NEWSLETTER
Volume 3, Issue 4 - January 27, 2023
Governor and Mayors Discuss Conservatorship Reform
Yes, other issues were discussed on this Zoom, which occurred earlier today, but conservatorship was front and center. Suffice to say that the Governor is very open to changing the law even further. The challenge - as we've discussed in the Newsletter many times over the last year - is getting the right bills in the right form to his desk for signature. The Big City Mayors will now turn their attention back to the Legislature, specifically Senator Eggman's new bills (to be co-sponsored by CSAP), but also possibly others.
Parity
This week, CSAP joined other organizations in submitting formal comments on the Department of Managed Health Care’s (DMHC) proposed regulations to implement Senate Bill 855. You may view the comment letter here. In the back and forth leading up to finalization of the letter, DMHC staff were convinced to take a second look at previously closed cases to determine if further assessment of complaints is necessary. Also, in the case of Spravato, this coalition emphasized the need for coordination between referring/transferring providers since many health plans routinely identify providers available for consultation without regard to whether they are REMS-certified or even available to initiate treatment (rather than merely provide a consult) by a certain date. Lastly, the coalition stressed the issue of health plans identifying providers as "in-network" when in fact they are not. Very specifically, SYASL advocates ensured that DMHC staff understand physicians and practices have recently been exposed to immense financial risk due to delays and denials by the health plans, and that new regulations need to remedy this as much as possible.
Legislation
Next Thursday, the CSAP Government Affairs Committee and Board will consider the following new bills:
AB 29 (Gabriel) Firearms: California Do Not Sell List
This bill would require the Department of Justice to develop and launch a secure Internet-based platform to allow a person who resides in California to voluntarily add their own name to the California Do Not Sell List. The bill would require the department to ensure that information on the list is uploaded and reflected in the National Instant Criminal Background Check System. The bill would make it a crime, punishable as misdemeanor or a felony, to transfer a firearm to a person who is validly registered on the California Do Not Sell List.
AB 85 (Weber) Social determinants of health: screening and outreach
This bill would require a health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2024, to include coverage for screenings for social determinants of health, as defined. The bill would require a health care service plan or health insurer to provide primary care providers with adequate access to community health workers in counties where the health care service plan or health insurer has enrollees or insureds, as specified.
AB 317 (Weber) Pharmacist service coverage
This bill would require a health care service plan and certain disability insurers that offer coverage for a service that is within the scope of practice of a duly licensed pharmacist to pay or reimburse the cost of services performed by a pharmacist at an in-network pharmacy or by a pharmacist at an out-of-network pharmacy if the health care service plan or insurer has an out-of-network pharmacy benefit.
SB 45 (Roth) California Acute Care Psychiatric Hospital Loan Fund
This bill would establish the California Acute Care Psychiatric Hospital Loan Fund and would continuously appropriate moneys in that fund to the authority to provide loans to qualifying county or city and county applicants for the purpose of building or renovating acute care psychiatric hospitals, psychiatric health facilities, or psychiatric units in general acute care hospitals.
SB 70 (Winer) Prescription drug coverage
This bill would prohibit limiting or excluding coverage of a dose of a drug or dosage form, and would apply these prohibitions to a prescription drug that is prescribed for off-label use. The bill would prohibit a health care service plan contract from requiring additional cost sharing not already imposed for a drug that was previously approved for coverage.
SB 238 (Wiener) Health care coverage: independent medical review
This bill would require a decision regarding a disputed health care service to be automatically submitted to the relevant Independent Medical Review System if the decision is to deny, modify, or delay specified mental health care services for an enrollee or insured 0 to 21 years of age, inclusive.
You may review a complete list of bills being tracked (so far this legislative session) by CSAP here. The closer we get to the bill introduction deadline February 17, the fuller this list will become.
CARE Court
Legal Challenge
This week, Disability Rights California, Western Center on Law & Poverty, and the Public Interest Law Project filed a petition to the California Supreme Court to block Governor Newsom's CARE Court, challenging the constitutionality of the program. The "groups argue that the sweeping new court system will violate due process and equal protection rights under the state constitution, while “needlessly burdening fundamental rights to privacy, autonomy and liberty." Read more here.
Counties Weigh in With Judicial Council
Final joint comments from county organizations on the proposed CARE Court Rules and Forms that were promulgated by California's Judicial Council:
Joint Comment Letter
County Recommendations
JCC Proposed CARE Rules-County Recommendations
Prescribing Issues
Prescribing Issues (Continued)
From CSAP's Government Affairs Committee Chairwoman Emily Wood:
CSAP remains committed to:
- Protecting the treatment decisions that are made in collaboration between a patient and their psychiatrist
- Supporting legislation and regulations that emphasize substance misuse prevention and treatment
- Parity of mental health and substance use care with other types of medical health care
- Equity, justice, and inclusion in the provision of behavioral health care
The opioid epidemic has wreaked havoc on communities across the country. In the last several years, >50,000 people have died each year from opioid overdose alone. The rates of overdose involving most drugs, including synthetic opioids, psychostimulants, benzodiazepines, and antidepressants, have increased over the last 20 years. >99% of psychostimulant-involved overdoses are with methamphetamine or cocaine and the vast majority in the last several years have been in combination with synthetic opioids. Benzodiazepine and antidepressant-involved overdoses have risen almost exclusively due to combinations with synthetic opioids.
While synthetic opioids, medications that are rarely prescribed by psychiatrists, are the main culprits in recent overdose deaths, there is mounting evidence that pharmaceutical distributors are cracking down on all controlled substances using opaque algorithms designed to detect misuse. In turn, with limited supplies, pharmacies are denying prescriptions based on fabricated laws such as geographic distance between provider and patient. This process disproportionately targets psychiatric patients and psychiatrists since the vast majority of controlled substances are psychoactive drugs. Therefore, the current man-made drug shortages can be considered an issue of behavioral health parity with other types of medical health care.
Furthermore, we know that shortages are bound to most negatively impact those individuals in our society who are already suffering bias, stigma, discrimination, oppression, and systemic harm. In Los Angeles, one adolescent with ADHD whose family is able to pay cash for psychiatric visits will always manage to get stimulant medication, regardless of shortage. Their parents can spend whatever it takes to drive to multiple pharmacies until they find one with the right formulation. However, it may not be as easy for another adolescent with ADHD who dutifully takes two buses each way to the DMH clinic every month.
For these reasons, we continue to request that you provide data via our survey on prescribing issues that you and your patients are experiencing. We are getting close to having enough data to present to APA.
CSAP Prescribing Issues Survey
You can use this form multiple times to report on different issues. The form also has plenty of space for prose responses. You can also email issues to Paul@syaslpartners.com.
DEA Guidance
A newly approved guidance document has been posted to the DEA Guidance Document Portal and Question & Answers section. This guidance document clarifies that neither the Controlled Substance Act nor DEA regulations establish quantitative thresholds or place limits on the volume of controlled substances DEA registrants can order and dispense; and reminds all DEA registrants of the requirement to establish systems to identify and report suspicious orders of controlled substances to include Medication for Opioid Use Disorder (MOUD). You may view Suspicious Orders Q&A here.
SYASL has opened a dialogue with lobbyists in California who represent the large drug store chains as well as retailers in general. Next week, this group will meet to discuss the issues raised by many of you. In the meantime, this may be of interest: Walgreens' Secret Checklist for Pain Meds.
Crisis Care Continuum Plan
Today, the Council on Criminal Justice and Behavioral Health met and heard presentations from CalHHS and DHCS on a “Crisis Care Continuum Plan” for maintaining connections between Medi-Cal beneficiaries who are “experiencing a mental health or substance use disorder crisis” and support service providers. You may view SYASL staff notes here.
NPs
The California Department of Consumer Affairs' Nursing Practice Committee met this week and discussed AB 890 roll out. You may view SYASL staff notes here.
Medicaid - Incarcerated Persons
The federal Centers for Medicaid and Medicare Services notified California that it is the first state in the nation to receive approval to offer a targeted set of Medicaid services to youth and adults in state prisons, county jails, and youth correctional facilities for up to 90 days prior to release. More than one million adults and youth enter or are released from California prisons and jails annually, and at least 80 percent of these justice-involved individuals are eligible for Medi-Cal. The intent of the demonstration is to build a bridge to community-based care for justice-involved Medi-Cal members, offering them services to stabilize their condition(s) and establishing a re-entry plan for their community-based care prior to release to improve health outcomes and prevent unnecessary admissions to inpatient hospitals, psychiatric hospitals, nursing homes, and emergency departments, and reduce overdose, suicide, homelessness, and recidivism. They are also at higher risk for injury and death as a result of violence, overdose, and suicide compared to people who have never been incarcerated. Read more here.
CMA
Medicare physician fee schedule updated for 2023
When Congress passed its year-end omnibus legislation in the final days of 2022, it included a 2% Medicare physician payment cut for 2023. As a result, the Centers for Medicare and Medicare Services (CMS) updated the 2023 conversion factor to $33.8872 for 2023. Noridian—California’s Medicare contractor—has now updated its 2023 Medicare Physician Fee Schedule to reflect this change and has started releasing 2023 claims for payment. For more information, including information on a free one-hour webinar, please see here.
Congress eliminates need for waiver to treat opioid use disorder
In its year-end omnibus legislation passed on December 23, 2022, Congress took steps to a expand access to medication-assisted treatment for opioid use disorder. Under the new law, physicians no longer must obtain a special federal waiver to prescribe buprenorphine, which is used to treat patients with opioid use disorder. Read more here.
CMS updates Open Payments data
On January 20, 2023, the Centers for Medicare & Medicaid Services refreshed Open Payment data for program Years 2015 through 2021 to reflect changes to the data that have been made since the 2021 Program Year data was published in June 2022. The updated dataset is now available for viewing at openpaymentsdata.cms.gov. Read more here.
Master Plan on Aging
The Assembly Committee on Aging and Long-Term Care has set an informational hearing for late February on the State's Master Plan for Aging. We will share more information as it becomes available. In the meantime, you may view the latest annual report, implementation tracker and more on the Master Plan for Aging website.
State Updates
First Quarterly CYBHI Public Webinar
Please join the California Health & Human Services Agency (CalHHS), in partnership with its departments, on February 1, 2023, from 2 p.m. to 4 p.m. for a webinar on the Children and Youth Behavioral Health Initiative (CYBHI). February’s webinar will provide a closer look at the recently released CYBHI January 2023 Progress Report; share updates on recent developments, work-to-date, and upcoming next steps of the Initiative and its workstreams. Register here.
Grant Opportunities and Opportunities for Public Comment
We are regularly notified of grant opportunities and opportunities to comment on draft behavioral health regulations. For information on the latest opportunities, see here.
Fed / APA Update
Last year APA heard that its Communications Resources and training could be helpful to you all. So this year, APA is going to be reaching out every quarter with those resources. APA would like to encourage you to take advantage of all they have to offer!
- February, 14, 3 pm- 4 pm EST:
Storytelling for Advocacy, as delivered by Kathy Orellana (Senior Regional Director, State Government Relations) and Ginnie Titterton (Director, Corporate Communications and Public Affairs)
Register Here
- April 11, 3 pm- 4 pm EST:
Social Media for Organized Psychiatry, as delivered by Luke Waldron (Senior Social Media Manager) Register Here.
VIDEOS FOR SHARING:
APA’s Youtube channel has a plethora of mental health focused videos you can use on social media or share elsewhere.
This month, check out APA's explainer videos playlist, filled with information on common mental health disorders, here.
INFOGRAPHICS FOR SHARING:
APA also has many infographics you can use, including those covering our latest two polls on Seasonal Affective Disorder and Mental Health New Years Resolutions, view here.
NEWS AND UPCOMING THEMES:
We recently released poll data on mental health New Year’s resolutions and tracking anxiety over current events over the past six months. While we’ll mark Black History Month throughout February, we are also planning a release in the month’s first week on relationships and mental health, and later we will release Eating Disorders Practice Guidelines. March’s theme is pets and mental health, and will also mark Women’s History Month. Please contact APA (vtitterton@psych.org) with any questions you have.
UC Webinars
Last week, the UC Sacramento Center held a webinar, "Addressing Mental Health and Neurocognitive Dysfunction in Chronic Homelessness." You may view SYASL staff notes from the webinar here.
The UC Sacramento Center has additional helpful webinars in the coming weeks. Please see below.
The Other Revolving Door: From the ER to the Streets and Back Again (Feb 1)
Nowhere to Go: Advancing Structural Solutions to Homelessness (Feb 8)
Seeking Solutions to Chronic Homelessness: A Panel Discussion (Feb 15)
California’s Homeless and Incarcerated Mentally Ill in Historical Perspective (Feb 22)
CalHealthCares Loan Repayment Program
The CalHealthCares Loan Repayment Program launched its fifth application cycle on January 18, 2023. The program expects to award approximately 269 physicians and dentists with $63.1M in loan repayments. Applications submitted by the early review deadline of February 3, 2023, will receive feedback and the opportunity to resubmit their updated application prior to the March 3, 2023 application close date. You may view an excel spreadsheet with Cohorts 1-4 data regarding applications by specialties, along with, awardees and awards by county (with secondary counties). If you have any questions or would like additional information, feel free to contact CalHealthCares Program Director, Erica Miller, at emiller@phcdocs.org.
Worth a Read
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