May 21, 2019

May 2019: Advocacy Update

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

APA-Supported Legislation Introduced in U.S. Congress

APA continues to work with its coalition partners and congressional champions to modernize an outdated law, 42 CFR Part 2, that prevents health care providers from sharing a patient’s substance use disorder history with other members of the health care team. This law, written before HIPAA, was originally intended to protect a person’s medical privacy but now it jeopardizes patient safety, undermines collaborative care models, and further stigmatize substance use disorders. As the Administration appears poised to propose a new rule to improve the law, Reps. Earl Blumenauer (OR-D) and Markwayne Mullin (OK-R) as well as Sens. Shelley Moore Capito (WV-R) and Joe Manchin (WV-D) have introduced legislation (H.R. 2062/S. 1012) that would align 42 CFR Part 2 with HIPAA while also enhancing penalties for any breach of a patient’s privacy concerning substance use disorder records.

Support this legislation by asking your federal lawmakers to cosponsor H.R. 2062 or S. 1012.

APA Concerned by Transgender Military Ban

Earlier this month, the Department of Defense began implementing its ban of transgender individuals serving in the military. In a statement, APA reiterated its concern about this policy and the fact that it was not informed by medical evidence. APA reaffirmed that “being transgender or gender diverse implies no impairment in judgment, stability, reliability, or ability to serve in the military.” The ban went into effect on April 12th.

Telepsychiatry Toolkit: Children and Adolescents

In partnership with the American Academy of Child and Adolescent Psychiatry (AACAP), APA has recently launched new child and adolescent-specific content within its Telepsychiatry Toolkit. The new material is organized into five content areas: History and Background; Legal, Regulatory, and Safety Issues; Setting-up a Practice; and Special Populations. Each content area contains short informational videos along with topic summaries and literature references.

APA Responds to the Administration’s Draft Report on Pain Management Best Practices

APA provided feedback to the Pain Management Best Practices Inter-Agency Task Force’s draft report. APA largely supported the report’s recommendations, but encouraged the Task Force to ensure that any proposed intervention to reduce opioid misuse should not impose burdensome requirements on prescribers (such as prior authorizations), study pharmacy-based interventions to protect the patient-physician relationship, and also study the general public’s understanding of naloxone and the impact of standing pharmacy orders, which would allow all individuals to obtain this medication without a prescription.

Unintended Consequences of Administration’s Proposed Drug Price Transparency Plan

APA submitted comments to HHS in response to the Administration’s proposed rule that would eliminate the safe harbor protection from current anti-kickback laws for rebates paid on prescription drugs by manufacturers to Medicare Advantage and Part D plans, as well as their pharmacy benefit managers (PBMs). While the comments expressed support the Administration’s overall goals to enhance price transparency and lower out-of-pocket costs of medications, they also expressed concern about unintended consequences that may result from the proposed rule, such as additional use of utilization management protocols.

APA Supports VA Proposed Rule to set Access Standards

APA responded to a proposed rule released by the Department of Veterans’ Affairs to set access standards for community care and urgent care. APA supported the rule and recommended the final rule ensure patients in crisis have immediate access to care, extending the length of time beyond 14 days that a patient may access a non-VA prescription, and ensure coordination. APA also reiterated support for aligning VA health plans with the Mental Health Parity and Addiction Equity Act and ensuring an appropriate network of providers and up-to-date, accurate, and complete provider directories.

Administration Proposed Measure Could Negatively Impact Reimbursement for Inpatient Psychiatrists

APA sent a letter to the Administration expressing concerns about a proposed episode-based cost measure that could negatively impact reimbursement for inpatient psychiatrists. In the letter, APA stated additional modifications were necessary and has requested the opportunity to work collaboratively with CMS to resolve our concerns before adopting the measure.

APA Supports House Efforts Proposals to Strengthen ACA

On April 3, APA sent a letter expressing support for a number bills to strengthen the Affordable Care Act which were under consideration by the U.S. House of Representatives Energy and Commerce Committee. Specifically, the APA expressed support for:

  • Additional resources to promote open enrollment advertising and educational campaigns on the ACA;
  • A new reinsurance program that would lower premium prices by helping to offset the costs of insuring high-risk individuals; and
  • Two bills that block the administration’s effort to expand access to short-term limited duration health insurance plans. These plans were originally created to provide coverage during a temporary gap in coverage and, as such, are not required to comply with the ACA’s core consumer protections.

APA also took the opportunity to encourage the Committee to address cost-control practices like prior authorization or step-therapy that delay or limit patients access to critical medications.

APA Leads Group in Supporting Medicaid Reentry Act

APA is leading the Mental Health Liaison Group, a coalition of over 60 national organizations, in drafting a letter in support of the Medicaid Reentry Act (H.R. 1329) which was recently introduced by Representative Paul Tonko (NY-D) and Mike Turner (OH-R). The bill would provide access to critical mental health and substance use disorder services for incarcerated populations by allowing states to restart benefits for Medicaid eligible incarcerated individuals 30 days before their release date.

Expanding the Collaborative Care Model

APA is proactively addressing access to care issues, and has created model legislation that would require private insurers within the state to cover the billing codes for the Collaborative Care Model (CoCM). Illinois introduced this legislation (S 2085) earlier this year and it passed the Senate unanimously. It is now headed to the House where it is expected to have bipartisan support. A number of other states, such as Delaware and New Jersey, are working to have this legislation introduced in the near future.

Model Legislation to Advance Mental Health Parity

APA’s model legislation concerning mental health parity and coverage of SUD services continues to make its way through many state legislatures. Going into this year, Delaware, the District of Columbia, Illinois and Tennessee had already enacted parity legislation. This year New Jersey and Wyoming have already signed our legislation into law and 11 other states (California, Colorado, Connecticut, Florida, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Montana, and Pennsylvania) are considering the legislation. Additionally, in April, APA presented on mental health parity at the National Association of Insurance Commissioners (NAIC) spring meeting. The presentation was well-received and the relevant NAIC committee is now considering the possibility of creating a new parity subcommittee.

Safe Prescribing

Ten states have seen some form of psychologist prescribing legislation introduced this legislative session. APA has worked closely with District Branches and State Associations (DB/SAs) across the country to address this legislation, and through the hard work and dedication of members, legislation in six of those states has been prevented from moving forward. With continued collaboration between DB/SAs and APA, the outlook is positive for other states who are still working to ensure safe prescribing in their states. Additionally, the Oklahoma DB and APA worked closely together to stop legislation that would have added psychologists to the definition of “physician” within Oklahoma law; there could have been serious unintended legal consequences if the legislation had moved forward.

Expanding Access to Care

APA continues to work with states to expand access to mental health care. These efforts include our work to support Medication Assisted Therapy (MAT) coverage, which is included in APA’s model parity legislation, and telemedicine as well as our efforts to oppose cost-control policies imposed by insurance companies like prior authorization, step therapy, and restrictive preferred drug lists in Medicaid.

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