By Carey Potter, CPNP Government Affairs Consultant
This year, even more than in previous years, psychiatric and mental health services have been at the forefront of patient care. As senseless tragedies keep happening across the country and Congress seems to do little, if anything, to address issues around mental health and substance abuse, the talk has shifted to key words like reform, efficiency and fiscal savings. And the discussion is about many topics immediately related to you, as a psychiatric pharmacist.
Comprehensive Medication Management (CMM) and Enhanced MTM Services
Your ACCP/CPNP coalition continues to make inroads with leadership in subcommittees of both the Senate Finance and House Energy and Commerce Committees, working with leadership staff to address the need for both an improved MTM prescription drug program as well as the need for CMM and true patient healthcare reform that results in better outcomes and team based care through clinical pharmacy services. In essence, we have two bites at the apple, as we are working within both Medicare Part B and Medicare Part D. Advocates have long agreed that CMM and the services performed by clinical pharmacists, under collaborative practice agreements, far exceed basic MTM as we’ve known it. With the ongoing concerns over the effectiveness of the Part D MTM program, members of Congress are realizing that these two acronyms both involve pharmacists, but that’s about where the similarities end.
Our messaging about “getting the medications right” and working as part of the healthcare team is on target with both committees who want to see more patient centric care in a checks and balances type system. We have been assured several times by respective committees that the need for a concept like CMM is very real, and “some of our ideas are under consideration.” What ideas, we do not know… and when they will be considered remains to be seen. But, as the snail continues up the mountain, we are, clearly, on the radar with our CMM effort. We’ve also seen a slowdown in momentum since the Energy and Commerce Committee took action and is working to improve MTM. Hearings were held to discuss what will improve the participation and services of the program. CMS has announced funding for Enhanced MTM pilot programs and has identified states that could apply for these funds. While there is great hope that innovation will prevail, things aren’t rosy. States have little time to apply for grants; prescription drug plans are not excited about creating a separate, new payment program for the pilot, and generally, nobody is jumping for joy over the idea. The overall success of the five year MTM pilot remains to be seen, but the upside is that this is another opportunity to bring the CMM message to the forefront.
A year ago, the Patient Access to Pharmacists’ Care Coalition (PAPCC) was on the fast track. They had found sponsors to introduce legislation that proposes to give pharmacists provider status. The goal remains for pharmacists to be reimbursed for whatever they do. Pharmacy organization members rallied members of Congress and they began signing on to HR 592 and SB 314. The PAPCC has successfully rallied 245 House members and 37 in the Senate. This is admirable. Getting legislation introduced is a big first step toward provider status, but next steps, including Congressional Budget Office scoring and scheduling hearings in the subcommittees of jurisdiction is the beginning of where the rubber really hits the road. Legislation must advance from both committees, amendments must happen and ultimately the President must sign the bill. So, the groundwork is being handled, but provider status is not close, yet, to being a reality.
Mental Health Legislation and Chronic Care
CPNP has reached out to Congressman Tim Murphy on many occasions, thanking him for his continued efforts to improve mental health services for patients and encouraging him to incorporate clinical pharmacists into the patient care effort. He has been responsive, and in mid-November he reached out to our coalition lobbyist, asking for a hand with HR 2646 Helping Families in Mental Health Crisis Act. We will continue meeting with Murphy. HR 2646 remains the only mental health legislation with a possibility of becoming law in 2016.
Also on our radar is the Senate Finance effort to study chronic care conditions. CPNP submitted comments stressing the need for CMM services. Not only is mental health a chronic condition, but our patients most always suffer from multiple conditions. Multiple chronic conditions mean cost to the Senate Finance Committee. We remain in contact with committee legal counsel and others, as this committee prepares to introduce legislation in 2016.
So, while we have not seen successful CMM legislation, neither have we seen successful MTM, Provider Status, or Mental Health legislation. We remain fully engaged in this legislative affairs process, at every angle. I thank the members of CPNP for their continued support of our efforts.