APA’s Government, Policy, and Advocacy Update (January 2024)

In response to a request for information from the National Telecommunications and Information Administration (NTIA), APA outlined the mental health risks and benefits of social media use among youth. “Recognizing the ubiquity, opacity, and saturation of online interaction in daily life, we recommend policies that place the responsibility for safe and age-appropriate design with tech companies and developers rather than kids, parents, and schools,” stated APA’s letter, which was signed by CEO and Medical Director Saul Levin, M.D., M.P.A. The letter was addressed to NTIA Administrator Alan Davidson. More research is needed to fully understand how social media use impacts youth mental health, APA argued. The research that is available, however, already suggests action should be taken to protect youth, while ensuring they can maintain access to the benefits of social media, as well.

APA outlined numerous health risks, including that youth who use social media heavily are more likely to be diagnosed with depression and anxiety, as well as to report lower levels of happiness. However, social media can also play a crucial role in connecting youth socially, especially those with minoritized identities who may not live in supportive homes. The letter noted that LGBTQ youth report feeling safe and understood in online spaces, which is associated with lower suicide risk. “The importance of these protective factors, and the stakes associated with reducing appropriate use of online tools by youth in need of information and community, makes certain policy choices around restricting youth access to online content unacceptable,” APA’s letter stated.

To advance research, APA advocated for policies that compel online platforms that monitor data usage among vulnerable populations, like youth, to share that data with research teams. “Increasing the flow of data from private institutions to research entities can help use these data for good,” the letter stated.

Last year, Aetna announced plans to terminate several telehealth services for mental health and substance use disorders on December 1, including intensive outpatient and partial hospitalization programs. In response, APA and 12 other health organizations sent a letter to Aetna’s President, Brian Kane, on November 2, strongly urging Aetna to reconsider.

Eliminating coverage of treatment for mental health and substance use disorders “will remove access to treatment for patients across the country,” the organizations wrote. “This policy will force patients to forgo treatment, increase acuity, and result in a higher and costlier level of care because of Aetna’s coverage decision.”

The letter pointed out that a growing body of research shows that intensive outpatient programs delivered via telehealth result in similar outcomes to those offered in person, including length of stay, symptom reduction, and improved quality of life. “Lack of patient and clinician choice in determining what treatment modality is most appropriate undermines the shared decision-making between patients and their clinician.”

In its December 2023 newsletter, Aetna clarified that the coverage changes would apply only to self-insured health plans, not fully insured plans. It also noted that some audiovisual behavioral health codes will continue to be covered.

As the Senate Finance Committee prepared to consider certain bills, APA wrote a letter expressing its support for many provisions that would support and expand the mental health workforce and improve access to care. The letter, signed by Levin, was addressed to Sens. Ron Wyden (D-Ore.), the committee’s chair, and Mike Crapo (R-Idaho), ranking member.

In the letter, APA urged the committee to support the following:

Further, APA expressed its support for the committee’s efforts to require Medicare Advantage plans to cover out-of-network costs resulting from inaccurate provider networks. It also urged the committee to seek input from stakeholders on best practices for insurers to maintain accurate provider directories. APA also urged the committee to support new Medicare graduate medical education slots for psychiatry and psychiatric subspecialties in rural and urban areas alike. ■