CEO Update 169
President Biden’s ‘Build Back Better’ Framework Includes Behavioral Health Provisions
President Biden on Thursday announced his framework for a $1.75 trillion spending bill that includes several provisions to address the nation’s myriad behavioral health problems.
Known as Build Back Better, the economic framework is the Biden administration’s plan to expand the social safety net and fight climate change. For behavioral healthcare providers, the plan is significant because it calls for civil monetary penalties for parity violations, investments to expand access to behavioral health, and funding to grow and diversify the maternal mental health and substance use disorder (SUD) workforce, as well as to support peer-recovery specialists. The president’s plan also includes funding for mental health and SUD professionals and for the national suicide prevention lifeline.
The announcement from the White House said President Biden is “confident this is a framework that can pass both houses of Congress.”
HHS Announces Overdose Prevention Strategy
U.S. Health and Human Services Department (HHS) Secretary Xavier Becerra this week announced the department’s new Overdose Prevention Strategy to increase access to the full range of care and services for individuals who use substances that cause overdose and their families.
The nation’s overdose epidemic has developed in recent decades, from increases in the prescribing of opioids in the 1990s, to rapid increases in heroin overdoses starting around 2010, to growth in overdoses from illicitly manufactured synthetic opioids—such as fentanyl—beginning in 2013, HHS reports.
A notable feature of the Overdose Prevention Strategy is harm reduction, as it calls for facilitating evidence-based use of fentanyl testing strips (FTS) and drug checking utilization in community and clinical settings, implementing comprehensive HIV services in Syringe Services Program (SSP) settings, and widening access to opioid overdose reversal treatments.
“We know that addiction is a disease that some people are more vulnerable to because of biological factors and the social conditions in which they grow up and find themselves,” Nora Volkow, M.D., director of the National Institute on Drug Abuse, said in a statement. “Interventions to buffer adverse social conditions are effective in preventing addiction, and this plan is an important step towards improving equity towards people who have been left behind due to racism and discrimination, and for dismantling the stigma against people who use drugs,” she continued. “Stigma and discrimination pose impenetrable barriers to the support and care that is needed to address the overdose crisis.”
Senate Confirms Rahul Gupta, M.D. as ONDCP Director
The Senate on Thursday confirmed Rahul Gupta, M.D., M.P.H., M.B.A. to serve as director of the White House Office of National Drug Control Policy (ONDCP), making him the first physician to become the nation’s “drug czar.”
Gupta begins his new role when America’s addition treatment providers face a historically high number of overdoses from opioids and methamphetamine, workforce shortages, and patient-access problems. A specialist in internal medicine and preventive medicine, Gupta served most recently as senior vice president and chief medical and health officer at the March of Dimes. Previously he served as West Virginia’s health commissioner.
In other ONDCP news this week, the office released details on its new U.S.-Colombia counternarcotics strategy. Developed by the Counternarcotics Working Group between the two governments, the strategy establishes the framework to define broader measures of success for counternarcotics efforts in rural communities to include metrics on access to state services, institutional presence, income for licit producers, and coca eradication.
This strategy supports the Biden administration’s broader drug policy strategy outlined in the Drug Policy Priorities for Year One, which includes expanding access to evidence-based prevention, treatment, harm reduction, and recovery support services, and reducing the supply of illicit drugs.
SAMHSA Releases 2020 National Survey on Drug Use and Health
The Substance Abuse and Mental Health Services Administration (SAMHSA) announced it estimates that 25.9 million past-year users of alcohol and 10.9 million past-year users of drugs other than alcohol reported they were using these substances “a little more or much more” than they did before the Covid-19 pandemic began.
These findings were included in the agency’s 2020 National Survey on Drug Use and Health released this week. According to the data, youths between the ages of 12 and 17 years old who had a past-year major depressive episode (MDE) reported they were more likely than those without a past-year MDE to feel that the pandemic negatively affected their mental health “quite a bit or a lot.”
Meanwhile, among people of mixed ethnicity 18 and older, 11% had serious thoughts of suicide; 3.3% made a suicide plan; and 1.2% attempted suicide in the past year.
SAMHSA Publishes Updated Treatment Improvement Protocol for Stimulant Use Disorders
SAMHSA this week published an updated treatment improvement protocol (TIP) to address the growing problems of use and overdoses of stimulants such as cocaine and methamphetamine, as well as prescribed stimulants, such as those used to treat attention deficit hyperactivity disorder.
Tip 33 Treatment for Stimulant Use Disorders was first published in 1999, and the updated guidance reviews a large body of recent research about the strong efficacy of treatment interventions. It also provides strategies for treatment planning and initiation, engagement, retentions, and initiating and maintaining abstinence.
Richard Rawson, Ph.D., deputy director of UCLA Addiction Medicine Services, led the TIP’s review team. Earlier this year, Rawson—who also serves as executive director of the Matrix Center and Matrix Institute on Addiction—spoke to NABH’s Addiction Treatment Committee about the contingency management intervention.
ASAM Adopts Public Policy Statement on Methadone Treatment Regulations
The American Society of Addiction Medicine’s (ASAM) Board of Directors this week adopted a public policy statement on methadone treatment regulations that lists 21 recommendations intended to improve patient access to methadone treatment and continuity among providers who share patients.
One of ASAM’s recommendations would permit pharmacy dispensing and/or administering methadone by authorized prescribers who are affiliated with an opioid treatment program (OTP), an addiction specialist physician, or a physician who has met specific qualifications. Those qualifications are not yet defined, but they could include training from medical schools and residency programs that provide qualified addiction medicine education.
NABH reviewed and provided comments on ASAM’s recommendations in August 2021.
CMS Seeks Public Comment on Quality Measures for Potential Use in IPFQR Program
The Centers for Medicare & Medicaid Services (CMS) announced its contractor Mathematica is inviting public comments on draft measure specifications for two clinical quality measures under development for the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program: 1) Improvement in Depression Symptoms during the Inpatient Psychiatric Facility (IPF) stay, and 2) 30-day Risk Standardized All-Cause Mortality Following IPF discharge.
CMS noted that clinical experts and a multistakeholder technical expert panel were consulted throughout the measure development process. Now the agency is asking stakeholders review and comment on draft measure specifications. In particular, CMS welcomes comments on the following:
- The extent to which measure scores indicate quality of care in IPFs
- The extent to which IPFs can effect change in measure performance
- The feasibility of implementing the measure in the IPF setting
- The usability of measure scores to improve quality
- Unintended consequences that might result from implementing the measure
- The accuracy and reasonableness of the draft measure specifications, including denominator exclusions and potential risk adjustors
The public comment period opened on Oct. 27 and will close at 11:59 p.m. ET on Nov. 26, 2021. Click here to review the draft measure specifications and send comments here.
Reminder: NABH Denial-of-Care Portal is Open to Members
NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials.
NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients.
This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more.
The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts.
Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.
Fact of the Week
New research from the Centers for Disease Control and Prevention shows that beginning in April 2020, the proportion of children’s mental health–related emergency department (ED) visits among all pediatric ED visits increased and remained elevated through October. Compared with 2019, the proportion of mental health–related visits for children aged 5–11 years old and 12–17 years old increased approximately 24% and 31%, respectively.
For questions or comments about this CEO Update, please contact Jessica Zigmond