November 21, 2019

November 2019: Advocacy Update

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

Webinar: How Can Boarding of Psychiatric Patients Be Reduced? Join us for a webinar hosted by APA, the American College of Emergency Physicians, and the Coalition on Psychiatric Emergencies on Wednesday, December 11 at 3:00pm ET to identify how communities and emergency departments can mitigate the problem of psychiatric boarding in Emergency Departments, and the role of psychiatrists to improve care for patients based on APA’s Resource Document, Boarding of Mentally Ill Patients in Emergency Departments. Register Now.

APA Supports Bill Expanding Access to Mental Health Services Provided Via Telehealth

APA applauds the re-introduction of H.R. 4932 / S. 2741, the CONNECT for Health Act, which would improve access to telehealth mental health services by designating the patient’s home as the “originating site” for patients and eliminating the geographic requirements for coverage of telehealth mental health services. APA’s long-time support for this legislation was recognized by Sen. Wicker (R-MS) during the sponsors’ press conference announcing the legislation. This bipartisan legislation is sponsored by U.S. Senators Brian Schatz (D-HI), Roger Wicker (R-MS), Ben Cardin (D-MD), John Thune (R-SD), Mark Warner (D-VA.) and Cindy Hyde-Smith (R-MS) and U.S. Representatives Mike Thompson (D-Calif.), Peter Welch (D-Vt.), David Schweikert (R-Ariz.), and Bill Johnson (R-Ohio).

CMS issues 2020 Physician Fee Schedule and MIPS

The Center for Medicaid and Medicare Services (CMS) recently issued its final rule for the 2020 Physician Fee Schedule and the Merit-based Incentive Payment System (MIPS). The final rule updates payment policies, payment rates, and other provisions for services furnished on or after January 2, 2020. Highlights for psychiatry include several items relating to outpatient evaluation and management (E/M) services that will take effect in 2021, including an increase in payments for outpatient evaluation and management services, as well as changes to the corresponding documentation requirements for these same services in 2021. CMS has dropped the requirement that psychiatrists can only bill based on time, when the majority of the session is spent in counseling and coordination of care. As of 2021, providers will be able to bill based on time (for outpatient E/M services), regardless of the focus of the encounter. Note this will not apply when also providing psychotherapy. CMS has also created an E/M add-on code to use for complicated patients.

For 2020, in regards to the use of and reimbursement for technology in clinical practice, CMS has approved bundled payment for physicians providing outpatient MAT services to patients with opioid use disorders, adding these new codes to the list of telehealth services. They have also begun to cover for care in Opioid Treatment Centers. CMS has reaffirmed that services for patients with substance/opioid use disorders, along with co-occurring mental health disorders, can be done via telehealth, without geographic restrictions. CMS has made a number of changes under the Quality Payment Program (QPP), including removing quality measures from the mental health measure set. Changes were made to existing episode-based cost measures, the third component of the MIPS program, that work to improve the attribution methodology so that physicians are not penalized inappropriately. CMS has also maintained the current percentage allocated to the episode-based cost measure component.

For the MIPS Promoting Interoperability Performance Measure, the amount of points assigned to that category remains the same from 2019, with some minor distribution among specific measures and the elimination or reduction of some specific reporting requirements. More information on MIPS can be found on the Quality Payment Program resource site. CMS will replace the MIPS program with the MIPS Value Pathway (MVP) program, which incentivizes the development of condition-specific measure sets, and corresponding cost measure and performance improvement activities. APA will be updating relevant educational materials and resources on the APA website.

APA Responds to CMS on Expanding 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 Joins Medical Community in Expressing Concern About Administration’s Actions on Medicare

On October 29th, APA joined a letter to Health and Human Services Secretary Alex Azar expressing concern about President Trump’s October 3rd executive order titled “Protecting and Improving Medicare for our Nation’s Seniors.” The letter raises concerns about unclear language in Section 5 of the order that appeared to “propose a regulation to eliminate or weaken current Medicare supervision requirements of nonphysician professionals.” The letter also clarifies that, while nonphysician health care professionals are an integral part of physician-led health care teams, “their skillset is not interchangeable with that of a fully trained physician.”

APA Supports Trump Administration’s Proposal to Ban Flavored E-Cigarettes

APA joined 66 health and medical organizations to express support for the Trump Administration following through on its September 11th proposal to protect children and adolescents by removing flavored e-cigarettes from the market. The joint statement was released amid concerns that the White House is backtracking from that initial proposal and expressed the groups’ consensus that the Administration should ‘swiftly and fully implement” the plan, which would “play a critical role in reversing the youth e-cigarette epidemic and preserve the health and well-being of our nation’s children.

APA Backs Legislation That Would Increase Access to MAT

APA sent a letter of support for legislation that seeks to protect Medicaid beneficiaries’ access to medication-assisted treatment. Representatives Paul Tonko (D-NY) and David McKinley (R-WV) introduced HR 3925, the Reducing Barriers to Substance Use Treatment Act, which would prohibit state Medicaid programs from imposing utilization control policies, such as prior authorization, on MAT coverage. APA argues that these policies increase the risk of harm to patients and the burden on physicians “at a time when the patient requires treatment as quickly as possible.”

APA Leads Physician Groups in a Call for Firearm Mortality Prevention Research Funding

APA led an effort with five other frontline physician associations to urge congressional leadership to agree to the House-passed proposal to provide the CDC and NIH with $50 million to conduct public health research on preventing firearm-related morbidity and mortality in fiscal year 2020.

APA/TPA Oppose Tennessee’s Proposed Medicaid Block Grant

APA and the Tennessee Psychiatric Association submitted a letter in opposition to the state’s proposal to block grant Medicaid through the waiver process. Our comments highlight that this policy would likely limit access to quality care for Medicaid patients. APA is concerned that Tennessee’s effort to seek relief from federal requirements may allow it to bypass parity compliance in Medicaid managed care programs that protect patients with mental health and substance use disorders (MH/SUD). APA also raised concerns around the proposal’s intent to implement a drug formulary that would impact patient access to effective medications and also address the current state of MH/SUD needs in Tennessee.

Pennsylvania Insurance Department Levies Significant Fine Against Insurer for Parity Noncompliance

The Pennsylvania Insurance Department (PID) levied a $1 million civil monetary penalty against United Health Care for numerous violations of the federal parity law. United also agreed to spend $800,000 to educate its enrollees about how to best access their mental health and substance use disorder benefits. APA has provided PID with ongoing technical assistance on parity since 2016, helping the department become the leading state regulator on parity.

Must Read: PsychNews Explores Veteran Care and Access Issues: APA’s Council on Advocacy and Government Relations is partnering with PsychNews to publish a series of articles to further highlight the advocacy efforts of APA members. In the latest article of this series, Dr. David Peyok, a second-year fellow on CAGR, explores the opportunities and challenges of community-based mental health care to veterans during the implementation of the VA MISSION Act. Dr. Peyok is currently a fourth-year psychiatry resident at the Jack C. Montgomery VA Medical Center in Muskogee, OK. Read Now

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