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.

Earlier this week NABH 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!

NABH Board Members Comment On SAMHSA’s 2023-2026 Strategic Plan

NABH Board Chair Harsh Trivedi, M.D., M.B.A. this week commented on behalf of the association about the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2023-2026 Strategic Plan.
 
Released last week, the plan presents a new person-centered mission and vision and identifies the following five priority areas to better meet the behavioral health needs of individuals, communities, and service providers: Preventing Substance Use and Overdose, Enhancing Access to Suicide Prevention and Mental Health Services, Promoting Resilience and Emotional Health for Children, Youth and Families, Integrating Behavioral and Physical Health Care, and Strengthening the Behavioral Health Workforce.

In a Behavioral Health Business article published Aug. 23, NABH Board Chair Trivedi supported the plan and emphasized access, behavioral-physical healthcare integration, and preventing substance use and overdose.

“Substance use is a chronic disease. We do not penalize people when their blood sugar goes out of whack or when their blood pressure goes a little too high,” said Trivedi, president and CEO of Sheppard Pratt. “We really do have to think about substance use in a different manner, which is that it’s going to be something that people battle over time. We can’t let a slip up mean that you, essentially, are out of treatment, which is exactly what you wouldn’t do for any other medical condition.”

NABH board member David White, Ph.D., CEO of BayMark Health Services in Lewisville, Texas, was also interviewed for the article and noted that the behavioral healthcare industry needs to see a comprehensive implementation plan.

“This agenda is huge, complex, and high-level,” White said. “The strategy, in most cases, is spot on, but it’s a very heavy lift for the execution phase and requires lots of great people with great abilities to impact each and every area in the way outlined.”

National Quality Forum to Join Joint Commission as An Affiliate

The Joint Commission and National Quality Forum (NQF) announced on Aug. 16 that NQF will join The Joint Commission enterprise, maintaining its independence in convening and developing consensus-based measures, implementation guidance, and practices that benefit all stakeholders.

The organizations said in an announcement that the affiliation allows The Joint Commission and NQF to build upon their shared expertise in measuring quality and rationalizing the measurement landscape so the focus shifts from competing measures to advancing key outcomes.

In addition, the affiliation is intended to strengthen The Joint Commission’s national and international accreditation and certification processes to be more evidence-based, data-driven, and outcomes-oriented.

Cigna Removes Prior Authorization Requirement for 25% of Medical Services

Cigna Healthcare on Thursday announced it would remove nearly 25% of medical services from prior authorization (or precertification) requirements.

With the removal of these more than 600 additional codes, Cigna Healthcare has now removed prior authorization on more than 1,100 medical services since 2020, with the goal of simplifying the healthcare experience for both customers and clinicians, Cigna said in an announcement.

More information about Cigna Healthcare’s approach to prior authorizations is available here.

Health Affairs: Five Urgent Steps to Address Violence Against Nurses in the Workplace

An Op-Ed published in the journal Health Affairs this week outlined five specific steps to address violence against nurses in the workplace, starting with enacting federal legislation to address workplace violence in healthcare, social service, and other sectors.

Seven authors collaborated on the opinion piece, including several nursing school professors and one psychiatric mental health nurse practitioner at the University of New Mexico College of Nursing.

“We write today, as psychiatric mental health nurses and workplace violence and nursing workforce researchers, to express our alarm: Our nurse colleagues aren’t safe at the bedside,” the authors wrote. “The American Psychiatric Nurses Association reports that fewer than two-thirds of nurses report feeling either safe or very safe at work. As nurses reported in last year in the National Plan for Health Workforce Well Being, violent injury of nursing staff by patients results in nurses’ short- and long-term disability, psychological stress, post-traumatic stress disorder, burnout, reduced quality of care, errors, and accidents.”

In addition to federal legislation, other steps to address the issue include: emphasizing quality indicators that elevate efforts to protect staff from harm; strengthening data systems to better monitor worker exposure to aggressive events; improving reporting of workplace violence; and holding educational institutions accountable for teaching about quality and safety standards that protect nurses and staff from injury.

DEA and FDA Issue Joint Letter to the Public on Actions to Address Shortages in Prescription Stimulants

Earlier this month the Drug Enforcement Administration (DEA) and U.S. Food and Drug Administration (FDA) issued a joint letter updating the public about the ongoing prescription stimulant shortages affecting patients nationwide and actions to resolve these shortages.
The DEA and FDA said both agencies are committed to working together on this issue and providing up-to-date information to the public.

“The FDA and DEA do not manufacture drugs and cannot require a pharmaceutical company to make a drug, make more of a drug, or change the distribution of a drug,” FDA Commissioner Robert Califf, M.D. and DEA Administrator Anne Milgram wrote in the letter to the public. “That said, we are working closely with numerous manufacturers, agencies, and others in the supply chain to understand, prevent, and reduce the impact of these shortages.
Click here to read the full letter.

Reminder: Please Submit Data to Enhance NABH’s Managed-Care Advocacy Efforts

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:

Half of parents say their child’s emotional and physical health has improved over the past year, according to a new Harris poll. Meanwhile, half also say their schools provide neither academic nor mental health counseling.

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

Federal Lawmakers Introduce Bipartisan Behavioral Health IT Legislation

Reps. Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio) and Sens. Markwayne Mullin (R-Okla.) and Catherine Cortez Masto (D-Nev.) recently introduced the Behavioral Health Information Technology (BHIT) Coordination Act to improve coordination of mental and physical healthcare by supporting behavioral healthcare providers’ efforts to adopt health IT systems.
                                 
NABH is proud to support the BHIT Coordination Act, which:

• Provides $20 million a year in grant funding over five fiscal years (FY25-29) to finance behavioral health IT adoption through the Office of the National Coordinator for Health Information Technology (ONC).
• Requires a report to Congress on the number and type of behavioral healthcare providers that receive the grant, their ability to electronically exchange patient health information with other provider types, and clinical and non-clinical outcomes for patients.
• Directs ONC and the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop voluntary behavioral health IT standards.
• Directs the Centers for Medicare & Medicaid Services (CMS), SAMHSA, and ONC to develop joint guidance on how states can use Medicaid authorities and funding sources to promote the adoption and interoperability of certified Electronic Health Record (EHR) technology for behavioral health providers.

“Robust, interoperable EHRs are a core clinical and operational tool to expand coordinated, high-quality care – and now we must ensure that all of our behavioral health providers have access to these vital IT systems,” Rep. Matsui said in an announcement about the bill. “Despite widespread recognition of the value of health IT, behavioral health providers do not have the resources to utilize these tools,” she added. “The Behavioral Health IT Coordination Act will bridge this gap and ensure we invest the necessary resources for widespread adoption throughout the behavioral health community.”

Rep. Matsui originally co-authored H.R. 3331, a bill to promote testing of incentive payments for behavioral healthcare providers to adopt and use certified electronic health record technology. In 2018, Congress included this legislation as Section 6001 of the SUPPORT Act. The BHIT Coordination Act seeks dedicated funding to fulfill the objectives of her previous efforts.

DEA Revises Existing Regulations to Expand Access to OUD Treatment Medication

The U.S. Drug Enforcement Administration (DEA) this week issued a final rule pursuant to the Easy Medication Access and Treatment of Opioid Addiction Act (the Act) that revises existing regulations to expand access to medications for Opioid Use Disorder (OUD).

The Act directed DEA to revise its regulation to allow practitioners to dispense not more than a three-day supply of narcotic drugs to one person for one person’s use at one time to initiate maintenance treatment, detoxification treatment, or both.

SAMHSA Report Highlights Cost and Financing Strategies for Coordinated Specialty Care for First- Episode Psychosis

SAMHSA has released Coordinated Specialty Care for First Episode Psychosis: Costs and Financing Strategies, which offers states financing strategies to provide critical services for first-episode psychosis.

SAMHSA estimates 100,000 people in the United States experience first-episode psychosis. Coordinated Specialty Care, or CSC, is a multi-component, evidence-based, early intervention service for individuals experiencing a first episode of psychosis who can improve their quality of life and social and clinical outcomes.

The new report provides an overview of the costs and outcomes of providing services for first episode psychosis and strategies for financing the services in different states.

FDA Recommends Minimum of Six Months for Pivotal OUD Device Trials

The U.S. Food and Drug Administration (FDA) has released guidance cautioning device makers developing products to treat OUD to proceed carefully as they design clinical studies, recommending pivotal trials last at least six months.

“Appropriate study duration is necessary because OUD is a condition with a high rate of relapse, and brief intervals of modification of drug use are unlikely to confer significant clinical benefit,” the guidance noted.

FDA Commissioner Robert Califf, M.D. said in a statement that the guidance should prompt industry to collect more comprehensive, timely, and diverse data to support device submissions that may help improve the lives of those with OUD.

“These and similar efforts will continue to advance within the agency, with the input from industry, stakeholders, and, most importantly, those managing opioid use disorder,” Califf added.

Public comments about the guidance are due by Thursday, Oct. 26.

Biotech Company Cessation to Initiate U.S. Clinical Trial for Drug to Prevent Fentanyl Overdose

Clinical-stage biotechnology company Cessation has announced the FDA has authorized the Chapel Hill, N.C.-based company to initiate a clinical trial this month for CSX-1004, a monoclonal antibody designed specifically to prevent fentanyl overdose.

The clearance follows the FDA’s review and approval of Cessation’s Investigational New Drug (IND) application and serves as a launching point for Cessation’s first in-human clinical trials, according to the company’s announcement. Cessation’s IND summarized years of the company’s safety and manufacturing data and included a detailed description of the planned clinical study in humans.
 
Cessation’s announcement said CSX-1004 works by sequestering fentanyl molecules as they enter the bloodstream, effectively neutralizing them in the blood before they reach the brain and preventing them from exerting their harmful effects.

Reminder: 2023 NABH Annual Meeting Photos Now Available

NABH is pleased to share photos from the 2023 Annual Meeting: Security the Promise of Parity.
If you choose to download and use a photo, please credit photographer Chris Ferenzi. Thank you.

Click here to learn more about the training.

Reminder: Please Submit Data to Enhance NABH’s Managed-Care Advocacy Efforts

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.

CEO Update During the Congressional August Recess

NABH will publish CEO Update only on Friday, Aug. 11 and Friday, Aug. 25 during the congressional August recess.

Fact of the Week:

A recent study published in Neuropharmacology suggests that central Ghrelin receptors (GHSR) mediate binge-like alcohol intake. These data reveal novel pharmacological compounds with translational potential in the treatment of alcohol use disorder (AUD) and provide further evidence of the GHSR as a potential treatment target for AUD, the study noted. The National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism published the study.

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

CMS Releases FY 2024 IPF PPS Final Rule

The Centers for Medicare & Medicaid Services (CMS) on Thursday released its Fiscal Year (FY) 2024 Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) final rule.
 
NABH’s Position

While the final rule includes many NABH priorities, we remain concerned that it does not go far enough to account for the cost pressures IPFs face. The NABH team will meet with CMS to discuss the field’s health information technology and other obstacles that will greatly hinder compliance with the quality measures (QMs) to be added to the inpatient psychiatric facility quality reporting program (IPFQRP).
 
Final Payment Update

The rule finalizes a net increase in Medicare FY 2024 payments to IPFs of 2.3%, or $70 million, relative to FY 2023. While the agency’s final FY 2023 payment update is larger than the proposed rule’s 1.9% increase, NABH will continue to push policymakers to recognize fully the high costs that our members face. The FY 2024 update includes increases in the federal per-diem base rate to $895.63 from $865.63, and in the outlier threshold to $33,470 from $24,630, which will reduce the number of cases that qualify for an outlier payment.

Updated IPF Marketbasket:

The rule also finalizes CMS’ proposal to rebase and revise the IPF marketbasket using more recent cost report data from 2021 in place of 2016 data.

Streamlined Process for Opening New IPF Units:

The rule will allow new IPF units to open and begin billing Medicare at any time during its cost reporting year, following a 30-day advance notice.

Final Updates to IPFQRP              

The final rule implements four new QMs and a data validation pilot, among other changes. The new QMs include these three QMs related to health equity and social drivers of health:

• A Facility Commitment to Health Equity measure, which providers will begin reporting in FY 2026 and will affect payments;
• A Screening for Social Drivers of Health (SDOH) measure, for which voluntary reporting will begin in FY 2025 and later will affect payments; and
• A Screen Positive Rate for SDOH measure beginning with voluntary reporting of CY 2024 data with impact on payment to begin in FY 2027.

The new data validation pilot program will begin data collection in FY 2025. While NABH supported the general concept of this pilot, we urged CMS to postpone it because the field is currently focused on its first year of submitting patient-level quality data. Because the agency is moving forward, we will continue to emphasize that the pilot is too much, too fast.

More information on these IPFQRP updates can be found in the NABH comment letter on this rule, as well as the final rule text using the link above.

HHS, DOL and Treasury Release Proposed Rules to Strengthen MHPAEA

The U.S. Health and Human Services (HHS), Labor (DOL), and Treasury Departments on Tuesday released proposed rules to bolster the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 and remove obstacles to behavioral healthcare access.
 
The rules propose several amendments to the 2013 MHPAEA final regulations, as well as provisions that would establish the content requirements of the Non-Qualitative Treatment Limitations, or NQTL, comparative analyses required under amendments to MHPAEA included in the Consolidated Appropriations Act, 2021 (CAA, 2021).

“In evaluating their compliance with these proposed rules, plans and issuers would be required to consider whether an NQTL is inhibiting access to treatment for mental health conditions and substance use disorders by examining whether the NQTL that applies to mental health or substance use disorder benefits is more restrictive than the predominant NQTL that applies to substantially all medical/surgical benefits within a classification of benefits set forth under the regulations,” the guidance noted.

Meanwhile, the guidance said a plan or issuer would also be required to consider whether the processes, strategies, evidentiary standards, or other factors that it uses to design or apply an NQTL to mental health or substance use disorder benefits in a classification are comparable to, and applied no more stringently than, those used in designing and applying the NQTL to medical/surgical benefits in the same classification.
 
The three departments also released a Technical Release on NQTLs that outlines principles and seeks public comment to inform future technical guidance about the application of proposed data collection and evaluation requirements to NQTLs related to network composition that the rule proposes.

Along with the proposed rules, the departments released the 2023 MHPAEA Comparative Analysis Report to Congress that the CAA, 2021 requires. The report includes information about the agencies’ enforcement efforts and identifies plans and issuers that received final determinations of non-compliance with MHPAEA.

The White House released a fact sheet about the rule and DOL’s Employee Benefits Security Administration posted all the related documents here.

NABH is a member of the CEO Alliance on Mental Health, which released a statement about the guidance this week.

“The Biden Administration, along with bipartisan leadership in Congress, has made great progress in increasing access to comprehensive mental health and substance use care, including expanding the Certified Community Behavioral Health Clinic (CCBHC) model, improving crisis services and suicide prevention, and addressing youth mental health,” the Alliance statement said. “However, more work is needed to ensure everyone can access high quality care as early as possible, so we thank President Biden for this focus on improving parity.”
CMS will accept comments until 60 days after the rules are published in the Federal Register. NABH will seek feedback from members and submit comments about the proposed rules and Technical Release.

CMS Releases Ligature Risk Guidance

CMS has released guidance to state survey directors about ligature risk and assessment in hospitals.

The agency’s guidance centers around three main elements CMS said hospitals should consider when ensuring patient safety related to ligature risk: patient assessment, staffing/monitoring, and environmental risk.

“Based on their clinical evaluation, some patients may require both a more restrictive environment and an increased level of monitoring than other patients,” the guidance noted. “Therefore, it is not expected that hospitals have the same ligature risk configuration throughout their facility, but rather focus on the specific needs and risks of individual patients, based on their clinical or psychiatric assessment,” it continued. “Similarly, corrective actions implemented in response to deficiencies or adverse events should focus on appropriately addressing the findings or failures, rather than universal remedies.”

The changes are effective 30 days from when CMS released the memorandum on July 17. Please send any questions to QSOG_Hospital@cms.hhs.gov.

Reminder: DEA Registration Training Requirement for Buprenorphine Prescribing

Early this year SAMSHA announced that clinicians no longer need a federal waiver to prescribe buprenorphine to treat opioid use disorder; however, clinicians must still register with the U.S. Drug Enforcement Agency (DEA) to prescribe controlled medications.

In late June, the DEA announced that both new and renewing applicants must complete a new, one-time, eight-hour training course. Exceptions for the training requirement are practitioners who are board-certified in addiction medicine or addiction psychiatry, and those who graduated from a medical, dental, physician assistant, or advanced practice nursing school in the United States within five years of June 27, 2023.

Click here to learn more about the training.

2023 NABH Annual Meeting Photos Now Available

NABH is pleased to share photos from last month’s 2023 Annual Meeting: Security the Promise of Parity.

If you choose to download and use a photo, please credit photographer Chris Ferenzi. Thank you.

Reminder: Please Submit Data to Enhance NABH’s Managed-Care Advocacy Efforts

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.

CEO Update During the Congressional August Recess

NABH will publish CEO Update only on Friday, Aug. 11 and Friday, Aug. 28 during the congressional August recess.

Fact of the Week:

A new study published in Psychiatric Services reports disruptions in opioid use disorder outpatient and medications for opioid use disorder were marginal during the pandemic, possibly because of increased telehealth services.

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

House Energy and Commerce Committee Passes SUPPORT Act Reauthorization Bill

The House Energy and Commerce Committee this week voted unanimously to pass the SUPPORT for Patients and Communities Reauthorization Act (SUPPORT), which would renew programs from the 2018 law that would otherwise expire at the end of September.
 
“Today’s SUPPORT Act reauthorization includes a number of key bipartisan wins, including agreements on lifting the IMD exclusion, helping people in our criminal justice system, and caring for foster youth in need,” House Energy and Commerce Committee Chair Cathy McMorris Rodgers said in a statement after the committee passed the bill on Wednesday.

Rep. Michael Burgess, M.D. (R-Texas) sponsored a bill included in the reauthorization act to remove the decades-old Institutions for Mental Diseases (IMD) exclusion.

“It is no longer the 1960s and there is no longer the same stigma against the treatment of mental health,” Burgess told the news outlet Politico. Burgess also pushed for boosting the healthcare workforce and supporting providers “to ensure that mental health and substance use patients have access to personalized care, personalized medicine.”

The legislation also includes a provision that would allow federal funding to pay for test strips that can detect drugs such as fentanyl and the animal tranquilizer xylazine that drug dealers often mix with it.

House lawmakers could vote on the measure before they leave Washington for Congress’ August recess. NABH will keep members apprised of developments.

Becerra to Host 988 Stakeholder Webinar Today at 1 p.m. ET

U.S. Health and Human Services Department (HHS) Secretary Xavier Becerra and Substance Abuse and Mental Health Services Administration (SAMHSA) Assistant Secretary Miriam Delphin-Rittmon will host a 988 Lifeline anniversary stakeholder webinar today, Friday, July 21 at 1 p.m. ET.

Other Biden administration officials will join the event, which commemorates one year since the 988 Suicide and Crisis Lifeline launched.

The webinar will last 30 minutes. Click here to register.

NABH Supports Bowman Family Foundation Report on Equitable Access

NABH supports the Bowman Family Foundation’s new report, Equitable Access to Mental Health and Substance Use Care: An Urgent Need, which examines strategies for bridging the gap in access to mental health and substance use care.

The 33-page report found that 57% of patients sought mental health or substance use care but did not receive any care in at least one case, compared with 32% of patients seeking physical healthcare. For children and teens under 18 (defined here as “adolescents”), the “care not received” figure was 69% for mental health or substance use compared with 17% for physical health (see Figure 2 on p. 11 of the report).

Meanwhile, 80% of patients in employer-sponsored health plans who received outpatient care from at least one out-of-network mental health or substance use provider said they went to out-of-network providers “all of the time,” compared with 6% of patients who said the same for physical healthcare.

NABH strongly supports the report’s recommendation for the Departments of Labor, Health and Human Services, and the Treasury to issue additional guidance on detailed templates for MHPAEA compliance data reporting to employer group plans, third party administrators, and insurance issuers that indicates what data they should be prepared to submit upon request.

SAMHSA Seeking Comments on Harm Reduction Framework Draft

SAMHSA is seeking public comment on a draft of the agency’s Harm Reduction Framework, which is intended to inform SAMHSA’s harm-reduction activities as well as all related policies, programs, and practices.

Comments are due by Monday, Aug. 14 at 5 p.m. ET.

SAMHSA Releases Advisory on Digital Therapeutics in Behavioral Health

SAMHSA this week released Digital Therapeutics for Management and Treatment in Behavioral Health, which describes the research, regulatory, and reimbursement implications for digital therapeutics, including those by various federal agencies.

The advisory also maps out selection and implementation considerations for payers and providers and addresses issues related to equitable access to behavioral healthcare.

Kaiser Family Foundation Examines Federal Policy for SUD Treatment

A new Kaiser Family Foundation analysis found that 24% more buprenorphine was dispensed in 2022 than in 2019, the year before the COVID-19 global pandemic.

Health policy researchers examined five essential federal policies governing SUD treatment, the changes they have undergone during the pandemic, and the implications for access and treatment to opioid use disorder.

Click here to read the brief analysis.

Reminder: DEA Registration Training Requirement for Buprenorphine Prescribing

Early this year SAMSHA announced that clinicians no longer need a federal waiver to prescribe buprenorphine to treat opioid use disorder; however, clinicians must still register with the U.S. Drug Enforcement Agency (DEA) to prescribe controlled medications.

In late June, the DEA announced that both new and renewing applicants must complete a new, one-time, eight-hour training course. Exceptions for the training requirement are practitioners who are board-certified in addiction medicine or addiction psychiatry, and those who graduated from a medical, dental, physician assistant, or advanced practice nursing school in the United States within five years of June 27, 2023.

Click here to learn more about the training.

Reminder: Please Submit Data to Enhance NABH’s Managed-Care Denials 

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:

A new report from the HHS Office of the Inspector General found three factors that raise concerns that some people enrolled in Medicaid managed care may not be receiving all medically necessary healthcare services intended to be covered: (1) the high number and rates of denied prior authorization requests by some managed care organizations, (2) the limited oversight of prior authorization denials in most states, and 3) the limited access to external medical reviews.

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

CMS Proposes to Expand Behavioral Healthcare Access in 2024 OPPS Rule

The Centers for Medicare & Medicaid Services (CMS) on Friday proposed expanding access to behavioral healthcare services through coverage of intensive outpatient services.
 
Currently, Medicare covers and pays for various behavioral healthcare services, including inpatient psychiatric hospitalizations, partial hospitalizations services, and outpatient therapeutic services; however, there is a gap in coverage when Medicare beneficiaries require levels of services more frequent than individual outpatient therapy visits, but less intensive than a partial hospitalization program.

The agency’s 2024 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule includes proposals to implement provisions of the Consolidated Appropriations Act, 2023 (CAA, 2023) that created a new benefit category for Intensive Outpatient Program (IOP) services. CMS proposed to establish payment and program requirements for the benefit across various settings, including hospital outpatient departments, Community Mental Health Centers (CMHCs), Federally Qualified Health Centers (FQHCs), and Rural Health Clinics (RHCs) effective Jan. 1, 2024.

CMS also proposed to establish payment for IOP services provided by Opioid Treatment Programs (OTPs) effective Jan. 1, 2024, and is clarifying that these intensive behavioral healthcare services are available for individuals with mental health conditions and for individuals with substance use disorders.

“This proposed rule reflects CMS’ commitment to ensure Medicare is comprehensive in its ability to address patient needs, filling gaps in the health care system including behavioral health,” Meena Seshamani, M.D., deputy administrator and director for CMS’ Center for Medicare, said in a news release. “Through these proposals, we will ensure people get timely access to quality care in their communities, leading to improved outcomes and better health.”

CMS provided the following details about the scope of benefits for IOP and its proposals for each setting:

Scope of Benefits for IOP:

CMS proposed a scope of benefits for IOP services that the CAA, 2023 mandates. The agency noted an IOP is a distinct and organized outpatient program of psychiatric services provided for individuals who have an acute mental illness or substance use disorder, consisting of a specified group of behavioral healthcare services paid on a per-diem basis under the OPPS or other applicable payment system when furnished in hospital outpatient departments, CMHCs, FQHCs and RHCs. CMS proposed to base the per-diem costs of items and services included in IOP that have been, and are, paid for by Medicare either as part of the PHP benefit or under the OPPS more generally.

Physician Certification and Plan of Treatment Requirements for IOP:

The CAA, 2023 requires that a physician determine that each patient needs a minimum of nine hours of IOP services per week, and this determination must occur no less frequently than every other month. CMS proposes to codify this requirement in regulation for IOP provided in all settings and is soliciting comments on the recertification period.

IOP Payment Rates and Policy in Hospital Outpatient Departments and CMHCs:

CMS proposed to establish two IOP ambulatory payment classifications for each provider type: one for days with three services per day and one for days with four or more services per day.

For CY 2024, CMS proposed to calculate hospital-based and CMHC IOP payment rates for three services per day and four or more services per day based on cost per day using a broader set of OPPS data that includes PHP days and non-PHP days.

CMS noted that while no Medicare IOP benefit currently exists, the agency believes using the broader OPPS data set would allow us to capture data from hospital claims that are not identified as IOP, but that include the service codes and intensity required for an IOP day.

Opioid Treatment Program (OTP) Settings:

CMS proposed to extend IOP coverage to include OTPs. The agency also proposed to establish a weekly payment adjustment via an add-on code for IOP services furnished by OTPs for the treatment of opioid use disorder (OUD) and to revise the definition of OUD treatment services to include IOP services.

The payment adjustment would also be updated based on the Medicare Economic Index and receive the Geographic Adjustment Factor if finalized. CMS proposed that Medicare would pay for IOP services that OTPs provide as long as each service is medically reasonable and necessary, and not duplicative of any service paid for under any bundled payments billed for an episode of care in a given week.

For an OTP to receive the additional payment adjustment for IOP services, a physician must certify that the beneficiary requires a higher level of care intensity compared to existing OTP services, and the certification, plan of care, and all other applicable requirements are met. CMS said it believes that payment for IOP services that OTPs provide would improve continuity of care between different treatment settings and levels of care, expand access to treatment for Medicare beneficiaries with an OUD and further promote health equity for racial/ethnic populations and older beneficiaries.

RHCs and FQHCs:

For CY 2024, CMS proposed to make conforming regulatory text changes to applicable RHC and FQHC regulations related to the scope of IOP benefits and services, certification and plan of care requirements, and special payment rules for IOP services as the CAA, 2023 mandates.

The scope of IOP benefits and certification and plan of care requirements will be the same for RHCs and FQHCs as described above for hospitals. CMS proposed to pay for three IOP services/day, and according to the statute, payment is based on the hospital rate. This means RHCs would be paid the three-services per day payment amount for hospital outpatient departments.

For FQHCs, payment would be the lesser of a FQHC’s actual charges or the three-services per day payment amount for hospital outpatient departments. For grandfathered tribal FQHCs, payment would be the Medicare outpatient per visit rate as the Indian Health Service has established when furnishing IOP services, and payment is based on the lesser of a grandfathered tribal FQHC’s actual charges or the Medicare outpatient per-visit rate.

Regarding OPPS payment rates, CMS proposed updating OPPS payment rates for hospitals by 2.8%. This update is based on the projected hospital market basket percentage increase of 3.0%, reduced by a 0.2 percentage point for the productivity adjustment.

CMS Includes Behavioral Healthcare Provisions in Proposed 2024 Physician Fee Schedule

CMS on Thursday included a provision to extend OTP periodic assessment flexibilities via audio-only telehealth through the end of 2024 in the agency’s proposed 2024 Physician Fee Schedule rule.

CMS noted it will continue to consider the value of extending this flexibility permanently. For mental healthcare, the agency’s proposed rule included implementing the CAA, 2023’s requirements that marriage and family therapists (MFTs) and mental health counselors (MHCs) can bill through the Medicare program.

The agency also proposed HCPCS codes for crisis psychotherapy services, and proposed permitting Behavior Assessments and Intervention to be performed and billed by clinical social workers, MFTs and MHCs. Increases for timed PFS behavioral health services will be implemented over four years, according to CMS.

988 Suicide & Crisis Line Adds New Services as One-Year Anniversary Approaches

This week the Biden administration announced it has added Spanish text and chat services as well as specialized services for LGBTQI+ youth and young adults to the nation’s 988 Suicide & Crisis Lifeline following a successful pilot test.

This Sunday marks the one-year anniversary of 988’s launch, and the Biden administration reports the Lifeline has answered nearly 5 million contacts in the past year—2 million more than were received in the previous 12 months—following a $1 billion investment from the administration.

Meanwhile, in June the National Alliance on Mental Illness (NAMI) released its 988 Suicide & Crisis Lifeline Tracker that found familiarity with 988 remains low despite increasing overall awareness since it launched last July. NAMI found that 63% of Americans report at least hearing something about 988, up 19% percentage points since September 2022 and up 41 percentage points since May 2022. Still, only 17% of Americans say they are very or somewhat familiar with it, while only 4% say they are very familiar with it.

The study also found Americans 49 and under are more likely than older Americans to report having heard of 988, and LGBTQ+ Americans are twice as likely to say they are familiar with it than non-LGBTQ+ Americans.

White House Releases National Response Plan to Address Emerging Threat of Fentanyl Combined with Xylazine

The White House Office of National Drug Control Policy this week released a national response plan to combat the dangerous and deadly combination of xylazine mixed with fentanyl.

Earlier this year, the Biden administration used its executive designation authority for the first time when it declared xylazine mixed with fentanyl as an emerging threat in the United States.

“Since we announced the emerging drug threat earlier this year, we’ve been working tirelessly to create the best plan of attack to address this dangerous and deadly substance head-on,” Rahul Gupta, M.D., director of the White House Office of National Drug Control Policy (ONDCP), said in an announcement. “Now, with this National Response Plan, we are launching coordinated efforts across all of government to ensure we are using every lever we have to protect public health and public safety and save lives.”

The plan outlines action steps and key responsibilities for departments and agencies across the federal government and directs them to develop and submit an Implementation Report to the White House in 60 days.

As required by statute in the SUPPORT Act and the Criteria for Designating Evolving and Emerging Drug Threats (Dir. No. 2022-002), the national response plan’s goal is to terminate fentanyl combined with xylazine as an emerging threat. This will require a 15% reduction (compared with 2022 as the baseline year) of xylazine positive drug poisoning deaths in at least three of four U.S. census regions by 2025.

NABH Members Highlight Behavioral Health EMR Gap in Health Affairs Commentary

A recent Health Affairs commentary explores the 2009 HITECH Act’s failure to include behavioral healthcare providers in its $19 billion of meaningful use incentives and the resulting lag in electronic medical record (EMR) adoption in the behavioral healthcare segment.

“There was no clear rationale for this exclusion beyond implicit prioritization of physical health over mental health in the competition for funding dollars. And this disparity continues to this day,” wrote the article’s authors William Shrank, M.D., Christopher Hunter, M.B.A., and Andrew Lynch, Ph.D., adding that EMR use has exceeded 95% since 2014 but only 6% of outpatient behavioral healthcare facilities and 29% of substance use disorder treatment centers use EMRs. Shrank is a venture partner at Andreeseen Horowitz; Hunter is CEO at NABH member Acadia Healthcare, and Lynch serves as Acadia’s chief strategy officer.

The article reviews earlier legislative attempts to bridge the EMR gap, including the bill Rep. Doris Matsui (D-Calif.) introduced last year.

Reminder: Provider Relief Fund Reporting Portal Now Open for Period 5

The Health Resources and Services Administration has announced that the Provider Relief Fund (PRF) Reporting Portal is now open for Reporting Period 5.
 
Recipients who received one or more General Distribution, Targeted Distribution, or ARP Rural Distribution payments exceeding $10,000, in the aggregate, from Jan. 1, 2022 to June 30, 2022 are required to report on the use of their payments during Reporting Period 5.

This latest reporting period will close at 11:59 p.m. ET on Sept. 30, 2023. Click here to learn more.

In Case You Missed It: NABH Education & Research Foundation Workforce Resources

If you missed the 2023 Annual Meeting, be sure to access the workforce resources that the NABH Education and Research Foundation featured at the meeting and are available on the Foundation’s Resources page.

First, watch speaker John Pallasch’s presentation and listen to the question-and-answer period from NABH members. Pallasch, founder and CEO of workforce consultancy One Workforce Solutions, served previously as the Senate-confirmed assistant secretary for employment and training at the U.S. Labor Department. Pallasch’s presentation challenged attendees to think beyond recruitment and retention and instead focus on re-designing the U.S. workforce system. He offered practical ideas for how NABH members can get involved in this process.

Also be sure to use the workforce resource guide that the Foundation co-branded with One Workforce Solutions. The guide includes links to state workforce agencies, workforce development boards, and more.

Reminder: Please Submit Data to Enhance NABH’s Managed-Care Advocacy Efforts

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:

The Centers for Disease Control and Prevention estimates that 109,940 people died of an overdose between February 2022 and February 2023, compared with 110,063 people in the same period the previous year. ONDCP cited the seizure of illicit drugs at the nation’s borders and access to naloxone as reasons for the continued flattening in the overdose rate.

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