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CMS Announces Demonstration Projects for SMI and SED The Centers for Medicare and Medicaid Services (CMS) this week announced opportunities for demonstration projects under section 1115(a) of the Social Security Act to improve care for adults with serious mental illness (SMI) and children with Serious Emotional Disturbances (SED). The 21st Century Cures Act required these demonstration projects, and NABH was instrumental in ensuring that the Cures Act included this provision. Section 1115(a) of the Social Security Act states that the HHS secretary may authorize a state to conduct experimental, pilot, or demonstration projects as long at the overall demonstration is budget neutral. A budget-neutral demonstration means that the Medicaid costs for a demonstration project do not exceed what the federal government’s Medicaid costs likely would have been absent the demonstration. This SMI/SED demonstration authority will allow states—upon CMS approval of their demonstrations—to receive Medicaid federal financial payments (FFP) for services furnished to Medicaid beneficiaries during short-term stays for acute care in psychiatric hospitals or residential treatment settings that qualify as IMDs. This SMI/SED demonstration opportunity is comparable with the recent section 1115 (a) demonstration opportunity to improve treatment for SUDs, including opioid use disorder (OUD). States may participate in the SUD demonstration opportunity and the SMI/SED demonstration opportunity at the same time. Under this demonstration, NABH members will be required to show that, statewide, the average length of stay for beneficiaries receiving care in Institutions of Mental Diseases (IMDs) does not exceed 30 days. This length-of-stay limit is higher than the current 15-day cap that applies to states that use the managed care authority to contract with IMDs. In fact, the 1115 limit is a statewide average length of stay, rather than a hard per-beneficiary cap of 15 days under the managed care contracting authority. It is not clear from this letter how states would use the managed care contracting authority together with a 1115 demonstration project if a state chose both approaches. NABH will work with CMS on ways to coordinate the 1115 demonstration authority with the managed care contracting authority, especially related to the 15-day cap versus the 30 day statewide average cap. States participating in the SMI/SED demonstration opportunity will be expected to implement efforts to improve community-based mental healthcare. Some of the goals regarding community-based care include: improving connections to community-based care following stays in acute care settings; ensuring a continuum of care available to address more chronic, ongoing mental healthcare needs of beneficiaries with SMI or SED; providing a full array of crisis stabilization services; and engaging beneficiaries with SMI or SED in treatment as soon as possible. The agency’s letter also outlines some specific objectives for the demonstrations, such as reducing utilization and lengths of stay in emergency departments; reducing preventable readmissions; improving availability of crisis stabilization services; improving access to community-based services, including integration of primary and behavioral healthcare; and improving care coordination, especially continuity of care in the community after episodes of acute care in hospitals and residential treatment facilities. States will also be required to conduct independent interim and final evaluations that will draw on data collected and will need to describe the demonstration’s effectiveness using quantitative and qualitative outcomes and cost analysis. NABH encourages its members to contact their respective state Medicaid director(s) to offer help in applying for this 1115 waiver for IMD services to SMI and SED beneficiaries. Click here to read the letter from CMS to state Medicaid directors. The NABH team will continue to keep members apprised of any changes and activities regarding this demonstration authority and any other matters related to the IMD exclusion. AHIP Finds Medicaid Enrollees with Serious Chronic Conditions Have Better Clinical Experiences than the Uninsured Population Medicaid enrollees experiencing mood disorders such as major depressive disorder or bipolar disorder were much more likely to receive a recommended combination of medication and psychotherapy treatments than uninsured individuals, according to a new report from America’s Health Insurance Plans (AHIP). The study—which concluded the same results for people with other chronic conditions—analyzed information from people who were uninsured, covered by a Medicaid private health plan, or covered by a commercial plan. Researchers then compared clinical care and prescription drug use patterns from 2013-2015 among people with one of three chronic conditions: asthma, diabetes, or mood disorders. According to the report, major depressive disorder affects about one out of 10 Americans each year, and about one out of five will experience at least one depressive episode throughout their lifetime. It also drives total annual costs of more than $211 billion. Meanwhile, the report estimated that bipolar disorder affects about 3 percent of the adult U.S. population and drives total annual medical costs of about $202 billion. “The proposition that having Medicaid coverage is somehow detrimental to one’s health is simply not supported by the clinical experiences described in this and other studies,” the report noted. “Indeed, results from this study suggest that quite the opposite is true.” GAO Report Describes the Top Practices for Certifying Peer Specialists Systematic screening of applicants, conducting core training in person, and incorporating physical health and wellness into training are among the six leading practices for certifying peer specialists that the Government Accountability Office (GAO) identified in a new report this week. The 21st Century Cures Act included a provision for GAO to study and identify best practices related to both training and certification in peer support programs in selected states that receive funding from the Substance Abuse and Mental Health Services Administration (SAMHSA). GAO researchers interviewed program officials in Florida, Georgia, Michigan, Oregon, Pennsylvania, and Texas, which are among the 41 states and Washington, D.C., that—as of July 2016—had programs to certify peer support specialists. Program officials in those six states generally cited six practices that have a basic set of competencies and have shown an ability to help support others. In addition to screening patients, conducting in-person core training, and incorporating physical health and wellness, the other best practices include preparing organizations to use peers effectively, ensuring continuing education requirements specific to peer support, and engaging peers in both leading and developing certification programs. U.S. Labor Department Announces Grant to Address Opioid Addiction in Rural California The U.S. Labor Department this week awarded California a National Health Emergency Dislocated Worker Grant to provide employment for eligible individuals in rural California counties that have been hit hard economically by the nation’s opioid crisis. The grant will provide employment for those seeking careers in healthcare professions related to addiction, treatment, prevention, and pain management. According to a news release from the Labor Department, California expects to serve participants in Amador, Calaveras, Humboldt, Inyo, Kern, Mariposa, Merced, Mono, and Tuolumne counties—all of which have had the highest opioid rates in the state. The Workforce Innovation and Opportunity Act of 2014 supports Dislocated Worker Grants, which temporarily expand the capacity of dislocated worker programs at the state and local levels as a response to unexpected economic events that cause significant job losses. Recovery Research Institute Finds Oxford Houses Offer Recovery Benefits and Cost Savings Oxford House participants had better outcomes over time across the board, even when models adjusted for participant gender, age, and the presence of a co-occurring psychiatric disorder, the Recovery Research Institute reported in a new study. Oxford Houses were first developed in 1975 and are a type of abstinence-focused recovery residence where residents are entirely responsible for house decisions and maintenance. According to the study, there are about 2,000 Oxford Houses in the United States and other countries that support about 24,000 people each year. This recent study analyzed whether Oxford House participation is helpful; who Oxford Houses are most helpful for; and if Oxford Houses can reduce the financial burden that substance use disorder causes. Click here to learn more. SAMHSA Announces Distress Helpline Information During California Wildfires SAMHSA posted its Distress Helpline information late last week to offer immediate counseling for those affected by the deadly wildfires in California. The resource is available 24 hours a day, seven days a week, and connects callers to trained professionals from the closest counseling center in a nationwide network of centers. Click here to access the helpline. As always, NABH thanks its members for providing quality behavioral healthcare services to those in need every day, especially during disasters and public health emergencies. Update Your System’s Information Today for the NABH 2019 Membership Directory Earlier this week the NABH team e-mailed all system members a link that provides access to update all system information for the 2019 NABH Membership Directory. The deadline to submit all data for the 2019 directory is Thursday, November 29, 2018. If you did not receive the link, or if you have questions, please contact Cemal Ozgur at cemal@nabh.org or 202-393-6700, ext. 106. Register Now for the 2019 NABH Annual Meeting Please visit NABH’s Annual Meeting homepage today to register and reserve your hotel room for the 2019 NABH Annual Meeting — Behavioral Healthcare: Improving Coordination, Collaboration, Integration. We look forward to seeing you at the Mandarin Oriental Washington, D.C. from March 18-20, 2019! For questions or comments about CEO Update, please contact Jessica Zigmond.