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Advocacy Update: October 2020

October 24, 2020

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

APA-Led Activities

APA Hosts Conference to Empower Psychiatrists to Advocate on a State Level

APA hosted its 2020 State Advocacy Conference on September 26 and was met with overwhelmingly positive feedback from members who attended the virtual meeting. The conference included panel discussions from state legislators regarding the importance of physician involvement in the legislative process, a panel discussion on telehealth, a session on social and racial justice, and a political update from a well-known state legislative professional. Some of the sessions from this conference will be available online in the future.

Protecting Veterans Against Dangerous Pilot Program

In September, APA successfully pushed back against a federal proposal to establish an experimental pilot program to allow clinical psychologists to prescribe and manage medications in the Veterans Administration health system. Ultimately, the U.S. House of Representatives Veterans Affairs Committee heard APA’s concerns and removed the provision from a legislative package to help prevent veteran suicides.

Instead, the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 (S. 785), which President Trump signed into law on October 17th, contains several important provisions that will help prevent the deaths of the 20 Veterans who die each day by suicide. For example, a provision that Senator Bill Cassidy, MD (R-LA) drafted with assistance from APA will require the Department of Veterans Affairs and the Department of Defense to establish a joint clinical practice guideline for treatment of serious mental illness. The common-sense approach builds on an already robust library of clinical practice guidelines that serve to standardize and reinforce treatment procedures in other areas.

  • How APA Members made an impact: Over 1,100 psychiatrists sent 3,600 letters to capitol Hill and reached nearly every member of Congress on this proposal. This grassroots effort was fundamental to APA’s successful legislative strategy. By responding to APA’s action alert and raising the alarm over this proposal, APA’s advocates drew their federal lawmakers’ attention to a provision that could have been easily overlooked. Responding to APA’s action alert emails is a quick and easy way to ensure your voice has an impact on legislation being considered on Capitol Hill as well as in your state’s capital.

APA’s Get Out the Vote Site

2020 promises to be a consequential election year and APA is here to help psychiatrists participate in the election process. Our Action Center provides you with everything you need to:

  • Easily register to vote;
  • Learn the important voting dates in your community;
  • Find out who will be a candidate on your ballot; and
  • Tell APA about the local or federal candidates you know who will be champions for mental health

College Mental Health During COVID-19

As a result of the COVID-19 pandemic, many college students have been abruptly displaced from their campuses to locations around the country and world. State legislation poses logistical challenges to maintaining continuity in care, while local treatment options may not be viable for a variety of reasons. To address these concerns, APA’s Committee on Telepsychiatry and College Mental Health Caucus has released a “Best Practices and Policy Considerations” document for mental health professionals to use as a resource. This document is available within APA’s Telepsychiatry Toolkit.

Advancing Integrated Care

APA, along with the major primary care organizations, is participating in an AMA-led coalition to advance the integration of mental health care into primary care. The AMA Behavioral Health Integration (BHI) Collaborative is producing webinars and a compendium of resources to provide a pathway for practices to implement integrated care. Learn more about the BHI collaborative here.

Informational Webinar on 42 CFR Part 2

APA, AAAP, and ASAM hosted a webinar focused on recent federal regulatory and legislative changes to 42 CFR Part 2 regarding confidentiality of substance use disorder patients records, to allow for better alignment with HIPAA.

Executive Branch Activities

$20 Billion for Phase 3 General Distribution of Provider Relief Funds: Application Deadline Nov. 6

HHS recently announced new funds for an expanded group of behavioral health providers, including psychiatrists who have either billed a health insurance company or who do not accept insurance and have billed patients. These funds are intended to address the rising need for treatment of mental health and substance use issues exacerbated by the COVID 19 pandemic. The deadline for application is November 6, 2020. HHS is urging all eligible providers to apply early. More information can be found here: Instructions for Phase 3 Distribution. Application can be made here: Provider Relief Fund Application and Attestation Portal.

CMS Reminds States of Mandatory Medicaid MAT Coverage

The Centers for Medicaid and Medicare Services (CMS) recently sent a reminder to States that under the SUPPORT Act of 2018, Medicaid programs are required to provide coverage of medication-assisted treatment (MAT) services and drugs under a new mandatory benefit. As described in the announcement, “…as of October 1, 2020, states must include as part of the new MAT mandatory benefit all forms of drugs and biologicals that the Food and Drug Administration (FDA) has approved or licensed for MAT to treat OUD. More specifically, under the new mandatory MAT benefit, states are required to cover such FDA approved or licensed drugs and biologicals used for indications for MAT to treat OUD. States currently cover many of these MAT drugs and biologicals (for all medically-accepted indications) under the optional benefit for prescribed drugs described at section 1905(a)(12) of the Act.” The announcement also noted that further guidance from CMS on implementation issues will be released soon.

Proposed Rule: 2021 Medicare Physician Fee Schedule and Quality Payment Program

APA submitted comments on the Centers for Medicare and Medicaid Services (CMS) proposals regarding the 2021 Medicare Physician Fee Schedule and Quality Payment Program. APA supported a number of proposals including increasing payments for outpatient E/M services as well as specific psychiatric services and collaborative care; continuation of a number of the flexibilities related to providing care via telehealth including expanding the number of Medicare approved telehealth services and audio only coverage; and increasing coverage for patients with substance use disorders. APA voiced support for congressional action to stop the reduction in the Medicare conversion factor in 2021 which, if left in place would result in decreasing payments for all services. APA also supported congressional action to remove the site of service and geographic restrictions for telehealth that would enable Medicare patients to be seen in their home via telehealth anywhere in the country. Additionally, APA submitted comments voicing support for stable payments for partial hospitalization services in hospital-outpatient departments and CMHCs as part of the Hospital Outpatient Prospective Payment Program (OPPS).

Final Rule on Interoperability and Information Blocking Released

The Office of the National Coordinator (ONC) released its long-awaited Final Rule around Interoperability and Information Blocking. This rule impacts the methods in which patient information is shared between patients, providers, software developers, and Health Information Exchanges/Networks. APA has developed a resource for members with questions about how this new Rule will impact their practice. APA intends to develop additional resources for members in the near future.

Administration Releases Rule on Ryan Haight Online Pharmacy Consumer Protection Act

The Administration released its final rule on the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which was created to regulate online prescribing and regulate the prescription of controlled substances through telepsychiatry. In the final rule, the Drug Enforcement Agency (DEA) states it will issue regulations for the "Special Registration for Telemedicine" process (one of several exceptions to Ryan Haight). APA has been advocating for the special registration to exempt the requirement that patients must receive an in-person evaluation prior to being prescribed a controlled substance. The requirement has been waived as part of the COVID-19 Public Health Emergency (PHE), but would be reinstated following the end of the PHE if the DEA does not release the special registration exemptions changing the requirement.

Public Health Emergency Declaration Extended to 2021

The Administration officially extended the COVID-10 Public Health Emergency (PHE) Declaration until the end of January 2021. Each PHE is in place for 90 days and then must be extended by the Secretary of the U.S. Department of Health and Human Services. APA has been advocating for some of the flexibilities allowed under the PHE to be made permanent, such as lifting the in-home and geographic site restrictions for the use of telehealth and allowing for the use of audio-only for evaluation and management and behavioral health to be reimbursed the same as in-person treatment.

Executive Order Forms Coronavirus Mental Health Working Group

The President signed an Executive Order (EO) on Saving Lives Increased Support for Mental and Behavioral Health Needs. The EO establishes a Coronavirus Mental Health Working Group that will develop and submit a report to the President “outlin[ing] a plan for improved service coordination between relevant public and private stakeholders and executive departments and agencies” to assist individuals within 45 days. The EO will also grant funding for states and organizations that permit in-person treatment and recovery support activities for mental and behavioral health.

Congressional Activities

House Passed Heroes Act Addresses Mental Health and Substance Abuse During COVID

On October 1, the House passed an updated version of the Heroes Act, which included funding for mental health and substance use disorder resources, in response to the COVID-19 crisis. The resources in the House-passed Heroes Act constitute a needed step toward treatment for mental illness and substance use disorders. The bill includes:

  • $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 in 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.

The Senate has yet to act on the House-passed Heroes Act proposal or pass an alternative plan. Congressional leaders and the Administration are continuing to negotiate to reach a compromise on the next COVID-19 package that will likely come after the election.

Legislation to Address Mental Health Care Disparities Passes House

APA-supported legislation that seeks to address the disparities in access, care and study of mental health issues among people of color passed the U.S. House of Representatives on September 29th. The Pursuing Equity in Mental Health Act, H.R. 5469:

  • Establishes grants and other funding to support research on racial or ethnic disparities in physical and mental health as well as programs to assist schools in identifying and screening for signs of trauma, mental health disorders and risk of suicide.
  • Increases funding for the National Institute on Minority Health and Health Disparities (NIMHD) to study mental health disparities in racial and ethnic minority groups, among other things.
  • Reauthorizes and doubles the funding authorization for the Minority Fellowship program that trains a diverse mental health workforce to serve in underserved areas.

Identical legislation, S. 4388, was introduced in the Senate by Senator Bob Menendez (D-NJ).

U.S. House of Representatives Condemns Anti-Asian Racism Related to COVID-19

On September 17th, 2020 the U.S. House of Representatives passed, by a vote of 243-164, an APA-supported resolution that condemned all forms of anti-Asian sentiment related to COVID-19. While not a binding law, H. Res 908 expresses the collective sentiment of the House that its members 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, as well as incidents and threats against the Asian American and Pacific Islander Community.

Similar legislation, S. Res 580, has been introduced in the Senate and awaits consideration by the U.S. Senate Judiciary Committee.

State Activities

Presenting the 2020 Javits Award to FL Senator Gayle Harrell

Dr. Jeffrey Geller, APA President, presented Florida State Senator Gayle Harrell with one of APA’s highest awards, the Jacob K. Javits Award for Public Service on September 26th. Senator Harrell has served in Florida’s House of Representatives for a total of 16 years before being elected to serve in the state Senate in 2018. Dr. Geller noted that during her tenure she has demonstrated a “steadfast commitment to improving services for individuals with mental illness.” Specifically, Senator Harrell has stepped in to require licensure for substance abuse treatment facilities, addressed gaps in the foster care system to ensure children had access to mental health treatment and led the way in modernizing Florida’s mental health care system.

Additionally, Senator Harrell has been a champion for patient safety; she has actively opposed psychologist prescribing in Florida and supported physician involvement in all medical care.

APA’s Jacob K. Javits Award annually acknowledges the efforts of public servants who make a significant contribution to the mental health community. APA alternates between acknowledging state and federal champions.

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