APA Council Reports

In late 2022, the 117th Congress passed legislation advancing numerous APA federal legislative priorities including the following:

Two hundred new Medicare Graduate Medical Education residency slots were funded, with 100 of these slots going directly to psychiatry or psychiatric subspecialties beginning in 2026.

Grants to integrate behavioral health with primary care and provide technical assistance to implement the Collaborative Care Model (CoCM).

Reauthorization of the Substance Abuse and Mental Health Services Administration (SAMHSA) Minority Fellowship Program for 5 years as well as an increase in authorized funding for the program.

Extended several telehealth flexibilities established during the pandemic until 2025, including the delay in the 6-month in-person requirement for telemental health.

Authorization of grants to states to enhance enforcement of the Federal parity law.

The APA’s federal legislative agenda includes these priorities:

APA is working with with Representatives Doris Matsui (D-CA) and Bill Johnson (R-OH) to reintroduce bipartisan legislation that permanently removes the 6-month in-person requirement for telemental health services (H.R. 3432). In addition, APA along with other stakeholders successfully lobbied congressional leaders to include the permanent removal of the 6-month, in-person requirement in the new version of the CONNECT for Health Act (H.R. 4189/S. 2061), which is a comprehensive and bipartisan telehealth bill.

APA spearheaded efforts to identify Congressional co-sponsors and worked closely with Representative Bonnie Watson Coleman (R-NJ) and Senator Robert Menendez (D-NJ) on the reintroduction of the Pursuing Equity in Mental Health Act (H.R. 3548/S. 1700). This legislation would provide increased data collection and funding for integrated care models to build a culturally competent workforce and ensure that youth of color have greater access to mental health services.

Bipartisan Senate champions introduced S. 1378, the Connecting Our Medical Providers with Links to Expand Tailored and Effective (COMPLETE) Care Act, which is based on an APA-led initiative. The bill would fund technical assistance and temporarily enhance Medicare payment rates for behavioral health integration services (for 3 years) to incentivize primary care to develop and implement integrated care models such as the Collaborative Care Model (CoCM.)

APA President Petros Levounis, M.D., M.A., took part in a Group of Six Leadership (G6) fly-in. During the lobby day, representatives of the six physician organizations (AOA, AAP, ACOG, AAFP, ACP, and APA) met with key House and Senate member and leadership offices to advocate to enact important legislation focused on physician payment, access to mental health care, and increasing the health care workforce.

APA member Robert Trestman, Ph.D., M.D., Chair of APA’s Council on Health Care Systems Financing, testified before the Senate Finance Committee on the inaccuracies and inequities of ghost networks. His APA testimony and responses to questions from Members of Congress focused on improving directory accuracy, increasing mental health reimbursement rates, addressing workforce shortages, and the impact of expanded telehealth and other policies on rural access to care.

APA member Smita Das, M.D., Ph.D., MPH, participated in a congressional briefing entitled, “A National Response to a Deadly Crisis: SUPPORT Full-Spectrum Addiction Care.” The briefing, hosted with the House Bipartisan Mental Health and Substance Use Disorder Taskforce and organized by APA and partner organizations, focused on strategies for Congress to address the current opioid and mental health crises.

APA held a briefing for Congressional staff entitled Maternal Mortality and the Mental Health Crisis. In collaboration with the American College of Obstetricians and Gynecologists (ACOG), Maternal Mental Health Leadership Alliance (MMHLA) and Mental Health Liaison Group (MHLG), the panel examined disparities in maternal mental health and potential federal policies to address the crisis. APA members Dr. Nancy Byatt moderated, and Dr. Denis Antoine served as an SUD issue expert. Congresswomen Lauren Underwood and Robin Kelly both participated and spoke on key maternal health legislation.

APA Climate Committee Chair Dr. Joshua Wortzel participated in a virtual briefing discussing the Community Mental Wellness and Resilience Act. The bill authorizes funding for community-led public health approaches to prevent and heal mental health impacts of natural disasters, toxic stresses and environmental emergencies in the age of climate change. Congressional participants included Representatives Paul Tonko (D-NY) and Don Bacon (R-NE).

APA has continued to partner with district branches and state psychiatry associations across the country in responding to district branch priority legislation, utilizing the experience of CAGR members where appropriate. In 2023, state-led initiatives included supporting mental health parity, the Psychiatric Collaborative Care Model (CoCM), prior authorization reform, and opposing unsafe prescribing.

APA members, including members from CAGR, worked with APA staff to develop legislation to reform the process and eliminate prior authorization for some medications, implement a faster appeals process, and require reviews be conducted by physicians who specialize in the treatment under review. APA has provided this comprehensive prior authorization reform legislation and an advocacy toolkit to all district branches. In 2023, Montana Governor Greg Gianforte signed APA model prior authorization legislation into law. Initiated by the Montana Psychiatric Association, SB 380 prohibits prior authorization in certain circumstances, including for generic prescription drugs, on any drugs that have been prescribed without interruption for 6 months, and on any long-acting injectable medication. The new law also requires that any denial of coverage be made by a physician in the same specialty as the prescriber. Massachusetts and New Jersey are also pursuing APA model prior authorization legislation this year, and other district branches are planning to support similar legislation in 2024.

APA previously developed model legislation designed to require transparency and accountability from insurers and state regulators pertaining to compliance with federal MH/SUD parity law as another proactive solution to ameliorate access-to-care problems. APA’s state model parity legislation has been signed into law in nineteen states (Arizona, Colorado, Connecticut, Delaware, Georgia, Illinois, Indiana, Kentucky, Massachusetts, Maryland, Maine, Montana, Nevada, New Jersey, Oklahoma, Oregon, Pennsylvania, Tennessee, West Virginia) and DC. Several other states have enacted partial versions of this law, while Louisiana, Mississippi, and Texas have enforced the parity law through the regulatory process. APA continues to partner with states to help them achieve full parity compliance. This year, CAGR members from several district branches also met with Department of Labor staff to discuss parity implementation in their states.

To further increase safe access to effective care, APA developed model Collaborative Care legislation for the states, which would require insurers to cover the codes for the CoCM. CAGR members have been key in promoting this legislation and testifying in states where they are constituents. So far, 10 states (Arkansas, Conneticut, Illinois, Louisiana, Massachusetts, Minnesota, Montana, New Jersey, Oklahoma, and Wyoming) have signed APA’s model bill into law, while Maryland, Nevada, and Texas passed legislation requiring Medicaid to cover the Collaborative Care codes. Arizona, Colorado, North Dakota, Pennsylvania, Texas, and Utah have passed bills allocating grant funding to practices interested in expanding the model. APA is working closely with several district branches interested in pursuing the CoCM in the 2024 legislative session.

While district branches have been able to defeat many unsafe prescribing bills the past few years, 2023 has been challenging. This year, many state legislatures have continued to see legislation from nurse practitioners (NP) and physician assistants (PA) seeking new authorizations to practice without physician involvement, and psychologist prescribing bills were filed in 11 states. APA has worked closely with over 35 district branches this year to oppose unsafe prescribing legislation and CAGR members have provided support to APA staff in the development of talking points, educational comparison charts, and other important data. APA continues to oppose psychologist prescribing and the practice of medicine by psychologists, who lack medical training.

In March 2023, Colorado Governor Jared Polis signed psychologist prescribing legislation into law. APA supported the Colorado Psychiatric Society in opposing the legislation. CPS’s close relationships with many legislators, especially Colorado State Senator Kyle Mullica, produced improvements before the bill passed, including strong physician involvement language and a requirement that prescribing psychologists be subject to education and training standards similar to nurse practitioners and physician assistants. Under the new law, prescribing psychologists must undergo a supervised practicum which must be in person and 1:1 with patients. The practicum must be at least 750 hours long and include seeing at least 150 patients, all under the supervision of a physician. The prescribing psychologist may only prescribe with a collaborative relationship with a physician who oversees the patient’s general medical care. Before prescribing, the prescribing psychologist must communicate to the patient’s primary treating physician the intent to prescribe and must receive an electronic written agreement from the physician that the medication is appropriate. The prescribing psychologist must keep the primary treating physician apprised of all lab tests. The new law also includes Truth in Advertising language to require prescribing psychologists to tell their patients they are not physicians prior to treatment. Prescribing psychologists in the state of Colorado must submit to a peer review process approved by the Colorado Medical Board and carry malpractice insurance of $1 million per claim and $3 million per year. The education and certification standards must also be approved by the Colorado Medical Board. APA staff continue to work with district branches to oppose current and future unsafe prescribing bills.

As part of APA’s state advocacy efforts, the Committee for Advocacy and Litigation Funding (CALF), chaired by Dr. Patrick Aquino, reviews district branch and state association grant requests for specific public affairs challenges on the state level. Due to limited budgets in many of APA’s district branches and state associations, CALF grants are heavily relied upon by states when confronting new legislative challenges. Once CALF approves an initial request from a district branch or state association, the request is sent to voting members of CAGR to approve, and the Board of Trustees (BOT) makes the final determination to award a grant. Between September 2022 and August 2023, grants were approved for Arizona, Arkansas, Hawaii, Illinois, Montana, New Mexico, Oregon, and South Dakota.

A Council member co-wrote several articles about the importance of good dental care and mental health and slowing dementia in Psychiatric News, “Interactions between Dental Care and Mental Health Care in Promoting Health and Longevity.”

At the APA Annual Meeting, the Council sponsored several sessions including “Social Media for Seniors: Pros, Cons and Scams,” as well as “Identifying Ageism: Moving Toward Addressing Gaps in Mental Health Care for Older Adults.”

The council presented a webinar on the management of behavioral disturbances and dementia in the nursing home and an APA blog on thriving in old age.

The Council met with the DSM Steering Committee to review changes to criteria for neurocognitive disorders to better reflect clinical practice. The Council concurred with the proposed changes.

The Council is actively discussing this issue considering the CMS audit of nursing homes which found a high rate of new onset schizophrenia diagnoses in nursing home patients on antipsychotics. The Council is working with the AAGP to consider appropriate actions.

Members of the Council voiced concerns regarding a recent article published in Annals of Long-Term Care that advocated for abrupt discontinuation of antidepressants in that setting, with very short term follow up. Several Council members continue to work on a review article to serve as guidance for clinicians to assess antidepressant use in long-term care, make determinations as to when it is appropriate to discontinue these medications, and offer recommendations on gradual reductions, as well as long-term follow-up to quickly identify recurrent depressive symptoms.

The Council is grateful that the APA has been and remains a strong advocate for continued insurance and Medicare coverage to expand access to care for elderly Americans in need of mental health treatment. The APA was involved in the Consolidated Appropriation Act which created 100 additional Graduate Medical Education slots for psychiatry and its subspecialties. The APA is pursuing debt reduction for those pursuing a Geriatric Psychiatry Fellowship. Collaborative care is also a focus with additional funding.

Dr. Nash is representing the Council and the APA as this workgroup updates the dementia quality measures.

The Council is actively reviewing information about the mental health of senior refugees and asylum seekers and considering the best way to present the information.

The Harford-Jeste Award was presented to Dr. Rajaram Manoharan and the Jack Weinberg Award to Dr. Shilpa Srinivasan at APA Annual Meeting during the session “A Clinician’s Guide to the Management of Behavioral and Psychological Symptoms of Dementia in the Era of Boxed Warnings.”

This workgroup, chaired by Dr. Jacqueline Hobbs, has been creating collateral materials to highlight the APA resource document on seclusion or restraint, including a blog post, and an educational webinar. There has been a lot of interest among members regarding potential bias (e.g., racial, ethnic, etc.) in the use of seclusion or restraint. Data and experiences from various institutions and populations have been reviewed. This topic was part of the discussion during the workgroup’s annual meeting presentation and will be included in future educational webinars. There are plans for the development of an article for submission to a relevant publication. Other areas of interest for the group are standardized safety huddles, patient safety dashboards, and risk adjustment.

The workgroup, chaired by Drs. Kathryn Ridout and Erik Vanderlip, developed a resource document that focuses on implementing MBC in solo or small practices. It covers topics such as implementation, technology, and reimbursement, along with challenges and solutions. The resource document was approved by the JRC in June 2023. Members of the workgroup have presented this topic at APA’s educational meetings, the APA Annual Meeting and the Mental Health Services Conference.

Members of the Council on Quality Care, with support from its component groups, continue to serve in leadership and advisory roles with the Core Quality Measures Collaborative. APA has nominated individuals to serve on relevant committees convened by the new Partnership for Quality Measurement, under Battelle, the new consensus-based entity, replacing the National Quality Forum. These multi-stakeholder panels are responsible for defining national quality measurement strategies, developing meaningful quality measurement tools, recommending appropriate use of quality measures and how institutions will be surveyed for behavioral health care. These appointments afford the APA an authoritative voice in the national quality enterprise.