1. Wellstone Bill Delayed
Senate impediments to the consideration of the Wellstone Mental Health Equitable Treatment Act (S. 486/H.R. 953) remain at this time. Senate HELP Committee Chairman Judd Gregg has disclosed his long-awaited amendment to the MHETA. As shared with APA, the amendment would allow employers to seek an exemption if they can show the cost of compliance is at least one percent, based either retrospectively on six consecutive months of real-world cost experience or prospectively based on the findings of a “qualified actuary.” The prospective exemption is a significant change from current law. The one percent threshold is also a major concern, since the current one percent exemption is based on projected costs to comply of 0.4 percent, while CBO estimates the likely cost of compliance with the tougher terms of the MHETA to be an average of 0.9 percent. APA will oppose the amendment unless significantly changed. Action on the bill is expected after the August recess.

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2. Jail Diversion Bill Heard
On June 22, the House Judiciary Subcommittee on Crime, Terrorism and Homeland Security held a hearing on the Mentally Ill Offender Treatment and Crime Reduction Act (H.R. 2387/S. 1194), introduced by Rep. Ted Strickland and Sen. Mike DeWine. The measure has already passed the Senate and is awaiting House action. Chairman Howard Coble supports this bill, which would establish a federal grant program to appropriately divert people with mental illnesses away from jails and towards comprehensive community treatment. The APA submitted a statement for the hearing record. At the hearing, Chairman Coble said that he would like to see the bill placed on the House’s unanimous consent calendar, which would insure speedy passage.

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3. Youth Suicide Bill Passed By Senate
On July 8, the Senate unanimously approved legislation to expand early intervention programs to curb youth suicide and to support mental health programs on college campuses. The Garrett Lee Smith Memorial Act (S. 2634, named for the late son of Sen. Gordon Smith) combines two separate bills, S. 2215 (on campus counseling) and S. 2175 (on suicide prevention). APA supported both of the original bills, and sent letters of support on S. 2175, while working closely behind the scenes on the legislative language to S. 2215. As the now combined bills have moved through the Senate and House, however, legislative language governing how programs would be set up, and particularly as such language impacts the various professions, has been altered in ways that concerns DGR. We are working to resolve these concerns to ensure that the focus of this most important legislation remains firmly centered on children and youth and ensuring that they have access to the full range of services, while at the same time being careful not to disrupt final passage of S. 2634. Floor consideration of the House version of the legislation (H.R. 4799) is imminent.

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4. Goldman Testified Before Senate Subcommittee
On July 20, APA Member Howard H. Goldman, M.D., Ph.D., testified before at the Senate Substance Abuse and Mental Health Services Subcommittee hearing, “Performance and Outcome Measurement in Substance Abuse and Mental Health Programs.” In his testimony, Dr. Goldman highlighted the need for an infrastructure that supports measurement of mental health programs’ performance and outcomes. Without that infrastructure, he said, the needed change in mental health policy will not occur, ultimately impacting those who suffer from mental illnesses. Dr. Goldman is a mental health services researcher at the University of Maryland School of Medicine, and he also served as the senior scientific editor of the 1999 Surgeon General’s Report on Mental Health and as a consultant to the President’s New Freedom Commission.

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5. Veterans Health Care Personnel Enhancement
The Senate Veterans’ Affairs Committee is now considering the Department of Veterans Affairs Health Care Personnel Enhancement Act of 2003 (S. 2484). The committee, chaired by Sen. Arlen Specter, could vote today, July 20, on the bill, which would revamp the VA pay system to allow higher salaries for some physicians and dentists, including hard-to-hire specialists. The department also would be able to adjust pay according to changes in the market.

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6. Appropriations Update
Both the House Labor, Health and Human Services Appropriations Subcommittee and the full committee have approved a small increase in federal funding for several mental health and substance use programs of interest to the APA. The bill is scheduled to go to the House floor this week. Overall, the funding recommendations for mental health and substance use programs were slightly more than funding for other public health programs.

For NIH, the bill provides a program level of $28.441 billion, an increase of $782 million (2.8 percent) over FY 2004. This is equal to the administration’s FY05 request. All institutes and centers are funded at the administration’s requested levels. For NIMH this means a $38.8 million increase over FY04, for NIDA a $21.8 million increase, and for NIAAA a $13.2 million increase.

For the Center for Mental Health Services, the PATH program received a $5.4 million increase over its FY04 funding level; the Children’s Mental Health Block Grant and the Protection and Advocacy program received slight increases. The newly proposed State Incentive Transformation Grants – which stem from the President’s New Freedom Commission – received a $20 million allocation, and administration cuts to programs for the elderly and jail diversion programs were restored.

Children’s GME is funded at $303 million, the same as FY04 levels.

The Homeless Veterans program, administered jointly by Labor, HHS and VA, was allocated $19 million, more funding than was anticipated.

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8. Bill Filed That Would Legislate A Diagnosis
Rep. Joe Pitts has introduced legislation that would create diagnoses of post-abortion depression and post-abortion psychosis, direct HHS to spend $3 million per year on research on these diagnoses, and fund treatment to the tune of $300,000 per year. Rep. Mike Bilirakis, Chair of the Commerce Health Subcommittee, has indicated that, in deference to Rep. Pitts, who is a member of his subcommittee, they would hold a hearing on the bill, as well as on legislation on post-partum depression supported by the APA. DGR is under the impression that the subcommittee action will likely end with the hearing. APA is working to educate Members abut problems with the bill.

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9. Clinical Drug Trials Update, Part I
At the 2003 annual meeting of the AMA House of Delegates, APA and AACAP introduced Resolution 514, which requested that the Council on Scientific Affairs conduct a study on the impact of funding sources on pharmaceutical research, and that the Council develop appropriate guidelines. At the 2004 Annual House of Delegates meeting in mid-June, Delegates adopted the CSA’s report, which specifically calls on the FDA to establish a clinical drug trials registry.

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10. Clinical Drug Trials Update, Part II
Interest in developing a new clinical trials registry or strengthening current rules governing the existing registry implemented under the Food and Drug Administration Modernization Act is growing. The APA and the American Academy of Child and Adolescent Psychiatry, along with AMA and the AAP, have held meetings with key Senators and Representatives interested in ensuring that physicians, other professionals, and the public have full access to all clinical trials information. The Academy and APA were driving forces behind the AMA’s efforts to support establishment of a clinical trials data bank at HHS. The House Energy and Commerce Oversight Subcommittee was to have held a hearing on “Publication and Disclosure Issues in Pediatric Antidepressant Clinical Trials” on July 20, but the hearing has been postponed until September. APA and the AACAP will provide a joint statement.

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11. Freedom Commission Roadmap Awaited
The release of the first iteration of the roadmap to operationalize the findings of the President’s New Freedom Commission on Mental Health is imminent. We will disseminate the document when it is unveiled. On a related note, the British Medical Journal, in anticipation of the roll-out, alleged in a disjointed story that the Bush administration will announce a plan to screen all Americans for mental disorders and promote antidepressant and antipsychotic drug use – allegations which we are told are well beyond the scope of anything the administration has planned and which seem to stem from a psychiatric survivors group. The BMJ story has gained some traction in derivative reports on the Internet, though mainstream media have not touched the story, in part thanks to APA’s work, for which the administration is appreciative.

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12. LCD Comment Deadline Extended
Mutual of Omaha, the Medicare Fiscal Intermediary (FI) in 49 states, quietly issued a proposed local medical review policy (LMRP)/local coverage decision (LCD) for inpatient psychiatric services. This LCD is one of several LCDs issued recently by Medicare FIs that create significant concerns for psychiatrists. As a direct result of APA’s alliance with hospital groups and strong and timely support from our members, Mutual of Omaha and CMS announced that the public comment period will be extended. In conjunction with NAPHS and others, the APA will meet with national and regional CMS officials and the FI and provide formal comments in an effort to effectuate changes in these overly prescriptive policies. APA, with NAPHS and others, has filed comments.

13. Psychotherapy Notes Protected
DGR and the Office of Healthcare Systems and Financing successfully convinced CMS to halt denials by Medicare Carriers and CERT contractors based on psychiatrists’ non-response to Medicare contractors’ requests for psychotherapy notes. APA said the requests violate HIPAA privacy rules. CMS will issue Medicare Carrier Manual instructions to explain to contractors the type of psychotherapy information that may be requested under HIPAA. CMS agreed, in the interim, that it would instruct CERT contractors and Medicare Carriers not to deny psychiatrists’ claims based on failure to produce psychotherapy notes. APA conveyed to CMS that, if a contractor requests certain information that is not defined by HIPAA as a “psychotherapy note” and that is allowed to be disclosed under HIPAA, the provider should comply with that specific request.

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14. Medicare Prescription Drug Regs Expected
We anticipate that, in the near future, CMS will issue proposed regulations related to the new Medicare prescription drug benefit for implementation in 2006. We have filed comments and are working with a coalition from NAMI, NMHA and the National Association of State Mental Health Program Directors to ensure that people with mental illnesses continue to receive appropriate access to a comprehensive range of medications in all therapeutic categories. In addition, the regulations should contain meaningful beneficiary protections and procedures to assure appropriate provision and access to non-formulary coverage. We anticipate several meetings with federal officials as these regulations are developed over the next several months.

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15. Psychology Prescribing Debated
On July 9, the APA participated in a National Academy of Sciences-sponsored debate entitled, "A Bitter Pill: Should Psychologists Have Prescriptive Privileges?" – one in a series of NAS seminars on science and technology policy issues. On very short notice, Eric Steckler, M.D., president of the Northern Virginia chapter of Washington Psychiatric Society, stepped up to go head-to-head with Commander Morgan Sammons, Ph.D., who represented the American Psychological Association and spoke as a “graduate” of DoD Psychopharmacology Demonstration Project. Dr. Steckler represented psychiatry and our patient safety concerns admirably. The audience consisted of about 100 graduate students in the sciences, as well as several media.

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16. Blue Dog Policy Breakfast
On July 14, Dr. Scully presented the APA’s top legislative priorities to 12 Members of Congress and several senior staff of the Blue Dog Coalition, which represents conservative and moderate House Democrats, during their weekly “Wednesday Policy Breakfast.” He spoke about the disconnect between research advances in understanding the brain and in treating mental illnesses and the short-sighted federal policies that continue to block patients from accessing mental health services. Bills discussed included the Wellstone Mental Health Equitable Treatment Act and the Medicare Mental Health Copayment Equity Act, both of which would help eliminate discriminatory treatment of psychiatric care. Members were particularly concerned about current Medicare law that imposes a 50 percent coinsurance requirement on outpatient psychiatric care.

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17. PAC Update
APAPAC continues to be extremely pro-active in advocating for psychiatry during this crucial election year. So far in 2004, APAPAC has received $99,000 in contributions from 750 APA members and staff. Over the 2003-2004 cycle, the PAC has contributed $266,000 to 120 candidates for Congress, with APAPAC hosting 58 fundraising events for candidates in D.C. and APA members meeting with 45 candidates in their districts to present checks personally. The PAC will increase its activities in the next few months leading up to the November election.

In The States:

1. New Mexico
As this writing, the New Mexico Board of Psychologist Examiners has yet to publish a “Notice of Proposed Rulemaking” in the New Mexico Register, though we are told to expect publication on Aug. 1. Publication of this notice will begin a formal 30-day written public comment period that will be followed by a final public hearing. As it did at the Board of Medicine hearing, the APA will provide testimony, raising objections and concerns for patient safety created by the shortcomings in the proposed rules. (Visit this link to see APA’s Board of Medicine comments, presented by William Ulwelling, M.D.: http://psych.org/advocacy_policy/reg_comments/phdrxrules06012004.pdf)

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2. Louisiana
Unlike New Mexico, where the medical and psychology boards have joint responsibilities for implementing the psychologist prescribing legislation, the Louisiana law vests total authority in the hands of the psychology board. While rulemaking has yet to begin on that law, which will become effective Aug. 15, 2004, the APA will work closely with the Louisiana Psychiatric Medical Association and the Louisiana State Medical Society to monitor activities and seek opportunities to participate in the process.

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3. General Psychologist-Prescribing Update
We continue to work with District Branches and State Associations such as California, Florida, Wyoming and Oklahoma to assess their vulnerability to psychologist prescribing legislation and to provide them with resources to prepare for the 2005 legislative sessions.

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Advocacy Extra:

1. Department of Government Relations Hires Two, Promotes Another
The APA has two new lobbyists on board. Maria H. Castillo began in June as the Department of Government Relations’ deputy director for federal affairs and is working to advance the APA’s legislative priorities in the U.S. House of Representatives. Andrew M. Whitman, J.D., began as DGR’s deputy director for regulatory affairs on May 19 and is charged with APA’s regulatory priorities in the executive branch, particularly within the Department of Health and Human Services and the Centers for Medicare and Medicaid Services. The APA has also promoted Tom Graham to the role of federal legislative coordinator, where he will take on an increased role in APA’s electronic communications and grassroots advocacy efforts.

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