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Sarah Mills, District Policy Group

The end of the 2019 legislative year, the first year of the 116th Congress, is wrapping up much like it started – gridlocked by partisan battles and struggling to complete work on major funding priorities. After failing to complete work on funding bills prior to the end of fiscal year (FY) 2019, Congress passed and the President signed a continuing resolution (CR) to keep the government open and operating at current funding levels through November 21. Now, Congress will pass another CR to carry us through to December 20th in the hopes that they can reach an agreement on regular appropriations bills.

In the midst of the continuing funding battles, political tensions between Democrats and the Administration have reached new heights as the House proceeds with their impeachment inquiry. As a result, opportunity has been and remains low for successful movement of bipartisan legislative priorities, no matter their reach on both sides of the aisle.

In addition to the aforementioned challenges, Congress and the Administration continue to balance a number of other competing priorities that are significantly unchanged from previous years including drug pricing, trade negotiations, immigration battles, and matters of national security.

Therefore, we are approaching 2020 at a standstill and with the Presidential elections in full swing. Democrats began the Presidential debates with 28 candidates. Following a series of debates, 8 candidates have dropped and 20 remain including numerous members of Congress. Beginning in January, candidates will be traveling regularly and focused on using their seats to generate support their platforms. In addition, the year will follow a compressed legislative calendar to make way for the primaries and to give candidates, including those running for seats in Congress, time to campaign in the fall. Any legislative priorities not completed by end of 2019 will face an increasingly short window of opportunity in 2020 and an uphill battle to get bipartisan support to pass the divided Congress.

Looking ahead to 2021 and the start of the 117th Congress, already 28 members of the current Congress have left or announced they will not be returning to their seats. The 2018 midterms saw a slew of new faces enter Congress and the new blood has increased political tensions with growing inter- and intra-party divides. Also similar to 2018, many leaving are likely to be long-serving members of Congress. It’s too early to tell where the White House, House, and Senate may end up in terms of party control, but many believe, at this point, a divided Congress and Administration still seems likely no matter who is in the White House.

A Year-In-Review: CPNP’s 2019 Advocacy Efforts

Entering 2019 with a rather bleak legislative outlook, one might wonder what opportunities existed for CPNP to advance our 2019 Health Policy Agenda after such an active 2018. But there is a natural ebb and flow to Washington: active legislative cycles have a tendency to yield as regulatory agencies take on the task of implementing new laws.

As a result, CPNP added a new focus to our advocacy efforts in 2019. While maintaining our efforts to build relationships in Congress and educate Members and their staffs about the important role of psychiatric pharmacists, we also sought to position ourselves as a resource for agencies working to implement legislation to improve treatment for mental health and substances use disorders (SUDs), including opioid use disorders (OUDs).

At the end of 2018, Congress completed work on the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT for Patients and Communities Act) and tasked the Administration with implementation. Much of this work centered on the Centers for Medicare and Medicaid Services (CMS) and the need for them to establish payment and reimbursement models for the treatment of SUDs, including OUDs. As a result, CPNP (Carla Cobb, Megan Ehret, Lisa Goldstone, Brenda Schimenti) met with officials at CMS in the Spring of 2019 in order to educate them on the services that psychiatric pharmacists provide as part of the interdisciplinary care team to treat mental health and SUDs and their ability to improve outcomes while also reducing overall costs. While recognizing that CMS does not possess the authority to grant psychiatric pharmacists direct billing privileges, CPNP also expressed concerns regarding the lack of adequate reimbursement that exists for psychiatric pharmacists across the various healthcare settings and made recommendations on ways the agency can improve reimbursement as we continue to work towards “provider status” legislation for pharmacists.

In follow-up to our meeting, CPNP submitted comments on the agency’s proposed rule for CY 2020 Payment Policies under the Physician Fee Schedule (PFS), reiterating psychiatric pharmacists role in helping to improve and provide treatment for patients dealing with SUDs, including OUDs, and recommending inclusion under the OTP coverage provisions as well as the SUDs bundled payment proposal. In addition, CPNP continued to express concerns regarding the inconsistent and generally inadequate reimbursement of psychiatric pharmacists services and the significant barrier this imposes to ensuring patients and other health care providers have access to their services across the hospital outpatient, physician office and specialty treatment settings. CMS received more than 40,000 comments on the proposed rule and though the agency decided not to move forward with commenters’ recommendations on several areas of interest to CPNP, the agency explicitly recognized our recommendations to include psychiatric pharmacists and expressed interest in continuing work with our community as they evaluate the needs for these programs moving forward.

CPNP’s meeting with CMS was the first of its kind in the history of our organization and was a significant step in our relationship building activities with key policymakers in Washington. As CPNP continues to grow our government affairs efforts, the latest acknowledgement by CMS serves as an important indication of our increasing visibility and influence within the policymaking process.

In support of our agency efforts, CPNP kept in close contact with key Congressional offices on our engagement with CMS and despite “provider status” taking a back seat to drug pricing this year, we actively worked in coalition with our partners and strengthened our relationships with key stakeholders by joining their efforts to ensure patients maintain and have affordable access to medications.

While awareness for the need to improve treatment for mental health disorders continues to rise, we also saw the mental health community presented with a number of new challenges. In response, CPNP actively sought out opportunities to engage with our coalition partners to ensure that beyond advocating for our profession, we continue to be a voice for our patients on issues that have the potential to negatively impact those dealing with mental health disorders, including SUDs.

Looking to 2020, we will continue to work with the Administration and Congress on efforts to improve and expand access to treatment for mental health disorders and appreciate the incredible work our members are doing to serve their patients, demonstrate the benefits of psychiatric pharmacy, and provide evidence based results that help to support our policymaking objectives.

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