Upcoming Meetings

Upcoming Meetings

HPMA Virtual meetings are held on the 2nd Monday of each month at 5:00 p.m. Please see the event calendar for more details.


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About Us

Mission

Helping Hawai‘i’s psychiatrists provide the highest quality care.

Overview

The Hawai'i Psychiatric Medical Association (HPMA) is a professional, non-profit corporation serving psychiatrists in Hawai'i. It is organized for the purpose of supporting professionalism in the practice of psychiatry and promoting top quality mental health care. HPMA fulfills a dual role, serving as a state association which focuses on local issues and as a district branch of the American Psychiatric Association (APA) linking HPMA members with developments in mental health care taking place regionally and nationally.

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Announcements

March 20, 2017

Last week, Republicans in the House of Representatives released the American Health Care Act (AHCA), draft legislation that is intended to repeal and replace the Affordable Care Act (ACA). APA responded within 24 hours with this press release.

As Congress deliberates how this and other proposals will impact access and coverage, it is crucial to ensure the gains that have been achieved for individuals with mental illness and substance use disorders are preserved and expanded.

Join the APA and your fellow psychiatrists in urging Congress to protect mental health care. Go to the APA Action Center and enter your zip code in the box. Draft text for your representative is provided, which you can easily edit and send.

Contact your representatives.

In terms of background, the proposed legislation has passed the Energy and Commerce, Ways and Means, and Budget Committees. The bill is expected to come to the floor of the House for a vote early next week and then move into the Senate. APA will be closely monitoring the situation and may further engage members to contact their Congressional representatives based on how the process unfolds.

Overall, APA continues to work in a bipartisan manner with key House and Senate leaders to improve the way our federal government finances and manages mental health services, especially for patients with serious mental illness and substance use disorders.

Thank you for being an APA member and taking time out of your busy schedule to participate in this effort.

Sincerely,

Maria A. Oquendo, M.D., Ph.D.
President, APA


Saul Levin, M.D., M.P.A.
CEO and Medical Director, APA


February 28, 2017 - Protections for Transgender Youth in Public Schools

On February 22 the Departments of Justice and Education issued guidance that eliminates protections for transgender youth in public schools, no longer allowing them to use restrooms corresponding with their gender identity.

Transgender children are already at increased risk for violence, bullying, harassment, and suicide. They may be more prone to depression and engaging in self-harm. These children need acceptance and affirmation, not stigmatization. Policies excluding transgender youth from facilities consistent with their gender identity have detrimental effects on their physical and mental health, safety, and well-being.

The American Psychiatric Association supports laws that protect the civil rights of transgender and gender variant individuals. The APA also opposes all public and private discrimination against transgender and gender variant individuals in such areas as health care, employment, housing, public accommodation, education, and licensing. The APA Position Statement on Discrimination Against Transgender and Gender Variant Individuals can be found here.

The Administration believes that policy regarding transgender bathrooms should be decided at the state level which makes District Branches and State Associations vital in protecting the civil rights of transgender and gender variant individuals in their states. The American Psychiatric Association is strategically reaching out to our partners and the APA Administration and stands ready to assist you with this important endeavor. View this draft op-ed and sample tweets for District Branches and State Associations that want to take action now. Please contact Ariel Gonzalez if you need further assistance at [email protected].


February 13, 2017 - MOC Requirements

APA has created a webpage that outlines its role in MOC and the actions taken, and creates an opportunity to provide feedback. In addition to MOC advocacy, APA also produces resources to help members meet MOC requirements, including:


January 19, 2017 - APA/APAF Fellowship Application Season is Upon Us! Deadline January 30

APA/APAF and the Division of Diversity and Health Equity are excited to announce a new online resource for resident fellow members!

The new Guide to APA/APAF Fellowships walks residents/trainees and training directors through the application process, beginning with why APA/APA fellowships are an amazing opportunity and what fellowships are offered.  

Residents can also take a peek into a day in the life of a Fellow by visiting the Fellowship Blog!

The deadline to apply for all APA/APAF fellowships is Monday, January 30th. For more information, please visit www.psychiatry.org/fellowships. If you have any questions, please visit the FAQ section or contact Tatiana Claridad at [email protected]


December 7, 2016 - Abstract Submissions: Mental Health Services Conference

The scientific program committee is now accepting submissions for consideration for the 2017 IPS: The Mental Health Services Conference to be held October 19-22, 2017 in New Orleans. The theme for this meeting will be “Optimizing Access & Effective Care.” Abstracts may be submitted online.

The submission site closes on January 10, 2017 at 11:59pm ET. All submissions must be complete at that time, including disclosures for all presenters and co-presenters. Because of space limitations, we are asking that all submissions (even long-standing recurring sessions) be submitted through the abstract submission site. If you have questions, please contact the Office of Scientific Programs via [email protected].


December 5, 2016 - APA Annual Meeting Registration Open

The 2017 Annual Meeting registration and housing for APA members is now open and will open to the public on December 15. Take a look at the Preliminary Program Guide and visit the APA website to access all pertinent event information, including: registration fees and dates, hotel descriptions and rates, courses, schedules, CME information and much more.


November 11, 2016 - APA Announced its Payment Reform Webinar Series

Both health care delivery and the way physicians are paid are constantly evolving. Whether you are treating patients in the public or private sector, or both, some of these changes are currently in place or are coming soon.

Today, APA relaunched its Payment Reform website and a new CME webinar series to assist you in preparing for the major payment changes going into effect for 2017, as a result of the Medicare Access and CHIP Reauthorization Act (MACRA). These changes impact 23,000+ psychiatrists who currently see Medicare patients, and are expected to have a ripple effect and spur similar efforts by other payers.

Our webinar series begins with the now-available Quality 101: A How-To Guide for Psychiatrists, which covers how to be a successful reporter of quality measures and how to use the data to inform clinical practice.

The remainder of the webinar series will be available both live and on-demand in the APA Learning Center:

• Final Rule Overview—November 16, 2016, 12-1 pm – Registration now open
This webinar summarizes key issues and options for psychiatrists under the two new payment pathways created in the Medicare Access and CHIP Reauthorization Act, or MACRA. The Merit-Based Incentive Payment System (MIPS) replaces current Medicare quality programs and offers new incentives. Some psychiatrists may earn incentives for participating in "Advanced" Alternative Payment Models. Highlights include the "low-volume" threshold excluding many psychiatrists from MIPS reporting requirements, and "Pick your Pace" options for reporting in 2017.
• MIPS Quality Category—November 30, 2016, 12-1 pm EST
• MIPS Advancing Care Information (EHR Use) Category—December 7, 2016, 12-1 pm EST
• MIPS Improvement Activities Category—December 14, 2016, 12-1 pm EST
• MACRA Alternative Payment Models—January 18, 2017, 12-1 pm EST

Register for the Payment Reform Webinar

For more information, please visit the APA Payment Reform website. If you have any questions, please email [email protected].


November 9, 2016 - APA - APAF Fellowships

The 2016 – 2017 recruitment season for APA/APAF Fellowship applications is open. Applications will be accepted through Monday, January 30, 2017 for any of the eight (8) APA/APAF fellowship programs (APA/APAF Leadership, Child and Adolescent Psychiatry, Diversity Leadership, Jeanne Spurlock Congressional, Public Psychiatry, Psychiatric Research, SAMHSA Minority and SAMHSA Substance Abuse Minority Fellowships). Learn more.


October 17, 2016 - MACRA Implementation and Updates

APA has provided updates to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA changes the way psychiatrists and other physicians working with Medicare patients will be paid. Learn more and see how APA can help you.


September 29, 2016 - Changes to DSM-5 to Take Effect on Oct. 1

Important changes to the DSM will take effect on Oct. 1. These changes are designed to bring ICD-10 codes in line with updated diagnoses in the DSM-5. As of Oct. 1, some ICD-10 codes relating to disorders in the DSM will no longer be valid. For a complete list of the disorders affected by this change, and the new codes associated with them, please visit the Psychiatric News story on the changes here


August 30, 2016 - Hillary Clinton Mental Health Agenda Released

Today, Hillary Clinton released the details of her mental health agenda. The APA strongly supports the thorough and comprehensive mental health agenda. The plan released by the Clinton campaign includes a pledge to hold a White House Conference on Mental Health within her first year in office. APA provided mental health position papers to the Clinton campaign over the last few months. The APA supports a number of initiatives outlined in Clinton’s plan, including:

  • A focus on early intervention efforts, such as the APA Foundation’s Typical or Troubled program, which trains educators to quickly identify children in need to behavioral health resources.
  • A pledge to enforce the Mental Health Parity and Addiction Equity Act of 2008, which requires insurers to offer coverage for mental illness on par with physical illnesses.
  • The creation of a national initiative headed by the U.S. Surgeon General for suicide prevention. According to stats cited in Clinton’s agenda, the overall rate of suicide in the U.S. increased 24 percent between 1999 and 2014, and is now at its highest level in three decades.
  • An effort to increase the integration between medical and behavioral health care systems and expand community-based treatment, which includes reimbursement for collaborative care models and a nationwide strategy to address the shortage of mental health providers.  Our report on the Economic Impact of Integrated Medical-Behavioral Healthcare indicates system integration could yield an annual savings of $26-48 billion to health care systems. 

We are pleased in this promising first step to implement mental health reform in this country. The APA will continue to work with legislators on both sides of the aisle for the remainder of this Congress and into the next, as well as with the next President of the United States, as we continue to push for substantive mental health reform. In the coming weeks we will continue our bipartisan outreach to Members of Congress and congressional candidates, as well as the Presidential candidates as we work to achieve results in the mental health arena. We remain thoroughly committed to achieving these critical reforms for our members.

Thank you,

Saul Levin, MD, MPA
CEO and Medical Director
American Psychiatric Association (APA)


August 10, 2016 - APA President-Elect Anita Everett Named SAMHSA Chief Medical Officer

President-Elect of the American Psychiatric Association (APA) Anita Everett, M.D., has been named the Chief Medical Officer at the Substance Abuse and Mental Health Services Administration (SAMHSA). In her role at SAMHSA, Everett will lead a newly created Office of the Chief Medical Officer with five dedicated staff, including an additional physician. She begins her duties at SAMHSA on Sept. 5.

“SAMHSA has selected a great physician whose experience and expertise as a psychiatrist will add value to SAMHSA through its newly created medical office,” said APA President Maria A. Oquendo, M.D. “Her experience will also benefit providers of prevention, treatment and recovery services for those with mental illness. We look forward to working with Dr. Everett in her new role and with SAMHSA and HHS.”

Everett and her office at SAMHSA will provide input into strategic initiatives, policy directions, and legislative issues to ensure effective, evidence-based approaches to behavioral health services are incorporated in SAMSHA programs and activities. Everett’s extensive behavioral health expertise and clinical experience will help the agency address pressing health care issues, such as integration of behavioral health services with primary care.

Everett is currently division director of Johns Hopkins Community and General Psychiatry, Bayview Campus, and associate professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins School of Medicine in Baltimore.

Everett was elected president-elect of APA in February 2016 and will take the office of President at the conclusion of the APA Annual Meeting in San Diego in May 2017. She has held numerous leadership roles at APA, including trustee-at-large on the APA Board of Trustees. She has also served as president of the Maryland Psychiatric Society and president of the American Association of Community Psychiatrists.

The American Psychiatric Association is a national medical specialty society whose more than 36,500 physician members specialize in the diagnosis, treatment, prevention, and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org.


July 29, 2016 - August Course of the Month

Updates in Women’s Health: Psychopharmacologic Approaches in the Perinatal Period

Psychiatric disorders during pregnancy and the postpartum period are common and, as such, psychiatrists are often asked to treat pregnant and postpartum women. Unfortunately, psychiatrists often do not feel well-equipped to manage treatment of perinatal patients, especially with the use of mood stabilizers and antipsychotics. This course provides and overview of the current evidence for the use of mood stabilizers and antipsychotics during pregnancy and lactation. Learn more and register.


July 15, 2016 - Comprehensive Addiction and Recovery Act (CARA) Passes Senate

The following CARA update is sent on behalf of Saul Levin, CEO & Medical Director, APA.  For more information on the conference report, see the embedded link. Please share this update with the membership.

I write to inform you that the Senate overwhelmingly voted (92 to 2) yesterday to adopt the conference report accompanying S. 524, the Comprehensive Addiction and Recovery Act (CARA).  The Senate’s action follows the House, which voted to adopt the report last week (407 to 5).

CARA takes a number of important first steps to address the opioid crisis plaguing the country.  Noteworthy provisions include:

• Provides grants to expand access to life-saving opioid overdose reversal drugs (such as naloxone) and to expand access to addiction treatment services, including evidence-based medication-assisted treatment.

• Provides grants to community organizations to develop and enhance recovery services and build connections with other recovery support systems.

• Provides grants to states to carry out comprehensive opioid abuse response, including education, treatment, and recovery efforts, prescription drug monitoring programs, and efforts to prevent overdose deaths.

A full summary of the conference report may be found here.

We anticipate that President Obama will sign this legislation into law.  APA will continue working with Members of Congress to ensure that the programs authorized by this legislation are adequately funded to ensure their effectiveness.


July 14, 2016 - Call for APA Nominations!

Submit nominations for the 2017 Election to [email protected]. Please make sure to include the full name of the nominated APA member and the corresponding office(s) for which he/she is being nominated. 

The deadline for nominations is October 1. 

The following offices are open for nominations:

  • President-Elect
  • Secretary
  • Minority/Underrepresented Representative (M/UR) Trustee
  • Area 2 & 5 Trustees*
  • Resident-Fellow Member Trustee-Elect (RFMTE)**

elected by eligible voters of their respective Area
** elected by APA Resident-Fellow Members 

2017 APA Election Schedule

  • Slate of Candidates Announced: By November 1
  • Voting Begins: January 3, 2017
  • Voting Deadline: January 31, 2017
  • Election Results Available: Mid-February 

July 7, 2016 - APA Applauds House Passage of Mental Health Reform Bill

Today the American Psychiatric Association (APA) praised the House of Representatives for passing bipartisan mental health reform legislation H.R. 2646, the Helping Families in Mental Health Crisis Act. The APA is calling upon the Senate to approve this legislation by the end of the year.

“Comprehensive mental health reform is urgently needed in our country, and this bipartisan legislation helps address this critical need,” said APA President Maria A. Oquendo, M.D. “We now strongly urge the Senate to take up mental health reform legislation that will make care more available to those who need it, especially patients and families living with serious mental illness. We look forward to working with Congress to pass mental health reform this year.”

Introduced by Reps. Tim Murphy (R- Pa.) and Eddie Bernice Johnson (D-Texas), the Helping Families in Mental Health Crisis Act has 197 cosponsors, including 141 Republicans and 56 Democrats, and it unanimously passed in the House Energy and Commerce Committee in June. Similar bipartisan comprehensive mental health reform legislation has been introduced in the Senate by U.S. Sens. Chris Murphy (D-Conn.) and Bill Cassidy, M.D., (R-La.)

The APA has firmly endorsed efforts in both the House and Senate to reform our nation’s mental health system.  Mental illness is widely prevalent in the U.S. — more than 68 million Americans have experienced a psychiatric or substance use disorder in the past year. Despite recent gains in medical research and public awareness, many people with mental illness or substance use disorders do not get the treatment they need. The Helping Families in Mental Health Crisis Act is an important step in addressing this need.

“We are grateful to Reps. Tim Murphy (R- Pa.) and Eddie Bernice Johnson (D-Texas) for their leadership in introducing the Helping Families in Mental Health Crisis Act and moving this legislation forward over the past two years,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “It is their dedication to improving the lives of people with mental illness and their years of persistence in advocating for change that has brought us close to achieving much needed comprehensive mental health reform.”

The American Psychiatric Association is a national medical specialty society whose 36,500 physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org.


June 23, 2016 - Daniel Gillison Named New Executive Director of the APA Foundation

The American Psychiatric Association Foundation (APAF) announced today that Daniel Gillison will assume the role of Executive Director beginning Monday, June 27.

Gillison joins the APAF, the philanthropic and public education arm of the APA, from the National Association of Counties (NACo) where he was the National Director of County Solutions and Innovation. In his role, he led corporate and philanthropic fundraising efforts and directed the educational programming of the NACo Research Foundation. During Gillison’s time at NACo, corporate support more than doubled and the NACo Foundation substantially expanded its educational offerings in mental health and criminal justice. He has previously held positions at Sprint, XO Communications, and Wesley Brown & Bartle.

“Daniel Gillison brings a wealth of experience in raising corporate support and securing foundation funding to the American Psychiatric Association Foundation. His significant strategic planning experience will be useful in guiding the APAF as it raises public awareness of mental illness,” said APAF Board Chairman Saul Levin, M.D., M.P.A.

Gillison replaces APAF Executive Director Paul Burke, who is retiring July 1 after more than nine years of service. 

The American Psychiatric Association is a national medical specialty society whose 36,500 physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org.

The American Psychiatric Association Foundation is the philanthropic and educational arm of the APA. Visit the APAF at www.americanpsychiatricfoundation.org.


June 14, 2016 - Free APA Webinar About MACRA

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) permanently repealed the old Medicare SGR formula and set in motion entirely new programs for quality reporting and new payment models.
On Wednesday, June 29 the APA will be hosting a live, free event that will provide psychiatrists with a basic understanding of the key features of MACRA and how they may impact their practices.
Learn more about:

  • The new Merit-Based Incentive Payment System (MIPS)
  • MIPS bonuses and penalties
  • MIPS reporting
  • Additional resources available

Register for this event.


June 14, 2016 - APA Mental Health Services Conference

Join the American Psychiatric Association on October 6-9 at the Washington Hilton in Washington, D.C. From administration to telepsychiatry, sharpen your skills in community psychiatry at the redesigned IPS: The Mental Health Services Conference. This year's theme is "Implementing Prevention Across Psychiatric Practice." Other featured topics include:

  • Addiction psychiatry
  • Medical Directors and Administrators Track
  • Integrated and Interdisciplinary Care
  • Prevention
  • Quality and Measurement
  • Technology in Healthcare

Register by the July 21 Early Bird deadline for the best registration rate and ensure your space in one of several courses offered at the meeting. Learn more.


May 13, 2016 - APAF Executive Director Chosen

I am glad to announce the selection of the new Executive Director of the APA Foundation, Daniel Gillison.

Dan joins the Foundation coming from the National Association of Counties (NACo) where he was the National Director of County Solutions and Innovation. In his role, he led corporate and philanthropic fundraising efforts and directed the educational programming of the NACo Research Foundation.

During his time at NACo, the corporate support increased from $800K to $1.8 million, while strengthening the brand, and increasing the footprint of private sector involvement. In addition, the Foundation was able to expand its educational offerings in mental health and criminal justice after securing new grant funding from foundations. Dan also has the strategic planning experience to guide the APA Foundation into its next chapter.

We thank the Selection Committee consisting of Drs. Maria Oquendo, Paul Summergrad, Bill Resnik, Donna Morris, Frank Brown, Louis Kraus, Richard Harding, Steven Sharfstein, Stuart Yudofsky, U.K. Quang-Dang, Mr. Steven Leifman and Mrs. Maureen O'Gara Hackett, who voted unanimously for Dan. The APA Foundation Board voted unanimously in his favor as well.

Daniel will be attending the APA Foundation's fundraiser at the Georgia Aquarium on Saturday the 14th, from 7:00 to 10:00 pm. He will also attend the APA Board of Trustees Luncheon on Sunday the 15th. I hope you will join me in attending to welcome him to the organization.


February 22, 2016
Free Training Opportunity with the APA

American Psychiatric Association (APA) to Offer Training!  APA is pleased to announce a new opportunity for psychiatrists interested in opportunities to advance integrated care. In September, the Centers for Medicare and Medicaid Services (CMS) launched the Transforming Clinical Practice Initiative (TCPI) and awarded $685 million to 39 national and regional healthcare transformation networks and supporting organizations to support practice transformation through nationwide, collaborative, and peer-based learning networks.  

As a TCPI Support and Alignment Network (SAN), APA received $2.9 million over four years to partner with the AIMS Center at the University of Washington and train 3,500 psychiatrists in the clinical and leadership skills needed to support primary care practices that are implementing integrated behavioral health programs. Once psychiatrists are trained (see below), APA will work to connect them with local Practice Transformation Networks (PTNs) participating in TCPI.

***Free training is available to psychiatrists through online modules and live trainings. CME credit is also offered. Content is similar for both training sessions so you may choose to participate in one or the other based on your learning preferences and availability.      

  • Online Modules - Get started! There are two parts to the training containing seven modules in all. It is recommended that participants complete both parts 1 and 2.
  • IPS: The Mental Health Services Conference – Registration opens Spring 2016. Check back at www.psychiatry.org for meeting information.

Stay up-to-date on TCPI and APA's Support and Alignment Network at www.psychiatry.org/sansgrant. If you have questions, contact Ashley Rutter, Program Manager at [email protected].


February 10, 2016
APA Election Results

The membership of the American Psychiatric Association has chosen      Anita Everett, M.D., as its next president-elect. The results were made public today, but are not official until the APA Board of Directors confirms the election at its March meeting.

Everett is currently division director of Johns Hopkins Community and General Psychiatry, Bayview Campus, and associate professor in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins School of Medicine in Baltimore, MD. She is also president of the American Association of Community Psychiatrists.

Everett has held numerous leadership roles at APA, including trustee-at-large on the APA Board of Trustees; chair of the APA Task Force on Healthcare Reform 2015; chair of the Scientific Program Committee of the Institute on Psychiatric Services; Assembly Representative; and chair of the Council on Healthcare Systems and Finance. She has also served as president of the Maryland Psychiatric Society.

“I am honored to have been elected to help lead APA,” Everett said. “Health care delivery and psychiatry are changing rapidly in a number of ways that affect psychiatric practice, community psychiatric systems, research and teaching. Issues such as access to care, parity, accountable payment structures, technology and integrated care bring many challenges as well and many opportunities for APA and psychiatry.”

Among Everett’s priorities as APA president, when she assumes that role in May 2017, are:

  • Ensuring  access to behavioral health for all Americans
  • Establishing APA as the "go-to" resource for all American psychiatrists through development of member benefits that result in a lifelong relationship with the organization 
  • Promoting effective community treatment and psychotherapy, such as evidence-based treatment for first episode psychosis,  supported employment and  housing, and day programs for people with serious mental illness

Her term as president-elect of the APA, once confirmed by the board, will begin this May at the conclusion of the APA Annual Meeting in Atlanta, when current President-Elect Maria Oquendo, M.D., begins her one-year term as president.

Other successful APA leadership candidates who will take office after the APA Annual Meeting in May 2016 include:

Treasurer 

Bruce Schwartz, M.D.  

Trustee-at-Large 

Richard Summers, M.D.

Area 3 Trustee

Roger Peele, M.D.    

Area 6 Trustee

Melinda Young, M.D.

Resident-Fellow Member Trustee-Elect

Uchenna Okoye, M.D., M.P.H.

 

The American Psychiatric Association is a national medical specialty society whose more than 36,000 physician members specialize in the diagnosis, treatment, prevention, and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org


January 5, 2016
2016 APA Election

Voting for the 2016 APA Election is now open! Do your part in selecting the next leaders of the APA. Visit their website to view the slate of candidates, election guidelines, voting eligibility, and to vote! Voting closes on February 1, 2016.


July 15, 2015
New Medicaid Requirements for Ordering, Prescribing or Referring Providers

The Affordable Care Act (ACA) now requires all ordering, prescribing or referring physicians to be enrolled in the state Medicaid program (42 CFR 455.410).  Traditionally, most providers have enrolled in a state’s Medicaid program to furnish cover services to Medicaid recipients and to submit claims for these services.  Now, the ACA requires physicians to enroll in the Medicaid program to order, prescribe and refer items or services for Medicaid recipients, even when they do not submit claims to Medicaid. 

This new enrollment requirement does not mean providers must see Medicaid patients or be listed as a Medicaid provider for patient assignments or referrals.   Rather, the ACA requires providers to enroll only to meet new ACA program integrity requirements designed to ensure all orders, prescriptions or referrals for items or services for Medicaid beneficiaries come from appropriately licensed practitioners who have not been excluded from Medicare or Medicaid. 

This new requirement is only applicable to physicians who order, prescribe or refer items or services for Medicaid beneficiaries.  Physicians who are already enrolled in Medicaid as participating providers and who submit claims to Medicaid are not required to enroll separately. 

Finally, it is important that providers understand the consequences of not enrolling in Medicaid.  If you are a physician that does not enroll in Medicaid then, other physicians, practitioners and facilities who actually render services to Medicaid beneficiaries based on your order, prescription or referral will not be paid for such items and services. 

In summary, if you are an ordering, prescribing or referring provider of items or services for Medicaid beneficiaries you:

  • must enroll in the state’s Medicaid program
  • are not obligated to see Medicaid patients
  • are not required to be listed as a Medicaid provider
  • are not required to annually renew enrollment
  • can continue to see Medicaid patients without billing the Medicaid program.

Failure to enroll will result in your orders, prescriptions and referral for Medicaid patients not being accepted or paid.

If you have any questions, please contact Maureen M. Bailey at 703-907-7399 or [email protected].


Dr. Akaka Delivers Check on Behalf of the American Medical Association Political Action Committee

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Dr. Akaka delivering a check for $2000 from the American Medical Association Political Action Committee to Congresswoman Tulsi Gabbard (D-HI) on October 30, 2014.  Dr. Akaka has known Congresswoman Gabbard for years, first meeting her when she was working in Senator Daniel Akaka's Washington DC office, where they first discussed legislation to improve the nation's mental health, particularly in Veterans.  At Congresswoman Gabbard's left is Lauren Zirbel, lobbyist for the Hawaii Medical Association.

 

 


Cutaneous Drug Reactions and Psychiatric Medications

September 19, 2012
Miki Shirakawa Garcia MD | Dermatology | Queens Hospital POB II

One of the most common manifestations of a drug reaction is a cutaneous eruption. If a drug reaction is suspected, the type of rash should be characterized and the onset in relation to the patient’s medications should be evaluated. There are some medications that are more commonly associated with specific types of eruptions.  If the possible offending medication is not a commonly associated medication, a literature search in Medline or in a drug database (Drug Alert Registry or Medwatch) can be helpful. Patients have a higher risk for a drug reaction if they are female, elderly, African American, immunosuppressed, take multiple medications, or have serious illnesses. The goal of this article is to provide a brief summary of cutaneous drug eruptions that are pertinent to medications commonly used in psychiatric patients.

Exanthematous or morbiliform drug eruptions present with symmetric erythematous macules on the trunk and upper extremities that progressively becomes confluent and palpable, sometimes urticarial or scarlatiniform (Figure 1). There is no mucous membrane involvement.  The rash may be accompanied by a low-grade fever and/or pruritus.  Exanthematous eruptions are most commonly seen four to fourteen days after starting the medication and most commonly secondary to antibiotics (aminopenicillins, sulfonamides, cephalosporins), anticonvulsants and allopurinol. After discontinuation of the offending medication, the rash will resolve on its own within one to two weeks.  Topical corticosteroids can be used to treat the pruritus.

Drug reaction with eosinophilia and systemic symptoms (DRESS) can be life-threatening due to possible internal organ failure.  Onset is usually two to six weeks after starting the medication and most commonly seen with anticonvulsants, antibiotics (sulfonamides, minocycline) and allopurinol. Clinically, DRESS manifests with a fever and a morbiliform eruption that starts on the face, trunk and upper extremities. Edema of the face is common. Patients will have prominent eosinophilia and liver enzymes should be monitored for possible fulminant hepatitis.  The cutaneous and systemic symptoms may last weeks to months after drug withdrawal. Treatment of DRESS requires corticosteroids, which should be systemic if there is internal organ involvement.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but potentially fatal drug reactions. SJS or TEN can start an average of one to three weeks after starting the medication. SJS and TEN are characterized by fever and painful mucocutaneous lesions that can be a dusky erythema or flat atypical targets.  The lesions usually start on the trunk and spread to the head/neck and proximal upper extremities.  This is followed by desquamation within hours to several days after onset. SJS involves less than 10% of body surface area and TEN involves greater than 30% of body surface area. Mortality rate is 1-5% for SJS and 25-35% for TEN. Most commonly implicated medications are sulfonamides, anticonvulsants, NSAIDs, and allopurinol. Specific to psychiatry, the most common offending medications are amithiozone, barbiturates, carbamazepine, chlormezanone, phenytoin, lamotrigine, and phenylbutazone. It is important that treatment is instituted in a closely monitored unit such as a burn unit with supportive care, wound care, and possible IVIG.

Some medications can cause a phototoxic or photoallergic reaction. Phenothiazines, in addition to tetracyclines, NSAIDs, and fluoroquinolones, can cause a phototoxic skin eruption. Phototoxic eruptions are characterized by an exaggerated sunburn appearance in the photodistributed areas, followed by hyperpigmentation. Photo-onycholysis and pseudoporphyria can also be seen in phototoxic reactions. Common medications to cause a photoallergy include phenothiazines, tricyclic antidepressants, thiazide diuretics, sulfonamide antibiotics, sulfonylureas, quinine or quinidine, NSAIDs and antimalarials.  Photoallergic reactions are usually more chronic and appear as a pruritic dermatitis or lichen planus-like eruption in sun-distributed locations.

Other uncommon drug reactions associated with medications used in psychiatry include fixed drug eruptions, linear IgA bullous dermatosis, pseudolymphoma and drug-induced psoriasis.  Fixed drug eruptions recur in the same location and can be secondary to sulfonamides, NSAIDs, barbiturates, tetracyclines and carbamazepine. Linear IgA bullous dermatosis is associated with vancomycin, β-lactam antibiotics, captopril, NSAIDs, phenytoin, rifampin, sulfonamides, amiodarone, furosemide, lithium and G-CSF. Pseudolymphoma can occur with anticonvulsants (phenobarbital, carbamazepine), antipsychotics (chlorpromazine, promethazine), imatinib mesylate, and angiotensin II receptor antagonists. Drug-induced psoriasis can occur with terbinafine, NSAIDs, antimalarials, ACE inhibitors, lithium and β-blockers.

The treatment for all cutaneous drug reactions is to discontinue the offending medication. Supportive treatment is indicated depending on the type of rash. Dermatology can be consulted if the morphology of the rash is difficult to determine or if there are other possible diagnoses to exclude which would require a skin biopsy.

References:

1. Revuz J, Valeyrie-Allanore L. (2008)Chapter 22: Drug Reactions. In Bolognia JL, Jorizzo JL, Rapini RP (Eds.), Dermatology, (edition 2, pgs 301-320 ). Spain: Elsevier.

2. French LE, Prins C. (2008) Chapter 21: Erythema Multiforme, Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. In Bolognia JL, Jorizzo JL, Rapini RP (Eds.), Dermatology, (edition 2, pgs 287-300). Spain: Elsevier.

3. Warnock JK and Morris DW. Adverse cutaneous reactions to antidepressants. Am J Clin Dermatol. 2002; 3(5): 329-39.

 

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Stop CPT Coding Abuses - Achieve Mental Health Parity Now

APA is Working For You
CPT code changes were intended to more accurately reflect the work psychiatrists do and improve patient access to care, but instead have been used as an excuse by some payors to discriminate against psychiatric patients and their psychiatrists in violation of the Mental Health Parity and Addiction Equity Act (2008). The issues differ from state to state and from carrier to carrier. The APA Board of Trustees has committed significant APA resources, both financial and staff, to understand the situation and use all reasonable means, including litigation, to correct the abuses taking place.

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