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Volume 2, Issue 43 - October 28, 2022

AB 890 / Nurse Practitioner Regulations 

Proposed regulations for AB 890 are out for review and comment. Below you will find links to the notice of proposed regulations, the initial statement of reasons, and the proposed regulatory language. These can also be found here under, “Categories and Scope of Practice of Nurse Practitioners”. 
You may also view CMA’s draft comment letter below. One inclusion in this letter, based on a number of concerns raised, is specifying that 103 and 104 NPs should not perform cosmetic medical procedures. CSAP will most likely also comment on these proposed regulations.

Notice of Proposed Regulatory Action 
Initial Statement of Reasons
Proposed Language
CMA's AB 890 Proposed Regulations Comments Letter 

Short item this week - SYASL has become aware of at least one physician's group retaining legal counsel to assist with the challenges presented by various health plans. SYASL is in the process of learning more about their efforts and possible coordination going forward. More to come.
Psychiatrists Helping Psychiatrists

Physician Support Line is a national, free, and confidential support line made up of hundreds of volunteer psychiatrists joined together in the determined hope to provide peer support for physician and medical student colleagues. Some CSAP members are already providing support; you may want to volunteer.

Also, no appointment necessary. You can call the national support line at 1-888-409-0141, or click here: Physician Support Line

New York Times - "It's Not Just You"

As many of you are aware, the New York Times has run a four-part mental health series of articles in its Sunday Opinion section. Their intro to it is as follows: 

"Americans are talking a lot about their Mental health these days. Social media influencers openly discuss their diagnoses; the language of trauma and self-care has found its way into everyday conversation; topics like teenage suicides and psychedelics are frequent subjects of consideration in the news. Maybe you've been talking about mental health more, too -- your own, your family's. Maybe it's not as good as it used to be. Over the course of the pandemic, rates of anxiety and depression have skyrocketed. Self-harm and suicide attempts among adolescents are on the rise. Even those who aren't staring into the void still feel like they're languishing. A national conversation about mental health is important. But we think something has been missing from it. Mental health is a personal experience, of course, but it's also something that is very much shaped by the world around us: our communities, our economies, our politics, our medical institutions. We're hoping this special issue of Sunday Opinion will make you think differently about mental health and, consequently, help make all of our mental health better. We can improve our collective mental health only if we recognize that the problems -- and the solutions -- are all of ours. In other words: It's not just you." Read more


Ryan Haight - Telehealth 

APA is currently working with the American Telemedicine Association to urge the Department of Justice and the Drug Enforcement Agency (DEA) to promulgate regulations to offer prescribing clinicians a long-term solution to this issue and to provide short-term guidance and continued flexibility when the Public Health Emergency ends to ensure patients have continued access to care.
Unfortunately, the APA is at the mercy of the DEA’s action / non-action and because they know members are anxious about the potential mid-January deadline, they will be hosting a webinar in the coming weeks. Registration information will be shared once it becomes available. 

Earlier this year, several organizations focused on health care access and public health sent a letter to strongly encourage the DEA to collaborate with the Department of Health and Human Services (HHS) to consider public health and health care access during the development of the Special Registration process for the use of telemedicine to prescribe controlled substances under the Ryan Haight Act. You may view the letter here


Study on Pediatric Antipsychotic Utilization

Rutgers Institute for Health, Health Care Policy and Aging Research is conducting a study of state Medicaid offices’ efforts to promote the safe use of antipsychotic medications among their children, funded by the Agency for Healthcare Research and Quality. From a review of the literature, state policies, and conversations with subject matter experts, Rutgers has selected California for a deeper dive into how the State has successfully promoted the safe use of these medications. As part of the study, they would like to interview some key stakeholders in California to document the development and implementation of the safe use initiatives for Medicaid-enrolled children. They would like to hear perspectives on approaching California’s landscape and would appreciate any connections or suggestions you can make for those within your network. You can view a one-page summary of the study here.

If you would like to participate or have any questions, please contact Jim Lloyd or Kylie Davidson.  


Fighting Rising Prescription Costs 

California Attorney General Rob Bonta has announced joining a coalition of 35 attorneys general in filing an amicus brief in the U.S. Court of Appeals for the Tenth Circuit in support of Oklahoma’s authority to regulate Pharmacy Benefit Managers (PBMs). As most of you know, PBMs act as middlepersons between pharmacies, drug manufacturers, health insurance plans, and consumers. This position allows them to have a significant impact on consumers’ access to affordable prescription drugs. Read more.

Homelessness in Los Angeles 

The Assembly Budget Subcommittee held an informational hearing in Los Angeles this week, Homelessness Opportunities, Accountability and Governance.  In the hearing, panelists shared a history of Skid Row and homelessness in Los Angeles, an overview of the region's homeless population, and an overview of homelessness strategy through state-funded programs like the Housing, Assistance and Prevention Program (HAAP), Homekey, and Encampments. You may view the agenda here, and SYASL staff notes from the hearing here

APA / Federal Update 

APA Advocacy 

APA held its State Advocacy Conference in Minneapolis, Minnesota, where they had over 100 APA members from various District Branches, Areas, and Councils in attendance. During the event, they covered topics such as social media training, the psychology of gun violence, 988 and the crisis of continuum of care, the Collaborative Care Model, and APA’s model legislation on prior authorization. They also heard from legislators about how to advocate in favor of patient safety and why it is important for physicians to be involved in advocacy. You may view the selection of resources APA shared with attendees here

CMA Update

Webinar: The Future of Primary Care in California

Recently, six California payors signed a Memorandum of Understanding committing to work together on a shared set of goals designed to improve the provision of primary care in California over the next three years. The goals include expanded transparency, value-based payment reform, increased investment and practice transformation support for person-centered care. In this webinar, physicians will learn about this new initiative and how it will help them provide higher quality patient care. In addition, physicians will hear a description of how one payor – Blue Shield of California – is implementing Advanced Primary Care in their network. With this knowledge, primary care physicians will be able to prepare their practices to meet the goals of the program, improving the experience of their patients. Register here

Webinar: CMS Medicare Updates 2023

Centers for Medicare and Medicaid Services (CMS) Regional Chief Medical Officer Ashby Wolfe, M.D., will provide an update on CMS policy for the 2023 calendar year. Information presented will be relevant to practicing clinicians, including an overview of the updates to the 2023 Physician Fee Schedule. Register here

Webinar - Making a Difference in 10 Minutes: Motivational Interviewing for Substance Use Disorders

Motivational interviewing (MI) may have more research to support its effectiveness than most medications and using it increases the chances our interactions with patients will be more rewarding, more connected and less argumentative. MI is applicable to any behavior change, has been studied cross-culturally, and employs some strategies that can actually shorten some visit types.

In this practical workshop, you'll get a brief overview of the most current and compelling research on MI and substance use disorders (SUD); learn the five most powerful strategies for helping patients struggling with SUD or other behavior changes; and learn two anti-growth statements to avoid saying to patients to increase the likelihood of positive care outcomes. Register here

New Polling on November Ballot Measures

The Public Policy Institute of Californian released new poll findings showing that support for Propositions 26 and 27 fall short of a majority. Proposition 26, which would legalize in-person sports betting on tribal lands and certain race tracks, has the support of 34 percent of likely voters. Prop 27, which would legalize online sports betting, fell to 26 percent in this survey, down from 34 percent in September. You may read the full poll findings here. You may also view an article from Politico regarding the same, here
New Feature - Reader's Q & A

CSAP gets a lot of great questions from you, the readers of this weekly newsletter. It occurs to us that the questions and answers could be shared with the entire membership / readership. (By the way - did you know that 3000 psychiatrists get, and read, this newsletter, every week?). This week's featured questions are:

Regarding AB 988 Implementation

Q: AB 988 requires the State to convene a state 988 advisory group, as described, for purposes of advising the agency on the set of recommendations - do you know how they are selecting people? 

A: CalHHS is doing some internal planning and assessment of how to execute our responsibilities but have not begun to think about who will participate in the state 988 advisory body housed at CalHHS. We do not intend to convene before the new year and in the interim our Behavioral Health Taskforce has been the body where conversations about the behavioral health crisis care continuum, including the transition to 988, and now the passage of AB 988, have been taking place. There has been quite a bit of activity at the BHTF on this topic this year and I would suggest that the interested person check out the resources on this webpage and to sign up to the BHTF listserv to get announcements about meetings, etc. They can do this by sending an email to:

Q: It looks like responsibility for oversight is not actually defined but floating somewhere between DHCS, OES, DPH. Is this accurate? Do you know where it might land?
A: As part of the State's responsibility to develop a 5-year implementation plan, CalHHS is charged with making recommendations for a state governance structure and we will be doing that in coordination with our departments, other elements of the administration, and with local implementation partner input.

Have a question? Just email Paul Yoder of SYASL. We'll get you the answer and it can also inform the rest of our approximately 3000-member readership!

Worth a Read

CSAP is a cooperative effort between the Central California Psychiatric Society, the Northern California Psychiatric Society, the Orange County Psychiatric Society, the San Diego Psychiatric Society, and the Southern California Psychiatric Society.

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