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Advocacy Update: October 2019

October 23, 2019

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

APA Continues to Advocate for Passage of Critical Parity Enforcement Legislation

Congressional support for APA’s Mental Health Parity Compliance Act (H.R. 3165/S. 1737) continues to grow, due in large part to APA members’ advocacy efforts. In the past few months, APA members have called, met with, or written letters to their federal lawmakers in support of this important piece of legislation. As a result, 31 members of the House of Representatives are cosponsoring H.R. 3165.

Support the Mental Health Parity Compliance Act: In September, a member of Congress joined our Mental Health Parity Compliance Act after receiving just one letter from a local psychiatrist. Have you sent your letter yet? Use APA’s online tool to write your lawmakers in support of mental health parity today.

Illinois Becomes the First State to Sign Model Collaborative Care Legislation Into Law

Illinois became the first state in the country to enact APA’s model Collaborative Care legislation when Governor J. B. Pritzker signed it into law on Friday, August 23. This law increases access to mental healthcare by requiring private insurers and Illinois’ Medicaid program to reimburse Collaborative Care Model billing codes. To learn how your state can adopt a similar law, contact [email protected].

APA Opposes Rolling Back Protections in the Flores Settlement Agreement

On August 21st, the Trump administration issued a final rule that would replace the Flores Settlement Agreement (FSA), a 1997 federal court ruling outlining standards for immigrant children in detainment. The proposed rule eliminates the 20-day limit on detainment and weakens licensing requirements of detention centers.

A statement from APA President Bruce Schwartz, M.D. was released, opposing the administration’s rule and stating that it would endanger the mental health of immigrant children. APA and 20 other health and child welfare organizations filed an amicus brief in the Flores v. Barr case, that oversees the FSA. On September 27th, a federal court blocked the Administration from enforcing this regulation, citing the brief as support for its finding that the rule failed to meet the original terms of the FSA. The Administration is expected to appeal this ruling.

Join PsychPRO and Help Bolster Meaningful MH/SUD Quality Measures

APA is developing quality measures and needs your expertise to ensure these measures meet the needs of psychiatrists treating those with mental and/or substance use disorders. By volunteering to be part of a learning collaborative through PsychPRO (APA’s mental health registry), APA members can lend their voices to this important initiative. To learn more about the initiative and incentives for participation, please visit the Quality Measures Development webpage.

APA Comments on Proposed Medicare Physician Fee Schedule and Quality Payment Program

APA sent comments to CMS on the 2020 proposed rule on the Medicare Physician Fee Schedule and Quality Payment Program. Our comments focus specifically on issues that affect the care of patients with mental health and substance use disorders (MH/SUDs). APA supports a number of proposals that would increase access to evidence-based services for mental health and substance use disorders including encouraging the expansion of access to telehealth services, and supporting CMS proposals to expand coverage for patients with opioid use disorders.

APA also encouraged CMS to adopt proposals that would reduce administrative burdens associated with documentation requirements and urged CMS to adopt recommendations that would increase payments for outpatient evaluation and management services beginning in 2021. Feedback was also provided on a proposed framework to streamline the quality reporting program and encouraged CMS to reconsider a draft cost measure that, if implemented, could hold psychiatrists accountable for costs they have no ability to control.

APA Responds to Proposed Rule on Medicare Part D

APA submitted comments to CMS on the proposed rule, “Medicare Program; Secure Electronic Prior Authorization for Part D.” The rule, which is an outgrowth of the Substance-Use Disorder Prevention that Promotes Opioid Recovery and Treatment (“SUPPORT”) Act, proposes changing the electronic transaction standard for Medicare Part D’s Drug Benefit program. This change would better align the ONC’s 21st Century Cures Interoperability and Information Blocking proposed rule’s electronic prescribing standard with electronic prior authorization, and foster improved communication between PDMPs and EHRs.

APA Encourages CMS to Expand Access to MAT for Medicaid and Medicare Patients

APA responded to CMS’s request for information on the agency’s action plan to prevent opioid addiction and enhance access to medication for addiction treatment (MAT). The action plan is mandated by the SUPPORT Act and directs HHS to collaborate with the Pain Management Best Practice Inter-Agency Task Force on a review of coverage policies for MAT and the treatment of acute and chronic pain. APA’s comments focused on improving OUD treatment coverage for Medicare and Medicaid patients, expanding access to treatment through telepsychiatry, studying the Collaborative Care Model’s potential impact on OUD treatment, and opportunities for data collection.

APA Responds to Request for Information: Identifying Priority Access or Quality Improvements for Federal Data and Models for Artificial Intelligence Research and Development

APA responded to the Office of Management and Budget’s (OMB) RFI on artificial intelligence (AI) and its potential for use in healthcare. In its response, APA made several recommendations. First, APA recommended that various agencies that will guide the integration of AI into care work together to adopt ubiquitous standards around AI research, development, privacy, and security, to ensure patient safety and maximize clinical utility. APA staff also reviewed approximately 1,500 federal datasets and recommended that a series of healthcare-related files be recoded, merged, or otherwise transformed so that healthcare AI researchers can use them for research and development.

APA Concerned with Implications of Executive Order

On October 3, the President signed an Executive Order (EO) on Protecting and Improving Care for Our Nation's Seniors. While the EO does not provide legislative or regulatory specifications, it raises policy areas that the President believes need to be addressed to improve the Medicare program. The EO raised concerns about the Medicare for All Act of 2019 introduced in the Senate and stated the Administration's intent to protect and improve Medicare by "building on those aspects of the program that work well, including market-based approaches in the current system." The Secretary of Health and Human Services is directed to take a number of actions within one year to improve Medicare. Some of the areas that may be addressed through regulatory process include:

  • Proposing reforms to Medicare to allow providers to spend more time with patients, addressing areas such as conditions of participation, supervision requirements, licensure requirements, addressing disparities in reimbursement between physicians and non-physicians, and other issues.
  • Studying the use of various alternative payment and competitive bidding approaches, including use of MA-negotiated rates to set fee-for-service rates.

APA will monitor and as appropriate engage with AMA and other groups as well as the Administration about the EO and will provide significant input into the regulatory process as work on these policy proposals progresses.

APA Participates in Hill Roundtable on Suicide

APA participated in a Capitol Hill roundtable discussion focusing on the needs of those who have lost a loved one to suicide, or are caring for someone who struggles with suicide. APA-member Paul S. Nestadt, M.D., from the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins School of Medicine, joined the panel of experts and advocates to help to identify policy solutions to the growing suicide crisis in America. Representative Susan Wild (D-PA), a Freshman member of Congress who lost her partner to suicide a year ago, organized the event, which was attended by eight members of Congress, including Speaker of the House Nancy Pelosi.

APA President Joins Physician Leaders on Capitol Hill

APA President Bruce Schwartz, M.D. joined other front-line physician leaders (Group of Six) in Washington, DC, to advocate for policies that would improve access to health care for patients. Specifically, he and his colleagues met with Congressional leadership to support mental health and substance use disorder parity, policies that would reduce the cost of drugs, funding for public health research into firearm mortality and injury prevention and interventions and coverage to improve maternal mortality outcomes.

APA Supports Efforts to Address Gun Violence

On September 10, the House Judiciary Committee advanced three gun violence-related bills to the House floor. APA, in collaboration with other mental health groups, worked with members of the House Judiciary Committee to ensure these measures did not stigmatize mental health histories. Specifically, legislation that would allow judges to remove guns from individuals deemed to be a danger to themselves or others was changed to protect individuals with histories of involuntary commitment. APA also joined six other physician and health professional organizations in calling for action to address the public health epidemic of firearm-related injury and death by recommending several evidence-based steps.

APA Aids State Psychiatric Societies in Planning Efforts for Next Year’s Legislative Sessions

APA’s State Government Relations team is holding a series of regional conference calls to assist psychiatric state associations and district branches plan for the next legislative sessions. The focus of these calls is to discuss challenges and opportunities on a variety of topics, including promoting both of APA’s model legislation mental health parity and collaborative care legislation. APA staff will continue working with DB/SAs in each state going forward and provide resources where necessary.

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