The last few months have seen significant movement across a broad array of issues.
APA-Led Activities
Lessons Learned: The Health Plan Experience With Implementing Collaborative Care
APA, in collaboration with the Association for Behavioral Health and Wellness, sponsored a webinar entitled “Lessons Learned: The Health Plan Experience With Implementing Collaborative Care” featuring William Beecroft, MD, DLFAPA Medical Director, Behavioral Health Strategy and Planning, Blue Cross Blue Shield of Michigan and Vik Shah, MD, MBA, National Medical Director for Quality & Network Performance, Cigna. To view the webinar, click here and use the passcode 9ZbWu*LT.
Executive Branch Activities
Coalition Expresses Concern with Upcoming CMS Changes to Split Visits
APA joined two coalition letters to CMS raising concerns and urging them not to move forward with the previously finalized changes to split or shared visits. The group proposed an alternative policy, which would allow physicians or qualified health professionals to bill split or shared visits based on time or medical decision-making. The letters requested CMS to seek further input from stakeholders to ensure that the revised policy does not have any unintended consequences for patients or physician-led team-based care.
APA Comments on NCQA’s Annual Update to HEDIS Measures
HEDIS, a set of measures assessing health plan performance across a range of domains related to healthcare quality and patient experience, is updated by the National Committee for Quality Assurance (NCQA) annually. This year, APA provided feedback to NCQA on measures addressing social risk screening and intervention, deprescribing of benzodiazepines in older adults, as well as an NCQA proposal to expand race and ethnicity stratification to select HEDIS measures.
APA Asks HHS to Delay Clawbacks of the Provider Relief Fund
APA joined the American Medical Association, the Medical Group Management Association, and others in a letter asking the Department of Health and Human Services to delay clawbacks of funds provided through the Provider Relief Fund. Many practices were unaware of the reporting deadline. According to a HRSA FAQ document, PRF funds are grants that do not have to be repaid, but providers must attest to receiving these funds and comply with the applicable terms and conditions of the fund. HHS asked providers to pay around $100 million in pandemic assistance back by April 10 for failing to comply with the agency's reporting requirements and deadlines.
APA Sends Letter to State Department and USAID on Ukrainian MH/SUD Assistance
On March 22, APA joined a letter to Secretary Anthony J. Blinken of the U.S. State Department and Administrator Samantha Power of the U.S. Agency for International Development (USAID) to thank them for their efforts in addressing the current humanitarian crisis unfolding in Ukraine. In the letter, we encouraged coordination with our world partners, such as the United Nations’ Children’s Fund (UNICEF) and the World Health Organization (WHO) to help address the inevitable mental health and substance use needs caused and exacerbated by Russia’s invasion of Ukraine. The letter expresses gratitude that the international community continues to help treat Ukrainian refugees for illnesses like HIV/AIDs and cancers and calls for parity in response for mental health and substance use disorder treatment, which historically is overlooked in global crisis response. APA will continue to monitor the situation in Ukraine, and we are ready to assist in addressing the MH/SUD needs associated with this crisis.
Congressional Activities
APA Members and President-Elect Testify Before Congressional Committees
On March 30, the Senate Finance Committee held its third mental health hearing of the year entitled “Behavioral Health Care When Americans Need It: Ensuring Parity and Care Integration.” APA member Anna Ratzliff, M.D., a Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington, testified on behalf of her university on the importance of effective integrated behavioral health care, and how this can be achieved using APA’s priority legislation, H.R. 5218, the Collaborate in an Orderly and Cohesive Manner Act. Senators asked witnesses to explain the collaborative care model (CoCM), and how this model can positively impact the current workforce shortage and help ensure mental health parity.In preparation for this hearing, the Committee released a new report entitled, "Mental Health Care in the United States: The Case for Federal Action," which details the Committee’s next steps to address gaps in mental health care. APA will continue to engage with the committee as it works to address the mental health and substance use disorder crises.
Additionally, on April 5, APA President-Elect Rebecca Brendel, M.D., J.D., testified before the House Energy and Commerce Committee’s Health Subcommittee in a hearing that focused on more than a dozen bi-partisan mental health bills, including APA’s priority legislation, H.R. 5218, which encourages uptake of CoCM. The hearing, which included two panels of witnesses, also featured the testimony of APA members Steven Adelsheim, MD, and Debra Pinals, MD, who respectively participated on behalf of Stanford Children’s Health and the National Association of State Mental Health Program Directors. Dr. Brendel’s written testimony can be read here.
APA Holds Bipartisan 988 Briefing with House Energy and Commerce Staff
On April 18, APA partnered with the National Association of State Mental Health Program Directors (NASMHPD) and the National Association of Counties (NACo) to provide a briefing for House Energy and Commerce majority and minority staff on the forthcoming launch of the new three-digit National Suicide Prevention Lifeline. The briefing, which included Carrie Slatton-Hodges, Commissioner of the Oklahoma Department of Mental Health and Substance Use, as well as representatives from each organization, focused on priority state and local needs in strengthening crisis services to support the initial launch of 988 in July and the subsequent implementation of the number throughout states. APA will continue to work with stakeholders to support the 988 launch and to expand access to the full continuum of crisis services.
APA Responds to the Healthy Future Task Force Modernization Subcommittee RFI
On March 6, APA sent a letter to Representatives Morgan Griffith (R-VA), Mike Kelly (R-PA), and Mariannette Miller Meeks (R-IA) of the Healthy Future Task Force Modernization Subcommittee in response to their Request for Information (RFI) on additional legislative steps Congress should take to improve access to effective, evidence-based mental health and substance use disorder (MH/SUD) care and services. In our letter, APA gave recommendations on how to address the current MH/SUD crisis, including making current pandemic telehealth flexibilities permanent and how this will ensure continuity of care and stability for both provider and patient. Additionally, our letter details how integrating primary and behavioral health care through the Collaborative in an Orderly and Cohesive Manner Act (H.R. 5218), can reduce the workforce shortages that employers and plans are experiencing in medically underserved areas. APA will continue to engage with the Task Force as they examine policies related to MH/SUD.
APA Sends Thank You Letter to Congress for Passing Dr. Lorna Breen Bill
On March 8, APA joined a letter to Senators Tim Kaine (D-VA) and Todd Young (R-IN) and Representatives Susan Wild (D-PA) and David McKinley (R-WV) for their work in championing the P.L. 117-105, the Dr. Lorna Breen Health Care Provider Protection Act. This bill addresses the high rates of burnout and suicide among health care providers by making mental and behavioral health resources more readily available. The legislation was named in honor of Dr. Lorna Breen, a Manhattan emergency room physician in practice at the New York Presbyterian Hospital who tragically died by suicide in April 2020 after being on the frontlines of the COVID-19 pandemic without receiving proper mental health care. On March 18, 2022, President Biden signed this bill into law. APA will continue to support bills that provide resources for physicians to receive the mental health care they need.
APA Sends Thank You Letters to House and Senate Champions of Parity
On March 13, APA sent a letter to Senators Chris Murphy (D-CT) and Bill Cassidy (R-LA) to thank them for their leadership in helping to strengthen compliance with the Mental Health Parity and Equity Act (MHPAEA). We also sent four nearly identical letters to champions of parity in the House, including Rep. Tony Cárdenas (D-CA), Rep. Gus Bilirakis (R-FL), Rep. Katie Porter (D-CA), and Rep. Brian Fitzpatrick (R-PA). In addition to these letters, APA also sent an action alert to APA members to highlight the recent Department of Labor parity report, which details how insurers and health plans are out of compliance with the MHPAEA. The alert encourages individuals to reach out to Congress and urge passage of the Parity Implementation Assistance Act (H.R. 3753/ S. 1962), which would help state insurance departments step up their parity enforcement. APA will continue to engage with Congress regarding mental health parity.
President Signs Fiscal Year 2022 Omnibus Spending Bill into Law
On March 15, President Biden signed the $1.5 trillion Omnibus spending package into law to keep federal agencies funded through September 30, 2022. The 2700-page bill, which was accompanied by supplemental aid to Ukraine, contained several APA supported provisions, including increased funding for crisis services via the SAMHSA Mental Health Block Grant, as well as for the SAMHSA Minority Fellowship Program, and an extension of increased federal medical assistance percentage (FMAP) for Puerto Rico and U.S. Territories. The bill also provides for a 151-day continuation of several telehealth flexibilities set to expire at the conclusion of the current public health emergency, including the delayed implementation of the requirement that Medicare patients seeking mental health services have an in-person evaluation within six months of the first telehealth visit with their clinician. The bill also creates a new Mental Health Crisis Response Partnership Pilot Program, which would provide $10 million to help communities create or enhance mobile crisis response teams designed to divert the response for mental health crises from law enforcement to behavioral health teams. APA will continue to monitor these programs and their funding allocations in the forthcoming Fiscal Year.
Biden Administration Releases FY 2023 Budget
On March 28, the Biden Administration unveiled its Fiscal Year (FY) 2023 budget request to Congress. The $5.8 trillion spending blueprint includes a proposed $1.64 trillion increase in discretionary spending for the Fiscal Year which begins October 1, a roughly 9 percent increase over the $1.51 trillion enacted in the fiscal 2022 omnibus bill earlier this month. In addition to increasing funding for APA priorities such as the SAMHSA Minority Fellowship Program and Community Mental Health Services Block Grant, the proposed budget also directed significant resources towards enforcing mental health parity requirements ($125 million over five years) and to bolster resources for parity enforcement via the Department of Labor ($275 million over 10 years). The budget also proposed to apply the Mental Health Parity and Addiction Equity Act (MHPEA) – the federal parity law – to Medicare, eliminate the 190-day lifetime limit on psychiatric hospital services, require Medicare to cover three behavioral health visits without cost sharing, eliminate Medicaid funding caps for Puerto Rico and other Territories, and extend telehealth coverage under Medicare beyond the COVID-19 Public Health Emergency. APA will continue to work with Congress via the appropriations process to support and advance aspects of the Biden agenda which are supported by the APA.
State Activities
APA Releases Safe Prescribing Toolkit for DBs after Messaging Project
With psychologist prescribing legislation in several states this year, APA commissioned polling, messaging, a website (www.saferxprescribing.org) and graphic design to help District Branches oppose psychologist prescribing legislation while supporting real solutions to increasing access to mental health care. Several of the graphics and talking points can also be used to counter scope expansion attempts by other non-physicians.
APA initiated polls of registered voters in ten target states and questions were also posed in a nationwide poll. 78% of those polled said that only those with a medical degree and state license to practice medicine should be allowed to prescribe psychiatric medications. Only 13% of those polled nationally thought that psychologists should lead patient care that includes prescribing. A toolkit with newly created advocacy tools and polling results has been delivered to APA District Branch presidents, legislative representatives, and executive directors for use by the District Branches.
APA Works with District Branches Opposing Scope Expansion Legislation
While psychologist prescribing is a concern for many states this legislative session, even more states are facing legislation seeking to remove physician involvement from all patient care. In states that temporarily expanded scope of practice during the pandemic, non-physicians are hoping to have these expansions codified and made permanent. APA has assisted states like Colorado and South Dakota in defeating physician assistant independent practice legislation this year, and has worked with states like Colorado and Tennessee to stop legislation that would allow nurse practitioners to involuntarily commit patients without physician involvement. Additionally, Indiana passed “Truth in Advertising” legislation, requiring any advertisements that include a practitioner’s name to prominently state the license or profession (as allowed by the board’s governing statute or rules) held by the practitioner. The bill also limits the use of medical specialty designations. APA continues to work with District Branches that seek APA’s help opposing scope expansion legislation and supporting legitimate methods to increase access to care.
Georgia Passes Mental Health Parity Law
Mental health parity legislation, HB 1013, was recently passed by both the Georgia House and Senate and sent to Governor Kemp for his signature. Both the Georgia Psychiatric Physicians Association and APA worked closely with other stakeholders in the state to secure the bill’s victory. Upon passing the legislation, Georgia House Speaker David Ralston said “Today, countless Georgians will know we have heard their despair and frustration. We have set Georgia on a path to lifting up and reforming a failed mental health care system." APA’s state model parity legislation has also been signed into law in 15 states (AZ, CO, CT, DE, IL, IN, KY, MD, MT, NV, NJ, OK, OR, TN, WV) and DC. APA is working closely with Georgia as they pursue parity legislation HB 1013, and assisting states like Arizona, Maryland, Oregon, Texas, and others on their parity regulatory processes. To learn more about APA’s state model parity legislation, visit this link.
Illinois Works To Expand Equity and Representation in Health Care
The Illinois Equity and Representation in Health Care Act aims to increase racial and ethnic diversity among health care providers, including psychiatrists, through scholarship and loan repayment programs. The bill references a 2021 study conducted by the National Institutes of Health, which found significant underrepresentation among Black, Hispanic, and Native American people across 10 different health care provider designations. The scholarship and loan programs established through HB 4645 will encourage health care providers to locate and practice in areas of greatest need, as determined by provider shortage area data or health disparity data, and to support efforts for health care providers to better reflect the communities they serve. The House and Senate unanimously passed the bill, which awaits House concurrence with a Senate amendment and will be sent to Governor JB Pritzker, who is expected to sign the bill into law. To share how your District Branch is working for equality, inclusion, and representation, please contact [email protected].