The last few months have seen significant movement across a broad array of issues.
APA-Led Activities
No Surprise Act Advocacy Continues
APA submitted comments to CMS regarding the first set of regulations issued to implement the No Surprises Act and expressed concern that the law could have unintended results: increasing financial stress for inpatient psychiatric units could hasten the loss of beds as demand is rising and there is a growing shortage of psychiatrists. APA urged the following:
- A requirement that insurers create adequate networks of clinicians to treat mental health and substance use disorders – in accordance with the Mental Health Parity and Addiction Equity Act.
- A requirement that insurers streamline the approval process for joining a network panel to no more than 30 days.
APA also wrote to CMS regarding the second set of regulations issued to implement the No Surprises Act and expressed concern that the independent dispute resolution protocol, laid out in the regulations, does not reflect the statutory language. APA signed onto a letter with AMA and other medical associations expressing similar concerns.
Educational materials have been created and circulated to APA members to assist with the implementation of the Good Faith Estimate requirements put in place as part of the administrative interpretation of the legislation as it related to patient protections and price transparency. APA will continue outreach to the Administration to reduce administrative burdens and potential impact on patient care.
HRSA Announces New Administrator, Carole Johnson
The Health Resources and Services Administration (HRSA) recently announced that Carole Johnson will serve as Administrator of the agency. Ms. Johnson currently serves as the Testing Coordinator for the White House COVID-19 Response Team and previously served as Commissioner of the New Jersey Department of Human Services where she oversaw Medicaid, food assistance, childcare programs, and mental health and addiction services. Ms. Johnson also served for more than five years as the White House Domestic Policy Council’s public health lead in the Obama Administration, which included oversight of HRSA issues. In addition, Ms. Johnson has worked on health care and health policy on Capitol Hill, in academia, and in the non-profit and philanthropy sectors.
HHS and CMS Announce New Medicaid Option for SUD Crisis Care
The Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) announced a new option for supporting community-based mobile crisis intervention services for individuals with Medicaid. Authorized under the American Rescue Plan Act (ARPA), the new option will help States integrate crisis intervention services into their Medicaid programs to support individuals with mental health and substance use disorders. As described in a press release, while several States have these services in place, ARPA grants CMS new authority to provide States with additional resources and tools to enhance these programs for up to three years. In addition, the Medicaid option will offer flexibility for States to design programs that work for their communities.
Congressional Activities
APA Applauds Passage of MPFS Legislation
Over the past few months, APA worked with colleagues in the House of Medicine to advocate for Congressional action to halt imminent Medicare cuts to physician and other clinician reimbursement. Advocacy efforts surrounded legislation that extends the moratorium on the 2% Medicare sequester cuts until April 1 and reduces the cuts from 2% to 1% from April 1 through June 30. The legislation also stops the 4% statutory Pay-As-You-Go sequester from taking effect. In addition, the legislation extends the 2021 Medicare physician fee schedule conversion factor increase adjustment of 3% through the end of 2022.
The APA has collaborated with other stakeholders over the past few months to encourage Congress to take action on these impending reimbursement cuts. The final bill passed the Senate in December by a 59-35 bipartisan vote, with the House having passed the bill a few days prior. President Biden signed the bill into law on December 10, 2021.
Congress Passes APA-Supported Veterans Legislation
The House and Senate passed the APA-endorsed Veterans mental health bill, H.R. 958/S.796, the Protecting Moms who Served Act. The bipartisan legislation, introduced by Reps. Underwood (D-IL) and Bilirakis (R-FL) and Sens. Duckworth (D-IL) and Collins (R-ME), codified and strengthened the Department of Veterans Affairs (VA) maternity care program aiming to increase access to care during and after pregnancy. The legislation also aims to eliminate maternal mortality, morbidity and disparities amongst veterans and requires the VA to implement a maternity care coordination program and provide community maternity care providers with training and support to accommodate the unique needs of pregnant and postpartum veterans, with a particular focus on mental and behavioral health conditions. The legislation, which was signed into law by President Biden on November 30th, was part of the Black Maternal Momnibus legislative package.
Reconciliation Update
Prior to Thanksgiving, the House of Representatives approved the Build Back Better (BBB) Act, by a margin of 220-213. The “human infrastructure” package included several APA endorsed priorities such civil monetary penalties for parity violations, new Medicare-supported graduate medical education residency slots allocated to psychiatry and other behavioral health training programs, and significant investments in expanding crisis services and Medicaid coverage. The primary Senate committees of health jurisdiction (HELP and Finance) subsequently released their respective draft sections of the package in mid-December, including near identical provisions, but the entire package has since stalled due to the inability of the White House and Senator Manchin (D-WV) to reach an agreement on the current bill. As of now, despite Majority Leader Chuck Schumer’s stated intention to force votes on some or all elements of the package early in the new year, the bill appears to be at an impasse. However, since there was common ground between the Administration and Manchin on a number of the bill’s provisions, there is potential for resurrecting some sort of package in 2022.
Congress Passes Continuing Resolution to Fund Government
In early December, Congress cleared a stopgap funding measure to avert a partial government shutdown, after reaching a bipartisan deal to extend the current funding levels for all federal departments and agencies through February 18. As with the prior stopgap measure enacted in September, the new continuing resolution included extensions of increased Federal Medical Assistance Percentage (FMAP) for Territories as well as the Conrad 30 waiver program. The continuing resolution will buy lawmakers additional time to work towards finalizing overdue appropriations for the fiscal year that began in October.
House Passes Several APA-Endorsed Bills
On December 8, the House passed H.R. 3894, the CARING for Social Determinants Act, and H.R. 2364, the Synthetic Opioid Danger Awareness Act, both of which have now been referred to the Senate with APA's support. Additionally, the House passed H.R. 1667, the Dr. Lorna Breen Health Care Provider Protection Act, with minor changes. The legislation directs resources towards researching and developing policies to prevent health care practitioner burnout and improving support for mental health among health care clinicians. In addition, the legislation aims to remove barriers to health care clinicians accessing mental health and substance use disorder care and treatment, including reducing stigma and addressing licensing concerns. Although the bill was passed by the Senate earlier this year, it will be referred back to the upper chamber for consideration given the changes made by the House.
APA Responds to Senate Requests for Information on MH/SUD
In November, APA sent a letter to Senate Finance Chairman Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) in response to their Request for Information (RFI) regarding how to address the unmet mental health needs that have been exacerbated by the COVID-19 pandemic. The APA Senate Finance RFI response letter highlighted the steps that Congress should take to improve access to effective, evidence-based MH/SUD care and services and promoted strategies to strengthen the health care workforce, increase integration and access to care, and promote mental health parity. APA expects to continue to engage with the Committee on its MH/SUD-related activity as the Committee works to develop MH/SUD legislation later this year and next.
In addition, on November 9, APA sent a letter to Senators Chris Murphy (D-CT) and Bill Cassidy, M.D., (R-LA) to respond to their Request for Information regarding programs authorized through the passage of the 21st Century Cures Act in December 2016. In our response, APA recommended funding increases and detailed support for programs boosting workforce diversity, diverting individuals with serious mental illness away from incarceration, and integrating primary and behavioral health care via the Collaborative Care Model.
APA Supports Safe Step Act
On November 15, APA sent letters to the House and Senate leads of the bipartisan Safe Step Act (H.R. 2163/S.464), which seeks to protect patients from unnecessary or harmful “step therapy” insurance policies. The legislation seeks to reduce the unnecessary use of step therapy by requiring ERISA-covered plans to develop a transparent process, with defined criteria and timelines, through which step therapy protocols may be overridden. The bill would also limit the documentation required to demonstrate the need for overriding a step therapy protocol only to what is “strictly necessary.”
State Activities
APA Works with District Branches to Limit Prior Authorization
APA staff has been working with several District Branches to develop legislation that would limit prior authorization in certain circumstances. APA meets with each District Branch to determine what kind of legislation would work best in each state, and then drafts legislation specific to that state’s codes. If your District Branch is interested in pursuing similar goals, please contact [email protected].
Psychiatric Collaborative Care Model Legislation in the States
Several states are planning on pursuing legislation to expand usage of the Psychiatric Collaborative Care Model as a way to safely increase access to mental health care. To learn more about the Psychiatric Collaborative Care Model and APA’s state model legislation, please visit APA's Collaborative/Integrated Care webpage.