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

APA Urges Congress to Expand Access to Telehealth

APA joined a letter sent to House and Senate leaders detailing how Congress can support health care professionals and patients by expanding access to telehealth. The letter was signed by dozens of physician groups, corporations, and health care organizations.

Many of the telehealth flexibilities that have dramatically improved access to care during the pandemic are limited to the duration of the COVID-19 public health emergency, which must be renewed every 90 days, the letter explains. Clinicians must “weigh the costs of investing in the technological and clinical infrastructure required to maintain telehealth programs at scale against the possibility that Congress may ultimately decide not to support permanently expanded telehealth coverage,” the letter states.

The letter outlines several actions Congress should take that would carve out a pathway to permanent telehealth reform, including the following:

• Authorize the continuation of all current telehealth waivers through December 31, 2024.

• Require the Department of Health and Human Services to complete all feasible evaluations related to telehealth by fall 2023, which would provide time to aggregate data on telehealth to inform legislation.

• Take up permanent, evidence-based telehealth legislation for implementation in 2024.

The letter is posted here.

Organizations Express Concern With Administrative Burden of Good Faith Estimates

APA signed onto a letter with a coalition of other mental health associations expressing concern to the Centers for Medicare and Medicaid Services (CMS) that the No Surprises Act’s requirement that clinicians must provide patients with a good faith estimate adds to their administrative burden.

“Our providers have a long-standing practice of being transparent about fees with their patients because it is required by their professional ethics,” the letter states. “Requiring clinicians to fill out the GFE [good faith estimate] form and update it every time there is a minor change in the treatment plan that may or may not have an impact on costs takes away from valuable treatment time—which is in extremely high demand as more and more people are struggling with the mental health impact of the COVID pandemic.”

The letter requests an exemption from this requirement for mental health professionals. In late January, CMS invited APA and the other signatories to a listening session to gain a better understanding of how the requirements impact the delivery of mental and substance use disorder care. CMS anticipates hosting more sessions with the behavioral health community.

The letter is posted here.

Concern Expressed Over FDA Modifications to Clozapine REMS

APA signed onto two letters to Congress expressing concerns about recent U.S. Food and Drug Administration (FDA) changes to Risk Evaluation and Mitigation Strategies (REMS) for clozapine and isotretinoin, a medication used to treat acne. Seven other organizations representing physicians, nurses, pharmacists, patient advocates, and public health officials also signed the letter.

The FDA’s clozapine REMS went into effect on November 15, 2021, and implemented changes such as requiring prescribers and pharmacies to be re-certified and that prescribers re-enroll their patients in the REMS program. The FDA temporarily suspended some of the clozapine REMS requirements for 90 days, but the organizations expressed concern that the suspension will end and more issues will arise (Psychiatric News). The letters outline similar concerns regarding a REMS issued for isotretinoin last December that has also caused access issues.

The letters urge Congress to hold hearings to shine a light on these issues and to request the FDA to halt the two REMS programs “until a thorough review of the programs is completed to reduce disruptions to treatment.”

The House letter is posted here.

The Senate letter is posted here.

State Team Works to Limit Prior Authorization, Introduce Collaborative Care

APA’s state team in its Division of Government Relations is working with district branches across the country to limit prior authorization in some circumstances. Staff have been meeting with district branch members and crafting legislation tailored for each state. District branches interested in doing similar work should contact Erin Berry Philp, APA’s director of state government relations, [email protected].

APA is also working with district branches to expand the use of the Collaborative Care Model (CoCM). An extensive body of research shows that CoCM is effective in delivering integrated mental health and general health services. More information about APA’s model state legislation is posted here. ■