Reminder: NABH Board Nominations Due Today, Friday, Oct. 20! 

NABH is seeking help from members as the NABH Selection Committee prepares to consider possible nominees to serve on the NABH Board of Trustees. Specifically, NABH requests that members help the association identify:

► Board Chair-Elect and
     ► Four Board seats that will become available in 2024

The Selection Committee is particularly interested in identifying senior managers who represent the broad diversity within the NABH membership, including various levels of care, organizational structures, and size.

Please download a nomination form to share your recommendations of individuals you would like to see included in the single slate for 2024. Please attach a curriculum vitae (CV) for each person you recommend. This will help the Selection Committee in its deliberations. You are welcome to suggest yourself.

Please return this form (and candidates’ CVs) by today, Oct. 20, 2023, to maria@nabh.org.

Sens. Thune, Hassan, and Blackburn Introduce SAVE IMD Options Act

Sens. John Thun (R-S.D.), Maggie Hassan (D-N.H.), and Marsha Blackburn (R-Tenn.) on Thursday introduced the Securing Advances and a Variety of Evidence-Based (SAVE) Institutions for Mental Disease (IMD) Options Act.

The bipartisan legislation would establish a permanent state plan option in Medicaid that allows states to provide patients between the ages of 21 and 64 with substance use disorder (SUD) treatment in an IMD. Current law does not allow federal Medicaid funds to be used for those patients at IMDs, which include hospitals, nursing facilities, or other institutions with more than 16 beds that provide care for mental health diseases, including SUD.

NABH strongly supports the bill and is working with the lawmakers’ congressional staff to provide support.

“Establishing a permanent state option in Medicaid for substance use disorder treatment provided in IMD will provide states with certainty and ensure individuals have access to this lifesaving treatment,” NABH President and CEO Shawn Coughlin said in a news release about the bill.

NABH Submits Parity Comments to HHS, DOL, and Treasury

NABH this week submitted comments to the U.S. Health and Human Services, Labor, and Treasury Departments on this year’s proposed parity rule and thanks all members who provided feedback.

In its letter, NABH recognized the three departments for their collective determination to enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) that passed 15 years ago this month and has yet to be implemented fully and fairly nationwide.

NABH’s letter also said the association especially supports the proposed rule’s requirement that each plan’s comparative analysis on parity compliance include substantive data on non-quantitative treatment limitations (NQTL), including network composition. These requirements will do much to enforce both the letter and spirit of the MHPAEA, NABH noted.

The letter continued by categorizing NABH’s comments into the following sections: 1) parity in behavioral healthcare benefits, 2) NQTL comparative analysis requirements, 3) improving and expanding meaningful parity standards, and 4) network adequacy.

“We appreciate that the rule addresses ambiguous definitions that contribute to the disparity between mental and physical healthcare,” the letter said in a section about clarifying meaningful coverage and scope of covered services. “Such ambiguity tends to yield overly flexible interpretations that generally favor health plans over patients. In particular, the proposed, more specific definitions for ‘meaningful coverage’ and ‘scope of covered services’ will bring valuable clarity and consistency to coverage determinations,” it continued. “Of notable benefit, we strongly support the proposed requirement for plans that provide behavioral healthcare benefits in any classification of care, to do so in all classifications of care. Similarly, we urge the departments to add to the final rule a definition of ‘meaningful’ as it applies to scope of covered MH and SUD benefits in each classification.”

Fewer Medicare Advantage Plans Earned a 5-Star Rating for 2024

In its 2024 Star Ratings released last week, the Centers for Medicare & Medicaid Services (CMS) gave 31 Medicare Advantage (MA) contracts a five-star rating, a notable drop from the 57 contracts that earned the top rating in 2023. An MA contract must earn at least a four-star rating to receive a quality bonus payment from CMS.

MA open enrollment for 2024 kicked off on Oct. 15 using new MA requirements that CMS finalized in April and will take effect on Jan. 1, 2024. The 40 quality metrics that apply to MA plans with a drug benefit in 2024 will include new restrictions on deceptive marketing, multiple prior authorization improvements, and affordable drug pricing, with the latter required by law.

CMS is in the process of remaking the star-rating system to remove incentives that inadvertently permitted lower quality and unnecessary spending. This effort includes applying more stringent criteria for star-rating quality metrics, which are expected to result in fewer insurers securing high ratings and greater financial benefits for insurers focused on treating disadvantaged populations.

CMS’ effort also includes changes from the 2024 MA final rule, which strives to improve coverage, ensure timely access to care, and advance parity between MA and traditional fee-for-service coverage.

The National Academies Seeks Experts to Participate in Workshop to Explore Data-Collection Efforts for People Who Use Drugs

The National Academies is seeking suggestions for experts to participate in a White House Office of National Drug Control Policy-sponsored workshop to explore data-collection efforts, evidence gaps, and research needs on harm-reduction services for people who use drugs (PWUD).

Specifically, the workshop will examine harm-reduction services that aim to prevent overdose and infectious disease transmission; enhance the health, safety, and wellbeing of PWUD; and offer low-threshold options for accessing SUD treatment. According to the National Academies, services include syringe services programs; providing fentanyl and xylazine test strips; distributing naloxone and other reversal medications; and facilitating connections to social services for PWUD in need of medical services, stable housing, food-assistance, or employment.

Nominations are due next Wednesday, Oct. 25 to help the National Academies establish a 10-person, volunteer planning committee for the project. Click here to learn more and submit a nomination.

Reminder: NABH’s Enhanced Denial-of-Care Portal is Now Available!

NABH thanks all members who have submitted data to the association’s Denial-of-Care Portal. You have provided critical information that expands the portal and helps NABH strengthen its advocacy efforts related to erroneous prior-authorization denials.

With guidance from our members, NABH has improved the portal by adding two elements:

1. Time-based data on the number of days between a request for coverage and a plan’s denial, which improves our ability to assess and compare health plan responsiveness.

1. The gap between days of provided care versus days of covered care to quantify and compare uncompensated days per health plan.

We strongly encourage all NABH members to submit their denial-of-care data in the portal. If you need help starting, or if you have other questions, please e-mail NABH Associate Manager for Congressional Affairs Emily Wilkins.

Reminder: The O’Neill Institute to Host Webinar on Recovery Housing Next Month

The O’Neill Institute’s Addiction and Public Policy Initiative will host a webinar next month about the current state of recovery housing and the opportunities for improving recovery housing in the United States.

As the O’Neil Institute explains, social determinants, such as housing, and expanded access to medications for substance use disorder are part of effective, long-term solutions. National standards for recovery housing, along with protecting the rights of individuals under the law, are central to facilitating a needed societal shift and maximizing opportunities for people with substance use disorder.

Recognizing the critical role that housing plays in improving outcomes for people with substance use disorder (SUD), SAMHSA recently issued Best Practices for Recovery Housing, and the U.S. Justice Department protects the rights of individuals with SUD afforded under the Fair Housing Act and the Americans with Disabilities Act.

Fact of the Week:

New data from the Centers for Disease Control and Prevention show 1 out of 5 persons who died from drug overdoses in 2020 worked in construction or restaurants.

For questions or comments about this CEO Update, please contact Jessica Zigmond.

FDA Creates Advisory Committee to Examine Digital Health Technologies

The U.S. Food and Drug Administration (FDA) this week announced it has created a Digital Health Advisory Committee to help the agency explore the scientific and technical issues related to digital health technologies (DHTs), such as artificial intelligence/machine learning (AI/ML), augmented reality, virtual reality, digital therapeutics, wearables, remote patient monitoring and software.

The new committee will advise the FDA on issues related to DHTs and provide expertise to help the agency better understand benefits, risks, and clinical outcomes associated with use of DHTs.

“As one of our strategic priorities, our goal is to advance health equity in part through expanding access by bringing prevention, wellness, and healthcare to all people where they live – at home, at work, in big cities and rural communities,” Jeff Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health, said in an announcement. “Digital health technologies are critical for achieving this transformation in care delivery,” he continued. “As digital health technologies advance, the FDA must capitalize on knowledge from inside and outside of the agency to help ensure we appropriately apply our regulatory authority in a way that protects patient health while continuing to support innovation.”

FDA’s announcement said the committee should be fully operational in 2024.

SAMHSA Releases Mental Health Client-Level Data 2021 Annual Report

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week released Mental Health Client-Level Data (MH-CLD) 2021: Data on Clients Receiving Mental Health Treatment Services Through State Mental Health Agencies, the annual report that details the total number of clients receiving mental health treatment services in 2021 by demographics, national outcomes measures, and the top five mental health diagnoses for children (ages 0-17) and adults (ages 18 and older) by geographic distribution.

SAMHSA uses the MH-CLD data to better understand publicly funded mental health treatment service systems. The data are also used to inform decisions about how SAMHSA’s uses its mental health block grant funds, and are used to help the agency learn about the technical assistance and support needs of mental health providers and the communities they serve.

CMS Administrator Brooks-LaSure to Host Stakeholder Update Next Week

CMS Administrator Chiquita Brooks-LaSure and her leadership team will provide a stakeholder and partner update about the agency’s recent accomplishments and efforts to advance the CMS Strategic Plan on Tuesday, Oct. 17.

Click here to RSVP for the hourlong call, which starts at 1 p.m. ET.

Manatt Health to Host Webinar Next Week on Emerging Fraudulent Healthcare Schemes

Manatt Health will host a webinar next week to help providers and health plans navigate the emerging landscape of fraudulent healthcare schemes and provide practical answers to the legal questions that resulted from recent litigation and enforcement actions.

The free webinar will feature panelists — all of whom have successfully defended litigants who have been forced to deal with inducement-based lawsuits in both federal and state courts – who will share an overview of the current litigation and policy landscape and offer insights into how providers and plans can protect themselves and their organizations.

The webinar also will discuss the findings from internal investigations that have uncovered fraudulent activities and improper conduct impacting patients’ health and safety and providers’ and plans’ financial viability.

Click here to register for the hourlong webinar on Tuesday, Oct. 17, which starts at 1 p.m. ET.

NABH’s Enhanced Denial-of-Care Portal is Now Available!

NABH thanks all members who have submitted data to the association’s Denial-of-Care Portal. You have provided critical information that expands the portal and helps NABH strengthen its advocacy efforts related to erroneous prior-authorization denials.

With guidance from our members, NABH has improved the portal by adding two elements:

1. Time-based data on the number of days between a request for coverage and a plan’s denial, which improves our ability to assess and compare health plan responsiveness.

1. The gap between days of provided care versus days of covered care to quantify and compare uncompensated days per health plan.

We strongly encourage all NABH members to submit their denial-of-care data in the portal. If you need help starting, or if you have other questions, please e-mail NABH Associate Manager for Congressional Affairs Emily Wilkins.

Reminder: NABH Board Nominations Due Next Friday, Oct. 20! 

NABH is seeking help from members as the NABH Selection Committee prepares to consider possible nominees to serve on the NABH Board of Trustees. Specifically, NABH requests that members help the association identify:

► Board Chair-Elect and
     ► Four Board seats that will become available in 2024

The Selection Committee is particularly interested in identifying senior managers who represent the broad diversity within the NABH membership, including various levels of care, organizational structures, and size.

Please download a nomination form to share your recommendations of individuals you would like to see included in the single slate for 2024. Please attach a curriculum vitae (CV) for each person you recommend. This will help the Selection Committee in its deliberations. You are welcome to suggest yourself.

Please return this form (and candidates’ CVs) by Friday, Oct. 20, 2023, to maria@nabh.org.

The O’Neill Institute to Host Webinar on Recovery Housing Next Month

The O’Neill Institute’s Addiction and Public Policy Initiative will host a webinar next month about the current state of recovery housing and the opportunities for improving recovery housing in the United States.

As the O’Neil Institute explains, social determinants, such as housing, and expanded access to medications for substance use disorder are part of effective, long-term solutions. National standards for recovery housing, along with protecting the rights of individuals under the law, are central to facilitating a needed societal shift and maximizing opportunities for people with substance use disorder.

Recognizing the critical role that housing plays in improving outcomes for people with substance use disorder (SUD), SAMHSA recently issued Best Practices for Recovery Housing, and the U.S. Justice Department protects the rights of individuals with SUD afforded under the Fair Housing Act and the Americans with Disabilities Act.

Fact of the Week:

Nearly 40% of primary care providers (PCPs) are screening patients for behavioral health conditions, according to a new report from The Advisory Board, which included survey responses from 300 PCPs.

For questions or comments about this CEO Update, please contact Jessica Zigmond.

DEA Extends Pandemic Telemedicine Rules Through December 2024

The Drug Enforcement Administration (DEA) on Friday said it will extend its eased, COVID-19 pandemic rules for prescribing controlled substances via telemedicine through Dec. 31, 2024.

This is DEA’s second extension of these rules; the agency first extended its pandemic-era, telehealth regulations in May 2023, which are set to expire on Nov. 11, 2023.

DEA said in its notice that DEA and HHS continue to consider revisions to the agency’s March 2023 proposed rule and that DEA’s telemedicine listening sessions last month helped inform this latest extension. NABH reported on those listening sessions in CEO Update on Sept. 15.

FDA Issues Draft Guidance on Developing Treatment Drugs for Stimulant Use Disorders

The U.S. Food and Drug Administration (FDA) this week issued draft guidance for developing drugs to treat stimulant use disorders.

Stimulant Use Disorders: Developing Drugs for Treatment addresses the FDA’s current recommendations regarding the overall development program and clinical trial designs for developing drugs to treat moderate-to-severe cocaine use disorder, methamphetamine use disorder, or prescription drug stimulant use disorder.

The FDA will accept public comments about the guidance through Monday, Dec. 4. Click here for comment submission instructions.

CMS Seeks Feedback on Assessing Parity Compliance in Medicaid Managed Care, ABPs, & CHIP

The Centers for Medicare & Medicaid Services (CMS) is seeking public comments about a set of questions regarding processes to assess compliance with mental health parity ad addiction equity requirements for Medicaid managed care arrangements, Medicaid Alternative Benefit Plans (ABPs), and the Children’s Health Insurance Program. (CHIP).

The questions for comment address a variety of topics, including model formats (e.g., templates) and key questions to consider that could make documenting compliance with parity requirements more efficient and effective; processes that states and managed care plans use to determine whether existing coverage policies are comparable for mental health and substance use disorders compared with medical and surgical benefits; how data should be collected; and more.

CMS will accept public comments here through Monday, Dec. 4. NABH will submit comments.

CBO Estimates Federal Subsidies for Health Insurance to be $1.8 Trillion in 2023

In a new report, the Congressional Budget Office (CBO) estimates federal subsidies for health insurance in 2023 to be $1.8 trillion, or 7% of the nation’s Gross Domestic Product.

Meanwhile, the CBO and the Joint Committee on Taxation (JCT) together project those net subsidies to grow substantially–reaching $3.3. trillion, or 8.3% of GDP, by 2033.

The CBO said this is the first time the projections reflect the entire population instead of only the civilian, noninstitutionalized population younger than 65.

CMS Administrator Brooks-LaSure to Host Stakeholder Update on Oct. 17

CMS Administrator Chiquita Brooks-LaSure and her leadership team will provide a stakeholder and partner update about the agency’s recent accomplishments and efforts to advance the CMS Strategic Plan on Tuesday, Oct. 17.

Click here to RSVP for the hourlong call, which starts at 1 p.m. ET.

NIMH Marks 75^th Anniversary with Podcast Series

The National Institute of Mental Health is honoring its 75^th anniversary with a podcast series that explores the stories behind influencers and innovators in mental health research and the lives of people with mental illness.

The latest podcasts feature “Depression: The Case for Ketamine,” and “Understanding and Preventing Youth Suicide.” Click here to listen.

Please Nominate Members for the NABH Board of Trustees!

NABH is seeking help from members as the NABH Selection Committee prepares to consider possible nominees to serve on the NABH Board of Trustees. Specifically, NABH requests that members help the association identify:

► Board Chair-Elect and
     ► Four Board seats that will become available in 2024

The Selection Committee is particularly interested in identifying senior managers who represent the broad diversity within the NABH membership, including various levels of care, organizational structures, and size.

Please download a nomination form to share your recommendations of individuals you would like to see included in the single slate for 2024. Please attach a curriculum vitae (CV) for each person you recommend. This will help the Selection Committee in its deliberations. You are welcome to suggest yourself.

Please return this form (and candidates’ CVs) by Friday, Oct. 20, 2023, to maria@nabh.org.

Fact of the Week:

People who work shift work are 22% more likely to develop depression than those who work a regular daytime schedule, according to a recent study published in JAMA Network Open.

For questions or comments about this CEO Update, please contact Jessica Zigmond.

HHS Releases Contingency Plan as Federal Government Shutdown Looms

HHS this week released a government shutdown contingency plan if federal lawmakers don’t pass legislation by Saturday, Sept. 30 to extend government funding and maintain federal operations. If they don’t, critical federal services will end at 12:01 a.m. on Sunday.

The ongoing government funding talks have put on hold consideration of all other bills that are set to expire after Sept. 30, including the SUPPORT Act reauthorization. NABH expects reauthorization to move through both chambers of Congress after lawmakers resolve the federal funding issue.

Meanwhile, here are HHS’ plans for the agencies that affect NABH members: the Agency for Healthcare Research and Quality, Centers for Medicare & Medicaid Services, Health Resources and Services Administration, National Institutes of Health, and Substance Abuse and Mental Health Services Administration.

SAMHSA Announces $131.7 Million in Grants for Youth and Families  

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week said it awarded $131.7 million in grant programs to connect youth and families with behavioral healthcare services.

The awards will fund a variety of programs and services, including cooperative agreements for school-based, trauma-informed support services for mental healthcare, expanding substance use treatment capacity in adult and family drug courts, preventing youth overdose, and more.

Click here to read more about the awards.

Joint Commission Revises Terms to Reflect Current Terminology in Addiction Medicine

The Joint Commission said it has revised two terms for Behavioral Health Care and Human Services to reflect current terminology in the addiction medicine field.

“Medication-assisted treatment” has been updated to “medications for substance use disorders,” and, if the requirement needs to be more specific, the term used is “medications for opioid use disorder” or “medications for alcohol use disorder.”

Meanwhile, the Joint Commission removed “detoxification,” which is now referred to as “withdrawal,” “withdrawal management,” or “medically supervised withdrawal management.”

“These revisions are editorial in nature and do not change any requirements,” the Joint Commission said in its announcement, adding that any questions should be directed to the organization’s Department of Standards and Survey Methods.

The changes take effect on Jan. 1, 2024.

October is Youth Substance Use and Misuse Prevention Month

As National Recovery Month draws to a close, the nation now turns to Youth Substance Use Prevention Month and Substance Misuse Prevention Month for October.

SAMHSA has created a Prevention Month toolkit with shareable social media graphics to help people promote the message of prevention for kids and family and developed other resources and events to help communities participate.

In conjunction with Prevention Month, SAMHSA this week announced it awarded $42.6 million in grants to 17 states and 60 communities—located across 33 states—as a foundational investment for substance use prevention. Click here to learn more.

Please Nominate Members for the NABH Board of Trustees!

NABH is seeking help from members as the NABH Selection Committee prepares to consider possible nominees to serve on the NABH Board of Trustees. Specifically, NABH requests that members help the association identify:

► Board Chair-Elect and
     ► Four Board seats that will become available in 2024

The Selection Committee is particularly interested in identifying senior managers who represent the broad diversity within the NABH membership, including various levels of care, organizational structures, and size.

Please download a nomination form to share your recommendations of individuals you would like to see included in the single slate for 2024. Please attach a curriculum vitae (CV) for each person you recommend. This will help the Selection Committee in its deliberations. You are welcome to suggest yourself.

Please return this form (and candidates’ CVs) by Friday, Oct. 20, 2023, to maria@nabh.org.

Fact of the Week:

Between 2014 and 2019, the national Hispanic population increased by 4.5%, or 5.2 million people. During the same period, the proportion of facilities that offered treatment in Spanish declined by 17.8%, or a loss of 1,163 Spanish-speaking mental health facilities, according to a study published in Psychiatric Services. Overall, 44 states saw a decline in the availability of services in Spanish, despite growth in Hispanic populations across all states.
 
For questions or comments about this CEO Update, please contact Jessica Zigmond.

White House Recovery Summit Seeks to Create a ‘Recovery-Ready Nation’

As part of Recovery Month, the White House this week held a Recovery Summit to celebrate people with substance use disorders (SUD) who are in treatment and to discuss ways that Americans can build a recovery-ready nation.
 
The Office of National Drug Control Policy Director Rahul Gupta, M.D., M.P.H. hosted the event, and one highlight included a panel of high school students who shared their personal recovery journeys. Assistant Secretary for Mental Health and Substance Use Disorders Miriam Delphin-Rittmon, Ph.D., who leads the Substance Abuse and Mental Health Services Administration (SAMHSA), moderated the panel, and Sen. Jeanne Shaheen (D-N.H.) and Rep. Paul Tonko (D-N.Y.) offered remarks.

Sarah Wattenberg, director of quality and addiction services at NABH, represented the association at the summit. Click here to learn more.

SAMHSA Releases New Data on Recovery from SUD and Mental Health Problems Among Adults

About 70 million U.S. adults aged 18 and older perceived they ever had a substance use and/or mental health problem, according to a new report SAMHSA released this week.

Using data from the 2021 National Survey on Drug Use and Health, the report also showed that for substance use specifically, 29 million adults perceived they ever had a substance use problem, and 20.9 million people (or 72.2%) considered themselves to be in recovery or to have recovered from their drug or alcohol use problem.
 
For mental health, of the 58.7 million adults who perceived they ever had a mental health problem, 38.8 million (or 66.5%) considered themselves to be in recovery or to have recovered from their mental health problem.

Click here to read the report, Recovery from Substance Use and Mental Health Problems Among Adults in the United States.

2023 NABH Membership Directory Updates Are Due Wednesday, Sept. 27!

NABH has extended the deadline for system members to submit changes about their organizations for the 2023 NABH Directory to Wednesday, Sept. 27.

NABH’s online-only 2023 Membership Directory is an essential member benefit that helps the association advance its advocacy efforts. Last month NABH sent system members a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use the link to verify your system’s information.

The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all your system’s facilities to help provide NABH with an accurate picture of our membership.

If you need assistance, please contact Maria Merlie maria@nabh.org or 202-393-6700, ext. 104.

Reminder: Deadline for Health Data Privacy Feedback to Senate HELP Committee is Next Week

Senate Health, Education, Labor, and Pensions (HELP) Committee Ranking Member Sen. Bill Cassidy, M.D. (R-La.) announced earlier this month he’s seeking information from stakeholders about ways to improve the privacy protections of health data in a way that safeguards sensitive information while balancing the need to support medical research.

According to a Senate HELP Committee announcement, Cassidy, an NABH Champion, hopes to use the stakeholder feedback to identify solutions to modernize HIPAA and ensure that all health data are safeguarded properly.
 
The deadline to submit feedback is Thursday, Sept. 28. Click here to read Cassidy’s full request and here to submit comments.    

Reminder: CMS to Host Webinar on Person-Centered Approaches to Improving Behavioral Health Condition Management

CMS’ Medicare-Medicaid Coordination Office recently announced an upcoming webinar that will examine how traditional silos of care impede comprehensive approaches to care coordination and explore potential solutions to improve behavioral health condition management in persons with intellectual and developmental disabilities.

Presenters include Andrea Witwer, Ph.D., associate clinical professor in psychiatry and behavioral health at Ohio State; family caregiver Patricia Nobbie, Ph.D.; and Olivia Ayers, LMCH, LPC, clinical director at Elevate Certified Community Behavioral Health Clinic in Iowa.

The 90-minute webinar will be held on Wednesday, Sept. 27 starting at 2:30 p.m. ET. Click here to learn more and to register.

Fact of the Week:

Researchers at the not-for-profit research institute RTI International have found that approximately 3.7 million, or 1.8%, of U.S. adults ages 18 to 65, have a lifetime history of schizophrenia spectrum disorders— a figure two-to-three times higher than previous studies. The findings came from the Mental Health and Substance Use Disorder Prevalence Study, which SAMHSA funds.
 
For questions or comments about this CEO Update, please contact Jessica Zigmond.

NABH Comments on 2024 OPPS and Physician Payment Proposed Rules

This week NABH submitted a comment letter to the Center for Medicare & Medicaid Services (CMS) about the agency’s proposed rules pertaining to both the outpatient prospective payment system (OPPS) and physician fee schedule (PFS) for 2024.

Outpatient PPS Proposed Rule. Among the rule’s multiple behavioral healthcare provisions, a key item was CMS’ proposed design and implementation of the congressionally mandated intensive outpatient program (IOP) as a new Medicare benefit in hospital outpatient departments, community mental health centers, federally qualified health centers, rural health clinics, and opioid treatment programs. NABH generally supports CMS’ proposed approach of basing many of the new IOP design features on the existing partial hospitalization program (PHP) framework because PHPs treat a similar mix of patients, although with a higher level of intensity.

That said, NABH raised concerns regarding some of the proposed design features, including the need to align the new IOP patient eligibility criteria with the clinical characteristics of current IOP populations. Specifically, NABH urged CMS to remove these criteria: “adequate support system at home” and “risk of danger to self or others” as they would exclude a significant portion of the patient population for whom this benefit is intended.
 
NABH expressed additional concerns related to the implementation of IOP benefit by opioid treatment programs including that the physician-driven IOP certification and treatment planning requirements do not align with the scopes of practice of non-physician professionals nor with the ASAM requirements for IOP and other level of care assessments; that additional specialty care settings should be considered for IOP services; and that CMS develop a contingency management bundle for individuals with stimulant use disorder.

Physician Fee Schedule Proposed Rule. NABH’s comments about the PFS rule respond to CMS’ proposed 2.0% increase for psychiatric service payments, relative to CY 2023 rates, which starkly contrasts to the proposed decrease for overall PFS payments of negative 3.3%. Our comments recommend increases for both overall and psychiatric services due to significant workforce and other pressures facing all healthcare providers. We also support the agency’s provision to set payments to 150% of facility-based payments for “psychotherapy for crisis” services that are furnished in a setting other than a physician’s office or mobile unit or home.

In addition, we support CMS’ proposal to allow three new behavioral healthcare practitioners to bill under Medicare Part B: marriage and family therapists, mental health counselors (MHCs), and addiction counselors that meet Medicare criteria for MHCs. NABH also called for a 10 percentage-point increase in payments for these providers and the addition of psychiatric mental health nurse practitioners to this group.

We also recommended that telehealth services offered by community health integration, social determinants of health, and principal illness navigation specialists be covered; that remote monitoring codes be developed for opioid treatment programs and office-based opioid treatment providers; and that progressively decreasing buprenorphine reimbursement rates be re-evaluated and increased.

Providers Share the Negative Impact of Returning to DEA’s Pre-Pandemic Telemedicine Rules

The Drug Enforcement Administration held a two-day listening session this week in response to almost 40,000 comments it received earlier in the year about its proposal to reimpose in-person visits for the prescribing of controlled substances, including buprenorphine.
 
DEA Administrator Anne Milgram announced that the agency would provide an additional comment period for telemedicine. This would likely require an extension of the telemedicine flexibilities offered during the COVID-19 pandemic.

Testimony over the course of two days addressed how changes to pandemic-era telemedicine rules would impede care for individuals needing medication for attention-deficit/hyperactivity disorder and opioid use disorder, individuals in end-of-life care needing opioids for pain relief, individuals receiving gender-affirming care, and many others.

The listening session requested recommendations on a “special registration” process that Congress requested many years ago.

National Academies Seeking Experts to Participate in Study to Develop National Prevention Infrastructure for Behavioral Health Disorders Blueprint

The National Academies of Sciences, Engineering, and Medicine is seeking suggestions for experts to participate in a study to develop a Blueprint for a National Prevention Infrastructure for Behavioral Health Disorders.
 
The study also will identify funding needs and strategies to support the infrastructure; identify gaps in policy research and health services research that may serve as barriers to implementing the program; and recommend state and federal policies to support the financing and infrastructure, including workforce development and data interoperability for promoting behavioral health. Click here to learn more about the scope of work for the ad hoc committee that will develop the blueprint and click here to submit recommendations of volunteer experts.

The deadline to submit recommendations is Wednesday, Sept. 20.

SAMHSA Releases Resources to Help Communities Address Opioid Overdose Crisis

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week released two resources to help community practitioners end America’s opioid crisis.

SAMHSA commissioned RTI International to develop—together with a SAMHSA technical expert panel— Engaging Community Coalitions to Decrease Opioid Overdose Deaths and Opioid-Overdose Reduction Continuum of Care Approach.

The guides are based on insights and tools from the ongoing National Institutes of Health (NIH) HEALing Communities Study. NIH and SAMHSA launched that study in 2019 to test the effect of an integrated set of evidence-based practices across healthcare, behavioral health, justice, and other community-based settings.

Reminder: Sept. 28 Deadline for Health Data Privacy Feedback to Senate HELP Committee

Senate Health, Education, Labor, and Pensions (HELP) Committee Ranking Member Sen. Bill Cassidy, M.D. (R-La.) last week announced he’s seeking information from stakeholders about ways to improve the privacy protections of health data in a way that safeguards sensitive information while balancing the need to support medical research.

According to a Senate HELP Committee announcement, Cassidy, an NABH Champion, hopes to use the stakeholder feedback to identify solutions to modernize HIPAA and ensure that all health data are safeguarded properly.

The deadline to submit feedback is Thursday, Sept. 28. Click here to read Cassidy’s full request and here to submit comments.   

Reminder: CMS to Host Webinar on Person-Centered Approaches to Improving Behavioral Health Condition Management

CMS’ Medicare-Medicaid Coordination Office recently announced an upcoming webinar that will examine how traditional silos of care impede comprehensive approaches to care coordination and explore potential solutions to improve behavioral health condition management in persons with intellectual and developmental disabilities.

Presenters include Andrea Witwer, Ph.D., associate clinical professor in psychiatry and behavioral health at Ohio State; family caregiver Patricia Nobbie, Ph.D.; and Olivia Ayers, LMCH, LPC, clinical director at Elevate Certified Community Behavioral Health Clinic in Iowa.

The 90-minute webinar will be held on Wednesday, Sept. 27 starting at 2:30 p.m. ET. Click here to learn more and to register.

Deadline Extended! 2023 NABH Membership Directory Updates Are Due Sept. 27

NABH has extended the deadline for system members to submit changes about their organizations for the 2023 NABH Directory to Wednesday, Sept.27.

NABH’s online-only 2023 Membership Directory is an essential member benefit that helps the association advance its advocacy efforts. Last month NABH sent system members a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use the link to verify your system’s information.

The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all of your system’s facilities to help provide NABH with an accurate picture of our membership.

If you need assistance, please contact Maria Merlie maria@nabh.org or 202-393-6700, ext. 104.

Reminder: Please Submit Your Managed Care Denials Data to Support NABH Advocacy

Thank you to all members who have submitted data to NABH’s denial-of-care portal!

We are still seeking data from additional members to support advocacy on health plan denials and prior-authorization timeliness. If you are a new participant, please e-mail NABH Administrative Coordinator Emily Wilkins for support.

Fact of the Week:

Recent research found that, overall, people with mental health conditions seemed to have an elevated risk of heat-related death. This was even more severe for people with schizophrenia: a 200% increase compared with typical summers.

For questions or comments about this CEO Update, please contact Jessica Zigmond.

CMS Announces AHEAD Model to Improve Overall Health of State Population

The Centers for Medicare & Medicaid Services on Thursday unveiled its States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model to better address chronic disease, behavioral health, and other medical conditions among state populations.

CMS said the new approach is intended to help participating states be better equipped to promote health equity, increase access to primary care services, set healthcare expenditures on a more sustainable trajectory, and lower healthcare costs for patients.
 
AHEAD also includes specific payment models for participating hospitals and primary care practices as a tool to achieve the model’s goals. Through AHEAD, CMS said it aims to strengthen primary care, improve care coordination for people with Medicare and Medicaid, and increase screening and referrals to community resources such as housing and transportation to address social drivers of health.

CMS will issue awards to up to eight states, and each selected state will have an opportunity to receive up to $12 million from CMS to support state implementation. The agency said states interested in participating in the model may apply during two different application periods and elect to participate in one of three cohorts with staggered start dates and performance years.
CMS will release the Notice of Funding Opportunity, which includes the specific application requirements, in the late fall.

CMS Releases Request for Applications for New ‘Making Care Primary’ Model

CMS also announced it is now accepting applications for its recently introduced voluntary Making Care Primary, or MCP, model.

Launching on July 1, 2024, the 10.5-year model will be tested in eight states – Colorado, North Carolina, New Jersey, New Mexico, New York, Minnesota, Massachusetts, and Washington – and is meant to give primary care clinicians the tools they need to form partnerships with healthcare specialists and leverage community-based connections to address patients’ needs.

“This model will attempt to strengthen coordination between patients’ primary care clinicians, specialists, social service providers, and behavioral health clinicians, ultimately leading to chronic disease prevention, fewer emergency room visits, and better health outcomes,” CMS said in its announcement about accepting applications.

CMS also said its new MCP care approach communicates the agency’s vision for three domains: care management, care integration, and community engagement. For the second domain of care integration, CMS said participants will strengthen their connections with specialty care clinicians while using “evidence based behavioral health screening and evaluation to improve patient care and coordination.”

CMS will accept applications through Thursday, Nov. 30, 2023 by 11:59 p.m. ET. Click here for more details and eligibility requirements.

Cassidy Seeks Information to Improve Americans’ Health Data Privacy

Senate Health, Education, Labor, and Pensions (HELP) Committee Ranking Member Sen. Bill Cassidy, M.D. (R-La.) on Thursday announced he’s seeking information from stakeholders about ways to improve the privacy protections of health data in a way that safeguards sensitive information while balancing the need to support medical research.

According to a Senate HELP Committee announcement, Cassidy, an NABH Champion, hopes to use the stakeholder feedback to identify solutions to modernize HIPAA and ensure that all health data are safeguarded properly.

The deadline to submit feedback is Thursday, Sept. 28. Click here to read Cassidy’s full request and here to submit comments.       

CMS Announces Webinar on Person-Centered Approaches to Improving Behavioral Health Condition Management

CMS’ Medicare-Medicaid Coordination Office this week announced an upcoming webinar that will examine how traditional silos of care impede comprehensive approaches to care coordination and explore potential solutions to improve behavioral health condition management in persons with intellectual and developmental disabilities.

Presenters include Andrea Witwer, Ph.D., associate clinical professor in psychiatry and behavioral health at Ohio State; family caregiver Patricia Nobbie, Ph.D.; and Olivia Ayers, LMCH, LPC, clinical director at Elevate Certified Community Behavioral Health Clinic in Iowa.

The 90-minute webinar will be held on Wednesday, Sept. 27 starting at 2:30 p.m. ET. Click here to learn more and to register.

2023 NABH Membership Directory Update Deadline is Next Week!

The deadline for NABH system members to submit changes about their organizations for the 2023 NABH Directory is Wednesday, Sept. 13.

NABH’s online-only 2023 Membership Directory is an essential member benefit that helps the association advance its advocacy efforts. Last month NABH sent system members a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use the link to verify your system’s information.

The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all your system’s facilities to help provide NABH with an accurate picture of our membership.

If you need assistance, please contact Maria Merlie maria@nabh.org or 202-393-6700, ext. 104.

Reminder: Please Submit Your Managed Care Denials Data to Support NABH Advocacy

Thank you to all members who have submitted data to NABH’s denial-of-care portal!

We are still seeking data from additional members to support advocacy on health plan denials and prior-authorization timeliness. If you are a new participant, please e-mail NABH Administrative Coordinator Emily Wilkins for support. 

Fact of the Week:

Of people appointed to HHS between 2004 and 2020, about one-third (32%) left for positions in industry, according to a comprehensive Health Affairs study of the “revolving door” in healthcare regulation. Axios, Becker’s Hospital Review, and Fierce Healthcare were among the news outlets that reported on the findings, which raise questions about the potential conflict-of-interest risks between industry and the federal department that regulates it.

For questions or comments about this CEO Update, please contact Jessica Zigmond.

Biden Highlights Parity in National Recovery Month Proclamation

Today kicks off National Recovery Month, a nationwide observance every September since 1989 to promote and support new evidence-based treatment and recovery practices, the nation’s recovery community, and the dedication of service providers and communities who make recovery in all its forms possible.

In his proclamation on the annual observance, President Biden noted that drug overdoses last year took more than 100,000 American lives and that addressing the country’s substance use disorder (SUD) crisis is a core pillar of his Unity Agenda.

“That work starts by fulfilling the promise of true parity for mental health and substance use disorder treatment for all Americans,” Biden said in the proclamation. “Mental health and substance use disorder care is healthcare.  It is essential to people’s well-being — to their ability to lead full and productive lives, to find joy and meaning, to take care of themselves and their loved ones, and to give back to their communities and our nation,” he continued. “It is about dignity. Health insurers should cover it the same way they would cover treatment for a broken bone or any other kind of health condition.  And since I took office, that is what we have been fighting to do.”

Click here to access the Substance Abuse and Mental Health Services Administration (SAMHSA) National Recovery Month toolkit.

And please remember to follow NABH @NABHBehavioral and on LinkedIn at the National Association for Behavioral Healthcare to read and share our social media posts about National Recovery Month.

Appellate Court Vacates Earlier Ruling in Wit v. UBH Case

A three-judge panel in the 9^th U.S. Circuit Court of Appeals last week vacated its prior holdings in the ongoing Wit v. United Behavioral Health (UBH) case for the second time and issued this opinion.

NABH consultant Meiram Bendat, JD, Ph.D, founder and president of Psych Appeal, summarized the decision: “Essentially, the appellate court affirmed the trial court’s findings that UBH’s medical necessity guidelines were inconsistent with generally accepted standards of care (GASC), but also held that the trial court erred in holding that UBH’s plans required it to cover all services consistent with GASC,” Bendat wrote, adding, “The appellate court affirmed the trial court’s class certification order to allow the classes to pursue their breach of fiduciary duty claim. The trial court findings that UBH violated the laws of jurisdictions requiring the use of state-mandated criteria also remain undisturbed,” he continued. “The appellate court also walked away from its previous holdings that remand is not an available remedy under ERISA and that all absent class members must exhaust their administrative remedies prior to pursuing their claims in court.”
 
Bendat added that—absent another petition for review—the case will be sent back to the trial court, which will likely again clarify that it based UBH’s liability on UBH’s deviation from GASC in its medical necessity guidelines, which were intended to implement the GASC requirement in the plans. The trial court is also expected to answer several other questions the 9th Circuit posed.

“In short, plaintiffs are now in a far better position than they were last year,” Bendat wrote. “Hopefully, folks can appreciate how important it is to have laws like SB 855, which require medical necessity to be made consistent with GASC and which don’t vest plan administrators with discretion to adopt self-serving clinical guidelines with which to deny claims.”

HRSA Announces More than $80 Million in Funding for Rural Communities to Combat Opioid Crisis

HHS’ Health Resources and Services Administration (HRSA) announced Thursday more than $80 million in awards to rural communities in 39 states to support key strategies that respond to the overdose risk from fentanyl and other opioids.

HRSA funding will support interventions such as distributing the lifesaving overdose reversal drug naloxone to prevent overdose; creating and expanding treatment sites in rural areas to provide medications to treat opioid use disorder; expanding access to behavioral health care for young people in rural communities; and, caring for infants in rural areas who are at-risk for opioid exposure or experiencing symptoms related to opioid exposure.

Click here to learn more and here to see the list of awardees.

SAMHSA Awards $57.6 Million to Connect Americans with Substance Use Recovery and Treatment Supports

As part of Overdose Awareness Week and the start of National Recovery Month, SAMHSA this week announced $57.6 million in seven grant programs to connect Americans who misuse substances to recovery and treatment supports.

According to SAMHSA, the grant awards facilitate ongoing efforts throughout the nation in treatment, recovery support and harm reduction – three of the pillars of the HHS’ Overdose Prevention Strategy.

Click here to read about the grant programs.

SAMHSA Releases Guide for Reentry from Criminal Justice Settings for People with Mental Health Conditions and SUD

SAMHSA has released Best Practices for Successful Reentry From Criminal Justice Settings for People Living With Mental Health Conditions and/or Substance Use Disorders, which examines the types of interventions that support successful reentry for adults with mental health conditions and/or substance use disorders who are leaving jail/prison.

The 85-page guide includes an issue brief on the topic, current evidence on three interventions, guidance for identifying and implementing evidence-based practices to support reentry, and more.

Manatt to Examine Latest Wit v. UBH Ruling in Mental Health Parity Webinar 

Manatt litigation and benefits experts will discuss a host of parity issues in an upcoming webinar, including the latest federal report to Congress, action items for health plans and service providers, and the latest decision in the Wit v. UBH case.
 
Presenters will include Manatt partners Joe Laska and Harvey Rochman, as well as
Jean Kim, special counsel, executive compensation and employee benefits. The hourlong webinar will take place Tuesday, Sept. 19 at 1 p.m. ET.
 
Click here to register.

Please Update Your Member Information for the 2023 NABH Membership Directory! 

NABH is developing its online-only 2023 Membership Directory, an essential member benefit that helps the association in its advocacy efforts.

NABH has sent members a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use the link to verify your system’s information.

The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all your system’s facilities so that we have a better picture of our membership.

The deadline to submit your changes to NABH is Wednesday, Sept. 13. If you need assistance, please contact Maria Merlie maria@nabh.org or 202-393-6700, ext. 104.

As always, thank you for your time and for all you do to advance NABH’s Mission and Vision!

Reminder: Please Submit Your Managed Care Denials Data to Enhance NABH Advocacy

Thank you to all members who have submitted data to NABH’s denial-of-care portal!

We are still seeking data from additional members to support advocacy on health plan denials and prior-authorization timeliness. If you are a new participant, please e-mail NABH Administrative Coordinator Emily Wilkins for support.

Fact of the Week:

This summer Texas lawmakers enacted Tucker’s Law. which mandates that middle schools and high schools educate students about fentanyl abuse prevention and drug-poisoning awareness.

NABH wishes its members, their teams, and families a happy and safe Labor Day weekend!

For questions or comments about this CEO Update, please contact Jessica Zigmond.