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Advocacy Update: June 2021

June 25, 2021

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

APA-Led Activities

APA Hosts its 2021 Federal Advocacy Conference

APA hosted its 2021 Federal Advocacy Conference virtually the first week of June. A record number of attendees spent the day on June 5th with APA’s leadership and staff learning about issues APA is spearheading on a federal level, including health equity in mental health, implementation of the Collaborative Care Model and funding to enforce the mental health parity law. Then, on June 10th, attendees brought psychiatry’s message to 150 congressional offices to advocate on these and other important issues. Want to learn more about how you can get involved in advocacy? Learn more about APA’s advocacy programs here.

American Psychiatric Association Honors Rep. Bonnie Watson Coleman With Jacob K. Javits Award for Public Service

During the 2021 Federal Advocacy Conference, APA President Vivian Pender, MD, recognized Representative Bonnie Watson Coleman (D-NJ) for her tireless pursuit of equity in mental health and leadership to prevent youth suicide, including her recent activities leading a Congressional Black Caucus task force to prevent suicides among Black youth and her leadership in developing and advancing the Pursuing Equity in Mental Health Act.

Each year, APA confers the Jacob K. Javits Award to a federal and or state public servant who has made outstanding contributions to the profession of psychiatry and mental health advocacy. APA established the award in 1986 in honor of Senator Javits, who represented New York State in the U.S. Senate from 1957 to 1981.

Ask an App Advisor

APA continues to hold monthly “Ask an App Advisor” events, the second Tuesday of each month at 3:00pm ET. These events feature a “mini-webinar” presented by members of APA’s App Advisor Expert Panel, focusing on relevant clinical and policy issues around using apps in mental health.

Recently, presenters offered an overview of the HIPAA Privacy and Security Rules and how they relate to the use of apps in care. They discussed the use of Business Associate Agreements between clinicians and app developers, as well as how the ONC's Interoperability and Information Blocking Final Rule addresses the use of apps between patients and their doctors.

Executive Branch Activities

Administration Continues Important Work on Behavioral Healthcare

HHS has announced plans to establish a Behavioral Health Coordinating Council focused on collaboration and strategic planning across the department. It will be co-chaired by Assistant Secretary for Health Rachel Levine, M.D., and Acting Assistant Secretary for Mental Health and Substance Use Tom Coderre.

HHS also announced that SAMHSA is distributing $3 billion in funding made available through the American Rescue Plan Act of 2021, which Congress passed earlier this year, in block grants to states, territories, and tribes. These funds will be used to improve community mental health services for people with severe mental illness, and to prevent, treat and help more people recover from substance use disorder.

Inpatient Psychiatric Facilities Prospective Payment System and Quality Reporting Program

APA recently submitted comments regarding the Inpatient Psychiatric Facilities Prospective Payment System and Quality Reporting Program. Our comments focused on reducing regulatory burdens, providing adequate funding for the full continuum of care; inclusive of inpatient, community, and residential options, to prioritize the development of more meaningful measures related to tobacco and substance use, support and incentivize improved attention to transitions of care through measures that meet the established standards for reliability, validity, and evidentiary support.

APA also supported CMS’ proposal to stratify quality measure results by dual eligibility which has been shown to be a powerful predictor of poor health outcomes. Stratification of results using dual eligibility as an indicator of social risk will allow for more appropriate comparisons of performance across facilities and will also help those facilities assess their efforts to address and close health disparities.

APA Shares Concerns on Proposed Cost Measure with CMS

APA members and administration met with Michelle Schreiber, MD, CMS Deputy Director for Quality and Value and her team to discuss concerns around a proposed episode-based cost measure applied to psychiatrists providing inpatient care to patients with psychosis and other related conditions. The episode-based cost measure, if implemented, is an attempt to reduce visits to the emergency room and inpatient readmissions by holding the inpatient psychiatrist responsible for the costs of care post discharge. APA has repeatedly raised concerns about the attribution method and the lack of control the inpatient psychiatrist has over the treatment once the patient is discharged.

Congressional Activities

Biden’s FY 2022 Budget Request

The Biden Administration released the President’s FY 2022 budget request on Friday, May 28th, which proposes significant funding increases for health programs, including programs focused on mental health and substance use disorders. The FY 2022 health budget proposes $131.8 billion in discretionary budget authority and $1.5 trillion in mandatory funding. This budget also prioritizes investments in areas such as maternal health, data and research, tribal health, and early childcare and learning. The budget supports a strong public health workforce, and addresses gaps in the existing public health infrastructure, including at the state and local levels.

The budget proposes to double the Community Mental Health Services Block Grant administered by the Substance Abuse and Mental Health Services Administration. The administration’s budget justification indicates that the $1.6 billion proposal is intended to respond to the systemic strain on our country's mental health care system. The discretionary request also proposes additional investments in programs focused on people involved in the criminal justice system, including those with mental illnesses and SUDs.

APA Provides Testimony to House Ways and Means Committee

In late April, APA continued to work with the U.S. House Ways and Means Committee to chart a path forward with telehealth. In written testimony submitted to the subcommittee working on telehealth legislation, APA argued that while telehealth should not replace in-person services, it does offer a path to improve access to appropriate mental health care for many patients. APA also advocated for the removal of certain telehealth restrictions and encouraged the committee to continue to allow audio-only services so that certain patients can continue to access services over the phone. APA also encouraged Congress to continue all telehealth flexibilities for at least one year beyond the public health emergency and study the impact that telehealth has had on access to care and quality of care during the pandemic.

APA Member, Charles Dike, MD, Testifies Before the U.S. House of Representatives

In May, Charles Dike, MD, an APA member from Connecticut, participated in a hearing about crisis care services hosted by the U.S. House Labor, Health and Human Services, Education and Related Agencies Appropriations Subcommittee. Dr. Dike explained the key elements of successful crisis service systems and what states and communities need to enhance their crisis response infrastructures.

The Subcommittee, which determines funding levels for federal health programs, is showing strong bipartisan interest in the role crisis services can play to strengthen partnerships between law enforcement and mental crisis responders and minimize tragedies and instances of excessive force. The panel also discussed how health inequities, including access barriers for minority communities and persistent stigma surrounding mental wellness in these communities, contribute to negative interactions between patients and law enforcement. Witness information for all panelists and a video of the hearing are available here.

APA-Endorsed Legislation to Address Mental Health Equity and Suicide Prevention Passes the House

In May, the U.S. House of Representatives passed a package of bills that aims to:

  • help prevent suicide,
  • expand diagnosis and treatment for substance use disorders,
  • increase mental health screenings in the emergency room and overall, and
  • support patients with mental health conditions and substance use disorders.

The Pursuing Equity in Mental Health Act (H.R.1475), introduced by Reps. Bonnie Watson Coleman (D-NJ) and John Katko (R-NY), and strongly supported by APA, was included in the package. This bill is the first comprehensive federal legislation aimed at addressing increasing suicide rates and mental health disorders among Black youth. Read APA’s press release on the legislation’s passage here.

APA-Endorsed Legislation Introduced in the Senate

Senators Bob Menendez (D-NJ), Cory Booker (D-NJ), and Catherine Cortez Masto (D-NV) introduced the Pursuing Equity in Mental Health Act. This legislation, which as discussed above, passed the House in May. It seeks to address suicide and mental health issues facing young people, particularly in socially and economically disadvantaged communities that have historically faced disparities in access to mental health treatment, as well as disproportionate adverse outcomes during the COVID-19 pandemic. Learn more about the legislation here.

Covid-19 Hate Crimes Act Signed into Law

APA applauded President Joe Biden for signing the Covid-19 Hate Crimes Act into law on May 20th. The law creates a position at the Justice Department to help speed up the review process of reported pandemic-related hate crimes. It also is designed to make it easier to report hate crimes at the state and local level, by helping to provide guidance to local law enforcement to allow for online reporting of hate crimes in multiple languages.

State Activities

State Legislative Sessions Close With Progress Made on Telehealth

State legislative bodies are going into recess for the year and APA is pleased to see that several states signed elements of its model telehealth legislation into law. In 2021, at least 20 states enacted positive telehealth legislation into law including: Arkansas, Colorado, Georgia, Idaho, Indiana, Kentucky, Maryland, Mississippi, Montana, Nebraska, Oklahoma, Oregon, South Dakota, Tennessee, Utah, Virginia, West Virginia, Washington, West Virginia, and Wyoming. A few other states, such as Illinois and Texas, have telehealth legislation awaiting gubernatorial signature.

Illinois Enacts Legislation To Improve Insurance Coverage Quality

Illinois will become the second state to enact legislation that responds to the Wit v. United Behavioral Health decision. That decision held that managed care organizations should use non-profit clinical specialty association criteria and guidelines when determining the type of care covered for a patient. In May, Illinois’s legislation, HB 2595, was sent to Governor Pritzker for his signature. Additionally, APA and California District Branches recently filed an amicus brief in support of upholding the Wit decision.

Funding State Plans for National Crisis and Suicide Prevention Hotline Start to Go Online

Last year Congress established 988 as a new nationwide telephone number for crisis and suicide prevention and gave states two years to implement the line. This year, several states, including Indiana, Nebraska, Utah, Virginia, and Washington, signed 988 implementation legislations into law. Additionally, Colorado and Nevada have legislation that is awaiting gubernatorial signature to be enacted.

The implementation of 988 and crisis response teams could be instrumental in transforming mental health care at the state level. For instance, legislation like Washington’s requires the state to create an up-to-date statewide bed registry and integration of crisis response teams with available mental health services. APA staff will be working with District Branches as they continue to implement this important service in their states.

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