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Vista Research Group Releases “The State of Addiction Treatment”

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NABH Releases The High Cost of Compliance: Assessing the Regulatory Burden on Inpatient Psychiatric Facilities

FOR IMMEDIATE RELEASE

CONTACT:

Jessica Zigmond

202.393.6700, ext. 101

Jessica@nabh.org

NABH Examines the High Cost of Compliance on Inpatient Psychiatric Facilities

WASHINGTON, DC (March 19, 2019) — The National Association for Behavioral Healthcare (NABH) on Tuesday released The High Cost of Compliance: Assessing the Regulatory Burden on Inpatient Psychiatric Facilities, a comprehensive report that examines the burdens that certain regulations impose on the nation’s inpatient psychiatric facilities.

NABH commissioned Manatt Health to conduct this first-of-its-kind study that focuses on three federal regulatory domains attached to participation in the Medicare program: the so-called “B-tag” requirements, a detailed set of standards for patient evaluations, medical records, and staffing in inpatient psychiatric facilities; “ligature risk points,” or those aspects of the physical environment that a patient could use to attempt self-strangulation; and the Emergency Medical Treatment and Labor Act (EMTALA), which obligates a hospital to screen all patients for emergency medical conditions, and, if an emergency condition is identified, to stabilize the patient before the patient may be discharged or transferred.

“Members of NABH’s Regulatory Overload Task Force worked closely with Manatt’s researchers on this study, which surveyed 62 inpatient psychiatric facilities,” said NABH Board Chair Pat Hammer, president and CEO of Oconomowoc, Wis.-based Rogers Behavioral Health. “The findings estimate that, taken together, these three regulatory areas impose $1.7 billion in compliance costs nationwide—each year,” he added. “That means these regulatory burdens represent about 4.8 percent of an average facility’s annual revenue for all inpatient services from all sources.”

NABH recognizes that rules are intended to serve the important goals of patient safety and high-quality care. But some of these regulations are outdated, and many are applied inconsistently by surveyors in the field.

“Federal regulators have an opportunity to lift heavy compliance burdens from inpatient psychiatric facilities without harming patient care,” said Randi Seigel, a partner with Manatt Health.

The report notes that doing so could ultimately improve patient care.

“By removing low-value compliance burdens, the reforms outlined in this report would free up clinician time and financial resources that could be better spent improving patients’ access to high-quality psychiatric care,” said Fatema Zanzi, a partner with Manatt Health.

NABH released the report at its 2019 Annual Meeting, where the association also launched its Access to Care initiative. Follow us @NABHBehavioral and at #NABH19 for live updates from the meeting.

“This report emphasizes what our members have been saying for too long: regulatory overload takes time away from patient care,” said Mark Covall, NABH’s president and CEO. “As our nation works to address its deadly opioid and suicide crises, we need our behavioral healthcare providers to focus on what they do best: provide mental health and substance use disorder patients with the right care, in the right setting, at the right time.”

Please visit www.nabh.org to read the full report and to see NABH’s other Access to Care resources, including the association’s Access to Care resolution and brief video.

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About NABH

The National Association for Behavioral Healthcare (NABH) advocates for behavioral healthcare and represents provider systems that are committed to delivering responsive, accountable, and clinically effective prevention, treatment, and care for children, adolescents, adults, and older adults with mental and substance use disorders. Its members are behavioral healthcare provider organizations that own or manage more than 1,000 specialty psychiatric hospitals, general hospital psychiatric and addiction treatment units and behavioral healthcare divisions, residential treatment facilities, youth services organizations, and extensive outpatient networks. The association was founded in 1933.

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NABH Board Adopts Access to Care Resolution

FOR IMMEDIATE RELEASE

CONTACT:

Jessica Zigmond

202.393.6700, ext. 101

Jessica@nabh.org

WASHINGTON, DC (March 18, 2019) — The National Association for Behavioral Healthcare (NABH) Board of Trustees on Monday approved a resolution that addresses unfair managed-care practices and recommends guiding principles for providers and payers to incorporate in contracts with managed care organizations (MCOs).

NABH’s provider systems are committed to ensuring patient access to behavioral healthcare treatment across the entire behavioral healthcare continuum, which includes inpatient, residential, partial hospitalization, intensive outpatient, outpatient, and recovery and support services. Too often, MCOs limit coverage to crisis stabilization or short-term, acute-care services for all levels of care because they use internally developed and/or proprietary and non-transparent, medical-necessity criteria.

“As our Access to Care resolution states, ‘Fair and appropriate coverage for behavioral healthcare services must ensure—not solely offer—access to the entire behavioral healthcare continuum,” said NABH Board Chair Pat Hammer, president and CEO of Oconomowoc, Wis.-based Rogers Behavioral Health. “For this to happen, fair and reasonable managed care contracts must include and apply generally accepted standards of professional practice.”

Articulated in clinical research and clinical specialty organization consensus statements, these generally accepted standards of care recognize that behavioral healthcare treatment is intended to:

  • Prevent, diagnose, and/or treat behavioral health conditions;
  • Promote age-appropriate growth and development;
  • Minimize the progression of disability;
  • Facilitate, maintain, and/or restore functional capacity; and
  • Support long-term recovery.

NABH created a Managed Care Committee last fall to identify problems and propose solutions in managed care contracts. The Board of Trustees adopted the Managed Care Committee’s resolution at its Board meeting in Washington, D.C. on the first day of the association’s 2019 Annual Meeting.

“We hope this resolution and the guiding principles in it will help our members as they work with MCOs to develop contracts that are patient-centered,” said Mark Covall, NABH’s president and CEO. “This resolution is also significant because it is a major piece of our new Access to Care initiative that we’re launching today. Through this initiative, we will provide information and resources to help inform policymakers, regulators, payers, and patient advocates that only true access to care can lead to recovery.

NABH’s Access to Care initiative focuses on two major challenges: unjust managed care contracts and countless regulations, both of which often prevent behavioral healthcare providers from offering patients a full range of services.

Please visit www.nabh.org to read the resolution, watch NABH’s Access to Care video, and learn more. And follow us @NABHBehavioral and at #NABH19 for live updates from the 2019 NABH Annual Meeting.

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About NABH

The National Association for Behavioral Healthcare (NABH) advocates for behavioral healthcare and represents provider systems that are committed to delivering responsive, accountable, and clinically effective prevention, treatment, and care for children, adolescents, adults, and older adults with mental and substance use disorders. Its members are behavioral healthcare provider organizations that own or manage more than 1,000 specialty psychiatric hospitals, general hospital psychiatric and addiction treatment units and behavioral healthcare divisions, residential treatment facilities, youth services organizations, and extensive outpatient networks. The association was founded in 1933.

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The High Cost of Compliance

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NABH Applauds Landmark Behavioral Healthcare Coverage Ruling

 

FOR IMMEDIATE RELEASE

CONTACT:

Jessica Zigmond

202.393.6700, ext. 101

jessica@nabh.org

 

NABH Applauds Landmark Behavioral Healthcare Coverage Ruling

WASHINGTON, DC (March 5, 2019)— The National Association for Behavioral Healthcare (NABH) applauds the decision filed in California’s Northern District that opens access to behavioral healthcare services for those who need it.

“It has been 10 years since President George W. Bush signed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, and we have yet to achieve full parity,” said Mark Covall, NABH’s president and CEO. “Today’s decision in California’s Northern District is a turning point. The federal court’s ruling made it clear that insurance companies must use generally accepted standards in the full behavioral healthcare continuum to help patients gain access to the care they need for recovery.”

In a nationwide class action lawsuit, the U.S. District Court for the Northern District of California on Tuesday held that United Behavioral Health (UBH) — the country’s largest managed behavioral healthcare organization — developed restrictive medical-necessity criteria that it used to deny coverage for outpatient, intensive outpatient, and residential treatment services.

According to the decision, the Court found that UBH’s internal guidelines limited coverage to acute care services, disregarding highly prevalent, chronic, and co-occurring disorders that required greater intensity and/or duration.

The Court also found that UBH failed to meet a requirement related to children and adolescents, asserting that although generally accepted standards of care do not require UBH to “create an entirely separate set of guidelines to address the needs of children and adolescents… they do, however, require that UBH’s guidelines instruct decision-makers to apply different standards when making coverage decisions involving children and adolescents, where applicable, including relaxing the criteria for admission and continued stay to take into account their stage of development and the slower pace at which children and adolescents generally respond to treatment.”

NABH is especially pleased to see the Court acknowledge that mental health and substance use disorders are chronic illnesses, and that managed care organizations must cover care that not only stabilizes the acute aspects of a patient’s illness, but also addresses a patient’s underlying condition.

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About NABH

The National Association for Behavioral Healthcare (NABH) advocates for behavioral healthcare and represents provider systems that are committed to delivering responsive, accountable, and clinically effective prevention, treatment, and care for children, adolescents, adults, and older adults with mental and substance use disorders. Its members are behavioral healthcare provider organizations that own or manage more than 1,000 specialty psychiatric hospitals, general hospital psychiatric and addiction treatment units and behavioral healthcare divisions, residential treatment facilities, youth services organizations, and extensive outpatient networks. The association was founded in 1933.

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NABH Applauds Landmark Behavioral Healthcare Coverage Ruling

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HHS: Assessing the Impact of Parity in the Large Group Employer-Sponsored Insurance Market

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AAP: Nonmedical Prescription Opioid Use by Parents and Adolescents in the United States

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JAMA: Assessment of Changes in the Geographical Distribution of Opioid-Related Mortality Across the United States

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