On Oct. 21, the AAMC submitted comments on discussion draft legislation designed to bolster the behavioral health workforce and expand access to care. The discussion draft, which was released in late September by Senate Finance Committee Chair Ron Wyden (D-Ore.), Ranking Member Mike Crapo (R-Idaho), Sen. Debbie Stabenow (D-Mich.), and Sen. Steve Daines (R-Mont.), would provide 400 new Medicare-supported graduate medical education (GME) slots for psychiatry and psychiatry subspecialties [refer to Washington Highlights, Sept. 23]. The AAMC applauded this proposal in a statement following the initial release of the discussion draft.
The letter reiterated the association’s appreciation for the proposal, while also urging committee leadership to take additional steps to address the ongoing mental health crisis. The letter encouraged the committee to increase the number of GME slots provided by the legislation from 400 to at least 1,000. In addition, the letter outlined the AAMC’s recommendations to ensure that the proposed slots are distributed to a diverse array of teaching hospitals well-positioned to immediately expand their residency programs.
The AAMC also provided guidance regarding the appropriate specialty-level allocation of the proposed slots. The letter noted that while the provision of additional residencies in psychiatry and psychiatry subspecialties is necessary to strengthen the behavioral health workforce, investment in prerequisite programs, such as internal medicine, is also needed. The association encouraged committee leadership to refer to the framework proposed by the AAMC-supported Opioid Workforce Act of 2021 (S. 1438), which would provide slots for addiction medicine, addiction psychiatry, and pain medicine, as well as associated prerequsite programs.
The letter concluded by highlighting the AAMC’s support for other proposals contained in the discussion draft, including a demonstration model whereby states can receive additional federal Medicaid funding to improve behavioral health network adequacy, as well as a new exception to the Physician Self-Referral Law (commonly referred to as the Stark Law) that would reduce regulatory barriers to accessing physician wellness programs offered by hospitals.
This discussion draft is part of a yearlong bipartisan effort by the Senate Finance Committee to identify and address barriers to mental and behavioral health care. In September 2021, committee leadership issued a request for information seeking recommendations to improve access to mental and behavioral health care [refer to Washington Highlights, Sept. 24, 2021]. The AAMC responded with guidance on how to strengthen the behavioral health workforce through investment in Medicare-supported GME, among other recommendations [refer to Washington Highlights, Nov. 19, 2021].
In February, committee leadership announced the creation of five bipartisan working groups, each tasked with formulating legislative recommendations to address a specific area of mental health care access. The Furthering the Use of Telehealth working group, co-chaired by Sens. Ben Cardin (D-Md.) and John Thune (R-S.D.) released a discussion draft of legislation in May. The Improving Access to Behavioral Health Care for Children and Young People working group, co-chaired by Sens. Tom Carper (D-Del.) and Bill Cassidy (R-La.) subsequently released a discussion draft in June. The Senate Finance Committee hopes to consolidate the working groups’ legislative proposals into one comprehensive package. The AAMC continues to advocate for the inclusion of these proposals in an end-of-year legislative package.