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CEO Update | 56

New Report Shows Prescription Opioid Volume Declined 17 percent in 2018 Prescription opioid dosage volume—defined by morphine milligram equivalents, or MMEs—declined 17-percent in 2018, according to a new report from IQVIA, a research firm that specializes in advanced analytics and technology solutions. The study, Medicine Use and Spending in the U.S.: A Review of 2018 and Outlook to 2023, notes this was the single-largest annual drop ever recorded within the U.S. market. The findings also showed that prescription opioid volume had increased annually since 1992 and reached its highest level in 2011. Then a series of regulatory and legislative restrictions, combined with stricter clinical prescribing guidelines and greater reimbursement controls, led to a 4-percent-per-year drop on average from 2012 to 2016; followed by a 12-percent drop in 2017; and the 17-percent decrease last year. Murray Aitken, IQVIA senior vice president and executive director of the IQVIA Institute for Human Data Science, noted in a news release that while prescription opioid usage continues to decline, researchers saw many more people receiving medication assisted treatment (MAT) for opioid addiction. “Our research shows new therapy starts for MAT increased to 1.2 million people in 2018, nearly a 300-percent increase compared with those seeking addiction help in 2014,” Aitken said. “This is an important indicator of the effects of increased funding and support for treatment programs to address addiction.” CMS Extends Enhanced FMAP Period for Certain Medicaid Health Homes for Persons with SUD The Centers for Medicare and Medicaid Services (CMS) has announced the availability of an extension of the enhanced Federal Medical Assistance Percentage (FMAP) period for certain Medicaid health homes for individuals with substance use disorder (SUD). According to CMS, last year’s Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act permits CMS to extend, at a state’s request, the period of 90-percent FMAP for certain Medicaid health homes if certain conditions are met. This is available only for expenditures for SUD-eligible individuals under an SUD-focused state plan amendment. “States whose health homes meet those criteria may request that the Secretary extend the enhanced FMAP period beyond the first 8 fiscal year quarters, for the subsequent 2 fiscal year quarters, for a total of 10 fiscal year quarters from the effective date of the state plan amendment,” the guidance noted. See CMS’ information bulletin for more information. Tennessee to Adopt Block Grant Funding for Medicaid Tennessee Gov. Bill Lee (R) is expected to sign a bill soon that seeks approval from the Trump administration to turn federal funding for the state’s Medicaid program into a block grant. The Wall Street Journal reported this week that other GOP-controlled states have adopted or are asking for federal approval for work requirements as a way to control costs, as growth in Medicaid means the federal healthcare program is making up a larger portion of state budgets. “The waiver would seek the CMS’ approval to transform TennCare, the state’s $12 billion Medicaid program covering 1.3 million Tennesseans, from an open-ended entitlement program to one where the federal government makes fixed payments,” Modern Healthcare reported. Needle Exchanges Endorsed and Legalized in GOP-controlled States Two states have made hypodermic needle exchanges legal this year while four other state legislatures are considering the move, Kaiser Health News reported this week. Georgia and Idaho, where Republicans control the House and Senate and the governor is a Republican, legalized needle exchange this year. Meanwhile, Arizona, Florida, Iowa, and Missouri have introduced bills to allow the practice. Research has shown the benefit of needle exchanges for years, the story noted, and lawmakers are now listening as the opioid crisis and infectious diseases have affected their communities. “The reality is maybe 10 or 15 years ago this wasn’t where Georgia was,” Republican state Rep. Houston Gaines, sponsor for Georgia’s needle-exchange law, said in the story. “But the medical and science community has shown that this works,” he added. “My hope is as Republicans, we can always be willing to embrace programs and ideas if they’re proven to work.” Opioid Addiction Drug Prescribed Mostly to Whites as Opioid Overdose Deaths Rose Among Blacks A new study in JAMA Psychiatry has found that white populations are almost 35 times as likely to have a buprenorphine-related visit than black Americans. This dominant use of the opioid-addiction drug happened at the same time opioid overdose deaths rose faster among blacks than whites. Poola Lagisetty, MD, an assistant professor of medicine at the University of Michigan Medical School and the study’s lead author, noted that most of the white patients either paid cash (40 percent) or relied on private insurance (35 percent) to fund their buprenorphine treatment. The statistic that only 25 percent of the visits were paid for through Medicaid or Medicare “does highlight that many of these visits could be very costly for persons of low income,” Lagisetty said in a joint story about the study from Kaiser Health News and National Public Radio. Longtime New York Times Healthcare Reporter Robert Pear Dies at 69 Robert Pear, a reporter for The New York Times since 1979, died Tuesday, May 7 following complications from a stroke. Pear, 69, worked out of the newspaper’s Washington bureau and wrote more than 6,700 articles for the Times during his career. He wrote many articles about behavioral healthcare and parity, giving visibility to these critical diseases. In his last published article on April 20, Pear wrote that while President Trump and congressional Republicans have said they are committed to protecting people with pre-existing medical conditions, many would have considerably less protection under their healthcare revisions. HRSA Accepting Applications for 2019 Graduate Psychology Education and Nurse Corps Programs The Health Resources and Services Administration (HRSA) is accepting applications for its Nurse Corps Scholarship Program (NCSP) through May 21. The NCSP awards funds to students enrolled in a diploma, associate, baccalaureate, or graduate degree nursing program accept applications for this program if those students commit to serving in high-need, underserved communities. Scholarship support covers tuition, required fees, other reasonable educational costs, and a monthly living stipend. HRSA will accept applications through May 21. Continue to Support Mental Health Month: Promote NABH’s Access to Care Initiative National Prevention Week  kicks off on Sunday, May 12 to observe increasing awareness around mental health and substance use disorders. The week is part of Mental Health Month, which the United States has observed throughout May since 1949 to promote awareness about the importance of mental health as a part of overall health. This year, NABH asks its members to promote this important national observance by supporting the association’s Access to Care initiative. Launched in March, NABH’s Access to Care initiative focuses on two major challenges that too often prevent providers from offering patients a full range of behavioral healthcare services: unjust managed care contracts and countless regulations. Please visit our Access to Care page, where you can find resources to post and share with your followers, including our Access to Care video (which you can post directly to your organization’s website and share with others), our Access to Care resolution, our regulatory report, The High Cost of Compliance: Assessing the Regulatory Burden on Inpatient Psychiatric Facilities, and social media messages, including a LinkedIn article from NABH President and CEO Mark Covall. Thank you for your help and support! Learn About NewYork-Presbyterian in NABH’s Newest Member Profile! Please take a moment to learn about NABH member NewYork-Presbyterian’s Psychiatry Inpatient Access Center in our newest member profile!   For questions or comments about CEO Update, please contact Jessica Zigmond.