The last few months have seen significant movement across a broad array of issues.
APA-Led Activities
Behavioral Health Integration Webinar Series
APA is working with other leading medical association to implement the American Medical Association’s Behavioral Health Initiative (BHI) Collaborative, a webinar series to enable physicians to sustain a collaborative, integrated, whole-person, and equitable approach to physical and behavioral health care in their practices during the COVID-19 pandemic and beyond.
New Schizophrenia Guideline Resources
New resources to accompany the APA Practice Guideline on the Treatment of Patients With Schizophrenia are now available: clinician and patient guides as well as two CME-related activities, a Performance in Practice Assessment Tool and SMI Adviser webinar. APA contracted with GuidelineCentral to create pocket guides for clinicians and patients. One clinician guide covers assessment and treatment of schizophrenia and another is specific to treating patients who may develop tardive dyskinesia as a result of some medications used to treat schizophrenia. A guide for patients, families, and friends is also available. It contains comprehensive information for patients and caregivers including psychosocial support, medications and their side effects, recovery, relapse and frequently asked questions. Digital and hard copy versions are available.
42 CFR Part 2 Update
The Center of Excellence for Protected Health Information (CoE-PHI) prepared answers to frequently asked questions that were raised by participants during the "Understanding the Final Rule for 42 CFR Part 2 and Next Steps" webinar hosted by APA, AAAP, and ASAM.
In addition, on December 14, 2020, SAMHSA released a final rule to make a technical change to 42 CFR Part 2 regarding the phrase “allegedly committed by the patient”. APA opposed the change when proposed and will work with the Biden Administration to amend.
Executive Branch Activities
APA Applauds the Biden Administration’s Executive Orders to Rescind Discriminatory Policies and Strengthen Health Insurance Coverage
As President Biden took office, he issued Executive Orders that APA strongly supports and had previously advocated, such as removing the ban on transgender people serving in the military, repealing the order that silenced diversity initiatives, and prohibiting discrimination on the basis of gender identity or sexual orientation.He also issued a series of action on immigration to address concerning policies and released an Executive Order to strengthen access to quality, affordable health coverage. APA is working with the Administration on implementation of the orders.
APA Opposes Changes to Part D Protected Classes
In the final days of the Trump Administration, CMS launched the Part D Payment Modernization Model (the “PDM Model” or the “Model”) to voluntarily test the impact of a modernized Part D program design that includes flexibilities. It would permit Part D sponsors approved for participation to treat five of the six protected classes – anticonvulsants, immunosuppressants, antidepressants, antipsychotics, and antineoplastics) as they would any other Part D drug. This could jeopardize beneficiary access to medically necessary prescription drugs and harm patients with serious illness such as cancer, HIV/AIDS, epilepsy, mental health issues, and transplant patients. APA has been working with other impacted organizations to ask Biden to not move forward with the flexibilities and rescind the policy.
President Biden Announced Members of the Biden-Harris Administration COVID-19 Health Equity Task Force
On February 10, the administration announced members of the COVID-19 Health Equity Task Force, which will provide recommendations for addressing health inequities caused by the COVID-19 pandemic and prevent such inequities in the future. Included on the Task Force is Octavio Martinez, MD, MPH, MBA, FAPA, the executive director of Hogg Foundation for Mental Health and a licensed psychiatrist.
Addressing Systemic Racism Through Clinical Preventive Service Recommendations From the US Preventive Services Task Force
USPSTF is creating a roadmap that will be guided by a workgroup commissioned to develop and advance the USPSTF approach to how systemic racism affects preventive health care. Throughout this process, the USPSTF will assess the effect of changes made in its approach and methods for making recommendations and iteratively modify its actions to achieve the goal of improving health equity through evidence-based clinical preventive services.
Surgeon General Releases Call to Action to Implement National Strategy for Suicide Prevention
On January 19, the U.S. Department of Health and Human Services (HHS) and the Office of the Surgeon General - in collaboration with the National Action Alliance for Suicide Prevention - released the Surgeon General’s Call to Action to Implement the National Strategy for Suicide Prevention. This new report outlines the actions that communities and individuals can take to reduce the rates of suicide and help improve resilience.
APA Urges CMS to Permanently Cover Audio-Only Services
As a result of CMS lifting restrictions on telehealth and recognizing the value of audio-only care during the nationwide COVID-19 Public Health Emergency, many vulnerable populations have been able to access necessary care. In a letter to CMS, APA strongly urged the administration to support permanent coverage for audio-only services for those beneficiaries when there lacks a reasonable alternative and is medically appropriate. These services are seen as the digital equalizer for those who lack access to broadband internet or video-enabled devices, and for those who cannot utilize dual audio-video devices. Although CMS’ establishment of an additional virtual visit code (G2252) for patient evaluation and assessment to determine the need for an in-person visit, is important, it does not go far enough. Coverage of audio-only services for routine care can serve as a response to the long-lasting impacts the COVID-19 crisis will have on vulnerable populations. Permanent audio-only care for beneficiaries, as well as equitable reimbursement for these services, will eliminate artificial barriers to care.
APA Cautioned CMS About Proposed Episode-Based Cost Measures Related to Mental Health Conditions
APA recently submitted comments in response to CMS’ proposal to develop episode-based cost measures (EBCM) used in the MIPS program to attribute the cost of an episode of care for patients with specific mental health conditions. APA expressed concerns that if not done properly, the measure could worsen health disparities and urged CMS collaboratively with us.
Congressional Activities
The American Rescue Plan Act of 2021 Impact on Mental Healthcare System
The American Psychiatric Association supported the inclusion of several provisions important to mental health in the $1.9 trillion coronavirus relief package, the American Rescue Plan Act of 2021, which President Joe Biden signed into law on March 11,2021. The final package includes approximately $4 billion in funding for programs that support prevention of and treatment for mental health and substance use disorders.
APA-supported provisions include funding for:
- Mental health/substance use disorder (SUD) services through the Community Mental Health Services Block Grant and Substance Abuse Prevention and Treatment Block Grant.
- The Dr. Lorna Breen Health Care Provider Protection Act, which supports training, educational programs and other initiatives designed to promote mental and behavioral wellness for frontline health care workers.
- Community behavioral health services, such as the National Child Traumatic Stress Network, Project AWARE (Advancing Wellness and Resiliency in Education), youth suicide prevention and Certified Community Behavioral Health Clinics.
Additionally, this package included multiple provisions that expand eligibility for premium assistance for individuals under the Affordable Care Act and incentives for more states to expand coverage for Medicaid. It also established pediatric mental health care access grants that will promote mental health integration with pediatric primary care. Finally, a portion of the significant funding provided to reopen elementary and secondary schools may be dedicated to mental health services.
APA is already working with the Administration to support these programs’ implementation.
APA Urges Additional Support for Medicaid During Pandemic
APA joined eight other physician associations in urging Congressional leadership to continue to provide additional resources to state Medicaid programs for at least a year after the public health emergency declaration expires.
Physician Groups Unite to Address Racial Health Inequities and Maternal Deaths
APA and five other frontline physician associations joined in applauding Senator Cory Booker (D-NJ) and Representatives Lauren Underwood (D-IL) and Alma Adams (D-NC) for introducing the Black Maternal Health Momnibus Act of 2021. This large legislative package aims to eliminate racial health inequities and preventable maternal deaths. The legislation focuses on ensuring that all patients receive high-quality, individual and respective care and includes a provision that supports culturally congruent care through collaboration with physicians. APA will continue to monitor this legislation as it progresses through the legislative process.
State Activities
Advocacy Webinar Available to Members Online
On January 26, the Council on Advocacy and Government Relations (CAGR) hosted a members-only webinar entitled “Physician Involvement in Patient Care.” Speakers included members of CAGR, as well as guest speakers Maryland Delegate Terri Hill, MD and Barbara Johnston, Director of Policy and Advocacy for the Mental Health Association in New Jersey. The webinar covered important topics including messaging to legislators about patient safety and access to care, working within coalitions to safely increase access to care, and how to work with APA staff when there is legislation removing patient safety requirements. APA members may view a recording of this webinar at psychiatry.com/unsafe.
Telehealth Legislation
This session, many states have introduced or will introduce telehealth legislation to ensure patients retain increased access to care through this modality. APA has created state model telehealth legislation and APA staff have resources to assist District Branches and members advocating in favor of such legislation, such as infographics, talking points, letters, and grassroots alerts. The Council on Advocacy and Government Relations will be recording a telehealth advocacy webinar soon to benefit members and their advocacy efforts.