APA’s Government, Policy, and Advocacy Update (April 2022)

Together with 71 other organizations, APA sent a letter to the Drug Enforcement Administration (DEA) and the Department of Health and Human Services calling for the permanent removal of the requirement that patients receive in-person evaluations prior to being prescribed controlled substances via telemedicine.

The requirement has been waived during the COVID-19 public health emergency, allowing patients to access medications for mental health and substance use disorders. In the letter, the organizations expressed their concern that, when the public health emergency ends, “many patients, especially new patients seen for the first time by a clinician during the pandemic, will be left without access to care.”

The organizations were convened by APA, the American Telemedicine Association, and ATA Action. DEA is currently developing the special registration process for the use of telemedicine to prescribe controlled substances under the Ryan Haight Act.

The letter is posted here.

APA and its partner organizations commended Congress’s passage of the Dr. Lorna Breen Health Care Provider Protection Act (HR 1667). The legislation would prevent and reduce suicide, burnout, and mental and behavioral health conditions among health care professionals by making resources more readily available. President Joe Biden signed the bill into law on March 18.

“The Lorna Breen Act is a milestone policy that, through vital grants to health care entities and long overdue investments in mental health resources, will help prevent incidences of suicide, substance use disorders, and other mental health conditions among physicians,” wrote APA, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American Osteopathic Association in a Group of Six statement.

The statement is posted here.

APA members and staff have been working together to develop state legislative language to address coverage of coordinated specialty care (CSC), an evidence-based early intervention model that is particularly suited for people experiencing first-episode psychosis. APA has also participated in outreach to private payers around coverage as part of a larger coalition.

CSC involves case management, family support and education, pharmacology and medication management, psychotherapy, supported education and employment, and coordination with primary care. Early intervention of first-episode psychosis is key, and experts believe that if CSC were utilized and uniformly covered, more patients would have better chances at long-term recovery.

In California, Senate Majority Leader Mike McGuire introduced SB 1337, APA-drafted legislation that would create uniform coverage for the evidence-based treatment for first-episode psychosis. For more information about APA’s legislation, contact Erin Berry Philp.

More information about CSC is posted here.

In July, the three-digit number 988 will go live as the new, nationwide number for mental health and suicidal crises. Federal legislation designated the number, but a great deal of work is still needed at both the federal and state levels to implement 988 and fully transform mental health crisis response and services.

APA is part of the Reimagine Crisis Response coalition, which is assisting states to implement 988 infrastructure. Last year, eight states passed 988 infrastructure bills, and 12 states have pending legislation. APA is working closely with district branches and coalition partners to assist these and other states.

Details about the coalition and how to get involved is posted here.

APA submitted comments to the Centers for Medicare & Medicaid Services (CMS) in support of a CMS proposal requiring health plans to demonstrate their compliance with network adequacy standards before CMS will approve an application for a new or expanded Medicare Advantage plan. “APA supports this proposal and commends CMS’s efforts to hold plans more accountable for providing an adequate network of providers to deliver care to MA enrollees,” APA Medical Director and CEO Saul Levin, M.D., M.P.A., wrote to CMS.

APA also provided information to CMS on actions it can take to encourage more health care professionals to join provider networks and supported efforts to improve health equity by requiring Special Need Plans to include one or more questions on the topics of housing stability, food security, and access to transportation as part of their Health Risk Assessments.

APA submitted comments on episode-based cost measures that CMS is developing for use in the Merit-based Incentive Payment System (MIPS) program. APA commented on cost measures related to major depressive disorder and psychoses and related conditions. The measures assess the cost of clinically related services furnished to patients during an “episode” of care for the condition in question. APA’s comments focused on the challenges faced by health care professionals in understanding, interpreting, and addressing the costs attributed to them under these measures, as well as potential unintended consequences that could arise from implementation of the measures. ■