Advocacy Update - APA: Statement in Response to Ninth Circuit Court Overturning 2019 Wit Decision; Network Access in Medicare Advantage Plans; Advocates DEA to Maintain Public Health Emergency Waivers; Are You Being Audited by Private Payers?; Interested in CoCM?

Members Published: Drs. Aimee Kaempf, Saira Kalia, Jordan Karp, Richard Lane, Wallace Mendelson, Noshene Ranjbar, Ramsha Rao, and Karen Weihs

This Spring, as I am writing my last newsletter Presidents’ message, I have been reflecting on the last 18 months and having the honor of being in this role. Starting my Presidency during the pandemic, there were definite challenges to the goals I had set forth for my tenure. On the list was mental health parity, GME expansion, physician mental health, member engagement, and RFM development. It heartens me to know that we worked on all these areas (and then some) with the involvement of our members, support from the APA, collaboration from ArMA, and tireless work by our staff and leaders. 

APS has been instrumental in continuing efforts to establish rules for mental health parity and addiction equity, with our Government Affairs team engaging stakeholders, legislators, and regulatory officials to continue the rulemaking process via GRRC. GME expansion is being discussed, and we were successful in advocating to retain Psychiatry GME spots which were at risk in 2021. Physician mental health was supported by our organization leading the charge to making a change to the AZ Medical Board’s physician licensing application removing undue barriers for physicians seeking mental health care. Membership is at a high point with all three Psychiatry residencies joining the 100% Club and consistently meaningful participation by our RFMs. 

I thank each of you for making the intentional choice to be a part of APS and for committing to stay engaged with issues that impact the ways we provide care. We invite you to share your expertise and interest via service on a committee. The input of our diverse membership is crucial to us providing inclusive and equitable representation. If it does not appear we are working in an area that is a passion project for you, please reach out. You may be the leader for whom we have been waiting! 

I also find myself looking to the time ahead as I am coming to the end of my term, renewing goals to realize my vision for Psychiatry and recommitting to service of our patients and profession. The lesson remains that ongoing, consistent efforts will be needed to make a lasting change. 

Most immediately, our efforts have been focused on bringing you an in-person annual meeting. Our theme for this years’ meeting is “Whole Body Medicine: At the Intersection of Primary Care and Psychiatry”. We are delighted to have so many excellent speakers and presentations that highlight the essential role of Psychiatry in high quality health care. This will also be a time for us to say farewell and share our gratitude for our fabulous executive director, Teri, who will be entering a new phase of renewal; what others might mistakenly call “retirement.” I hope you will join us on June 18th, 2022, for a day of connection, collaboration, and celebration! 

"Everything you do makes a difference. You just have to decide what kind of difference you want to make.” - Jane Goodall

The Arizona Psychiatric Society invites you to make the difference of leadership! Click below to submit an interest form in serving on an APS Committee. For more information on the APS Committees and their Chairs and Co-Chairs, CLICK HERE to read the recent Invitation to Serve and Call for Nominations for the Career Achievement in Psychiatry Award (must be an APS member) and the Mental Health Public Service Award (must be a mental health public service contributor in Arizona). Self-nomination not accepted. E-mail your letter of nomination to Teri by May 9, 2022.

Foremost my parents (and their parents for laying the groundwork) who provided a supportive and secure homelife, an abundance of opportunities and encouragement to study, work and play hard. Although many individuals influenced my career collectively my friends, teachers, classmates, coaches, teammates, professors, administrators, colleagues, residents, medical students and patients have affected me positively - more often than not by good example and much less frequently but also important by what not to do. My career thrived having the opportunity to learn and work with others and fortunately I was surrounded by wonderful people. Professionally this culminated the last two years of my career during the height of the pandemic. My Psychiatry faculty colleagues at Banner readily rose to the occasion making it easy for me to step aside. This was especially gratifying as each were graduates of our Residency Program and several were at one time our medical students. My work was done.

The value of their time mentoring and teaching students and fostering collegiality with each other. The investment is rewarded many times over in both the short and long term.

Whenever faced with a new but complicated endeavor I rely on Henry Ford's maxim "Before everything else getting ready is the secret to success." Preparation was likely instilled in me by the nuns at St. Francis Grammar School, flexibility by my coaches, and the strength in numbers by my teammates and colleagues. It helps to envision challenges as opportunities.

Fortunately, I find most everything fascinating. Being retired and without the urgency of a patient crisis, upcoming accreditation site visit or looming budget cutbacks I can choose and discard more easily. The journey now is slower paced but still fulfilling and fascinating.

The Annual Business Meeting of the Arizona Psychiatric Society will be held virtually at 6:15 pm on Thursday, June 16, 2022 (following the Q&A session with our 2022 authors), with the Annual Scientific Session and awards presentations held in-person on Saturday, June 18, 2022 at Wild Horse Pass Conference Center in Chandler, Arizona. The following APS Nominating Slate will be presented for vote at the Annual Business Meeting.

The elected Arizona APA Assembly Representatives positions are served in staggered terms. The term of Jason Curry, DO and Payam Sadr, MD, DFAPA will continue through the close of the 2023 APA Annual Meeting (May 2023).  The term of Jasleen Chhatwal, MBBS, MD will continue through the close of the 2024 APA Annual Meeting (May 2024).

It has been a very active legislative session, and with narrow margins between the parties, many initiatives have come down to very close votes. CLICK HERE for the latest APS Lobbyist Report for the current status of legislation being monitored and lobbied around by the Society. Thanks to contributions from Dr. Fowls, Dr. Chhatwal, Dr. Olson, Dr. Potts, and other members of the Government Affairs Committee, several bills have had benefit of input from the perspective of psychiatry. For the listing of legislation for which the Society registered a position in this session, CLICK HERE for the Chart of Bills.

The Legislative Session has been on a slow speed for the last few weeks with some indications that the budget process may pick up the pace beginning next week. The House and Senate are working well together on the budget, but the Governor’s Office wants additional funding for several projects. The top project is a billion dollars for a new water authority that would consolidate state water management, provide funding for new projects and function similar to the Arizona Commerce Authority with public private partnerships. To avoid the Governor vetoing bills similar to a few years ago to incentivize the Legislature to pass a budget, the Legislature has slowed down the Third Read votes sending only a few at a time to his office. Nevertheless, the Legislature would like to adjourn before Memorial Day to campaign and raise money from lobbyists and the businesses they represent, which cannot occur until after they adjourn.

As was reported previously, the Arizona Psychological Association submitted a Sunrise Application for 2022 that outlined a proposal to create a new specialty within the scope of practice for psychologists. This specialty would allow certain qualified psychologists to prescribe medications as an additional service within the practice of psychology pursuant to terms to be identified in state statute. With input from the Society and others with concerns around safe prescribing, the consensus was that the issue would benefit from stakeholder conversations, and no legislation was heard on this Application in this session. It is expected that such stakeholder meetings will occur after session, and we also believe that there is strong possibility of legislation being introduced from it in the 2022-2023 legislative session. The Sunrise Application does remain active for five years with potential for such legislation to be proposed. As the Application reads now, the Society is opposed. If you would like to contribute to the work of the Government Affairs Committee on this and other important issues impacting psychiatry and your patients, please contact Teri.

As the telehealth legislation from last session begins implementation, there is opportunity for physician input in the development of rules and policies. The AHCCCS AMPM Policy 320-I Telehealth proposed changes are currently open for public comment until 5 pm on May 30, 2022 at:

The Government Affairs Committee welcomes you to share any comment or feedback on this Policy as it applies to psychiatry with us. Members are invited to comment directly, and if there are comments to bring forward as a Society, we appreciate your feedback in developing the same.

Statement in Response to Ninth Circuit Court Overturning Wit Decision

The APA released a statement calling for fair and equitable treatment for patients with mental health and substance use disorders in the wake of the Ninth Circuit Court’s ruling that overturned a February 2019 decision in Wit v. United Behavioral Health. The 2019 decision that found United Behavioral Health (UBH) had violated its fiduciary duty by making coverage decisions based on financial interests rather than medical standards was seen as a victory for mental health parity enforcement. You can read APA’s full statement on the Wit decision here.

The important work on mental health parity, as authorized by Jake's Law in the State of Arizona, continues as shared in the state legislative update above.

APA submitted comments to the Centers for Medicare & Medicaid Services (CMS) in support of a CMS proposal requiring health plans to demonstrate their compliance with network adequacy standards before CMS will approve an application for a new or expanded Medicare Advantage plan. “APA supports this proposal and commends CMS’s efforts to hold plans more accountable for providing an adequate network of providers to deliver care to MA enrollees,” APA Medical Director and CEO Saul Levin, M.D., M.P.A., wrote to CMS.

APA also provided information to CMS on actions it can take to encourage more health care professionals to join provider networks and supported efforts to improve health equity by requiring Special Need Plans to include one or more questions on the topics of housing stability, food security, and access to transportation as part of their Health Risk Assessments.

APA has written CMS in support of a proposal where plan applicants be required to demonstrate that they comply with network adequacy standards before CMS approve an application for a new or expanded Medicare Advantage Plan. Click here to read more »

Together with 71 other organizations, APA sent a letter to the Drug Enforcement Administration (DEA) and the Department of Health and Human Services calling for the permanent removal of the requirement that patients receive in-person evaluations prior to being prescribed controlled substances via telemedicine.

The requirement has been waived during the COVID-19 public health emergency, allowing patients to access medications for mental health and substance use disorders. In the letter, the organizations expressed their concern that, when the public health emergency ends, “many patients, especially new patients seen for the first time by a clinician during the pandemic, will be left without access to care.”

The organizations were convened by APA, the American Telemedicine Association, and ATA Action. DEA is currently developing the special registration process for the use of telemedicine to prescribe controlled substances under the Ryan Haight Act.

The letter is posted here.

APA wants to hear from members who are undergoing billing and coding audits by private payers. This information will help APA shape its advocacy efforts. Please send an email describing your experience to APA’s Practice Management Helpline at practicemanagement@psych.org. Include your name, contact information, and the payer conducting the audit. The Helpline is a free resource that assists APA members with practice management issues.

APA members who are participating in collaborative care or have an interest in doing so are invited to join a new online community (Collaborative Care Community) to exchange information and ideas with other psychiatrists with similar interests. To join, send a request to SAN@psych.org.

CLICK HERE to join APAPC and receive your APAPAC e-mail badge and/or to sign-up for APA Advocacv Alerts.

The APA Annual Meeting Assembly will be held ijn person in New Orleans on May 20-22, 2022. Arizona will be represented at the Assembly by Arizona Assembly Representatives (Drs. Gretchen Alexander and Jason Curry, as well as Dr. Jasleen Chhatwal, attending as APA ECP Chair, and Dr. Magnolia Swanson, Area 7 RFM Assembly Rep. Drs. Alexander and Curry will be distributing for comment and feedback from our membership the Action Papers to be reviewed in this Assembly. We are looking to create a process that will support the Arizona Assembly Representatives voting with benefit of the views and perspectives of our Arizona members.

INVEGA SUSTENNA^® (1-month paliperidone palmitate) long-acting injectable (LAI) treatment for adults living with schizophrenia to the WHO Model List of Essential Medicines 2021 (EML).^[i],[ii] Essential medicines are those that satisfy the priority healthcare needs of a population, and the selection of INVEGA SUSTENNA^® is an incredible achievement and recognition of Janssen’s commitment to adults living with schizophrenia and schizoaffective disorder.

As you may know, schizophrenia is a chronic and severe brain disorder that affects approximately 20 million adults worldwide and can impact many aspects of a person’s daily life.^[iii] Access to appropriate treatment options, including LAIs, can help adult patients manage symptoms and delay time to relapse.^[iv] Click here to read about Patrick, an adult living with schizophrenia, who shares how access to Janssen’s schizophrenia LAI treatment options have helped him live a life less defined by schizophrenia.

I am excited about this Janssen addition to the WHO EML and this decision will help appropriate adult patients throughout the world gain access to this important treatment option—and ultimately help reduce the global burden of schizophrenia and schizoaffective disorder. This milestone adds to the commitment to continue improving and expanding access to schizophrenia. I invite you to share this news.

CLICK HERE to view the full product announcement.

Share overhead with two psychiatrists and a Trauma therapist. Two offices available. There is the opportunity to take over care of some patients in a year; to do part-time practice in Pinetop, AZ, and to purchase the five-office suite in Tucson. Call Maria at 520-795-0309.

Private office space available for a psychiatrist who needs space. Looking for independent MD/DO who is starting or building their own practice AND interested in getting involved in clinical trials, with negotiable option to use Neurostar TMS device for their patients. Opportunity for overflow of new patient referrals to help build their private practice, while gaining training and experience in clinical trials. Looking for assistance on clinical trials including back-up. Great opportunity for an early career psychiatrist. Rent and pay for clinical trials work is negotiable. Independent contractor status/not employee, with separate practice corporate status. Very nice space in midtown Phoenix between Camelback and Indian School, a few blocks off the 51. (The Atrium Building, 4602 N 16th Street, Phoenix 85016). Please forward your letter of interest and CV to Lee Ann Kelley, MD.

It is an honor to share the publishings of our Arizona Psychiatric Society members. We invite members to share their recent publications. To submit, please contact Teri.

Jordan Karp, MD, and Jamie Manser were co-authors on a series of articles in Psychiatric Times that highlighted the Psychiatry for Non-Psychiatrists conference presentations, including Psychiatry for Primary Care: A Behavioral Medicine Update (Part 1) https://www.psychiatrictimes.com/view/psychiatry-for-primary-care-a-behavioral-medicine-update-part-1-, Psychiatry for Primary Care: An Update on ADHD (Part 2) https://www.psychiatrictimes.com/view/psychiatry-for-primary-care-an-update-on-adhd-part-2-, and Psychiatry for Primary Care: An Update on Substance Use Disorders (Part 4) https://www.psychiatrictimes.com/view/psychiatry-for-primary-care-an-update-on-substance-use-disorders-part-4-.

Saira Kalia, MD, worked with several doctors to contribute the “Trauma and Reproductive Health” chapter to “Women’s Reproductive Mental Health.”

Aimee Kaempf, MD, with several other authors, had a book chapter published in the textbook, titled “Forensic Issues in Reproductive Psychiatry.”

Smith, R, Persich, M, Lane, Richard D. (MD PhD), and Killgore, WDS (2002). Higher emotional awareness is associated with greater domain-general reflective tendencies. https://www.nature.com/articles/s41598-022-07141-3

Wallace B. Mendelson, MD, The Psychoanalyst and the Nazi Nobelist: The Curious Story of Sigmund Freud and Julius Wagner-Jauregg.

Fourth-year medical student Madina Jahed, under the mentorship of Psychiatry Drs. Noshene Ranjbar, Saira Kalia, Studer, and Ramsha Rao, was published by medical journal Academic Psychiatry. Madina Jahed wrote movingly of her early childhood under the Taliban, her family’s challenges adapting to life in the U.S., and the need for health care providers to expand their awareness of refugees’ experiences.

Smith IS, Wellecke C, Weihs Karen L. (MD), Bei B, Wiley JF. Piloting Can Cope: an internet‐delivered transdiagnostic intervention to improve mental health in cancer survivors. Psychooncology. 2022;31(1):107‐115. https://doi.org/10.1002/pon.5787

Price SN, Hamann HA, Halaby L, Trejo JI, Corella F, Weihs Karen L. (MD) (In Press). Poor Subjective Sleep Quality Among Patients with Cancer and Comorbid Depression: An Opportunity to Inform Screening and Intervention. Behavioral Sleep Medicine.

THANK YOU FOR YOUR MEMBERSHIP AND FOR YOUR VALUED CONTRIBUTIONS TO EXCELLENCE IN PSYCHIATRY IN ARIZONA. If you have not renewed yet, please take a moment to continue your membership today.