APA’s Government, Policy, and Advocacy Update (July 2021)

The U.S. House of Representatives passed a package of bills to address several issues related to mental health, such as increasing funding for suicide prevention, expanding substance use disorder treatment and diagnosis, and increasing mental health screenings in emergency departments.

“We are pleased to see so many bills our members have supported move forward, including those that address health inequities, access to psychiatric care, and challenges for frontline clinicians,” APA CEO and Medical Director Saul Levin, M.D., M.P.A., said in a news release. “In the wake of the pandemic and its unfolding impacts on mental health, we urge the Senate to act as soon as possible.”

A bill that APA has strongly supported, the Pursuing Equity in Mental Health Act, was included in the package. It was introduced in the House by Reps. Bonnie Watson Coleman (D-N.J.) and John Katko (R-N.J.). Sens. Cory Booker (D-N.J.) and Catherine Cortez (D-Nev.) introduced the Senate companion to the bill. The legislation addresses suicide and mental health issues among young people, particularly in minority and other communities that have been disproportionately impacted by disparities in mental health treatment.

“By advancing the Pursuing Equity in Mental Health Act to the Senate, Congress has taken an important first step to addressing disparities in care that have been devastating for the mental health of young Black people and other BIPOC,” said APA President Vivian Pender, M.D., in a news release announcing the Senate bill’s introduction. “The provisions of this bill support the kind of tangible action needed to meaningfully confront these longstanding issues.”

A list of the APA-endorsed bills that were included in the House package is posted here.

APA staff have been working closely with district branches to permanently increase access to and coverage of telehealth in the states. At press time, numerous states had enacted versions of telehealth legislation, including Arkansas, Colorado, Georgia, Idaho, Indiana, Kentucky, Maryland, Mississippi, Montana, Nebraska, Oklahoma, South Dakota, Tennessee, Utah, Virginia, West Virginia, Washington, and Wyoming. A few other states, such as Illinois, have telehealth legislation awaiting gubernatorial signature. Several of the states used APA’s model telehealth legislation, and APA will continue to work with district branches to improve access to and coverage of telehealth care.

In 2019, a federal judge ruled in the case of Wit v. United Behavioral Health (UBH) that UBH had violated its fiduciary duty to beneficiaries seeking mental health care. The judge ruled that UBH was making coverage decisions according to guidelines established by UBH and influenced by financial interests, rather than according to accepted standards of care. UBH appealed the decision, and APA has filed an amicus brief in the case in the U.S. Court of Appeals for the Ninth District.

In the brief, APA called on the Court of Appeals to uphold the prior decision. “Despite the availability of professionally developed, evidence-based guidelines embodying generally accepted standards of care for mental health and substance use disorders, managed care organizations commonly base coverage decisions on internally developed ‘level of care guidelines’ that are inappropriately restrictive,” the brief stated. “Such guidelines may lead to denial of coverage for treatment that is recommended by a patient’s physician and even cut off coverage when treatment is already being delivered.”

APA was joined in the brief by the Southern California Psychiatric Society, Northern California Psychiatric Society, Orange County Psychiatric Society, Central California Psychiatric Society, San Diego Psychiatric Society, American Medical Association, and the California Medical Association.

The brief is posted here.

The Department of Health and Human Services (HHS) announced plans to establish a Behavioral Health Coordinating Council focused on collaboration and strategic planning across the department.

In a news release, APA applauded the Biden-Harris administration for creating the council, which will be composed of senior leadership from across HHS. It will be co-chaired by Assistant Secretary for Health Rachel Levine, M.D., and Acting Assistant Secretary for Mental Health and Substance Use Tom Coderre. “This council has great potential to ease the challenges we face as we begin to recover from the pandemic’s impact on our society, and APA looks forward to assisting in [these] efforts,” APA CEO and Medical Director Saul Levin, M.D., M.P.A., said in a news release.

HHS also announced that the Substance Abuse and Mental Health Services Administration (SAMHSA) is distributing $3 billion in funding made available through the American Rescue Plan Act of 2021, which Congress passed earlier this year. The Community Mental Health Services Block Grant (MHBG) and the Substance Abuse Prevention and Treatment Block Grant (SABG) programs will each disperse $1.5 billion to states and territories.

The MHBG funds will be used for a variety of treatment and recovery services for children with serious emotional disturbances and adults with serious mental illness (SMI). The block grant requires states to set aside 10% of their total allocation for first-episode psychosis or early SMI programs, and SAMHSA is recommending states set aside 5% for crisis services. The SABG will be used to plan, carry out, and evaluate prevention, intervention, treatment, and recovery services for communities impacted by substance use.

In late May, President Joe Biden signed the APA-supported COVID-19 Hate Crimes Act (S 937) into law. The law creates a position within the Department of Justice (DOJ) to facilitate the review of reported hate crimes. It also makes the process of reporting hate crimes easier by requiring DOJ to provide guidance to local law enforcement agencies to allow for online reporting of hate crimes in multiple languages, among other changes. ■