APA Advocacy Active Through Flurry of Federal Action on COVID-19

President Donald Trump last month signed into law a massive $2 trillion emergency spending bill to address the COVID-19 pandemic challenges that includes $4 billion for health care “extender” programs—including programs important to APA members such as Certified Community Behavioral Health Clinics (CCBHCs), Community Health Centers, the National Health Service Corps, and teaching centers with graduate medical education programs.

The Coronavirus Aid, Relief, and Economic Security Act (CARES Act, HR 748), signed by the president on March 27, also includes more than $400 million in new funds for the Substance Abuse and Mental Health Services Administration (SAMHSA).

“You can’t have a healthy economy without healthy people—and that includes mental health,” said APA President Bruce Schwartz, M.D. “These stimulus bills and regulatory changes will strengthen our ability to help the millions of Americans with existing mental illnesses or substance use disorders and more with emerging mental health issues as the pandemic unfolds. These changes to how we are allowed to provide mental health services are promising developments in the nation’s efforts to fight the impact of COVID-19.”

The CARES Act is the third and largest emergency spending bill passed in a flurry of legislative and regulatory actions taken by Congress and the Trump administration. At press time, a fourth spending bill was in the works, and the number of cases of coronavirus in the United States had reached 304,826, and the number of deaths climbed to 7,616. Cases have been reported in all 50 states, the District of Columbia, and several territories.

APA staff are closely monitoring the progress of the fourth spending bill and advocating for psychiatrists and their patients.

The health care “extenders” in the CARES Act include a variety of public health programs (often hospital-based programs or federal programs and demonstration projects) that are authorized and funded periodically by Congress and extend care to a range of beneficiaries in the community. The SAMHSA funding in the CARES Act also provides $250 million for CCBHCs and extends the demonstration project to November 30 and from eight states to 10 (the two new states are to be announced later). New SAMHSA funding also includes $50 million for suicide prevention programs and $100 million for mental illness and substance use emergency grants during the pandemic.

The CARES Act also addresses these key APA priorities:

• 42 CFR Part 2: APA is pleased that the CARES Act includes compromise language that should allow sharing of substance use disorder records with health care professionals while also protecting patients’ rights to privacy and control over their own substance use disorder records. This is a long-term priority of APA, which, along with other mental health and substance abuse advocacy organizations, has argued that 42 CFR Part 2—which predates the emergence of integrated care networks that rely on sharing information—inhibits quality care for people with substance use disorders. APA worked with a handful of stakeholder groups through the “Partnership to Amend 42 CFR Part 2” to craft language for Congress that would accomplish this goal.

• Sequester cuts: The Budget Control Act of 2011 mandated automatic “sequestration”—budget cuts to certain categories of spending in an effort to control the ballooning national deficit at the time. Those cuts included a 2% annual cut to Medicare. The CARES Act suspends the 2% Medicare sequester cuts through December, an action for which APA had advocated.

• Additional telehealth provisions: The CARES Act repeals the requirement that prohibited physicians from seeing new patients via telemedicine unless they had seen that patient within the past three years; this prohibition remained in place even after the Department of Health and Human Services had loosened many other restrictions on the use of telemedicine under the president’s declaration of a national emergency earlier in March (see Psychiatric News). APA and other groups have argued that the three-year requirement was an obstacle to widespread use of telemedicine.

The CARES Act will also increase the national stockpile of personal protective equipment for frontline medical responders.

The mental health provisions in the first three spending bills and regulatory actions taken by the administration have been the product of advocacy by APA’s Division of Government Relations and the Division of Policy, Programs, and Partnerships along with the AMA and numerous other physician and mental health and substance use disorder advocacy organizations. APA has worked particularly closely with the Group of Six frontline physician groups on advocacy related to COVID-19 (see Psychiatric News).

“As we respond to one of the largest public health threats facing our country in decades, funding for behavioral health initiatives and expanding telemedicine are critical,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “We strongly believe that the federal and state governments will need to continue to support physicians, who will be working long hours and in many cases risking their own health as we continue to address this pandemic.” ■