the Collaborative Care Model. Plan representatives acknowledged the need to provide primary care practices with additional support to encourage them to integrate behavioral health care. AHIP members also noted interest in advancing measurement based care and telehealth.

Executive Branch Activities

Registration Requirements for Narcotic Treatment Programs With Mobile Components Final Rule

The DEA published their final rule on Registration Requirements for Narcotic Treatment Programs With Mobile Components in late June. In April 2020, the APA had submitted comments on the proposed rule, advocating for a special registration for telehealth in order to reduce barriers to essential psychiatric services. In the final rule, the DEA acknowledged that while the comments regarding telemedicine special registration were beyond the scope of the rule, the DEA intends to promulgate regulations for the telemedicine special registration in the near future. In this final rule, DEA will not expand the definition of mobile NTPs to include mobile internet health based applications.

CMS Inpatient Prospective Payment System (IPPS) Proposed Rule

APA submitted comments on the Centers for Medicare & Medicaid Services (CMS) FY 2022 Hospital Inpatient Prospective Payment System (IPPS) proposed rule. The comments focus on reporting requirements under the Promoting Interoperability program for Eligible Hospitals and Critical Access Hospitals and provide input on Graduate Medical Education (GME) funding and distribution of additional GME slots in areas with workforce shortages.

Congressional Activities

Legislation to Protect Access to Telemental Health Services Introduced

APA-supported legislation to remove barriers to high-quality, virtual mental and behavioral health care for Medicare beneficiaries was introduced in June by Senators William Cassidy (R-LA), Tina Smith (D-MO), Ben Cardin (D-MD) and John Thune (R-SD) as well as Representatives Doris Matsui (D-CA) and Bill Johnson (R-OH). Late last year, Congress passed legislation that removed many restrictions on mental health services delivered through virtual means but kept an unnecessary requirement that patients seeking mental health services be seen in-person every six months. The Telemental Health Care Access Act would remove this barrier so that patients accessing mental health are treated like others seeking substance use disorder services by Medicare.

APA Expresses Support for the Women’s Health Protection Act

Twenty physician and patient groups, including APA, joined together to applaud Senator Richard Blumenthal (CT-D) and Representative Judy Chu (CA-D) for introducing the Women’s Health Protection Act (S. 1975/H.R. 3755). This legislation seeks to protect the patient-physician relationship by prohibiting legislative interference into clinical decision making and preserving the ability of physicians to provide evidence-based care to their patients. The bills await consideration of the Senate Judiciary Committee and the House Committee on Energy and Commerce.

APA Member, Dr. Michelle Durham, Testifies Before Senate Finance Committee

On June 15th, APA member Dr. Michelle Durham testified before the Senate Finance Committee’s bipartisan hearing entitled “Mental Health Care in America: Addressing Root Causes and Identifying Policy Solutions.” During the hearing strong, bipartisan support was demonstrated for expanding mental health services through telehealth and for integrating mental and physical health services. Dr. Michelle Durham suggested that the committee address the mental health workforce shortage by increasing Graduate Medical Education (GME) funding for psychiatry residency slots, increasing funding for loan forgiveness programs for health care providers who serve in underserved areas, and support of efforts for increased diversity among mental health professionals. Additionally, Committee Chair Ron Wyden (D-OR) expressed his concerns regarding the mental health workforce shortage, insurance coverage limitations for mental health and substance use disorder services, and racial inequities in the mental health care space. Ranking Member John Thune (R-SD) promoted APA-supported legislation to remove the new Medicare requirement that patients be seen in person within six months of starting mental health treatment.

Effort to Increase Visas for IMGs Endorsed by APA

A bipartisan group of members of Congress recently re-introduced the Healthcare Workforce Resilience Act, which seeks to address the healthcare workforce shortage by recapturing 15,000 unused immigrant visas for International medical graduates (IMGs). IMGs play a critical role in providing care, particularly in rural areas, and make up approximately 30% of active psychiatrists. APA applauds the bipartisan group including: Senators Dick Durbin (D-IL), John Cornyn (R-TX), Patrick Leahey (D-VT), Todd Young (R-IN), Chris Coons (D-DE) and Susan Collins (R-ME) as well as Representatives Brad Schneider (D-IL), Tom Cole (R-OK), Tom O’Halleran (D-AZ) and Don Bacon (R-NE).

State Activities

Medical Necessity Criteria

This month, Oregon became the third state to successfully pass medical necessity criteria legislation, marking a significant win for psychiatrists and their patients. This bill gives teeth to the Wit v. United Behavioral Healthcourt decision, which found that UBH had illegally denied coverage for psychiatric care. This bill requires that managed care organizations use non-profit clinical specialty association criteria and guidelines when determining the type of care covered for patients. Similar bills were passed in Illinois earlier this year and in California in 2020.

State Action on Mental Health Parity

APA’s state model parity legislation has been signed into law in fourteen states (AZ, CO, CT, DE, IL, IN, KY, MD, MT, NV, NJ, OK, TN, WV) and DC. Montana and Nevada’s bills were signed into law this Spring and Oregon’s law is awaiting gubernatorial signature. Several other states have enacted partial versions of this law. APA continues to partner with states to help them achieve full parity compliance.

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