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Advocacy Update: November 2020

November 23, 2020

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

APA-Led Activities

Psychiatry’s Impact on the 2020 Election

The 2020 election took place on Tuesday, November 3rd. As has been widely reported, Former Vice-President Joe Biden won the election with 306 electoral votes. Democrats narrowly held onto the House of Representatives, but control of the Senate still remains undecided and will not be determined until Georgia hosts two runoff elections in January.

APAPAC saw great success in the 2020 election, having contributed $459,000 to 163 federal legislative champions and committees with 91% of APAPAC supported candidates winning their election or re-election. At least 18 physicians will be coming to or returning to Congress in 2021, in part, due to APAPAC support.

Sixty-one percent of APAPAC contributions were made to democratic committees and candidates. Bringing back champions like:

  • Representative Katie Porter (D-CA), who sponsored the Mental Health Parity Compliance Act (HR 3165)
  • Representative Bonnie Watson Coleman (D-NJ), a leader in efforts to address health care disparities
  • Senator Tina Smith, who sponsored legislation promoting telehealth and has championed mental health improvements in our schools

Thirty-nine percent of contributions were made to republican committees and candidates, which supported champions like:

  • Representative Gus Bilirakis (R-FL), who sponsored the Mental Health Parity Compliance Act (HR 3165)
  • Representative Markwayne Mullin (R-OK), who led efforts to improve patient safety for individuals with substance use disorders
  • Senator William Cassidy, MD (R-LA), a strong advocate for the House of Medicine in the Senate and lead Republican sponsor of the Mental Health Parity Compliance Act (S. 1737)

As of this printing a few congressional races remain undecided, but there will be at least 64 new members of Congress when the 117th Congress convenes on January 3, 2021. Healthcare will likely be a major focus of the new Congress and APAPAC will need the support of every APA member to help build relationships with these new lawmakers as well as ensure psychiatry has a seat at the table when lawmakers make crucial decisions regarding issues like permanent access to tele-health, the federal response to the COVID-19 pandemic and ensuring mental health parity. Join APAPAC and the Congressional Advocacy Network today!

2020 State Elections and Psychiatry

During a presidential election, much ink gets devoted to the outcome of the federal election results; however, this year there were 11 gubernatorial elections and elections that determined control of 86 of the 99 state legislative chambers. State health care policies play a fundamental role in guaranteeing psychiatric patients receive the highest quality of mental health care. State legislation affects patients directly, from mental health parity implementation, to physician involvement in mental health (scope of practice), to access to prescription drugs, among other crucial issues.

In 2020, three Democratic governors were elected in Delaware, North Carolina and Washington state while eight Republicans were elected in Indiana, Missouri, Montana, New Hampshire, North Dakota, Utah, Vermont and West Virginia. After the 2020 elections, Republicans hold trifectas (control of the legislature and both legislative chambers) in 23 states, Democrats hold trifectas in 15 states, and 12 states have divided control. This year, New Hampshire’s House and Senate both flipped to Republican, the only state chambers to change hands.

APA’s Department of Government Relations is already working with our district branches and state associations to build relationships with new state lawmakers and work with current allies to introduce pro-psychiatry legislation when states’ sessions begin in January. Get involved with your district branch in these efforts, if you’re not already. They are vital to our success in the states.

Executive Branch Activities

APA expresses concern regarding two proposed rules affecting IMGs

APA sponsored a letter signed by 18 District Branches and 7 ACROSS members against a new proposed rule from the Department of Homeland Security that would eliminate the duration of status as an authorized period of stay for J-1 visa holders. This change will result in thousands of J-1 physicians - 395 of which are psychiatry residents - being unable to continue their training programs on July 1 each year, thus, disrupting their pre-assigned clinical physician services over thousands of hospitals. We urge the Administration to exclude J-1 physicians from this proposed rule. APA also worked with our Frontline physicians coalition on a similar letter. In addition, another rule was quietly released (without input for comment) by the Department of Labor that significantly increases the minimum required salary that hospitals and practices must pay physicians with H-1B visas. These steep increases will make it challenging for health systems and physician practices to hire physicians with H-1B visas, and in turn disrupt the pipeline of physicians in training and jeopardize our health care workforce amid a global pandemic and national public health emergency. Accordingly, we worked with our Front line Physician colleagues in a letter to oppose this change for physicians with H-1B visas.

Congressional Activities

House Passes Ten Healthcare Bills

On November 17th, the House unanimously passed ten healthcare-related bills that support new research into health disparities, improve food and drug labeling, and authorize funding for federal programs addressing trauma centers as well as substance abuse and prevention. Of most relevance to psychiatry, the House-passed:

  • NIMHD Research Endowment Revitalization Act of 2020 (H.R. 4499) which authorizes the National Institute on Minority Health and Health Disparities to facilitate research on minority health disparities through research endowments at current or former centers of excellence;
  • State Opioid Response Grant Authorization Act of 2020 (H.R. 2466) which reauthorizes the Substance Abuse and Mental Health Services Administration (SAMHSA) State Opioid Response Grants program
  • Easy Medication Access and Treatment for Opioid Addiction Act (H.R. 2281) or the “Easy MAT for Opioid Addiction Act,” which would require the Drug Enforcement Administration (DEA) to allow a practitioner to dispense up to a three-day supply of medication-assisted treatment. This practice is intended to relieve potential acute withdrawal symptoms while the individual awaits longer-term treatment;
  • Ensuring Compliance Against Drug Diversion Act of 2019 (H.R. 4812) which terminates the controlled substance registration of any registrant if the registrant dies, ceases legal existence, discontinues business or professional practice, or surrenders registration, and includes additional requirements for contacting the DEA to transfer a registration.

Progress Slow in Congressional Negotiations on COVID Relief Package

Congressional discussions for the next Covid relief package have renewed with President-elect Joe Biden joining congressional Democratic leaders in demanding a new economic relief package before the end of the year. Senate Majority Leader Mitch McConnell (R-Ky.) flatly rejected such a proposal, while Sen. Susan Collins (R-Maine) implored both sides to begin negotiating as the virus infection rates rose.

In October, the House passed an updated version of the Heroes Act. The $2.2 trillion package maintains most key priorities from the previous version of the legislation that passed the House in May, but would add more funding for mental health. The future of these provisions depends on the scope of whatever Covid relief package is ultimately negotiated between the House, Senate and White House. Key provisions of the bill include:

  • $8.5 billion for the Substance Abuse and Mental Health Services Administration to fund state mental health and substance abuse block grants, trauma-informed care and other services and supports for schoolchildren, suicide prevention and Certified Community Behavioral Health Clinics.
  • A 14% increase in Medicaid funding for states, as well as medical assistance under Medicaid for inmates during the 30-day period preceding their release.
  • $1 billion grants for schools of medicine in diverse and underserved areas, including minority-serving institutions.
  • $4.7 billion for the National Institutes of Health (NIH), including $200 million specifically for the National Institute of Mental Health, and funds for data collection across the Department of Health and Human Services on health disparities.
  • Expedited visa processing for physicians and health care workers to ensure International Medical Graduates can assist with the country’s workforce shortage during the pandemic.

Efforts Underway to Fund Federal Mental Health Programs in 2021

To avoid a government shutdown on December 11, Senate Majority Leader Mitch McConnell (R-KY) and House Speaker Nancy Pelosi (D-CA) have both telegraphed their interest in a negotiating an omnibus spending bill by the end of the year. This legislation would fund the government for the entirety of fiscal year 2021 rather than extend current funding levels through January. To proceed with these negotiations, the Senate Appropriations Committee released its proposals for funding levels on November 10th, but the two Houses have yet to agree. Once the two houses of Congress agree on funding levels for each of the twelve appropriations bills, appropriators will negotiate a final bill. Although there is substantial interest in making this happen, success is far from certain. We remain hopeful a deal can be reached and are continuing to advocate for APA’s priorities.

State Activities

APA Developing New Parity Enforcement Legislation

APA is working closely with the Kennedy Forum to develop state model legislation to strengthen parity enforcement. Similar to legislation that was recently signed into law in California, this pro-psychiatry legislation would ensure that health plans cover medically necessary care that aligns with practice guidelines and treatment criteria that are developed by specialty associations like the APA. If you or your state is interested in learning more, contact [email protected].

Louisiana Becomes Latest State to Implement Mental Health Parity Enforcement

On October 19, Louisiana became the latest state to implement parity enforcement policies when its Department of Insurance issued new regulations. APA and the Louisiana Psychiatric Medical Association worked closely with Louisiana administrators to draft the regulation which mirrors APA’s model parity legislation. Currently, there are 15 states that have adopted APA’s model parity enforcement policy either through regulation or legislation.

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