APA Members Advocate for Top Priorities, Including Equity, Parity

Earlier this year, the House of Representatives passed the APA-supported Pursuing Equity in Mental Health Act (HR 1475). It was introduced by Rep. Bonnie Watson Coleman (D-N.J.), who was the recipient of APA’s 2021 Jacob K. Javits Public Service Award (see box). Sen. Robert Menendez (D-N.J.) introduced a companion bill (S 1795) in the Senate, and APA staff explained the details of the legislation to attendees so they could urge their senators to support the bill. Watson Coleman joined APA’s virtual advocacy day, spoke to attendees about her legislation, and encouraged APA members to be actively involved in health equity advocacy.

The Pursuing Equity in Mental Health Act addresses a number of issues related to mental health equity. It provides grants for culturally competent mental health services, increases authorization funding levels for research and the Minority Fellowship Program and directs resources to federal departments to address health disparities.

“The issues that disproportionately affect Black mental health, such as racism, economic barriers, and social and criminal injustices, will not soon end,” said Dionne Hart, M.D., an adjunct assistant professor of psychiatry at the Mayo Clinic College of Medicine and Science. “It is crucial that we share our unique, sometimes painful, experiences to advocate for those living with serious mental illness.”

Last December, Congress passed APA’s priority legislation, the Strengthening Behavioral Health Parity Act. The law provides federal and state governments with more tools and authority to hold health plans and insurers accountable to the Mental Health and Addiction Parity Act of 2008, which prohibits insurers from instituting more restrictive benefit limitations for mental health and SUD care than those that apply to medical or surgical care.

But ensuring that health plans are complying with the parity law is complex and resource intensive, and many states lack the necessary resources to do so. To address that issue, APA is supporting new legislation, the Parity Implementation Assistance Act, that would authorize federal grants to state insurance departments to boost their compliance activities. Sens. Chris Murphy (D-Conn.) and Bill Cassidy, M.D. (R-La.) and Reps. Tony Cárdenas (D-Calif.) and Brian Fitzpatrick (R-Pa.) have introduced the legislation in their respective houses of Congress.

Another APA priority is to expand the use of the evidence-based CoCM, which greatly enhances access to mental health care. When the model is implemented, consulting psychiatrists work directly with behavioral health care managers embedded in primary care offices to oversee psychiatric treatment and offer support on more complicated cases.

Reps. Lizzie Fletcher (D-Texas) and Jamie Herrera Beutler (R-Wash.) plan to introduce APA-supported CoCM legislation in the House. The legislation would provide grants to primary care practices so they can establish the CoCM, because one of the barriers to implementing the model is the associated startup costs. The legislation would also establish national and regional technical assistance centers to work with primary care offices to implement the model. Finally, the legislation would fund research to look at other models that integrate evidence-based mental health care with primary care.

Congress is deliberating how to address telehealth services past the end of the COVID-19 public health emergency (PHE). During the conference, participants learned about several key issues on which APA recommends that Congress act, including permanently eliminating the Medicare six-month, in-person visit requirement before providing telehealth services for mental health care that is scheduled to kick in after the PHE ends; extend the telehealth flexibilities put in place during the pandemic for at least a year after the PHE ends so telehealth services don’t abruptly stop and study the impact of those flexibilities on telehealth; and allow for the use of audio-only telehealth when there are no reasonable alternatives or when a clinician believes it is clinically appropriate.

Earlier this year, the Physician Shortage Reduction Act of 2021 (S 834) and the Resident Physician Shortage Act of 2021 (HR 2256) were introduced in the Senate and House. Conference participants had the option to speak with their lawmakers about these bills, which would create 2,000 additional Medicare-supported GME positions a year for seven years, ultimately resulting in 14,000 new positions. The legislation was introduced by Sens. Bob Menendez (D-N.J.), John Boozman (R-Ark.), and Chuck Schumer (D-N.Y.) and Reps. Terri Sewell (D-Ala.), John Katko (R-N.Y.), Thomas Suozzi (D-N.Y.), and Rodney Davis (R-Ill.).

“As psychiatrists, we have an important role to play in advocating for change that benefits our patients and our medical specialty,” Katherine Kennedy, M.D., chair of APA’s Council on Advocacy and Government Relations, said during the opening remarks. “We must work hard to ensure that our voices are heard.” ■