Volume 2, Issue 50 - December 16, 2022
A Note From CSAP's Government Affairs Committee Chairwoman
Earlier this week, Paul Yoder and I were able to attend a round table discussion hosted by the Steinberg Institute to start a dialogue about how we can establish a mental health “right to care” in California. A truly multidisciplinary group of folks representing providers across the behavioral health continuum of care as well as dedicated legislative and patient advocates was present and provided key insights from many perspectives. The idea behind the initiative is that individuals with mental illness should have a right to receive high-quality, evidence-based treatment services. For instance, the questions “what should be considered a minimum set of services?” and “is a right to housing necessary?” were brought up. Many stakeholders pointed out that we should consider focusing first on fully funding adequate behavioral health care that incorporates substance use disorders. And, this concern was echoed in discussions about how CalAIM may and may not improve behavioral health services. Overall, it was a collaborative and productive meeting that suggests 2023-24 could be another big legislative cycle for mental health care in California.
Thank you for your involvement and continued support of CSAP and its advocacy. I wish all of you and your loved ones holidays of love, peace, hope, and joy!
There continue to be reports of controlled substance prescribing issues and we want to keep hearing from you about the issues as they arise. We are collecting your problematic pharmacy encounters with our survey to better understand the situation in California for discussions with state and federal regulators. A recent Reuters article with quotes from 2 SoCal psychiatrists explains how the crackdown on opioids has spilled over into other controlled substances. In an attempt to decrease their liability, distributors are limiting supplies to pharmacies and patients based on arbitrary quotas with little clinical basis. At the same time, stimulants are increasingly difficult to find due to supply chain issues and record prescriptions by online providers. We will continue to advocate for you and your patients in these matters.
In other news, all 5 of our district branches approved our high-level policy platform which will be published in next week's newsletter. Over the coming year, we will flesh out many of these points into a more comprehensive platform and utilize it to direct our statements on specific policies. For some background on the platform language choices, you can read my recent article in the December 2022 SCPS Newsletter, where you’ll also find a Q&A with Paul Yoder.
Steinberg Institute / Right to Care
Per Emily's note above, the following questions were posed to the group convened by the Steinberg Institute:
1. What should the minimum set of services be as part of a right to care? Are there models we can look to as we establish what this standard set of services should include?
2. For Medicaid services, do you see any gaps or implementation challenges in CalAIM that could be addressed through legislation to support a right to care?
3. What barriers do you experience in trying to deliver services to people who need care in California?
General Questions for Consideration
1. Are there other entitlement models (i.e. education, developmental disabilities, physical health etc.) in the country or around the globe that could serve as a foundation for a right to mental health and substance use care?
2. Are there any failed entitlements that might shed a light on what pitfalls to avoid?
3. For people covered by Medicare/Medicaid/commercial insurance, what needs to change to ensure access to care?
4. What non-traditional services should be included in a right to care (e.g. housing, employment services, community supports)?
5. What remedy(ies) would ensure a right to care is fully realized?
6. How does the workforce shortage affect how impactful establishing a right to care would be?
7. What specific outcome measures and/or fiscal information should be in place to support a right to care?
As fate would have it, the next day, the DMHC posted of the rulemaking for "Mental Health and Substance Use Disorder Coverage Requirements" that can be viewed here: Open Pending Regulations. CSAP plans to comment on these proposed regulations, if you want to forward any thoughts re same, please do so.
Coalition Letter to the DMHC
CSAP just signed on to a coalition letter expressing concerns about several recent instances in which the Department of Managed Health Care (DMHC) has permitted health care service plans to terminate medically necessary mental health and substance use disorder (MH/SUD) treatment in a manner inconsistent with Senate Bill 855’s requirements. These cases are troubling given previous discussions with DMHC in advance of proposed rulemaking on SB 855, specifically with respect to health plans’ obligations to ensure timely access to ongoing mental health services in a manner consistent with generally accepted standards of care. These discussions had the coalition to believe that our understanding of what the statute requires aligns with DMHC’s. The first area of concern is that DMHC is permitting plans to terminate coverage for out-of-network care arranged due to the unavailability of timely or geographically accessible mental health services when plans belatedly identify network providers. This coercive practice subverts the therapeutic alliance, a critical agent of cure, and disregards generally accepted standards of MH/SUD care, a key requirement of Senate Bill 855. The second area of concern is that DMHC is permitting plans, notwithstanding generally accepted standards of care, to terminate coverage for ongoing, out-of-network services when plans lack and fail to arrange in-network services available within timely access standards, in violation of the statute. Read more here.
DMHC Posts Formal Proposed SB 855 Regulations
January deadline for signing the State's first-ever data sharing agreement
The California Health and Human Services Agency (CalHHS) has opened its new online portal to allow practices to sign California’s Data Sharing Agreement. The agreement is part of the state’s new Data Exchange Framework meant to improve health information exchange. Under state law, physician practices and medical groups are required to sign a template Data Sharing Agreement by January 31, 2023. Under state law, physician practices and medical groups are required to sign a template Data Sharing Agreement (DSA) by January 31, 2023.
Signing the agreement is one of the first steps in complying with California’s new Data Exchange Framework. The goal of the framework is to create a statewide data sharing agreement to expedite and expand the exchange of information among all health and human services organizations throughout the state. The DSA is meant to serve as a contract between physician practices, hospitals, health plans, and other health care entities stating that they will make data available to one another upon request. The DSA lays out the parameters of that agreement and outlines what information needs to be exchanged, privacy and security standards, and permitted uses of data. The CMA has published resources to help members understand the new framework and how it will impact their practices, including (Note: these resources are free to CMA members only):
- A fact sheet that provides background, timelines and a list of frequently asked questions.
- An on-demand webinar about the Data Exchange Framework and how to prepare for it.
New state law requires physicians to notify patients about Open Payments database
A new California law that takes effect January 1, 2023, requires California physicians to provide patients with a written or electronic notice about the availability of the federal Open Payments database. It also requires physicians to post in their offices and on their websites a notice informing visitors about the Open Payments database.
Under federal law, drug and medical device manufacturers are required to report their financial interactions with physicians – including consulting fees, travel reimbursements, research grants and other gifts. Any payments, ownership interests and other “transfers of value” are reported to the Centers for Medicare and Medicaid Services (CMS) for publication in the public Open Payments database.
Open Payments data is published annually by June 30, and physicians are able to preview the data attributed to them during a 45-day, pre-publication review and dispute period that runs from April 1 to May 15. Physicians are encouraged to review the data attributed to them during the review period.
Physicians who believe their data contain discrepancies can initiate a dispute with the reporting entity. This gives the reporting entity an opportunity to correct the information before the data is made public.
Disputes can be initiated until the end of the calendar year in which the record was submitted, but disputes initiated after the end of the review and dispute period will not be reflected in the initial publication.
For more information, visit cms.gov/openpayments. CMA has published sample forms and notices available at cmadocs.org/open-payments.
APA / Federal Update
CMS Proposes Rule to Expand Access to Health Information and Improve the Prior Authorization Process
As part of the Biden-Harris Administration’s ongoing commitment to increasing health data exchange and investing in interoperability, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services. CMS proposes to modernize the health care system by requiring certain payers to implement an electronic prior authorization process, shorten the time frames for certain payers to respond to prior authorization requests, and establish policies to make the prior authorization process more efficient and transparent. The rule also proposes to require certain payers to implement standards that would enable data exchange from one payer to another payer when a patient changes payers or has concurrent coverage, which is expected to help ensure that complete patient records would be available throughout patient transitions between payers. Read more here.
Longtime Contract Lobbyist for the California Psychiatric Association to Retire
Nielsen Merksamer Parrinello Gross & Leoni LLP reports that James "Jim” Gross will retire at the end of this year. Gross started with the firm in 1984 and was the first member of its government law section. During his career he’s “worked on a variety of healthcare issues, professional licensing, state and local tax policy and local government issues.” For many years, Jim was the contract lobbyist for the now-defunct California Psychiatric Association.
New Lobbyist the California Psychological Association
Jennifer Alley has been named the Director of Governmental Affairs for the California Psychological Association. Jennifer worked previously for the California Association of Marriage and Family Therapists. Jennifer has close to 20 years of health care lobbying and government relations experience. In previous roles, she represented health plans, home health, hospice, and adult day programs.
Q & A
Q: I just got my first insurance bill since the enactment of AB 35 (Stone) regarding "MICRA reform". My premium increase was 4%. Are you hearing from other members?
A. TO ALL MEMBERS: Have you received your latest insurance renewal? Are you seeing increases higher than 4%? Please let us know.
Do you, or someone you know, have remaining student loan debt? Have you talked to them about the County Medical Services Program Loan Repayment Program (CMSP LRP)? The CMSP Governing Board is continuing its partnership with the Department of Healthcare Access and Information to offer educational loan repayments to primary care health professionals of up to $50,000 in exchange for two-years of service at a CMSP-contracted provider site. Please see this attachment regarding cycle information and applicant eligibility and share this important information with anyone you know who might be interested.
Behavioral Health Task Force Meeting 12/13
At its last meeting in 2022, the BHTF discussed the following issues:
- Fetal Alcohol Spectrum Disorder
- Substance Use Disorder Efforts
- Cannabis-Related Efforts.
- Fentanyl-Related Efforts
- Innovative SUD Services, Treatment, and Support
The slide deck has tons of information, which you can view here.
Worth a Read