Federal News & Legislative Updates

November 14, 2018

Elections

Looking east, newly elected US House Democratic majority signifies ACA may be safe. Would be nice to see repeal and replace in my rear-view mirror. Attempts numbered 76 or so. Still, attempted mayhem to eliminate ACA pre-existing condition protections plays out in federal courts, with US Department of Justice refusing to defend against lawsuits by attorneys general in red states. Blue state attorneys general riding to the rescue, defending.

November 2, 2018

Legislation

We’ve have had recent conversations to move the ball forward and improve the CPA grave disability bill, AB 1971, which will, in all likelihood, be reintroduced in 2019. Other conversations are refining an approach to 2019 legislation providing a continuum of care for youth with substance use issues – after two CPA vehicles were not successful in 2018. We are working as well with a legislator who would like to see a mental health curriculum for secondary school students. After the shooting at Stoneman Douglas High School in Florida, high school students approached this California Assemblymember and complained that “nobody ever tells us anything”. A curriculum could change that. And, we hear rumblings that the state will itself initiate expanded funding for loan repayment incentives for physicians serving in underserved areas. Would like to think that CPA’s two 2018 bills had something to do with that process. Please VOTE!!!

August 17, 2018

Requiem

Online Bill Registry and Public Psychiatry Loan Repayment. Two CPA sponsored bills bit the dust and were held in Senate Appropriations Committee yesterday, on the dreaded suspense file – graveyard for many bills. AB 1193 (Eggman) which would have established an online real-time psychiatric bed registry, faced obdurate and implacable opposition from the agency that would have administered it, the California Department of Public Health, citing a list of mostly unconvincing concerns. AB 2018 (Maienschein) provided loan repayment incentives for RFMs to go into public psychiatry was also held, for reasons more fiscal - the Committee analysis noted that the current level of resources dedicated to physician loan repayment cannot absorb new, additional workload related to new applications from additional practice sites. Funding was no doubt critical in both actions of the Committee. Finding new funding sources for both will commence this fall.


August 2, 2018

CMS Releases Proposed 2019 Medicare Fee Schedule, Collapses Some E/M Codes Into Single Rate

The Centers for Medicare and Medicaid Services (CMS) has released the proposed 2019 Physician Fee Schedule, including proposals to reduce documentation burdens associated with evaluation and management (E/M) services and to substitute a single “flat rate” payment for some E/M services. The proposed changes apply only to those E/M codes billed in an office setting for new and established patients (99202-99205 and 99212-99215).

The proposed changes to documentation requirements would allow physicians to choose between documenting on the basis of current guidelines for a level 2 service, documenting by time only, or documenting by medical decision making only. This would simplify documentation for billing purposes.

The proposed single flat rate would take the place of the different levels of complexity (2 through 5) currently reportable by clinicians. That means physicians would be paid the same rate for E/M services regardless of the complexity of the work a patient requires.

Overall, psychiatry would see a small increase in payment for E/M services if the proposed flat rate is made final, according to an estimate by the AMA. However, certain subspecialists and physicians who treat more complex patients would likely see a decrease in overall payment. For example, payments to addiction medicine physicians and geriatric psychiatrists for E/M services are estimated to drop by 2 and 3 percent, respectively. Rates may or may not be offset by payments for other billed services.

APA staff are analyzing the proposal and are working with member experts as well as other physician specialty and subspecialty groups in crafting a response.

“We are pleased to see the administration is taking steps to ease the administrative burdens facing physicians in their daily practice,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “We are carefully analyzing the administration’s proposed fee schedule and especially the proposal for a single, flat-rate for office-based E/M services. Based on that analysis, we will send our comments to the administration and work with our affiliate organizations to secure appropriate payment for all psychiatrists and ensure access to care for all patients.” 

The deadline to submit comments on the proposed rule is Monday, September 10.


June 1, 2018

CPA Sponsored Bill Scorecard

Youth SUD Treatment Continuum. Sadly, AB 2328 (Nazarian) never emerged from the graveyard for many bills, the Appropriations Committee. Yet, other bills address pieces of the problem of lack of SUD services for youth. CPA will play a part in promoting them.

IN PLAY. Loan Repayment Incentive Bills AB 2018 (Maienschein) and AB 2143 (Caballero) both passed the Assembly by unanimous consent and are waiting in the Senate. AB 2018 will be heard in Senate Health Committee on June 6.

IN PLAY. Online Psychiatric Bed Registry. Set aside last year because of opposition from the state Department of Public Health, AB 1136 (Eggman) is back in play. A recent meeting with DPH made some small progress outlining strategies for addressing current obstacles that could lead to success. AB 1136 waits in the Senate.

IN PLAY IN A BIG WAY. CPA requested $1 million in state funds to support fellowships for psychiatric education of primary care physicians which was approved last week by the Assembly. It now waits in the Joint Budget Conference Committee which reconciles differences in the proposed budgets from the two houses. The final product must be presented to the Governor for his signature by midnight June 15.

IN PLAY IN A BIG WAY. Changes in involuntary treatment laws always stir up strong feelings in the Capitol. AB 1971 (Santiago) is a perfect example. Who would have thought that trying to prevent people with severe mental illness from dying on the streets from preventable health conditions would engender fierce opposition? Despite a coalition of patient rights and client groups opposed to AB 1971 it received a vote of confidence when it passed off the floor of the Assembly 75-0 on Wednesday.


May 18, 2018

Graduate Medical Education

To address the acute shortage of mental health professionals, the May Revision proposes an increase of $55 million to support psychiatric graduate medical education programs serving Health Professional Shortage Areas or Medically Underserved Areas in rural portions of the state. CPA intends to protect this proposal from appropriation for other purposes.


April 6, 2018

California Psychiatric Association sponsorship of AB 2018

Late in the afternoon on Tuesday, April 3, as it's last order of business, the Assembly Health Committee heard CPA sponsored AB 2018, a bill that creates an innovative and unique incentive program for psychiatrists to engage in community psychiatry training and practice. The CPA team that testified was led by UC San Diego public psychiatry Fellow Priti Ojha, M.D., and recent UC San Francisco Public Psychiatry Fellowship Program graduate Carrie Cunningham, M.D. Both gave personal testimony about experiences working with severely disadvantaged communities and severely mentally ill individuals, such as those with schizophrenia.

Three Fellows from the UC San Diego program also appeared to testify, as did their Program Director Steve Koh, M.D.. UC San Francisco was well represented by Christina Mangurian, M.D., the Public Psychiatry Program Director. At the end of the hearing the committee unanimously approved the bill and passed it out for a total of 15 'Yes' votes. One member of the committee, Asm. Aguiar-Curry, representing Yolo and Napa Counties, asked if she could become a co-author on the bill, citing the rural nature of her assembly district and the need for more psychiatric services. The author, Asm. Maienschein from San Diego, is a champion for mental health issues and we were lucky to have him, as well as the co-sponsorship of the Steinberg Institute.

Thanks to the participating Fellows who included Dr. Martinez and Dr. Castillo along with Dr. Malak, associate director for the UCSD Fellowship Program.