Volume 2, Issue 49 - December 9, 2022
California Prescribing & Medication Filling Issues
The American Psychiatric Association (APA), CSAP and California's District Branches (CCPS, NCPS, SCPS, OCPS, SDPS) have recently received reports from members regarding growing difficulty of filling prescriptions for controlled substances and the unusual investigative activities of physicians by regulatory boards that seem to be related or triggered by prescription of controlled substances. To further understand these issues in California and ways to address them, CSAP and the DBs seeks input and examples from members. It uses condition logic so that you only get certain questions if you respond affirmatively to others. If you don't want to go through all the options, this is the outline:
District Branch *Multiple choice
Practice city or zip code
What is the general issue? *Multiple choice
You can access the form here. PLEASE fill this out as soon as possible to help your advocacy partners pursue solutions to these issues. Please note that you can fill out the form more than once if necessary.
- Unusual investigations by the California DOJ and/or the medical board related to controlled substances.
- Investigating entity *Multiple choice
- Cal DOJ
- Medical Board of California
- Please describe the incident (investigating entity if not Cal DOJ or MBC, stated or suspected reason, other details) Short answer text
- Pharmacy refusal to fill medications (controlled substances or other psychotropic medications)
- Medication prescribed *Multiple choice
- Non-Adderall stimulant
- Other controlled-substance (schedule II-IV)
- Non-controlled psychotropic medication (schedule V)
- Pharmacy *Multiple choice
- Mail-order service
- Pharmacy identified issue *Multiple choice
- address considerations
- Is patient in a different state? *Multiple choice
- Patient's city or zip code Short answer text
- Pharmacy city or zip code Short answer text
- medication dispensing quota or limit
- medication shortage
- requesting physician provide medical records or a plan for taper
- CURES-related concerns
- Other or additional issues and considerations Short answer text
California Behavioral Health Community-Based Continuum Demonstration
In 2023, the Department of Health Care Services will apply for a new Medicaid Section 1115 Demonstration to increase access to and improve mental health services for Medi-Cal members statewide. This will permit states to secure Federal Financial Participation (FFP) for services provided during short-term stays, defined as stays up to 60 days, in psychiatric hospitals or residential treatment settings that are considered IMDs. Read more here.
2023-24 Legislative Session Begins
Bold Proposals on Tap?
You may have heard about an "invitation only" event on Monday, 12/12 hosted by the Steinberg Institute regarding a "right to care" in California. Will CSAP be there? Yes. Paul Yoder of SYASL and CSAP's Government Affairs Chairwoman Emily Wood will both participate.
Here's the thing though: this is just a piece of what could happen in 2023. There are some amazing conversations already underway that involve all the major political players in Sacramento on mental health and SUD issues about how to propose something truly significant to the voters statewide in November, 2024. In the future, we will report on these discussions to the fullest extent we are allowed. As we've said: you may all, every single one of you, have a role to play over the next two years with respect to the future of funding and policy in California. Much more to follow.
A New Class of Legislators
Tracking legislative turnover this year has been quite a task. In addition to a large class of new incoming legislators, redistricting was also a factor. Here’s where we stand:*
35: The number of new legislators, including Assembly members moving to the Senate (or in the case of Janet Nguyen, returning), meaning nearly a third of seats feature fresh faces.
62 and 32 : The number of Democrats in the Assembly and the Senate, respectively. That puts Assembly Democrats 8 votes above the two-thirds threshold and Senate Dems 5 over.
51: The number of women legislators — an all-time high but still short of the 60 seats needed for gender parity. Speaking of diversity: We count at least 12 LGBTQ legislators; 12 African-American lawmakers; 37 Latino lawmakers; 13 API lawmakers.
*(note: two races remain undecided. We are counting with current totals that have Democratic Sen. Melissa Hurtado surviving a challenge from Republican David Shepard — Hurtado took a 12-vote lead on Friday — and Republican Greg Wallis edging Democrat Christy Holstege).
Governor Newsom Announces Grants for Youth Mental Health
Governor Gavin Newsom has announced $480.5 million in awards for 54 projects to improve California’s behavioral health infrastructure for children and youth. As part of Governor Newsom’s Master Plan for Kids’ Mental Health, this investment provides grant funding to construct new facilities and expand existing facilities that help children, youth, transition-age youth, and perinatal individuals with a mental health and/or substance use disorder. Examples include $57.4 million for a Psychiatric Acute Care Hospital in Los Angeles and $27.6 million to treat substance use disorder and expand adolescent residential treatment facilities for youth in Orange County. Read more here.
Community Assistance, Recovery & Empowerment (CARE) Act
The California Health and Human Services Agency (CalHHS), in collaboration with its partners at the Department of Health Care Services (DHCS) and the Judicial Council of California (JCC), will be sharing a webinar with general information and important updates on the implementation of the Community Assistance, Recovery & Empowerment (CARE) Act. The recorded webinar will be posted on the CARE Act website on December 19th.
The webinar will cover:
- 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 implementation activities
CalHHS will establish a CARE Act Working Group in early 2023 and will continue its ongoing engagement with representatives from a wide variety of networks, including peers, disability rights organizations, families, racial equity advocates, housing and homelessness stakeholders, behavioral health providers, associations, and more.
The Kennedy Forum has released a 988 issue brief, "Ensuring Coverage of Behavioral Health Emergency Services." The brief identifies gaps in current insurance coverage requirements for behavioral health emergency ("crisis") services and breaks down how state and federal policymakers can guarantee coverage for the full range of behavioral health emergency services, including using the Federal Parity Act. Currently, commercial insurance rarely pays for behavioral health emergency services. You can view the brief here.
Racial and Ethnic Bias in Healthcare Algorithms
California Attorney General Rob Bonta has sent letters to hospital CEOs across the State requesting information about how healthcare facilities and other providers are identifying and addressing racial and ethnic disparities in commercial decision-making tools. The request for information is the first step in a DOJ inquiry into whether commercial healthcare algorithms – types of software used by healthcare providers to make decisions that affect access to healthcare for California patients – have discriminatory impacts based on race and ethnicity. Read more here.
We want to make sure you have all seen CMA's new laws report and highlight AB 1278 (Nazarian) which will soon require physicians to provide notice to their patients regarding the Open Payments database, which is managed by the U.S. Centers for Medicare & Medicaid Services, or CMS.
Specifically, this new law requires physicians to do the following beginning January 1, 2023:
- At the initial office visit with their patient, a physician must provide either a written or electronic notice of the Database that includes the following text:
“The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov.”
If the physician uses an electronic records system, they must include a record of this notice in the patient’s records.
If the physician uses a paper-based records system, then the written notice to the patient must include a signature from the patient (or their representative) and a date of signature. Further, a copy of the written notice must be provided to the patient (or their representative) and included in the patient's records.
- Post a notice regarding the Database at each location where the physician practices, in an area likely to be seen by all persons. That notice must include an internet website link to the Database and the following text:
“For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.”
If a physician is employed by a health care employer, that employer is responsible for meeting this requirement.
Beginning January 1, 2024, a physician who uses a website in their medical practice must conspicuously post the same notice described above in number 2 on their website. If a physician is employed by a health care employer, that employer is responsible for meeting this requirement. Under this law, a violation of these requirements constitutes unprofessional conduct. The requirements created by this law do not apply to a physician working in a hospital emergency room. For additional information, please see the text of AB 1278.
School Based Mental Health
The California Association of School Psychologists and a panel of psychologists, counselors and social workers met to discuss their experiences and on-going work related to school based mental health services. You can view SYASL staff notes here, and meeting materials here.
Manifesting a Thriving Workforce
The California Alliance brought together institutions of higher education and the public behavioral health field for a dialogue on promising solutions, partnerships, and what is possible to deal with the workforce crisis. Keynotes included Tony Thurmond, State Superintendent of Public Education, and Linda Burton, Dean, UC Berkeley School of Social Welfare. Panelists discussed dismantling the barriers currently plaguing the professional career pathways within behavioral health and how they can create pipelines to help first-generation, low-income, and underrepresented students explore careers in the behavioral health workforce. You may view SYASL staff notes from the event here.
APA / Federal Update
APA / APAF Fellowship Program
The 2022-2023 recruitment season for APA/APAF Fellowship applications is open. Applications will be accepted through Friday, February 3, 2023, for nine (9) APA/APAF fellowship programs.
This year, APA and APAF is pleased to offer a new fellowship program, the Community Diversity Leadership Fellowship for psychiatry residents from diverse backgrounds. APA and APAF are aiming to substantially increase the number of applicants from MUR groups, the uniformed services, and underserved regions of the United States. The Community Diversity Fellowship provides residents with leadership, networking, and mentorship opportunities as well as a field placement component.
Additionally, they have a SAMHSA-funded summer opportunity for medical students and encourage you to utilize the this flyer to promote relevant timely opportunities through your communication channels – including social media, newsletters and web.
Upcoming Events & Reminders
Q & A
Q: Can you remind me of the federal gun violence bill that became law this year?
A. Yes, here is the federal bill that was passed earlier this year on the gun violence: https://www.congress.gov/bill/117th-congress/senate-bill/2938/text. Everyone should familiarize themselves with this new law.
Children and Youth Behavioral Health Initiative
Lunch and Learn
The Behavioral Health Task Force met to hear an update on the State’s Crisis Care Continuum Plan. You may view SYASL staff notes here.
Worth a Read