NEWSLETTER
Volume 1, Issue 21 - May 21, 2021
APA and District Branches File Amicus in Wit v. UBH
Wednesday, May 19, the American Psychiatric Association (APA) filed an amicus brief in the United States Court of Appeals for the Ninth Circuit, in the case Wit v. United Behavioral Health (UBH). Joining the brief were 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.
On Feb. 28, 2019, the United States District Court for the Northern District of California decided that UBH, the country’s largest managed behavioral health care organization, violated its fiduciary duty to mental health beneficiaries by making coverage decisions according to guidelines established by UBH and influenced by financial interests rather than according to the accepted standards in the industry, as required by the plans it manages. UBH has appealed the decision to the Ninth Circuit.
The APA’s brief in this case calls on the Court of Appeals to uphold the prior decision, noting that “[d]espite 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. 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.” The brief is informed by a 2020 APA Position Statement on Level of Care Criteria for Acute Psychiatric Treatment.
“Standards of care should be based on the best treatment for patients, not the bottom line,” said APA President Vivian Pender, M.D. “Some managed care organizations develop their own coverage guidelines that are overly focused on stabilizing acute symptoms of mental health and substance use disorders, rather than treating the underlying illness. When the injury is physical, insurers treat the underlying disease and not just the symptoms. Discrimination against patients with mental illness must end.”
“Failure to provide appropriate levels of care for treatment of mental illness and substance use disorders leads to relapse, overdose, transmission of infectious diseases, and death,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “APA calls upon courts, legislatures, and insurance commissioners to require insurance companies to deliver the care for which patients and employers have paid based upon evidence-based, objective, and patient-centered guidelines, rather than company profits.”
Governor's May Revise Revisited
Last week, we reported on the Governor's May Revise. For additional perspective from other organizations, please see the following:
The levels of funding are historic, as is the extent to which the Governor is proposing to weave better behavioral health into various state programs, including early education and homelessness. At their May 20 meetings, the CSAP GA Committee and Board voted to endorse the Governor's May Revise proposals, commend him for his focus on these issues, and urge the Legislature to adopt as much of what the Governor has proposed as soon as possible.
Legislative Update
In addition to reviewing the Governor's May Revise proposals, the CSAP GA Committee recommended, and the Board approved, the following new positions:
- AB 369 (Kamlager) - Would allow for streamlined Medi-Cal enrollment and service delivery for persons experiencing homelessness. SUPPORT
- AB 852 (Wood) - Would add the new category of nurse practitioners (NPs) who are authorized to practice independently starting January 1, 2023, to provisions of law that include physician and surgeons and other relevant health care licensees, corrects a drafting error related to the conditions when an independent NP must refer to a physician and surgeon, adds the new independent NPs to pharmacy definitions for prescribers, and makes other technical and clarifying changes. OPPOSE UNLESS AMENDED (THE AMENDMENTS PROFFERED BY THE CMA)
- SB 340 (Stern) - Would permit a family member, friend, or acquaintance with personal knowledge of a person receiving treatment to make a request to testify in a judicial review proceeding, as specified. SUPPORT
- SB 441 (Hurtado) - Would require the Office of Statewide Health Planning and Development to include students and professionals with training in geriatrics in administering health workforce professions programs. SUPPORT WITH AMENDMENTS TO ADD GERIATRIC PSYCHIATRY AND ADDITIONAL FUNDING
- SB 508 (Stern) - Would require a health plan, health insurer, or a Medi-Cal managed care plan (MCMC) that is required to cover mental health services to enter into a contract with all local educational agencies (LEAs) in which 15% or more of the students at the LEA, are enrolled are covered by the health plan, insurer, or MCMC, as specified. Authorizes a mental health professional employed by a LEA that has not executed a contract with a health plan, insurer, or MCMC to provide and be reimbursed for mental health services to all referred students, as specified. Exempts the contracting and reimbursement provisions of this bill from applying to county mental health plans. Requires telehealth be included as an approved modality for the Medi-Cal program for the specified services provided by an LEA. SUPPORT WITH AMENDMENT TO ENSURE THAT THE BILL REFERENCES "LICENSED" RATHER THAN "APPROPRIATE" MENTAL HEALTH PROFESSIONAL
The latest bill matrix can be found here. If you feel strongly about any of the bills on this list, please contact Paul Yoder at SYASL. FYI, Senate and Assembly leadership have directed that no members of the legislature can move more than 12 bills through the other house. This will narrow the field of viable bills going forward.
AB 988 Survives Appropriations Suspense File
Last week, we reported that AB 988 (Bauer-Kahan), the bill to create a 988 crisis hotline in California, was amended prior to its hearing in the Assembly Appropriations Committee to do the following:
1. Set the new surcharge in any month to not exceed $0.80 and require that the 988 surcharge for the years 2022 and 2023 is set at the same amount as the 911 surcharge; and,
2. Specify that funds can in fact be used for mobile crisis teams; and,
3. Require counties to use funds made available through the 988 State Mental Health and Crisis Services Special Fund to expand access to mental health crisis services.
Coming out of this same committee, we expect the bill to be significantly amended again. For those of you following this bill closely, please understand that the next round of amendments will be designed to get the bill off the Assembly floor more easily by only requiring a simple majority vote rather than a supermajority (2/3) vote.
Also, Congress mandated a follow-up report on 988 implementation which was released 2 days ago. As directed by Congress, the Bureau prepared a report that examines the benefits, technical feasibility, and potential costs of transmitting 988 calls with dispatchable location information which can be found here: https://www.fcc.gov/document/988-geolocation-report-national-suicide-hotline-designation-act
And, Oakland has also decided to take the police out of nonviolent 911 calls:
https://www.kuow.org/stories/oakland-becomes-latest-city-looking-to-take-police-out-of-nonviolent-911-calls
HHS Announces $3 Billion in ARP Funding for SAMHSA Block Grants
The Substance Abuse and Mental Health Services Administration (SAMHSA) is distributing $3 billion in American Rescue Plan funding - the largest aggregate amount of funding to date for its mental health and substance use block grant programs. This will mean approximately $400 million in new funding for California.
The COVID-19 pandemic and the corresponding economic crisis have been especially devastating for Black, American Indian, Alaska Native and Hispanic communities, who are experiencing a disproportionate number of COVID-19 infections and deaths as well as higher-than-average unemployment rates. Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations have experienced increased stigma and hate due to COVID-19 anti-Asian rhetoric, which is impacting the behavioral health of AANHPI communities.
The Centers for Disease Control and Prevention (CDC) preliminary data points to 90,000 overdose deaths for the 12 months ending last September – about 20,000 more than the same period the year before. CDC data also shows that American adults in June 2020 reported elevated levels of adverse mental health conditions, substance use, and suicidal ideation. The prevalence of symptoms of anxiety was approximately three times those reported in the second quarter of 2019, and prevalence of depression was approximately four times that reported in the second quarter of 2019.
Last week, the Centers for Medicare & Medicaid Services (CMS) released data highlighting health services received by millions of Medicaid and Children Health Insurance Program beneficiaries during the COVID-19 Public Health Emergency. Despite an overall rebound for most of these services, mental health utilization remains below pre-pandemic levels.
With the nation's mental and substance use disorder needs squarely in focus, HHS Secretary Xavier Becerra is establishing a new Behavioral Health Coordinating Council (BHCC). The Assistant Secretary for Mental Health and Substance Use and the Assistant Secretary for Health will serve as the co-chairs of this coordinating body, which is comprised of senior leadership from across the Department. The BHCC's primary goal is to facilitate collaborative, innovative, transparent, equitable, and action-oriented approaches to addressing the HHS' behavioral health agenda.
"Behavioral health is a priority for the Department of Health and Human Services. The COVID-19 pandemic has made clear the need to invest resources in our nation's mental health and address the inequities that still exist around behavioral health care. That's why we are making this historic investment in mental health and substance use services," said HHS Secretary Xavier Becerra. "In addition, this national problem calls for Department-wide coordination to address the issue. That's why I am convening the Behavioral Health Coordinating Council to work across HHS to facilitate collaboration and strategic planning as we implement our behavioral health agenda."
"Across America, we are seeing a startling rise in mental health and substance use disorders during the COVID-19 pandemic," said Assistant Secretary for Health Dr. Rachel Levine. "We know multiple stressors during the pandemic – isolation, sickness, grief, job loss, food instability, and loss of routines – have devastated many Americans and presented the unprecedented behavioral health challenges across the nation. Addressing the COVID-19 mental and behavioral health impacts on vulnerable and disenfranchised populations are among the top priorities of the Biden-Harris Administration. Establishing a new Behavioral Health Coordinating Council will assure the right prioritization and guidelines are in place to provide pathways to prevention, intervention, treatment and recovery services."
"The Biden-Harris Administration's support through the American Rescue Plan funding will increase community-level supports for Americans who have been grappling with devastating emotional and mental challenges during the COVID-19 pandemic," said Acting Assistant Secretary for Mental Health and Substance Use Tom Coderre. "Given the significant impact mental and substance use disorders can have on the lives of individuals, families and communities, the establishment of the BHCC provides a critical tool in addressing these issues in a collaborative and strategic way."
The MHBG program enables states and territories to provide comprehensive community mental health services and address needs and gaps in existing treatment services for those with severe mental health conditions.
The SABG program allows states and territories to plan, implement and evaluate activities to prevent, treat and help more people recover from substance use disorder. This funding will also allow recipients to make investments in existing prevention, treatment and recovery infrastructure, promote support for providers and address unique local needs to deliver substance use disorder services.
Funding allocation tables can be viewed here:
CSAP / APA Advocacy Training Day
CSAP / APA Advocacy Training Day: CSAP and it's state advocates at SYASL Inc., in conjunction with the APA, will be holding an advocacy training day on June 3 from 6 - 7:30 pm. If you ever wondered about the do's and dont's of advocacy, you will want to participate. This training will also include updates on state and federal legislation. CME credits will available. To register, contact Erica Smith at SYASL.
6:00 PM: INTRODUCTIONS
Dr. Steve Koh, Chair, Government Affairs Committee, CSAP
Dr. Ilse Wiechers, Vice Chair, Government Affairs Committee, CSAP
6:05 PM: OVERVIEW OF CSAP ADVOCACY STRUCTURE
Engagement with CSAP, Role of DB Advocacy Committees & Forecast of 2021 priorities
Paul Yoder, Andrew Antwih, Priscilla Quiroz, SYASL - Legislative Advocates, CSAP
6:20 PM: SENATOR JOSH NEWMAN
Best practices for building relationships with legislators
The Honorable Josh Newman, California State Senate
6:40 PM: DEVELOPING YOUR ELEVATOR SPEECH
Outlining Your Elevator Speech: Problems, Solutions & Patient Stories
Calls to Action, Lending Expertise & Delivering Testimony
Erin Philip, Director of State Government Relations, American Psychiatric Association
6:55 PM: PUBLIC AFFAIRS & ADVOCACY
Talking to the Media, Writing Op-Eds and LTEs, Leveraging Social Media
Ginnie Titterton, Director of Corporate Communications & Public Affairs,
American Psychiatric Association
7:25 PM: WRAP-UP
Identify DB Advocacy Chairs and EDs
Dr. Koh and Dr. Wiechers
Develop an understanding of the legislative process and become advocates for psychiatry and patients in need at CSAP’s advocacy training workshop. As state policymakers work to address the mental health impact of the COVID-19 pandemic, it is critical that they hear from psychiatrists to fully understand how their legislative proposals can impact how patients get care. This workshop is intended to provide psychiatrists with an overview of the legislative process, effective advocacy strategies, and the resources available to APA members. Attendees will be equipped and empowered to engage their policymakers and serve as effective advocates for California’s psychiatry and patients in need of treatment.
At the end of this training, attendees will:
• Develop an understanding of the legislative process and the fundamentals of
advocacy;
• Develop the skills to advocate for psychiatry and patients in need of mental health
and/or substance use treatment; and
• Begin outlining a plan to engage local policymakers.
ACCREDITATION STATEMENT
This activity has been planned and implemented in accordance with the accreditation
requirements and policies of the Accreditation Council for Continuing Medical Education
through the joint providership of the American Psychiatric Association (APA) and the
Northern California Psychiatric Society. The APA is accredited by the ACCME to provide
continuing medical education for physicians.
DESIGNATION STATEMENT
The APA designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credit.
Physicians should claim only the credit commensurate with the extent of their participation
in the activity.
CSAP Political Action Committee
Did you know that CSAP has a political action committee (PAC)? It does.
If you are interested in participating, please see this link to make contributions.
https://www.efundraisingconnections.com/c/CaliforniaPsychiatristsPoliticalActionCommitte
More on this in upcoming issues.
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