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May 2020 Advocacy Updates

Advocacy Update: COVID-19 Edition

APA’s Government Relations and Policy teams have been working around-the-clock in responding to the COVID-19 global pandemic to ensure your psychiatric practice and patient care are not interrupted. Our advocacy work and more resources can be found on APA’s COVID-19 Information Hub.

How You Can Help

Advocate for Emergency Behavioral Health Funding

With your help, we can ensure that mental health and substance use organizations in local communities have the resources needed to keep their doors open and provide much needed mental health and addiction care.

Share Your Story

You are our boots on the ground during this crisis. Keep us informed of what's happening in your community - let us know if these new regulations are working or not working for you, and where the gaps in access or provision of care are. We will use these stories to shape our legislative strategies and share your story with lawmakers when appropriate.

APA Influences the Federal Response

APA Advocates for MH During the Congressional Response to the Pandemic

Throughout this crisis, APA has worked closely with Congress to ensure psychiatrists have the tools and resources needed to continue to provide the highest quality mental health care to patients. On March 27, President Trump signed the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which was 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. Among its many provisions, this package:

  • Provides $425 million for Substance Abuse and Mental Health Services Administration (SAMHSA) programs, including:
    • $250 million for reauthorization and expansion of Certified Community Behavioral Health Clinics
    • $50 million for suicide prevention programs
    • $100 million for mental health and substance use disorder emergency grants
  • Gives $4 billion to community health centers, which is $1.32 billion over current fiscal year 2020 funding levels.
  • Allows Medicare reimbursement for telemedicine provided to new patients, not just those seen within the last three years.
  • Improves 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.
  • Suspends 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. That first stimulus package allowed 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. Since the CARES Act was signed into law, APA has been working to further expand access to telehealth.

Looking Ahead: APA Outlines Its Priorities for Next COVID-19 Legislation

As Congressional leaders negotiate a potential fourth stimulus package in response to the COVID-19 pandemic, APA remains hard at work advocating for the needs of the mental healthcare system. On April 13, APA sent a letter to Congressional leadership outlining its priorities for future support. APA’s immediate focus remains on:

  • Increasing access to telehealth services by requiring ERISA plans to cover telehealth visits and establishing Medicare coverage and payment parity of telehealth audio-only visits
  • Protecting Health Care Clinicians by:
    • updating medical liability protections to cover physicians who are treating COVID-19 patients or practicing outside their usual specialty,
    • providing appropriate personal protective equipment, and
    • funding mental health support services for healthcare workers.
  • Enforcing mental health parity
  • Providing emergency funding for Community Mental Health Care and Treatment.

In the future, APA also suggests that Congress increase access to mental health services by increasing reimbursement for the collaborative care model, implement psychiatric loan forgiveness programs and increase funding for psychiatric beds.

Securing Federal Funds for MH/SUD Practices and Organizations

APA Meets with House Small Business Committee to Discuss the Economic Impact of the Pandemic

On March 27, majority staff members of the House Small Business Committee met with the leadership of over 30 medical associations, including Dr. Saul Levin, APA CEO & Medical Director, as well as Dr. Bruce Schwartz, then APA President. The Committee wanted to learn from the House of Medicine how the COVID-19 pandemic is impacting physicians’ practices as well as medical associations. Drs. Levin and Schwartz relayed the early concerns of psychiatrists, discussed the educational resources that APA developed in response to the pandemic and spoke about how the pandemic was impacting APA.

APA Joins Forces with the House of Medicine and Other Mental Health Organizations

As a fourth stimulus package is developed, APA is working in coalition with the House of Medicine and other mental health advocacy groups to advocate on behalf of the psychiatric profession and our patients.

On April 7, APA joined over 20 other mental health organizations in issuing a statement of joint legislative priorities. The statement requests emergency funding for behavioral health organizations, the National Mental Health and Suicide Prevention Hotline as well as local crisis response programs. The Coalition also requested that Congress increase access to telehealth, prohibit prior authorization in Medicare/Medicaid for medications that treat mental health or substance use disorders during the pandemic, and improved parity compliance.

APA also joined the House of Medicine in recommending that Congress take specific steps to provide physicians and their practices financial relief, increase access to telehealth, support resident physicians and medical students, and address certain medical liability concerns facing physicians providing care to COVID patients.

APA Works to Provide Financial Relief to Mental Health and SUD Organizations

A recent survey of mental health providers shows that more than 60% of providers have already been forced to close one or more programs and 62% of providers warn that they cannot survive more than three months without emergency financial assistance. As such, APA has been working in coalition with other mental health organizations and our congressional champions to direct funds from the Public Health and Social Services Emergency Fund, which was established by the CARES Act, to Community Mental Health Organizations and Community Behavioral Health Organizations. On April 27th, APA and other leading mental health organizations made a request to HHS Secretary Alex Azar. Additionally, APA worked with Senators John Cornyn (R-TX), Debbie Stabenow (D-MI) and 24 other senators to echo this request in a letter to CMS.

APA Calls on Congress to Support Medical Associations

Medical associations provide the House of Medicine with the educational resources and support they need to provide the highest quality of care during this crisis as well as in the future. While APA remains in solid financial standing, it like many other associations had to cancel its annual meeting as well as other conferences, which are sources of revenue. As such, APA applauds Rep. Chris Pappas (D-NH) for introducing H.R. 6697, which would amend the CARES Act’s Paycheck Protection Program to allow certain nonprofit organizations, like APA and other medical associations, to participate. APA also joined numerous medical and dental specialty associations in a letter calling for emergency financial relief in early April.

PPE and Safety

APA Joins Mental Health Organizations in a Call for Additional Personal Protective Equipment (PPE) for Behavioral Health Care Professionals

On April 1, APA CEO & Medical Director Saul Levin joined the leadership of Mental Health America, the National Alliance on Mental Illness, and the National Council for Behavioral Health in a letter to Vice President Mike Pence concerning the shortage of PPE for health professionals in residential MH/SUD treatment facilities. The letter notes the particular challenges of providing treatment amid the COVID-19 public health crisis in a safe manner for patients and providers alike, and that the lack of PPE has exacerbated an existing workforce shortage in these facilities.

APA Joins the Council of Medical Specialty Societies in Advising the Administration on Enforcing Social Distancing and PPE

The Council of Medical Specialty Societies, representing more than 800,000 physicians across 45 specialties, including APA put out a statement on April 2 strongly urging action to ensure safer working conditions for physicians and other healthcare professionals on the frontline of direct patient care. The statement called for the distribution of adequate PPE across the U.S. and stated that, while these items are in short supply, physicians should be allowed to bring their own PPE to protect themselves and their patients. CMSS and APA also sent a letter to the administration requesting their leadership in supporting science-based recommendations on social distancing measures to slow the spread of the virus. The letter calls for a nationwide effort, noting that statewide efforts alone are an insufficient response to the pandemic.

Minority Health

APA and Stakeholder Groups Urge CMS to Extend Medicaid Postpartum and Approve Select Section 1115 Waivers During COVID-19

APA, alongside several healthcare organizations, urged Administrator Verma to invoke flexibilities granted to CMS, through the declaration of a national emergency, to expeditiously approve pending Section 1115 Waivers and work with additional states to ensure that postpartum women who rely on the Medicaid program receive continuous coverage one year after delivery. Citing the United States’ rising maternal mortality rate, the letter stated that CMS should prioritize this at-risk population and take action to increase coverage for women by supporting state efforts to expand Medicaid coverage one year postpartum.

APA Requests Data Collection on COVID-19’s Impact on Vulnerable Populations

Numerous reports have shown the disproportionate impact of the COVID-19 pandemic on minority and vulnerable populations. As such, APA has sent a letter to the Department of Health and Human Services Secretary Alex Azar requesting the collection, analysis, and publication of explicit and comprehensive, standardized data on race, ethnicity related to the testing status of hospitalization, and mortality associated with COVID-19.

APA Joins Nearly 50 Scientific Organizations in Condemning Anti-Asian Discrimination

Since January 2020, there has been a dramatic increase in reports of hate crimes and incidents against members of the Asian American Community. Sadly, even members of our APA-membership have been harassed and scapegoated during the COVID-19 pandemic. APA joined nearly 50 professional scientific organizations in condemning this trend and calling on Congress to pass H.Res 908. This congressional resolution, and its companion version Sen. Res. 580, condemn all forms of anti-Asian sentiment during the COVID-19 pandemic and call on law enforcement at all levels of the government to investigate and track all credible reports of hate crimes, incidents and threats against the Asian American and Pacific Islander Community.

Join APA in urging Congress to take a stand against Anti-Asian Discrimination. Write your lawmakers in support of these resolutions today.

Access to Care

APA Advocates for Eased Telehealth Restrictions and Reimbursement for Telephone Appointments During COVID-19

Following up on a letter to CMS on March 20 requesting waiving video requirements in Telemedicine during the global pandemic, APA sent Administrator Verma a critical request that the agency waive the video element of telemedicine for mental health and substance use diagnoses. The request for CMS to allow for audio-only Telehealth appointments came as a response to APA member concerns for their vulnerable patients who lack the technical capacity or willingness to communicate with video applications. On April 8, following CMS action to enhance the ability of the workforce to provide treatment by providing regulatory flexibilities during this national emergency, APA alongside many other medical organizations, urged CMS to provide payment parity between telephone evaluation and management codes and office visit codes, as well as provide immediate guidance to Medicare Administrative Contractors to ensure that CMS guidance is followed appropriately with regards to enabling payments of these telephone claims. On May 1, APA released a press statement praising CMS for increasing telehealth access through audio-only visits.

APA’s Members Lend their Voices to Capitol Hill on Telehealth Coverage

Robert Trestman, PhD, MD, Chair of APA’s Council on Healthcare Systems & Financing Chair, and other Virginia-based mental health providers met with Senator Tim Kaine (D-VA) to discuss behavioral health needs during the COVID-19 crisis. Dr. Trestman discussed the quick transformation from in-person to almost 95% telehealth during the pandemic, and specifically noted the importance of conducting audio-only visits and appropriate reimbursement for these visits. Senator Kaine empathized with Dr. Trestman’s remarks and promised to continue to push for appropriate audio-only allowance and reimbursement.

APA Leads the Effort to Support the Conrad-30 Program

Since 1994, the Conrad State 30 program has brought thousands of foreign physicians who are trained in the United States to medically underserved communities. In return for their service, the U.S. waives a requirement that they return to their home country after their residency for two years and provides them with priority access to the green card system if they serve in the community for five years. APA has led the charge to ensure this program continues to play a critical part of the workforce providing mental health and substance use services during COVID-19. APA led a group of medical societies to send a letter to Ken Cuccinelli, acting Director of U.S. Citizenship and Immigration Services (USCIS), urging the USCIS to temporarily extend visas automatically, and expedite approvals of extensions and changes of status for non-U.S. citizen international medical graduates (IMGs).

APA also supports the Conrad State 30 and Physician Access Reauthorization Act (S. 948/H.R. 2895), which would reauthorize the Conrad State 30 J-1 visa waiver program for international medical graduates and make critical improvements to the program by allowing additional waiver spots for states that use a high portion of their existing waiver capacity, and letting the program to be “more responsive to the needs of patients in states with an especially severe shortage of physicians.” On April 16, APA sent a letter of support for this critical legislation.

Want to support this critical program? Use APA’s online advocacy tool to write your lawmakers in support of the Conrad State 30 and Physician Access Reauthorization Act.

State Responses

How State Governments Are Responding to COVID-19

States have adopted a variety of approaches to address the healthcare systems’ needs during the COVID-19 crisis. All states have sought to increase Medicaid enrollment and suspend prior authorization by applying for Section 1135 Waivers from CMS. Additionally, many states have greatly expanded access to telehealth by reducing administrative barriers to coverage and requiring private insurers to cover telehealth. Some states have temporarily expanded scope of practice for non-physician health care professionals such as APRNs, physician assistants, pharmacists, and EMTs, among others.

APA’s government relations team continues to track these efforts throughout the states, update members with State-by-State Guidance, and assist DB/SAs with planning and implementing their response. We are also strategizing with DB/SAs as some states reopen and go back into legislative session.

Resources for Psychiatrists

Psychiatric Practice Guidance

APA is constantly tracking and updating guidance released by the Department of Health and Human Services and at the state level related to COVID-19 to assist psychiatrists with providing mental health and substance use services. View recent changes and guidance impacting telehealth, substance use disorders and treatment services, and inpatient psychiatric settings at Practice Guidance for COVID-19.

APA’s Practice Management HelpLine

If you are an APA member, APA's Practice Management HelpLine is ready to assist you with your practice management needs. Help is available on how to manage the day-to-day operations of your practice in the midst of this pandemic, including telehealth, coding, documentation, reimbursement, contracting with managed care companies, Medicare, Medicaid, and more. Our dedicated helpline has helped over 200 members since the beginning of the COVID-19 pandemic.

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