CEO Update 245
Congress Faces Host of Decisions as Federal Funding Deadline Looms
Congress returned from its August recess last week to a fall agenda that requires lawmakers to
decide on how it will fund the federal government and extend critical healthcare programs.
The House has 10 legislative days, and the Senate has 12 legislative days to determine how to fund federal government operations before the Sept. 30 deadline.
Multiple factions within Congress have advocated different funding approaches. The White House this week suggested Congress delay the upcoming government shutdown deadline to Jan. 31, creating a four-month extension that Democrats and many Republican lawmakers oppose.
The proposal would couple a funding extension of federal health insurance subsidies set to expire on Jan. 1 with government funding through September 2026. As congressional Republicans continue to manage messaging about pending Medicaid changes included in this summer’s H.R. 1, One Big Beautiful Bill Act (OBBBA), the threat of surging costs for those families who purchase their insurance through the exchanges is becoming clearer. Unless Congress acts, premiums will spike for both subsidized and unsubsidized enrollees. If the enhanced tax credits expire, an estimated 4 million people could stop receiving coverage through the Marketplace by 2026.
Meanwhile, Democrats and Republicans alike are paying close attention to pending Medicaid Disproportionate Share Hospital (DSH) cuts, which could be addressed as part of a government funding extension. DSH payments help compensate hospitals that deliver care to a high volume of uninsured individuals and Medicaid beneficiaries, as Medicaid reimbursement is typically well below the actual cost of behavioral healthcare. Medicaid DSH cuts are scheduled to take effect on Oct.1, 2025, unless Congress acts. If this occurs, many behavioral healthcare providers will be forced to reduce services, limit availability of inpatient treatment, or close their doors.
NABH sent an Action Alert to members asking them to urge their lawmakers to act by Sept. 30 to avert the DSH cuts before the Oct.1 deadline and also act by Sept. 30 to extend the enhanced tax credits.
We also joined our coalition partners in asking our members to urge their representatives to sign a congressional letter to House leaders imploring them to prevent the DSH cuts. NABH sent this Action Alert Thursday and hopes to have several new representatives sign the letter by next week’s Tuesday, Sept. 16 deadline. As of Sept. 11, more than 60 representatives signed the letter to House Speaker Mike Johnson (R-La.) and House Minority Leader Hakeem Jeffries (D-N.Y.).
Numerous other healthcare programs are set to expire at the end of September, including extending telehealth authority and reauthorization of the SUPPORT Act. Last week, Rep. Buddy Carter (R-Ga.) and Rep. Debbie Dingell (D-Mich.) introduced H.R. 5081, the Telehealth Modernization Act, bipartisan legislation to establish permanency for telehealth access. NABH continues to push for telehealth permanency and advocates for H.R. 4619, the Medicare Mental Health Inpatient Equity Act, which would eliminate Medicare’s 190-day lifetime limit for inpatient psychiatric hospital services.
Meanwhile, Congress’ regular appropriations process continues as congressional leaders address a stop-gap funding measure. A $108 billion funding bill for the U.S. Health and Human Services Department advanced in the House Appropriations Committee by a 35-28 party-line vote on Sept. 10. The bill cuts the agency by 6%, more than $25 billion shy of the reduction President Trump requested.
The Trump administration requested more than $20 billion for the Administration for a Healthy America, a proposed unit that would consolidate several HHS agencies, which the bill does not fund. The full Senate Appropriations Committee passed a $116 billion HHS bill in July, which includes a $446 million increase in discretionary funds compared with the current fiscal year. Both the House HHS bill and the Senate HHS bill now await floor votes in both chambers and a Conference Committee to resolve any differences.
NABH Sends Comments to CMS on Agency’s 2026 Physician Fee Schedule Proposed Rule
NABH on Sept. 11 sent a letter to the Centers for Medicare & Medicaid Services (CMS) supporting several policy proposals affecting behavioral healthcare providers that the agency included in its 2026 Physician Fee Schedule rule.
In our letter to CMS Administrator Mehmet Oz, M.D., NABH applauded efforts to promote primary and behavioral healthcare integration among Advanced Primary Care Management (APCM) services. While we support CMS’ clarification that Digital Mental Health Treatment (DMHT) codes finalized in CY 2025 can be used for ADHD treatments and all FDA-cleared tools, we noted concern about establishing coding and payment for a broader set of services using digital tools that do not require FDA regulatory oversight.
We also supported the rule’s proposal to include marriage and family therapists and mental health counselors as practitioners who can bill Medicare directly for Community Health Integration and Principal Illness Navigation services.
Finally, NABH expressed support for CMS’ proposal to make permanent certain telehealth flexibilities, including removing frequency limitations for subsequent inpatient visits and adopting a definition of direct supervision to include virtual presence via appropriate audio/video real-time communications technology.
NABH Urges CMS to Ensure the Rural Health Transformation Program Funding Includes Behavioral Healthcare Providers
NABH sent a letter to CMS Administrator Oz, M.D. this week requesting that CMS’ Rural Health Transformation (RHT) Program prioritize a key part of the rural health infrastructure: inpatient and outpatient programs that provide mental health and substance use services.
As we posted in last week’s CEO Update, CMS released information about the RHT Program, for which H.R. 1 (OBBBA), has provided $50 billion to be allocated to states over the next five fiscal years starting in 2026. In both H.R. 1 and the RHT Program guidance, Congress and CMS have rightly identified infrastructure and technology investments as necessary for maintaining rural healthcare systems and identified mental health and substance use programs in rural areas as eligible rural healthcare providers.
Because the HITECH Act omitted behavioral healthcare providers from eligibility for the incentives physical healthcare providers received for electronic health record (EHR) system adoption, NABH members are not at parity with physical healthcare providers in their HIT infrastructure.
In our letter, we urge CMS to clarify to states in the RHT Program funding notice and additional guidance that inpatient psychiatric hospitals and units, residential treatment facilities, partial hospitalization and intensive outpatient programs, and Opioid Treatment Programs are allowable sub-recipients of RHT Program funds.
“If CMS and states exclude behavioral health providers from the RHT Program, we fear the disparities in infrastructure and technology between physical healthcare and behavioral healthcare delivery systems in rural areas will be further exacerbated,” our letter noted.
Click here to learn more about CMS’ RHT program.
Livestream Available for Rural Health Transformation Planning Summit on Sept. 30
Interested NABH members can participate virtually in a Rural Health Transformation Planning Summit at the Watergate Hotel in Washington, D.C. on Tuesday, Sept. 30.
The one-day event will convene state and federal officials with organizations investing in new and better ways to reach Americans in rural areas with high-quality healthcare.
A host of companies will sponsor and support the summit or provide state grants, including ATI Advisory, Bamboo Health, Barr-Campbell Family Foundation, BioIntelliSense, Epic, Guidehouse, homeward, Horne, Magellan Health, maximus, McKinsey & Company, Philips, Rural Health Innovators, surescripts, Trualta, welldoc.
Click here for the livestream registration.
NABH Comments on MAHA Strategy & Report in ‘Behavioral Health Business’
NABH President and CEO Shawn Coughlin was quoted this week in a Behavioral Health Business story about the Trump administration’s Make America Healthy Again (MAHA) Commission’s Make Our Children Healthy Strategy to implement its earlier-released report.
Coughlin noted NABH will continue to review the strategy and join our partner organizations in urging the Trump administration to inform every action with thoroughly researched scientific evidence from psychiatrists and other behavioral healthcare practitioners.
“We also emphasize that when comparing our practices with practices in other countries,” Coughlin’s statement continued, “differences in prevalence in no way make overdiagnosis and overtreatment ‘empirically evident.’”
SAMHSA and CMS Release State Health Official Letter on Best Practices for Implementing the Continuum of Crisis Services
The Substance Abuse and Mental Health Services Administration (SAMHSA) and CMS’ Center for Medicaid and CHIP Services (CMCS) this week issued guidance to states about the crisis services continuum and how states may support implementing this continuum through Medicaid and CHIP.
The letter to state health officials describes specific Medicaid and CHIP authorities and flexibilities to support the full continuum of crisis-response services and suggests strategies for measuring and monitoring crisis response. The letter references SAMHSA’s recently published National Guidelines for a Behavioral Health Coordinated System of Crisis Care.
SAMHSA and CMS encourage states to take advantage of Medicaid and CHIP flexibilities for ensuring individuals who are in crisis have access to inpatient, residential, or intensive outpatient services. The letter includes specific financing flexibilities, fee-for-service and managed care considerations, payment strategies, and best practices for measuring and monitoring utilization and outcomes.
SAMHSA and CMS Release State Health Official Letter on Best Practices for Implementing the Continuum of Crisis Service
CMCS released a letter Sept. 9 detailing OBBBA’s provisions directing CMS to reduce the total Medicaid payment rate limit for state-directed payments (SDPs) for four services: inpatient hospital services, outpatient hospital services, nursing facility services, or qualified practitioner services at academic medical centers.
CMS published this letter to aid state-planning efforts and noted it will release a notice of proposed rulemaking (NPRM) with more specific directions. As part of the NPRM, CMS is considering changes to the total payment rate limit for SDPs for other services beyond the four services that OBBBA mandates.
The letter provides an overview of Section 71116 of the OBBBA, which requires the total Medicaid payment rate for any SDP for those four services to 100% of the specified total published Medicare payment rate for expansion states or 110% of the Medicare payment rate for non-expansion states. OBBBA included a provision temporarily grandfathering certain SDPs until the rating period beginning on or after Jan. 1, 2028. CMS offered a preliminary interpretation of this provision in its letter.
Study Finds 41% Lower Risk of Death for People Who Receive Contingency Management
A study published this week in the American Journal of Psychiatry found that among veterans with stimulant use disorder, those who received contingency management (CM) were 41% less likely to die within one year than those who did not – a statistic similar to the lower chance of death associated with taking buprenorphine for opioid use disorder.
This is the first study to assess the relationship between CM and mortality, and the findings underscore the potential for CM to greatly enhance the outcomes of people with stimulant use disorder.
“Our data confirm that wide-scale access to CM for individuals with [stimulant use disorder] can save lives, both reducing all-cause mortality and preventing overdose deaths,” the authors noted. “This is particularly important given that these findings are from real-world clinical care as opposed to clinical trials focused on efficacy, lending support to the assertion that wide-scale uptake of CM across health systems and states could potentially help reduce deaths.”
MACPAC to Webcast Public Meeting Next Week
The Medicaid and CHIP Payment and Access Commission (MACPAC) will webcast its two-day meeting next week.
MACPAC will host its meeting on Thursday, Sept. 18 from 9:30 a.m. to 4:30 p.m. ET and on Friday, Sept. 19 from 9:30 a.m. until Noon ET.
Click here to register.
Fact of the Week
State lawmakers this week sent Gov. Gavin Newsom (D-Calif.) a bill that would block artificial intelligence chatbots from representing themselves as medical professionals, Politico and other news outlets reported.
For questions or comments about this CEO Update, please contact Jessica Zigmond.