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Advocacy Update: March 2020

March 24, 2020

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

APA’s Advocacy During the Novel Coronavirus Pandemic

On March 27, 2020, President Donald J. Trump signed the Coronavirus Aid, Relief, and Economic Security Act (CARES) Act (P.L. 116-136) into law. This is the third in a series of stimulus packages designed to bring support to our economy and public health systems that have been impacted by this pandemic.

APA worked with its congressional champions and coalition partners to ensure the legislation addresses the nation's mental health needs. As a result of these efforts, we have included some highlights of provisions included in the CARES Act below:

  • Increased stockpile of Personal Protective Equipment, ventilators and other essential medical supplies.
  • $425 million for Substance Abuse and Mental Health Services Administration (SAMHSA) programs, including: $250 million for Certified Community Behavioral Health Clinics, $50 million for suicide prevention programs, $100 million for mental health and substance use disorder emergency grants.
  • $4 billion for community health centers, which is $1.32 billion over current fiscal year 2020 funding levels.
  • Extension and expansion of the Community Mental Health Services demonstration program through November 30.
  • Allows Medicare reimbursement for telemedicine for new patients, not just those seen within the last three years.
  • Improvements to patient safety by modernizing patient privacy regulation 42 CFR Part 2, so that an individual's history of SUD can be shared with their other providers.
  • A special enrollment period for patients to enroll in health insurance through the federally facilitated health insurance marketplace.
  • Suspension of the 2 percent Medicare sequester cut through December 2020.

The inclusion of these provisions built upon APA's previous success in the Coronavirus Preparedness and Response Supplemental Appropriations Act that was signed into law on March 6, 2020. This law authorized the U.S. Health and Human Services to temporarily lift restrictions on Medicare access and coverage of telehealth services, such as live videoconference consultations with doctors.

You can learn more about the changes to telemedicine here. Additionally, APA has a coronavirus information hub that we are continuously updating with the most up-to-date information on COVID-19 related changes to your practices.

APA Co-Hosts Capitol Hill Event to Draw Attention to Necessary Telepsychiatry Coverage Reforms

On February 18th, APA and AACAP hosted a joint congressional briefing on Capitol Hill titled “Improving Access to Telemedicine: Barriers and Solutions in Treating Mental Health and Substance Use Disorders.” An estimated 80 individuals attended the briefing, including staff from key offices in both the House and Senate. APA President Bruce J. Schwartz, MD moderated the panel of telepsychiatry experts, which included APA members Robert Caudill, MD (KY) and Shabana Khan, MD (NY), as well as a representative from the patient advocacy group Shatterproof. The panelists called for additional support for three APA-supported pieces of legislation that address barriers to Medicare coverage of telepsychiatry:

  • The CONNECT for Health Act (H.R. 4932 / S. 2741);
  • Rep. Gus Bilirakis’ (R-FL) EASE Behavioral Health Services Act (H.R. 5473); and
  • Rep. Doris Matsui’s (D-CA) Telemental Health Expansion Act (H.R. 5201).

Safe Prescribing

In response to members’ alarm over certain pharmacies dispensing 90 days of medication, despite the prescribers’ explicitly limiting the quantity to be dispensed to 30 days at a time, APA has created a one page white sheet to educate legislators around the dangers of 90 day prescriptions for certain patients and drafted model legislation for states to use to address this patient safety problem. APA members’ alarm about this practice caught the attention of medical investigatory reporter Ellen Gabler of the New York Times, who wrote a compelling article on pharmacy retail practices and published on January 31, 2020. The article, How Chaos At Chain Pharmacies is Putting Patients At Risk, can be found here. APA has also convened a work group to update our policy around prescription drugs, including better transparency around pricing.

APA Responds to NIH’s Proposed Research Initiative to Decrease Maternal Mortality

In feedback to the NIH's proposed research initiative on maternal mortality, APA emphasized the need to address psychiatric disorders, including anxiety, depression, psychosis and substance use disorders. The letter notes that pregnancy-associated suicide accounts for more deaths than many other obstetric complications and needs more urgent attention. APA also encouraged more research to identify best practices for integrated treatment and the removal of barriers to proven treatment models, such as telehealth.

APA Advocates for VA Specialty Education Loan Repayment Programs

APA commented on the Department of Veterans Affairs’ (VA) proposed rule to create a Specialty Education Loan Repayment Program (SELRP) and advocated to have psychiatry specifically included. The APA noted its history in advocating for better recruitment of psychiatrists in the VA through the Clay Hunt Suicide Prevention for American Veterans Act, which included a pilot program to offer medical school loan repayments for psychiatrists on par with those offered by other government agencies and private practices. Although the program was never implemented, this recent proposal has the potential to incentivize more psychiatrists to pursue careers in the VA.

Confidentiality for Records of Immigrant Children

APA, alongside the National Alliance on Mental Illness (NAMI), sent a letter to the Departments of Homeland Security and Health and Human Services on recent reports about unaccompanied minors’ mental health records being illegally and unethically shared during immigration proceedings.

The letter detailed legal arguments protecting immigrant children from this record sharing, as well as the ethical concerns of mental health providers wanting to provide care to children in Office of Refugee Resettlement government facilities. APA and NAMI requested a meeting with DHS and HHS to further discuss ways to correct this harmful practice and ensure immigrant children’s access to necessary mental health services.

APA Member Testifies on Opioid Policy During Congressional Hearing:

APA member Dr. Smita Das, M.D., Ph.D., M.P.H., an addiction psychiatrist and assistant professor at Stanford University School of Medicine, testified before the House Energy and Commerce Health Subcommittee on March 13, 2020. The Committee was considering over a dozen bills to address the opioid crisis and Dr. Das spoke to the need to expand the workforce of substance use disorder treatment professionals, as well as the need to break down “silos” of care and to enforce federal parity law. APA supports several of the bills the Committee is considering including:

  • The Medicaid Reentry Act (H.R. 1329) which would allow inmates to enroll in Medicaid 30 days before their release if they meet the program’s eligibility criteria.
  • The Opioid Workforce Act (H.R. 3414) which would provide additional residency positions through 2026 to teaching hospitals that have or will have an approved residency program in addiction medicine, addiction psychiatry, or pain medicine.

Congressional Committees Address Surprise Medical Bills

With APA’s support, the AMA and other physician groups are working to address costly surprise medical bills that patients encounter when they receive out-of-network care in a hospital. APA, the AMA and other physician groups support proposals that would resolve these medical bills through an independent dispute resolution process like the one that was established in New York. Recently, two House committees released different versions of legislation intended to address surprise medical bills:

  • The Ways & Means Committee considered the Consumer Protections Against Surprise Medical Bills Act (H.R. 5826) on February 12. This legislation would prohibit charging patients more than the in-network cost-sharing amount, and includes a mediated dispute resolution process, new patient protections, and help for uninsured or those paying with cash out of pocket.
  • The Education & Labor committee considered the Ban Surprise Billing Act (H.R. 5800) on February 11. Their legislation relies on monetary benchmark mechanisms to resolve payment disputes between patients and payers and also includes a number of provisions to improve transparency in health coverage.

February Marks the Beginning of the Funding Process for Key Mental Health Programs

The federal funding process for 2021 officially kicked off on February 10th, when President Trump released the administration’s proposed budget. While this proposal is extremely unlikely to pass in its current form, it is seen as a statement of the Administration’s priorities for the upcoming year. The proposal:

  • Calls for an increase in funding for the Mental Health Block Grant and Certified Community Behavioral Health Centers program despite cutting SAMHSA’s funding by $140 million,
  • Estimates $135 billion in savings from unspecified drug pricing reforms,
  • Foresees $900 billion in cuts to Medicaid and CHIP and an additional $800 billion in cuts to Medicare over 10 years.

The week of February 24th, HHS Secretary Alex Azar justified the Administration’s budget proposal for his agency before four congressional committees. Over the course of this process, APA will advocate for adequate and sustained funding for programs that address our patients’ needs and support the psychiatric workforce.

More States Consider APA’s Model Parity Legislation

In March, Arizona, Indiana and West Virginia passed APA’s model mental health parity legislation. In 2020, 12 other states introduced APA’s model parity legislation; however, in light of the corona pandemic the majority of state legislatures have closed. Learn more about our parity legislation here.

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