CEO Update 213
HHS and DEA Partially Extend COVID-19-Era Telehealth Flexibilities
HHS and the U.S. Drug Enforcement Administration (DEA) on Wednesday proceeded with rulemaking to partially extend COVID-19 pandemic-era flexibilities for prescribing controlled substances via telehealth without ever having conducted an in-person medical evaluation.
The federal agencies introduced a final rule focused on buprenorphine for opioid use disorder (OUD), and a notice of proposed rulemaking (NPRM) for special registrations focused on all Schedule II-V controlled substances.
The final rule will allow practitioners to prescribe buprenorphine for OUD for up to six months via audiovisual or audio-only telehealth before conducting an in-person medical evaluation, subject to certain requirements. This rule is likely to become effective on Feb. 16, 2025.
The NPRM would create multiple special registrations for practitioners to prescribe controlled substances via telehealth indefinitely, including a Telemedicine Prescribing Registration covering Schedules III-V; and an Advanced Telemedicine Prescribing Registration covering Schedules II-V, which would be limited to practitioners with specific specialties (e.g., psychiatry, pediatrics) or who work in long-term care facilities. In addition, practitioners would generally be required to obtain a State Telemedicine Registration for each state in which their patients are located.
The NPRM includes various requirements for practitioners, such as noting the special registration number on prescriptions, expansive PDMP checks, reporting certain prescribing information to DEA annually, being physically located in the same state as a patient when issuing a Schedule II prescription, limiting the number of special registration Schedule II prescriptions to less than 50% of the total number Schedule II prescriptions issued each month, and using audiovisual technology (there is an exception for buprenorphine for OUD, whereby audio-only visits are permitted after a telehealth evaluation with audiovisual technology).
NABH staff will coordinate with relevant NABH committees to develop a response to the NPRM. We expect that comments will be due by March 18, 2025.
Please read NABH’s Issue Brief for more details.
MedPAC Supports Eliminating Medicare’s 190-day Lifetime Limit
The Medicare Payment and Advisory Commission (MedPAC) this week unanimously supported a draft recommendation to Congress to eliminate both Medicare’s 190-day lifetime limit on covered days in freestanding inpatient psychiatric hospitals, as well as the policy that reduces the cap on covered days for patients who received similar care during the 150 days preceding Medicare eligibility.
MedPAC reported that while only 50,000 Medicare beneficiaries were at or near the 190-day limit in 2023, this group of patients is “highly vulnerable” relative to the general Medicare population. The Commission projects that changing these 60-year-old policies would increase access to care and cost approximately $50 million in additional federal spending per year.
NABH expects the Commission to vote on the measure this month and include the recommendation in the Commission’s annual March report to Congress. The Commission will report its related research on the quality of care and readmissions within 30 days of discharge for these hospitals this spring.
HHS Releases Report on Private Equity in Healthcare
HHS this week released a report highlighting the effects of increasing consolidation in America’s healthcare markets and recent influx of private equity (PE) and other private investors active in the healthcare space.
The U.S. Justice Department and the Federal Trade Commission contributed to the nearly 40-page report after the three federal agencies announced a tri-agency collaboration in December 2023 to promote competition in healthcare markets. As part of that effort, the three agencies released a request for information in March 2024 to understand how certain healthcare market transactions among health systems, private insurers, PE funds, and other private investors may increase consolidation and compromise patients’ health, quality of care, and affordability—and may also threaten workers’ safety, satisfaction, and wages while creating taxpayer burden.
One of the key findings of the report showed through case studies how PE firms loaded hospitals with debt, sold the hospitals’ underlying assets, and paid investors through dividends and financially engineered sales, resulting in negative consequences such as bankruptcy, closure of facilities and service lines, staffing shortages, and patient safety and quality concerns.
The report also included policy recommendations, such as enhancing ownership transparency; increasing disclosures of mergers & acquisitions in healthcare by lowering reporting thresholds, requiring review and approval, and empowering relevant authorities with data and resources needed to conduct review of health care transactions; pursuing further enforcement actions to halt hospital mergers and industry rollup; and continuing to improve data sharing and other collaboration across agencies, Congress, and state and local authorities in an all-government approach to promote competition.
SAMHSA Releases Updated National Behavioral Health Crisis Care Guidance
The Substance Abuse and Mental Health Services Administration (SAMHSA) this week released updated National Behavioral Health Crisis Care Guidance that includes three documents: the 2025 National Guidelines for a Behavioral Health Coordinated System of Crisis Care, Model Definitions for Behavioral Health Emergency, Crisis, and Crisis-Related Services, and Mobile Crisis Team Services: An Implementation Toolkit Draft.
The updated National Guidance reflects the nation’s transition to the 988 Suicide & Crisis Lifeline in 2022 and other progress and emerging needs related to behavioral health crisis care. It also provides a framework for transforming behavioral health crisis care systems in communities throughout the United States, at a time when the country continues to face record high rates of suicide and overdose.
Reminder: CMS and Abt Seek Nominations for TEP to Design a Patient Assessment Instrument
CMS and its contractor Abt, a research and consulting firm, are assembling a TEP that will provide guidance on clinical and operational issues to design and implement a patient assessment instrument (PAI).
Abt seeks a mix of clinical and operational leaders, including participants with direct knowledge of the patient assessment process. Please refer to the TEP Charter for more information. The TEP will meet periodically for up to four years. All meetings will be held virtually, including the first meeting in February or March 2025.
Nomination packets must include a signed TEP nomination form, letter of interest, and CV, all of which must be e-mailed to IPF-PAI_testing@abtglobal.com with “Nomination” in the subject line. The deadline for applications is next Friday, Jan. 24, 2025 at 5 p.m. ET.
Update: CMS Launches Innovation in Behavioral Health Model in Four States
At the start of January, the Centers for Medicare & Medicaid Services (CMS) launched an eight-year Innovation in Behavioral Health (IBH) model with the Medicaid agencies in Michigan, New York, Oklahoma, and South Carolina to develop managed care payments for integrated physical and mental healthcare services.
These states will partner with managed care organizations and outpatient providers, including physician practices, opioid treatment programs, hospital- or university-affiliated outpatient behavioral healthcare providers, safety net providers and others. Behavioral healthcare provider participants will conduct patient screenings. assessments of behavioral and physical health needs, and other care management functions. Participants will be eligible to receive infrastructure funding and risk-adjusted per-person-per-month integration payments in years two through five, followed by integration payments, performance-based payments and possible bonuses in years four through eight.
The infrastructure funding will range from $100,000 to $200,000 per participant and can be used on staffing, information technology (IT,) and workflow changes needed to implement the model, including the adoption and upgrading of electronic health record systems and telehealth tools.
To learn more, please refer to the Notice of Funding Opportunity, FAQs, and fact sheet. Those who are interested may register for CMS’ listserv to receive ongoing updates and/or issue questions to CMS’ healthcare strategy team.
Congratulations to 2023 NABH Board Chair Harsh Trivedi on Joint Commission Appointment
NABH congratulates 2023 NABH Board Chair Harsh Trivedi, M.D., M.B.A on his recent appointment to The Joint Commission’s Board of Commissioners on Jan. 1.
Trivedi, president and CEO of Sheppard Pratt, was one of six new members named to the Commission’s governing body, which advises on strategies to drive organizational success.
Congratulations, Harsh!
Coming Soon: NABH Developing Advocacy Document on Potential Medicaid Changes
NABH is developing an advocacy document to educate policymakers about the risks of proposed changes to Medicaid financing and eligibility.
The analysis will describe how state efforts to offset reduced revenue could exacerbate existing challenges with low reimbursement and narrow networks, and it will outline potential issues with applying work requirements to people with behavioral health conditions.
NABH’s resource will emphasize the critical need for Medicaid as a funding source for behavioral healthcare organizations, particularly Opioid Treatment Programs.
Save the Date: Join Us in May for the 2025 NABH Annual Meeting!
Please plan to join your peers and the NABH team at the Salamander Washington, DC from May 12-14 for the 2025 NABH Annual Meeting.
NABH will provide more details soon in future editions of CEO Update and in NABH Annual Meeting Alerts. We look forward to seeing you in Washington!
Fact of the Week
A National Institutes of Health-funded study of nearly 10,000 adolescents has identified distinct differences in the brain structures of those who used substances before age 15 compared with those who did not. Many of these structural brain differences appeared to exist in childhood before any substance use, suggesting they may play a role in the risk of substance use initiation later in life, in tandem with genetic, environmental, and other neurological factors.
For questions or comments about this CEO Update, please contact Jessica Zigmond.