NEWSLETTER
Volume 2, Issue 51 - December 23, 2022
Happy Holidays!
CSAP Adopts 2023 Policy Platform
After much discussion that included CSAP's Government Affairs Committee (GAC), Board, and the Councils of all five District Branches, CSAP officially has a Policy Platform for 2023. This document will be public-facing and is intended to let the world know about our organizational values and long-term, broad goals. It is also to be used by SYASL, our advocacy team, to provide guidance on what issues should be flagged for our attention and discussion. It is NOT a "position statement" on any particular bill or proposed regulation. The Platform is a living document that can and should be amended over time as our values and goals shift with the changing landscape of our society. In time, the GAC and Board will explore a lengthier platform in consultation with all five District Branches.
This effort was a model for future inter-District Branch advocacy, discussion, and compromise. It demonstrates the strength of the new CSAP structure as the inclusive voice of California psychiatry.
More MH Funding in Federal Omnibus
Congress passed H.R. 2617, the Consolidated Appropriations Act, 2023. The Act contains several priorities of the American Psychiatric Association (APA) - their statement can be found here and funding highlights are provided below.
HRSA
Apprenticeship Grant Program
The agreement provides $285,000,000 to support registered apprenticeships. The agreement directs the Department to provide semiannual briefings to the Committees on all spending activities.
Behavioral Health Workforce Education and Training Mental and Substance Use Disorder Workforce Training Demonstration
The agreement includes $34,700,000 for this activity. Within the total, the agreement includes $25,000,000 for the Addiction Medicine Fellowship Program to foster robust community-based clinical training of addiction medicine or addiction psychiatry physicians in underserved, community-based settings who see patients at various 13 access points of care and provide addiction prevention, treatment, and recovery services across health care sectors.
Peer Support
The agreement includes no less than $14,000,000 for community-based experiential training for students preparing to become peer support specialists and other types of behavioral health-related paraprofessionals, as described in House Report 117-403.
NIMH
Mental Health Treatment Research
The agreement provides an increase of $5,000,000 to support research to inform mental health treatment approaches, service delivery, and system transformation, consistent with the fiscal year 2023 budget request.
SAMHSA
Certified Community Behavioral Health Clinics (CCBHC) [total of $385 million, a $70 million increase from FY 22]
The agreement continues to encourage SAMHSA to work with CMS to review and update the Department's approach to CCBHC certification activities. SAMHSA and CMS are directed to provide an update on the review and implementation of the CCBHC expansion included in the Bipartisan Safer Communities Act within 90 days of enactment of this Act. Within the increase, the agreement includes $3,000,000 for the expansion and operation of the CCBHC-Expansion National Training and Technical Assistance Center to assist stakeholders on the application of certification criteria, data reporting requirements, financing questions, and best practices related to the expansion of the demonstration program included in the Bipartisan Safer Communities Act (P.L. 117-159).
Mental Health Block Grant [total of $1,007,571,000, an increase of 150 million from FY 22]
The agreement continues to include a five percent set-aside of the total for evidence-based crisis care programs that address the needs of individuals with serious mental illnesses, children with serious emotional disturbances, or individuals experiencing a mental health crisis.
Behavioral Health Crisis Services and 988 Program (988) [total of $501,618,000, an increase of $390 million from FY 22]
The agreement reflects a one-time appropriation provided in section 145 of P.L. 117-180 and provides an increase in funding to support local crisis center capacity and centralized network functions in order to respond to the increase in contacts as the National Suicide Prevention Lifeline (Lifeline) continues its transition to 988. The agreement encourages SAMHSA to expand existing intervention and suicide prevention hotline and web services and focus outreach on youth. The agreement also encourages SAMHSA to partner with academic institutions and organizations in areas with high concentrations of veterans and active duty military personnel to ensure access to 988 and crisis lifeline resources. The agreement requests a briefing within 90 days of enactment of this Act on the implementation of the 988 program, which shall include a spend plan for the resources allocated through 988. Within the increase for 988, the agreement provides $7,000,000 for the Behavioral Health Crisis and 988 Coordinating Office. In addition, within the increase for 988, the agreement provides $10,000,000 to provide services for Spanish speakers seeking access to the Lifeline through texts or chats. SAMHSA shall make this funding available to one or more organizations with the capacity and experience to offer culturally competent, Spanish language text and chat services for mental health support and crisis intervention. Furthermore, within the increase for 988, the agreement provides $29,700,000 and directs the activities included in House Report 117-403, including making funding competitively available to provide the capacity and infrastructure to handle vulnerable youth callers, chats, and texts through interactive voice response technology and other technology solutions where appropriate.
Mental Health Crisis Response Grants [total of $20,000,000, an increase of 10 million from FY 22]
The agreement includes an increase for the activities directed in House Report 117-403
Mental Health Awareness Training [total of $27,963,000]
The agreement includes an increase for Mental Health Awareness Training and directs SAMHSA to continue to include as eligible grantees local law enforcement agencies, fire departments, and emergency medical units with a special emphasis on training for crisis de-escalation techniques. SAMHSA is also encouraged to allow training for college students, veterans and armed services personnel and their family members and to broaden applicable settings to include non-educational and non-healthcare settings where appropriate.
Also: looks like some communities in California will get related earmarks as follows: City of Hermosa Beach, CA - Mobile mental health crisis response teams - $1,000,000; City of Modesto, CA - Mental health and crisis services through a community mobile response teams including vehicles - $1,000,000; County of San Diego, CA - Mobile behavioral health crisis response teams - $4,480,000; San Gabriel Valley Council of Governments, Alhambra, CA - Mental health crisis response services and equipment - $1,500,000; City of San Fernando, CA - Mental health crisis response services - $800.000.
Medicare and Medicaid
Medicare: Physicians were facing a Medicare payment reduction of nearly 8.5% beginning Jan. 1, on top of the 2% Medicare payment cut phased back in this year. The spending bill offsets much of that, but unfortunately physicians will still face a 2% reduction.
Medicaid: Millions of people who enrolled in Medicaid during the COVID-19 pandemic could start to lose their coverage on April 1. The legislation would sunset a requirement of the COVID-19 public health emergency that prohibited states from booting people off Medicaid. The Biden administration has been under mounting pressure to declare the public health emergency over. Millions are expected to be bumped from the program, which grants health care coverage to nearly 80 million low-income people throughout the country. The federal government will also wind down extra funds given to states for the added enrollees over the next year under the proposal.
Online Protections
Tech trade groups petition SCOTUS on Texas social media law
As reported in Politico, "The tech industry is asking the Supreme Court to protect their First Amendment rights to remove extremist and hate content from platforms like Facebook and Twitter — arguing that a Texas law banning “censorship” of viewpoints is unconstitutional." In California, this relates to AB 2273 (Cunningham), which was supported by CSAP and signed by Governor Newsom. In response to this legal challenge, Governor Newsom stated, “This organization is working to block a law that protects our kids from predatory online practices. As a father of four, I know the constant toll exposure to social media platforms and devices can have on our children and their mental health. It is critical that we build safeguards to protect kids and their online privacy.”
Substance Use Disorder Residency Grants
From the California Association of Family Physicians (CAFP)
"CAFP has been fortunate to receive funding from the Dept of Health Care Services to convene a CA Residency Program Collaborative (CRPC) to improve care for patients with OUD/SUD. We are very excited to announce the launch of the attached RFA with an email to all the California Residency Program Directors and Coordinators. We hope you can also share the news through any appropriate channels. Our website with more information is here: https://www.familydocs.org/crpc/. We've managed two prior CRPC initiatives and it is truly a pleasure to see the collaboration between specialties through this work. We know they gained some great insight into what other specialties face, commiserated on common barriers, brainstormed solutions and ways to help each other and work together when possible (Psych, EM, FM, IM, Peds, and ObGyn are invited). Last year, LAC+USC Psychiatry Residency Program participated in the collaborative and did a fantastic job! I've attached their final report and were so impressed with them that their project lead, Sid Puri, MD, will now serve on our Executive Advisory Panel for this year's initiative. We hope to have participation by more Psychiatry residency programs this year and are happy to answer any questions you might have."
Opioids
Walgreens Settlement
California Attorney General Rob Bonta announced a $5.7 billion multistate settlement agreement in principle with the retail pharmacy chain Walgreens to address its role in fueling the opioid epidemic. The settlement will resolve allegations that the company failed to appropriately oversee the dispensing of opioids at its pharmacies and could bring more than $500 million in funds for California to fight the harms caused by the opioid epidemic. Today’s announcement comes on the heels of last month’s announcement of a proposed $3.1 billion settlement with Walmart to resolve similar claims.
“This settlement is another win in our ongoing fight to bring help and healing to California communities harmed by the opioid crisis,” said Attorney General Bonta. “To all those struggling with substance abuse disorders, to all those desperately in need of treatment and recovery options — help is on the way. The California Department of Justice is working to bring valuable funding to our state's efforts to combat the opioid crisis from the companies who once chose profits over the well-being of our communities.”
Funds from the settlement will be divided among participating states, local governments, and tribes. The vast majority of settlement funds must be used to combat the opioid crisis, including by providing treatment and recovery services to people struggling with opioid use disorder. California will be eligible to receive up to approximately $510 million in abatement.
The settlement will also have broad, court-ordered injunctive relief requirements to help prevent this type of crisis from happening again, including:
- The implementation of a Controlled Substance Compliance Program to ensure compliance with injunctive terms, to train employees, and to help prevent drug diversion;
- A requirement to investigate and resolve prescriptions with potentially suspicious "red flags" before dispensing the drug;
- Site visits and compliance reviews of individual pharmacy locations;
- An agreement to provide unblinded "867" sales data from the company's distributor to drug manufacturers, which will help identify and prevent drug diversion.
APA / Federal Update
Pharmacy - It's a National Issue
In November and December 2022, APA asked members through an informal 2-Question Survey about challenges their patients are facing to fill stimulant prescriptions. 879 members responded to the survey and many others sent emails and contacted the Practice Management Helpline (practicemanagement@psych.org). To date, members from around the country have shared that their patients are experiencing challenges filling prescriptions. And we would also encourage members to continue to reach out to the Practice Management Helpline to share their experiences. Because of this response, we were able to better understand the landscape and formulate a plan for next steps that are already in place. The information collected suggests that this is a national issue, rather than a state or regional regulatory or supply issue, which informs the APA team where to direct our conversations. We have reached out to our national pharmacy partners who have shared their challenges with supply and demand. We will continue to work with our partners and the federal government, including the FDA drug shortage staff and the DEA, to share these challenges and offer solutions to improve access and remove barriers to care. Please reach out to Abby Worthen (aworthen@psych.org) with any questions on this information.
Psychologists Prescribing
APA President Rebecca Brendel, MD, JD, joined a panel hosted by the CATO Institute entitled, “Can Prescribing Psychologists Help Solve the National Mental Health Crisis?” The panel discussed whether lawmakers should expand psychologists’ scope of practice to allow them to prescribe medication. The panel included two psychologists and a psychiatrist who supervises prescribing psychologist students in Illinois. Dr. Brendel discussed the lack of data on safety and efficacy of psychologists prescribing and encouraged support for access improvements like telemedicine and the Collaborative Care Model. The briefing can be watched in full here.
Webinars
- January 11, 2023, 1 pm EST: What Happens When the Public Health Emergency Ends? Telepsychiatry and Hybrid Practice Post – PHE (Register here)
- January 19, 2023, 7pm EST: The Collaborative Care Model to Optimize Patient Outcomes in Mental Health Care (Register here)
Billionaire Mark Cuban Takes on Pharmacy Giants
Billionaire investor Mark Cuban’s self-titled low-cost pharmaceutical company Mark Cuban Cost Plus Drug Company partnered with a major pharmaceutical company this week as the Dallas Mavericks owner looks to access employer benefit programs and compete more directly with pharmacy giants like CVS, Rite Aid and Walgreens. Cuban’s drug company announced earlier this month it is partnering with pharmacy benefit management company EmsanaRX—expanding the employer-provided health care program by allowing Americans to sign up through its subsidiary, EmsanaRX Plus, for low-cost drugs offered by Cuban’s company. Through the program, customers must request a prescription from a U.S.-based provider in order to purchase medication from its website, while employers can now use Emsana RX as a supplement to existing health benefits packages for lower-cost drugs. Read more here. How it works here. Mental health medications listed here.
CARE Court
The California Health and Human Services Agency (CalHHS), in collaboration with the Department of Health Care Services and the Judicial Council of California, released a recorded webinar with general information and updates on the implementation of the Community Assistance, Recovery & Empowerment (CARE) Act. Presentation slides from the webinar are attached, and the recorded webinar (about 35 minutes) can be viewed on YouTube here: https://youtu.be/gUpnxcNhl4A
The webinar covers:
- An overview of the CARE Act, based on the enacted law SB 1338
- Discussion of Frequently Asked Questions about CARE
- Updates on implementation activities
- Information about upcoming CARE Act implementation activities
Additional CARE Act information can be found on the CalHHS CARE Act webpage.
Worth a Read
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