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

APA Led Activities:

APA Offers Solutions to Expand Access to Mental Health Care in Underserved Communities

APA responded to the U.S. House of Representatives Ways and Means Committee request for information on bipartisan policy options to improve rural and underserved community health care delivery and health outcomes. APA suggested that the Committee support policies that:

• Expand access to the collaborative care model,
• Increase utilization of telepsychiatry, and
• Improve cultural and population-specific data collection to expand medical health research.

Mental Health and Criminal Justice Groups Offer Mental Health Policy Recommendations

APA is a major partner in a coalition that advocates for improvements to how the criminal justice system addresses behavioral health. Recently, the coalition released a comprehensive list of policy recommendations, which was highly informed by the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC), on which many APA members served.

Executive Branch Activities:

APA Comments on ONDCP’s Drug Court Efforts

The Office of National Drug Control Policy (ONDCP) requested public comments regarding adult drug courts’ efforts to serve patients with opioid use disorder (OUD). In its comments, APA commended ONDCP’s expansion of evidence-based treatments for vulnerable patients in the criminal justice system, but also urged the agency to ensure that drug courts provide high-quality, culturally-, and gender-relevant evaluation, treatment, and monitoring to all individuals seen through the drug court system.

Furthermore, APA’s comments urged ONDCP to consider the stigma and misinformation that has been attached to medication treatment for substance use disorders and, furthermore, ensure that individuals in drug courts have access to all evidence-based medications for OUD and that decision making be appropriately provided by trained medical professionals.

Congressional Activities:

APA Applauds Mental Health Funding in Federal Spending Bill

President Donald Trump signed the congressionally passed $1.4 trillion fiscal year 2020 spending bill on December 20th, 2020. APA successfully advocated for several of the provisions within the package, including:

• Combatting the Opioid Epidemic: In addition to funding state opioid response grants and research, the bill also includes $12 million in new funding for a student-loan repayment program for the SUD workforce and $26.7 million in new funding to establish grants to train professionals to provide treatment for mental illness and SUD.
• Firearms Injury Prevention: The National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC) both received $12.5 million to take a comprehensive approach to studying the underlying causes and evidence-based methods of prevention of firearm injury.
• $5.9 Billion for SAMHSA: This includes a $1 million increase in funding for the Minority Fellowship Program as well as funds for many other important mental health programs.
• Increased Funding for Medical Research: NIH was provided a 6.7 percent increase in funding and the National Institute of Mental Health's budget was increased by $155 million.

During APA's Federal Advocacy Conference, attendees lobbied Congress for the $12 million in new funding for the student-loan repayment program.

APA and Mental Health Advocates Support Bipartisan Suicide-Prevention Legislation

APA and other members of the Mental Health Liaison Group expressed support for the Suicide Training and Awareness Nationally Delivered for Universal Prevention (STANDUP) Act, S. 2492. This bipartisan legislation seeks to prevent youth suicide by encouraging state and local educational authorities to implement suicide awareness and prevention training policies for children and adolescents. Sen. Cory Gardner (R-CO) and Sen. Doug Jones (D-AL) introduced the STANDUP Act in the U.S. Senate.

State Activities:

APA Continues to Assist District Branches and State Associations with Next Year’s Legislative Agenda

While APA continues to work with DB/SAs whose legislatures are still in session, it is also learning about DB/SAs’ legislative goals and concerns for next year. 2020 will be a very busy legislative session with states tackling a number of important legislative issues next year, including:

• Parity,
• Scope of practice,
• Collaborative Care model reimbursement
• Prior authorization, and
• Medical marijuana.

Please contact [email protected] if you would like to discuss advocacy training, legislative strategy, or any other state legislative matters.

Rep. Dean Phillips Attends Minnesota Psychiatric Society 2019 Fall Program

The Minnesota Psychiatric Society’s fall conference focused on addressing the barriers to mental health care that are resulting in overutilization of emergency rooms. Rep. Dean Phillips (D-MN) addressed the well-attended meeting and provided a federal perspective on policies that can increase access for patients. The program concluded with plans to continue the conversation with coordinated, tangible next steps teaming psychiatry with emergency physicians and other stakeholders to find ways to improve access to psychiatric referrals and reduce emergency room boarding issues.

New Jersey Meets with State Policymakers During Advocacy Day

The New Jersey Psychiatric Association held its advocacy day in early December. NJPA members met with key staff from Governor Phil Murphy’s office and the state legislature to discuss their legislative priorities, including combating the opioid crisis in the state, implementation of New Jersey’s parity bill, and expansion of the Collaborative Care Model. NJPA will continue to advocate on these issues when the legislature reconvenes in early 2020.

APA Responds to Georgia’s 1332 and 1115 Waiver Requests

APA submitted comments in opposition to Georgia’s proposed 1332 waiver and adding work requirements to its 1115 waiver proposal expanding Medicaid. Under the 1332 waiver proposal, all or part of four major provisions of the Affordable Care Act (ACA) appear to be waived. This would include section 1301(a), requiring Qualified Health Plans (QHP) to cover the essential health benefits (EHBs) that requires coverage of mental health and substance use disorders as well as section 1311(c) that requires the Department of Health and Human Services to develop QHP certification standards related to discriminatory benefit design, network adequacy, essential community providers, accreditation, quality improvement, standard format to compare plans, and quality ratings.

It also requires mental health parity protections apply to QHP and leaves uncertain if the state would have to comply with section 1557, the nondiscrimination provision of the ACA that is not dependent on regulations. The law prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities. Without the requirements of the EHB, parity compliance, and 1557, APA expressed concern that services for the most chronically ill and complex patients would be scaled back.

Concerns were raised about the effort to impose work requirements on Medicaid patients under the 1115 waiver. Under the proposal, the effort to expand Medicaid to those working at least 80 hours a month and with incomes below 100 percent provides unnecessary barriers to coverage. People with mental illness and/or substance use disorder also face unique barriers to stable employment due to their fluctuating ability to function, which can lead to job loss. These patients disproportionately have criminal records, often tied to their medical conditions.

Additionally, research shows that patients with serious mental illnesses die years earlier than the general population, with the majority of them perishing due to physical health conditions. Taking coverage away from these patients will likely lead to delayed treatment and costly physical and mental health outcomes.