Author: Administrator

CMS Announces 1.5-percent Increase for Inpatient Psychiatric Facilities for 2020 in Final Rule The Centers for Medicare and Medicaid Services (CMS) announced a Medicare payment increase of 1.5 percent next year for inpatient psychiatric facilities in the final Inpatient Psychiatric Facilities Prospective Payment Systems (IPF PPS) rule the agency released earlier this week. Compared with the 2019 payment rate, the increase reflects a total increase of $65 million for Medicare-participating inpatient psychiatric facilities in fiscal year 2020. The payment update aligns with the agency’s proposed rule earlier this year. The rule also adds one new claims-based measured starting in fiscal year 2021 payment determination and continuing in subsequent years. The measure—Medication Continuing Following Inpatient Psychiatric Discharge (National Quality Forum #3205)—assesses whether patients admitted to IPFs with diagnoses of Major Depressive Disorder, schizophrenia, or bipolar disorder filled at least one evidence-based medication within two days before discharge or during the 30-day, post-discharge period.   CMS Proposes Slight Payment Increase for PHPs and CMHCs in 2020 The CMS has proposed a hospital-based partial hospitalization program (PHP) payment rate of $228.20 for 2020, up from the 2019 rate of $220.86, in the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (OPPS/ASC) proposed rule the agency released on July 29. CMS also proposed an increase for community mental health centers (CMHCs), which could see a payment rate of $124.59 in 2020 if the rule is made final. By comparison, CMHCs received a payment rate of $120.58 in 2019. The rates set in the proposed CY 2020 rule are not based on the most recent average cost data from the PHP program, a deviation from CMS’ long-standing policy. When CMS calculated the average PHP program cost for the CY 2020 proposed rule, the agency found it had decreased by nearly 15 percent for CMHCs and 11 percent for hospitals-based PHPs. After finding this decrease, CMS reviewed the data sets and found that a single provider in the CMHC set and a single provider in the hospital-based set had such dramatically lower reported costs that it significantly skewed the average cost for both data sets. Because the lower average costs were the result of single providers and could significantly reduce access for beneficiaries, CMS decide to use the CY 2019 cost average as a floor for both type of PHP rates in the CY 2020 rule. If not for this change, the rate for both types of PHPs would have been significantly lower than what CMS proposed in the rule. It is important to note that CMS stressed that it does not intent to carry this policy forward: “To be clear, this policy would only apply for the CY 2020 rate setting,” the agency said in the rule. CY 2020 Rates Level 1 Health and Behavior Services                                                     $28.59 Level 2 Health and Behavior Services                                                     $81.06 Level 3 Health and Behavior Services                                                     $130.27 Partial Hospitalization (3 or more services) for CMHCs                            $124.59 Partial Hospitalization (3 or more services) for Hospital-based PHPs        $228.20   NABH will submit comments on the proposed rule to CMS by the Sept. 27 deadline.   CMS Addresses OUD Treatment in OTPs and Office Settings in Proposed Rule  Also this week, CMS issued a proposed rule for establishing a Medicare Part B benefit and payment bundles for opioid use disorder (OUD) treatment services in opioid treatment program (OTP) settings and new HCPCS codes and bundled rates for office-based treatment of OUD.   The proposal implements Section 2005 of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act.   The rule proposes:

• A definition of OUD treatment services and OTPs, including an explanation that services include access to all FDA-approved medications, counseling and therapy, and toxicology testing;
• Enrollment policies that align with SAMHSA OTP regulation and that do not have additional conditions of participation;
• Bundled payment methodologies that separate drug from non-drug treatment components, account for different medications and variable intensity of services, provide for service add-ons and partial- and full-billing for weekly episodes;
• Use of audio-video communication technology; and
• Zero beneficiary cost-sharing requirement for a time-limited period.

  The agency also proposed a bundled payment for office-based OUD treatment services, to encourage the expansion of access to OUD care, including:

• Coverage of OUD management, care coordination, psychotherapy, and counseling; medication to be billed and reimbursed under existing Medicare Part B or D; toxicology testing to be billed under Clinical Lab Fee Schedule;
• Bundled payment methodologies that are based on monthly billing cycles to better align with office-based practices; one bundle for the initial month of treatment that is more service-intensive; and a second bundle for subsequent “maintenance months,” service add-on codes, and not restricted to addiction specialists;
• Three new HCPCS codes to Category I of the list of Medicare telehealth services for office-based substance use disorder (SUD)/OUD services, permitting a patient’s home as a telehealth originating site; and
• No changes to cost-sharing.

  In addition, the proposed rule requests information on emergency department practice patterns related to the initiation and use of MAT, and referral or follow-up care, for developing such bundles in future rulemaking. Comments are due September 27, 2019. NABH has engaged a consulting firm to help analyze the proposed bundled payment methodology and payment rates, and the association will submit comments. CMS Releases Informational Bulletins as Part of the SUPPORT Act CMS late last week released two informational bulletins as part of last year’s SUPPORT Act to provide states with guidance on treatment for infants, expectant mothers, and post-partum women.   In the first bulletin, the agency explains that neonatal abstinence syndrome (NAS) is a “constellation of symptoms in newborn infants exposed to any of a variety of substance in utero, including opioids.” The SUPPORT Act added an optional provider type, a residential pediatric recovery center, defined as a facility that offers items and services for which medical assistance is available under the state plan to infants who have NAS. This brief provides additional information about this condition and the impact of these recovery centers.   Meanwhile, the agency’s second bulletin provides background information about Medicaid coverage for pregnant and post-partum women and examines a new, limited exception to the IMD exclusion.   A section of the SUPPORT Act states that a woman who is eligible on the basis of being pregnant (and up to 60 days post-partum) who is a patient in an IMD for SUD treatment, and who is either enrolled under the state plan immediately before becoming an IMD patient, or who becomes eligible to enroll while a patient in an IMD, the exclusion cannot prohibit federal financial participation for medical assistance for items and services that are provided outside the IMD.   MACPAC Releases Issue Brief on Recovery Services for Medicaid Beneficiaries with SUD The Medicaid and CHIP Payment Commission (MACPAC) this week released an issue brief about recovery support services for Medicaid beneficiaries with SUD.   MACPAC documented coverage for clinical SUD services in the fourth chapter of its Report to Congress on Medicaid and CHIP in June 2018. This week’s issue brief complements that information by presenting results from the commission’s 50-state policy review of coverage for clinical SUD services.   The brief also describes how Medicaid programs pay for recovery support services and discusses opportunities to coordinate clinical treatment and recovery support services.   For questions or comments about CEO Update, please contact Jessica Zigmond.

Threat of Sequestration Ends with Bipartisan Budget Act White House and Congressional leaders agreed to large increases in base funding for defense and nondefense spending on Thursday, with the expectation of support by the Senate in a vote next week. The budget deal establishes a funding base above spending cap levels that could trigger mandatory automatic spending cuts, referred to as sequestration. The bipartisan compromise suspends the federal debt ceiling and spending caps for two years, thus marking the end of sequestration that was due to sunset in 2021. Defense spending was increased by $22 billion and nondefense spending was increased by $27 billion. As part of the negotiations, Congressional leadership agreed to avoid the inclusion of any contentious measures that do not have bipartisan support during the FY2020 appropriations process. This agreement will allow for a budget process that will avoid a government shutdown. Medicare Plans Dramatically Reduce Prior Authorization Rates A recent study published in a JAMA Research Letter found large reductions in the percentage of Medicare Part D and Medicare Advantage Plans using prior authorization for buprenorphine medications for opioid use disorder (OUD). In the two years between 2017 and 2019, the percentage of plans using preauthorization for generic buprenorphine-naloxone medications dropped from 96 percent to zero, and for brand buprenorphine-naloxone medication rates dropped from 88 percent to 3 percent. These findings follow two federal policy initiatives: a 2017 buprenorphine labeling change by the Food and Drug Administration, and a 2018 announcement by the Centers for Medicaid and Medicare Services (CMS) that they would no longer approve Medicare Part D formularies that preauthorize buprenorphine products more than once per year. Looking forward, the study states the importance of the data “because Medicare policy is often viewed as a standard that is subsequently adopted by private health plans and Medicaid.” Tami Mark, lead author of the study said, “Although Medicare has significantly reduced prior authorization for opioid use disorder medications, it is still in common use in Medicaid and private health plans.” Legal Action Center Calls for Removal of Prior Authorization in Medicaid The Legal Action Center (LAC) in a new report calls for Medicaid programs to adopt the successful “Medicare Model” of eliminating prior authorization for medications to treat opioid use disorder (OUD) and expanding coverage of all FDA-approved medications. Citing the success of a 2018 federal policy that virtually eliminated prior authorization for buprenorphine products in Part D and Medicare Advantage programs (see previous article), LAC reports that most Medicaid plans continue to require prior authorization for OUD medications. Specifically, buprenorphine-naloxone medication requires prior authorization in 40 Medicaid programs, and buprenorphine medication requires authorization in 35 Medicaid programs. Formulary restrictions and dose limitations also pose barriers to medication assisted treatment (MAT). MAT can reduce mortality by almost half. Medicaid covers four out of 10 adults with OUD and thus “plays a significant role in delivering effective OUD treatment and reducing barriers to FDA-approved medications,” the report states.  The Report recommends that CMS issue a guidance letter to State Medicaid Directors to increase the use of all medications for OUD. Arnold Ventures Funds Research on Insurance Fraud Arnold Ventures is funding a new two-year study to develop methods for identifying fraudulent opioid use disorder treatment and recovery services. Led by Boston University researchers and in collaboration with a former federal health-fraud investigator, the study intends to provide a broader view of fraudulent practices, including excessive medical testing, patient brokering, and the geographic scope of such practices. Through a review of insurance data for more than 50 million individuals and the deployment of secret shoppers, the study seeks to provide insurance companies with tools to improve detection and support policymakers in developing procedures to improve oversight. Fair Health Sheds Light on Rapid Growth of Telehealth A new white paper from FAIR Health found that provider-to-patient telehealth grew by 1,293 percent for non-hospital-based providers between 2014 and 2018, accounting for 84 percent of all telehealth claim lines. Telehealth for all providers grew by 624 percent. In a review of over 29 billion private claim records for 2018, the analysis found that mood disorders (six percent) and anxiety and other nonpsychotic mental disorders (five percent), were the second and third most common conditions for which individuals sought telehealth services. Upper respiratory infections were the most common reason. Telehealth gains were larger for urban providers, increasing 1,227 percent, with rural providers increasing by 897 percent. Rural areas, however, showed stronger gains than urban areas for telehealth after hospital discharge, with an increase of 407 percent. A previous FAIR Health study found that between 2016 and 2017, telehealth grew more than any other place of service, including emergency rooms and retail clinics. According to FAIR Health, the findings suggest “important implications for improving healthcare quality and lowering costs by reducing avoidable hospitalizations, readmissions and urgent/emergent care visits.” National Institutes on Drug Abuse to form Justice Community Opioid Innovation Network Ten research institutions and two centers have been funded by the National Institutes on Drug Abuse (NIDA) to support research on treatment for opioid use disorder (OUD) in criminal justice settings. Twelve grants were awarded to develop a Community Opioid Innovation Network (JCOIN) to shore up the response capacity of the justice system to the opioid epidemic. Awards total approximately $155 million for a multi-year initiative in which research investigators will collaborate with justice and behavioral health stakeholders to identify promising interventions on adoption of new medications, retention of individuals in treatment, and preventing relapse after community re-entry. JCOIN is part of the National Institute of Health grants called HEAL (Helping to End Addiction Long-term Initiative). SAMHSA Suicide Prevention Resource Center Hosts Webinar The Suicide Prevention Resource Center (SPRC) will host a webinar on the intersection between serious mental illness (SMI) and suicide Monday, July 29 at 4:30 p.m. ET. Webinar panelists will present an overview of approaches to addressing suicide risk for patients diagnosed with SMI who are seen in health and behavioral health organizations. Individuals with SMI are at higher risk of dying by suicide. Informational resources will be shared, as well as tailored interventions, methods of engagement, and supporting family and friends. SPRC is funded under a grant by the Substance Abuse and Mental Health Services Administration to advance the implementation of the National Strategy for Suicide Prevention. For questions or comments about CEO Update, please contact Jessica Zigmond.

House Energy and Commerce Committee Advances No Surprises Act The House Energy and Commerce Committee this week approved legislation to end “surprise” medical bills with the addition of third-party arbitration. House Energy and Commerce Committee Chairman Frank Pallone (D-N.J.) and Rep. Greg Walden (R-Ore.), the panel’s ranking member, co-sponsored the No Surprises Act, which advanced through the committee as part of the Reauthorizing and Extending America’s Community Health Act with amendments. Under the bill, healthcare facilities would be required to notify patients at least 24 hours before an elective treatment that an out-of-network provider would be involved in their care. The bill also would prohibit healthcare facilities and providers from balance-billing patients for that care and would establish rates for payments from commercial health plans to providers based on the local market. The initial bill did not include a process for providers and payers to challenge the basic median reimbursement, while the amended version that passed this week includes such a process. Overall hospital groups responded both favorably and cautiously to the news, suggesting that while the bill is significant for offering an arbitration option, the legislation could also set a precedent for the federal government to set private rates. The legislation now moves to the full House for a vote. JAMA Pediatrics Study Shows Parental Drug Use Has Led to Increase in Foster Care Cases A new JAMA Pediatrics study suggests that greater parental drug use has contributed to a rise in foster care caseloads and coincides with increasing trends in opioid use and overdose deaths. Researchers from Weill Cornell Medical College and Harvard Medical School examined data from the Adoption and Foster Care Analysis and Reporting System, a federally mandated collection system that receives case-level information on all children in foster care in the United States. They found that after more than a decade of declines in U.S. foster care caseloads, cases have risen steadily since 2012. Meanwhile, the number of foster care entries attributable to parental drug use rose substantially to 96,672 home removals from 39,130 removals between 2000 and 2017, reflecting a 147-percent increase during that period, according to the findings. “These findings suggest that greater parental drug use has contributed to increases in foster care caseloads and coincide with increasing trends in opioid use and overdose deaths nationwide during this period,” the study said. The authors noted the study’s limitations include potential reporting inconsistencies in parental drug use, and that it’s possible that factors other than drug use influenced entries for parental drug use. “Policymakers must ensure that the needs of this new wave of children entering foster care because of parental drug use are being met through [sic] high-quality foster care interventions,” the study said. “These have been shown to mitigate some of the adverse effects of early childhood deprivation and disruptions in attachment.” NQF Convenes Opioid Use Disorder TEP and Seeks Comment The National Quality Forum (NQF) will convene a Technical Expert Panel (TEP) to oversee a review of measures and concepts related to opioid use, opioid use disorder prevention, treatment, and recovery. In its announcement, the NQF said the move is meant to “further identify measure gaps and priorities relevant to the United States opioid overdose epidemic and the broad healthcare quality challenges that surround it.” The TEP will provide guidance on the environmental scan of current measures; identify and prioritize measure gaps in quality measurement to inform future measure development efforts; and provide recommendations on the use of opioids and opioid use disorder measures in federal programs. The NQF will accept comments on this process through July 26. Also this week, the NQF together with the Blue Cross Blue Shield Association releasedEnhancing Access to Medication-Assisted Treatment, a guide that provides strategies, implementation examples, tools, and resources to help healthcare delivery systems, practitioners, and payers expand using MAT. Netflix Removes Suicide Scene from ‘13 Reasons Why’ Netflix Inc. has removed a suicide scene from an episode in the first season of its teen drama “13 Reasons Why” after some debate over whether the show increased the risk of teen suicide. The Wall Street Journal reported this week that although a Netflix spokesman declined to comment, the company tweeted on July 16 that, based on advice from medical experts, the company decided to edit the scene from the episode. The National Institutes of Health released a study in late April that suggested “13 Reasons Why”—which premiered in March 2017—was a factor in increased teen suicides in the United States (see CEO Update, May 3, 2019). HRSA Awards $20 million to 27 Organizations to Increase Rural Workforce HHS’ Health Resources and Services Administration (HRSA) awarded about $20 million in Rural Residency Planning and Development Program (RRPD) grants to help boost the nation’s rural healthcare workforce. Recipients across 21 states will receive up to $750,000 over a three-year period to develop new rural residency programs. The funding is part of HRSA’s multi-year initiative to expand the physician workforce in rural areas by developing new, sustainable residency programs in family medicine, internal medicine, and psychiatry. Grant recipients include rural hospitals, community health centers, health centers that the Indian Health Service operates, Indian tribes or tribal organizations, and schools of medicine. Click hereto the see the list of grant awards. SAMHSA Releases Guidance to States on Using MAT in Criminal Justice Settings The Substance Abuse and Mental Health Services Administration (SAMHSA) has released a guide to states on using medication assisted treatment (MAT) in criminal justice settings. Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings is a 76-page resource that focuses on using MAT for opioid use disorder in the nation’s jails and prisons during the reentry process when justice-involved persons return to the community. It provides an overview of policies and evidence-based practices that reduce the risk of overdose and relapse. SAMHSA to Host Virtual Learning Series on Recovery SAMHSA will host a three-part virtual learning series focused on recovery supports for people considering using MAT for opioid use disorder or co-occurring disorders. Held on consecutive Wednesday afternoons — July 24, July 31, and August 7 — each hourlong session will feature presenters who will address common misperceptions about MAT; offer up-to-date, accurate information; and suggest ways to learn more and educate others about opioid use disorders, co-occurring disorders, and MAT. These free events will take place from 2 p.m. to 3 p.m. ET. Click here to register. For questions or comments about CEO Update, please contact Jessica Zigmond.

New Quality Summit to Assess HHS’ Quality Programs HHS Deputy Secretary Eric Hargan this week announced the department’s new Quality Summit, which will join government leaders and healthcare industry stakeholders to discuss how to adapt and streamline HHS’ current quality programs in a way that improves outcomes for patients. Hargan will co-chair the Quality Summit with Peter Pronovost, M.D., Ph.D., an internationally renowned expert on healthcare quality and patient safety. In March, Hargan discussed the regulatory barriers that often hinder treatment during his presentation at the 2019 NABH Annual Meeting in Washington. “Over the last decade we have seen efforts by HHS to incentivize the provision of quality care, only to be met with limited success,” Hargan said in a news release. “This is in part because patients have not been empowered with meaningful or actionable information to inform their decision making. At the same time, important quality programs across the department have remained uncoordinated among the various agencies and inconsistent in their demands on healthcare providers,” he added. “We believe the Quality Summit will not only strengthen the protections these programs afford patients, but also improve value by reducing costs and onerous requirements that are placed on providers and ultimately stand between patients and the high-quality care they deserve.” Late last month, President Trump signed the Improving Price and Quality Transparency in American Healthcare to Put Patients First executive order, which directs federal agencies to develop a Health Quality Roadmap intended to align and improve reporting on data and quality measures across federal health programs. OIG Report Finds Opioid Use Decreased and MAT Increased Among Medicare Part D Beneficiaries A new report from HHS’ Office of Inspector General (OIG) found a significant decrease in the number of Medicare Part D beneficiaries who received opioids in 2018 and a steady increase in the number of beneficiaries who received drugs for medication assisted treatment (MAT). Nearly three in 10 Medicare part D beneficiaries received opioids in 2018, the OIG reported, while at the same time the number of beneficiaries who received MAT for opioid use disorder reached 174,000. Meanwhile, about 354,000 beneficiaries received high amounts of opioids in 2018, with about 49,000 of them at serious risk of opioid misuse or overdose—which was also fewer than in the previous two years. “Progress has been made in decreasing opioid use in Part D, increasing the use of drugs for medication assisted treatment, and increasing the availability of naloxone,” the OIG reported noted. “It is imperative for the Department of Health and Human Services— including CMS (Centers for Medicare and Medicaid Services) and OIG— to continue to implement effective strategies and develop new ones to address this epidemic.” O’Neill Institute Evaluates Democratic Candidates’ Views on Addiction and Opioid Crisis The O’Neill Institute at Georgetown Law this week released an analysis of the 2020 Democratic presidential candidates’ plans to address America’s continued opioid crisis. In a post on the O’Neill Institute’s webpage this week, authors Regina LaBelle—a 2019 NABH Annual Meeting speaker—and Leigh Bianchi noted that most all of the presidential candidates have not issued detailed policy proposals on the topic. Instead, their positions on the issue were taken from statements at campaign events and from their record in public office. LaBelle and Bianchi categorized the candidates’ positions by federal officials, state and local officials, and other candidates. Click here to read their analysis. SAMHSA and CMS Issue Joint Bulletin on Addressing Mental Health and SUD in Schools The Substance Abuse and Mental Health Services Administration (SAMHSA) and CMS this week issued a joint information bulletin that describes Medicaid mandatory and optional state plan benefits and other Medicaid authorities states may use to cover mental health and substance use disorder (SUD) treatment for children in schools. The bulletin includes tools and resources to help states, educational agencies, and healthcare providers work together to identify and treat students’ mental illness or substance-related challenges in school-based settings. It also outlines best practices to help implement quality, evidence-based, and comprehensive mental illness and substance use-related services for students. Included in the 28-page bulletin are specific examples of state-level strategies for Medicaid and other financing of school-based mental health services. Study Examines Association of Nonmedical Prescription Opioid Use with Heroin Use Initiation in Adolescents A study published in JAMA Pediatrics this week found that nonmedical prescription opioid use was prospectively associated with subsequent heroin use initiation during four years of adolescence among youth in Los Angeles. Researchers conducted an eight-wave cohort study of 14-year-old and 15-year-old high school students in Los Angeles who had never used heroin at baseline and found that youth reporting no, prior, and current nonmedical prescription opioid use during high school showed estimated “cumulative probabilities” of subsequent heroin use initiation by the end of the 42-month follow-up of 1.7 percent, 10.7 percent, and 13.1 percent, respectively. The reason for the study stemmed from the concern that nonmedical prescription opioid use is associated with increased risk later of heroin use initiation among adolescents but that longitudinal data addressing this topic are lacking. The study’s authors noted that future research is needed to determine whether this association is causal. House Energy and Commerce Subcommittee Hearing Will Examine Spread of Illicit Fentanyl The House Energy and Commerce Subcommittee on Oversight and Investigations will host a hearing next Tuesday, July 16 to examine the increasing threat of illicit fentanyl. The hearing announcement noted recent statistics from the Centers for Disease Control and Prevention that show there were more than 47,000 drug overdose deaths involving opioids in 2017, of which 28,000 involved synthetic opioids such as fentanyl—a nearly 47-percent increase from the prior year. Tuesday’s hearing will feature witnesses from the key federal agencies responding to the nation’s opioid crisis. CMS to Host Webinar on QIOs and IPFs Working Together to Reduce Readmissions Quality experts from CMS and quality improvement organization MPRO will lead a webinar for participants in the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program next Thursday, July 18 at 2 p.m. ET. Christina Goatee, M.S.N., R.N. from CMS and Barbra Link, L.M.S.W., CIRS-A/D from MPRO will lead the hourlong webinar, Quality Improvement Organizations and Inpatient Psychiatric Facilities Working Together to Reduce Readmissions, to provide an overview of the Quality Improvement Organization (QIO) program and show how collaborative relationships with QIOs can reduce inpatient psychiatric facility readmissions and enhance outcomes. Click here to register.   For questions or comments about CEO Update, please contact Jessica Zigmond.

CDC Provisional Data Show Opioid Deaths Likely to Fall for First Time Since 1990 Provisional data from the Centers for Disease Control and Prevention (CDC) show drug-overdose deaths are on the brink of declining, but researchers are quick to caution the nation’s deadly opioid crisis is far from over. The CDC’s data predict there were nearly 69,100 drug deaths in the 12-month period ending in November 2018, down from almost 72,300 predicted deaths for the same 12-month period ending in 2017. If the trend continues through December— those data likely will be available next month—then annual drug deaths will fall for the first time since 1990, when about 8,400 people died from overdoses. “I think we’re probably looking at a decline,” Robert Anderson, Ph.D. chief of the Mortality Statistics branch at the CDC’s National Center for Health Statistics, told the Wall Street Journal this week. “We shouldn’t say oh, we’ve won and we’ve defeated the drug-overdose epidemic.” The story reported that health officials and epidemiologists say there is little cause for celebration, especially as the death rate remains “swollen by powerful synthetic opioids like fentanyl.” Meanwhile, the story noted one driving factor for the downward trend has been broadened access to the overdose-reversal drug naloxone, often known by the brand-name Narcan, according to officials in Ohio, Pennsylvania, and Rhode Island. Jim Hall, an epidemiologist at Nova Southeastern University in Florida, echoed Anderson’s measured optimism in his interview with the Wall Street Journal. “I’m ready to say that the opioid crisis in in early remission, yet at a high risk of relapse,” Hall said. CMS Announces Funding Opportunity for State Medicaid Agencies to Address SUD The Centers for Medicare & Medicaid Services (CMS) announced this week that up to $50 million is available to help increase capacity for Medicaid providers to deliver substance use disorder (SUD) treatment and recovery services. The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act authorized the planning grant funding, which is available to at least 10 states for 18 months, CMS announced in the funding opportunity notice. Meanwhile, up to five states that receive planning grants will be chosen to implement 36-month demonstration projects and receive enhanced federal reimbursement for increased expenditures for SUD treatment and recovery services. Click here to learn more and apply for a grant. Veterans with PTSD More Likely to Die from Suicide, Hepatitis Veterans with post traumatic stress disorder (PTSD) have a higher risk of dying from mental illness and other diseases than the general population, according to a new study published in the American Journal of Preventive Medicine. The study’s researchers analyzed mortality data from nearly 500,000 veterans who started treatment for their PTSD at a Veterans Affairs (VA) medical center between 2008 and 2013 and found that veterans with PTSD were about twice as likely to die from suicide, accidental injuries, and hepatitis than the general population. The study acknowledged a few limitations related to both the sample selection and follow-up. For one, the study’s approach did not account for relevant confounders, including race/ethnicity, psychiatric and medical comorbidity, and treatment. “Although the cohort was started in 2008 to account for changes in the VA delivery of evidence-based PTSD care, this study did not address patient-level treatment characteristics and was not designed to determine whether PTSD care affects mortality.” NABH Supports BETTER Act to Expand Medicare Telehealth Benefits NABH was one of more than a dozen organizations this week that signed a letter supporting the bipartisan Beneficiary Education Tools Telehealth Extender Reauthorization (BETTER) Act of 2019, a House bill intended to improve Medicare’s telehealth benefits for patients who need mental health services. In a letter to Reps. Richard Neal (D-Mass.) and Kevin Brady (R-Texas), the chairman and ranking member, respectively, of the House Ways and Means Committee, NABH and 13 other groups this week noted that CMS reports mental disorders are at the top of diagnoses for Medicare beneficiaries receiving telehealth services in 2016. “However, current law restrictions prohibiting the receipt of telehealth services in the home and limiting coverage to specific geographic areas hamper the accessibility of effective mental health services to treat Medicare beneficiaries,” the letter said. “We are very pleased that H.R. 3417 removes these barriers and allows Medicare patients to access psychotherapy services through telehealth no matter where they live and in their own homes. NABH Supports CREATE Act to Expand MAT Programs for Incarcerated Individuals with OUD NABH and other member organizations of the Coalition to Stop Opioid Overdose (CSOO) sent a letter this week to the federal lawmakers who introduced the Community Re-entry through Addiction Treatment to Enhance (CREATE) Opportunities Act, which is intended to expand Medication Assisted Treatment (MAT) programs for individuals with opioid use disorder (OUD) who are incarcerated. Specifically, the legislation from Rep. Ann Kuster (D-N.H.) and Sen. Ed Markey (D-Mass.) would provide $50 million each year from fiscal year 2020 through fiscal year 2023 for the U.S. Attorney General to make grants and enter into cooperative agreements with states and local governments to develop, implement, or expand programs to provide MAT to individuals who have OUD and are incarcerated. The bill also includes requirements for the covered programs. Click here to read the letter from the CSOO. CEO Update Will Publish Next on Friday, July 12 NABH’s office will be closed on July 4 and 5 for Independence Day and will not publish CEO Update next week. CEO Update will publish next on Friday, July 12. The entire NABH team wishes you a happy and safe Independence Day weekend!   For questions or comments about CEO Update, please contact Jessica Zigmond.

NABH Submits FY 2020 IPF PPS Rule Comments to CMS NABH this week urged the Centers for Medicare & Medicaid Services (CMS) not to include any new measures in the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program, but instead work with the behavioral healthcare provider community to improve existing measures. That was the broad message in NABH’s comment letter to CMS about the agency’s proposed fiscal year (FY) 2020 inpatient psychiatric facility prospective payment system (IPF PPS) rule. Commenting on CMS’ proposal to develop a new measure for a standardized patient perception of care, NABH President and CEO Mark Covall explained that the majority of NABH members participating in the IPFQR program use some version of a patient perception of care measure; however, there is not one single measure that all providers or a majority of providers use. “Therefore, we have strong concerns that CMS will make it mandatory for behavioral healthcare providers to adopt something such as the Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS) survey,” Covall wrote. NABH also recommended CMS work closely with the behavioral healthcare provider community to develop a safety-planning measure for patients who have suicidal ideation. Click here to read NABH’s letter. SAMHSA Releases The Behavioral Health Barometer, Volume Five The Substance Abuse and Mental Health Services Administration (SAMHSA) has released volume five of The Behavioral Health Barometer, one of a series of national, regional, and state reports that offer a glimpse of behavioral health in the United States. “Behavioral Health Barometers for the nation, 10 regions, and all 50 states and the District of Columbia are published as part of SAMHSA’s behavioral health quality improvement approach,” Elinore McCance-Katz, M.D., Ph.D., assistant secretary for mental health and substance use at SAMHSA, wrote in the report’s foreword. “Most importantly, the Behavioral Health Barometers provide critical information in support of SAMHSA’s mission of reducing the impact of substance abuse and mental illness on America’s communities.” The 74-page report examines youth, young adult, and adult mental health and substance use as well as adult mental health and mental health service use. SAMHSA also included a special focus on the misuse of prescription pain relievers, heroin use, and medication assisted therapy for opioid addiction. AMA Passes Opioid Policies that Address Barriers to Effective Treatment The American Medical Association (AMA) has approved several opioid-related policies meant to shift the focus of pain treatment back on patients and away from what the association referred to as “arbitrary third-party controls.” Physicians accepted the resolutions at the Chicago-based association’s annual meeting last week. In a news release, the AMA said the measures take aim at barriers to treatment that state and federal authorities, insurers, pharmacy benefit management (PBM) companies, and national pharmacy chains have enacted. ““The barriers include tactics such as prior authorization and step therapy – which can delay treatment – and misguided laws and other policies setting hard thresholds for prescriptions,” the announcement said. One proposal recommends developing treatment plans based on individual needs, rather than a one-size-fits-all approach of hard thresholds. Another measure opposes pharmacies, PBMs, and insurers using “high prescriber lists,” without due process, to keep physicians from writing prescriptions for controlled substances and preventing patients from filling prescriptions at their pharmacy of choice. Opioid Crisis Increases Number of Organs Available for Transplant Taken together, America’s opioid crisis and organ shortage have led the nation’s surgeons to consider transplanting organs deemed less than “perfect” in an effort to expand the donor pool and save more lives, according to new research published in The Annals of Thoracic Surgery. Nader Moazami, M.D. of NYU Langone Health in New York and his colleagues evaluated trends in organ donation and transplants among drug overdose deaths using data from the Scientific Registry of Transplant Recipients between 2000 and 2017. They found that of the 15,904 isolated heart transplants from adult donors during this period, opioid overdoses (10.8 percent) were the fourth common cause of death, behind blunt injury (30.5 percent), hemorrhage/stroke (22.1 percent), and gunshot wound (18.3 percent). “The opioid epidemic has increased the proportion of hearts transplanted from overdose death donors (ODD),” Moazami said in a news release from the Society of Thoracic Surgeons. “One of the roles of the transplant community is to at least partially mitigate the tragedy of this exponentially growing problem by maximizing the utilization of organs from ODD.” JAMA Psychiatry Study Finds Fewer Psychiatrists Accepting Medicaid Patients Post Expansion Fewer psychiatrists are accepting Medicaid patients even as more patients have gained coverage under the federal insurance program, according to a recent research letter published in JAMA Psychiatry. Although Medicaid is the principal payer of behavioral health services in the United States, little is known about recent trends in psychiatrists’ acceptance of Medicaid patients, the letter said. For this analysis, researchers used data from the 2010-2015 National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of physicians who were not federally employed, based in offices, and primarily engaged in patient care. The study found the number of psychiatrists accepting Medicaid patients fell to 35 percent between 2014-2015 from nearly 48 percent between 2010-2011. “This study was limited by the relatively small physician sample size in the NAMCS and only 2 years’ post expansion data in most expansion states,” the research letter said. “Furthermore, low Medicaid participation among primary care physicians has been attributed to low Medicaid physician fees, reimbursement delays, and administrative burden,” it added. “However, we lacked data to explore the relative importance of these potential factors in psychiatrists’ decision to accept Medicaid patients.” A Reuters story about the findings quoted the study’s co-author Adam Wilk, who said he suspects the nation’s shortage of psychiatrists is the reason why they haven’t expanded their capacity to accept Medicaid patients. “Market deficiencies allow psychiatrists to make more money by taking patients who have private insurance,” Wilk, an assistant professor of health policy and management at Emory University’s Rollins School of Public Health, told Reuters. “In fact, there’s a rising trend among psychiatrists of opting out of insurance altogether.”  JAMA Pediatrics Study Suggests Sexting Associated with Sexual Behaviors and Mental Health Risk Factors in Adolescents A meta-analysis of 23 studies has found that adolescent sexting is significantly associated with sexual activity, multiple sexual partners, lack of contraception use, delinquent behavior, internalizing problems, and substance use. Published in JAMA Pediatrics, the analysis comprising 41,723 participants found the association between sexting and multiple sexual partners, drug use, smoking, and internalizing problems were stronger in younger compared with older adolescents. “Results of this study suggest that sexting is associated with various sexual behaviors and mental health risk factors,” the authors noted in the study. “Moving forward, education campaigns should focus on providing youth with comprehensive information about sexting and digital citizenship.” Justice Department Releases Grant Solicitation for Rural Communities to Address Opioid Crisis The U.S. Justice Department’s Bureau of Justice Assistance (BJA) has announced the Rural Responses to the Opioid Epidemic Grant solicitation, which is intended to build local capacity, foster cross-sector collaboration, and support innovation to address the nation’s deadly opioid crisis. BJA is sponsoring the initiative with the Centers for Disease Control and Prevention and the State Justice Institute and will select up to eight rural communities or regions for grant awards up to $750,000, each for a 24-month period. BJA has scheduled a webinar to discuss the grant application process for Wednesday, June 26 at 2:30 p.m. ET. Applications are due by Friday, July 26. National Consortium of Telehealth Resource Centers Announces Webinars on Telehealth for SUD The National Consortium of Telehealth Resource Centers will explore what type of substance use disorder services a community health center can offer via telehealth in a webinar next Friday, June 28 at 9 a.m. ET. Click here to register. For questions or comments about CEO Update, please contact Jessica Zigmond.

Representatives Porter, Bilirakis, and Norcross Introduce Mental Health Parity Compliance Act Reps. Katie Porter (D-Calif.), Gus Bilirakis (R-Fla.), and Donald Norcross (D-N.J.) this week introduced the Mental Health Parity Compliance Act, the House version of the bill that Sens. Bill Cassidy, M.D. (R-La.) and Chris Murphy (D-Conn.) introduced last week. The legislation is based on a best-practice approach that state legislatures in Delaware, Illinois, New Jersey, and Washington, D.C. have enacted and ensures that health insurance providers are following the 2008 Mental Health Parity and Addiction Equity Act. “As part of removing the stigma for treating mental illness, we must ensure that mental health needs are recognized as legitimate healthcare issues,” Bilirakis said in a news release. “One way to do that is to ensure parity between coverage for healthcare and mental healthcare services—which happens to be the law.” NABH, a Mental Health Liaison Group member, signed on to letters supporting both the House and Senate bills. CMS Issues Request for Information for its Patients Over Paperwork Initiative The Centers for Medicare & Medicaid Services (CMS) recently issued a Request for Information (RFI) seeking new ideas from the public about how to continue the agency’s Patients over Paperwork initiative. Launched in 2017, Patients over Paperwork has worked to streamline regulations in healthcare that often take clinicians away from their primary purpose of caring for patients. The new RFI provides an opportunity for the public to share ideas that were not suggested during the first RFI period two years ago. Specifically, CMS is looking for ways to improve reporting and documentation requirements; coding for Medicare and Medicaid payments; prior authorization procedures; policies and requirements for rural providers, clinicians, and beneficiaries; policies and requirements for dually enrolled beneficiaries; beneficiary enrollment and eligibility determination; and CMS processes for issuing regulations and policies. In its comments to CMS, NABH will highlight The High Cost of Compliance, the association’s report that assessed the regulatory burden on the nation’s inpatient psychiatric facilities. Released in March, the report found that three specific regulatory areas impose $1.7 billion in compliance costs each year nationwide, which represent 4.8 percent of an average facility’s annual revenue for all inpatient psychiatric services from all sources. NABH will continue to work with CMS to address the report’s key findings and recommendations. Comments are due by Monday, August 12. HHS’ Office of Adolescent Health Releases Updated Data on Nation’s Teens New data from HHS’ Office of Adolescent Health (OAH) show 31 percent of U.S. high school students in 2017 reported they felt sad or hopeless almost every day for at least two weeks in a row in the past year. The findings are part of OAH’s updated national and state data sheets, which OAH released June 10 to provide estimates on a range of measures related to adolescent health and behavior. The analysis draws on large, nationally representative surveys, and measures include physical activity and nutrition, mentorship, family meals, cigarette and e-cigarette use, driving under the influence, depression systems, bullying, dating violence, and more. ASPE and RTI Recruiting Organizations to Participate in Telehealth Case Studies HHS’ Office of the Assistant Secretary for Planning and Evaluation (ASPE) and RTI International are recruiting organizations to participate in case studies as part of their new assessment of telehealth to treat mental and substance use disorders in youth and adolescent patients. According to ASPE, the goal of the project is to better understand how telehealth is used for these populations; what challenges providers and patients face; and what innovations are happening. This project will especially focus on understanding what policies influence the use of telehealth, including the role of Medicaid in promoting access to telehealth programs. RTI is recruiting organizations to participate in case studies, which will consist of RTI staff conducting in-person discussions with individuals involved in providing, coordinating, and supporting telehealth services (such as administrators, clinicians, and peer support specialists), and a walk-through of the site’s general telehealth model and the technology that is used for it. Discussions during the site visits will focus on challenges the organization may have encountered, strategies employed to overcome these challenges, and overall lessons learned in implementing telehealth to support the delivery of behavioral healthcare. Please e-mail Sarah Wattenberg, NABH’s director of quality and addiction services, if you would like your organization to participate. SAMHSA Accepting Applications for Mental and Substance Use Disorder Practitioner Data Grant The Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting applications for its fiscal year 2019 Mental and Substance Use Disorder (SUD) Practitioner Data grant, which is intended to provide comprehensive data and analysis on individuals who address these conditions. According to the funding notice, the program’s goal is to provide valid data on existing practitioners and usable information to SAMHSA that the agency can use to make policy and planning decisions. SAMHSA said total available funding is $1 million, and applications are due by Monday, Aug. 12. Click here to learn more and apply. CDC Study Examines Connection Between Prescription Opioid Misuse and Binge Drinking More than half of the 4.2 million people who misused prescription opioids during 2012-2014 were binge drinkers, and binge drinkers had nearly twice the odds of misusing prescription opioids, compared with non-drinkers, according to a new study published in the American Journal of Preventive Medicine. Binge drinking is consuming four or more drinks for women and consuming five or more drinks for men, according to the Centers for Disease Control and Prevention (CDC), which conducted the study. The CDC’s analysis shows that people who binge drank were nearly twice as likely to misuse prescription opioids as non-drinkers, even after accounting for other factors that could affect the relationship between prescription opioid misuse and binge drinking, such as age and sex. For this report, CDC researchers analyzed data from the National Survey on Drug Use and Health for 2012, 2013, and 2014 on self-reported binge drinking and prescription opioid misuse during the past 30 days. Scientists found that while young people who binge drank and had higher rates of prescription opioid misuse, two in three people who binge drank and misused prescription opioids were age 26 years and older. Study Finds Association Between Medical Cannabis Laws and Opioid Overdose Mortality Has Reversed Over Time Claims that enacting medical cannabis laws will reduce opioid overdose death should be met with skepticism, researchers noted in a new study in the Proceedings of the National Academy of Sciences (PNAS). Published earlier this week, the study explains that medical cannabis has been touted as a solution to the nation’s opioid overdose crisis since an earlier study found that from 1999 to 2010 states with medical cannabis laws experienced slower increases in opioid analgesic overdose mortality. This recent study used the same methods to extend that analysis through 2017 and concluded that not only did the findings from the original analysis not hold over the longer period, but the association between state medical cannabis laws and opioid overdose mortality reversed direction from -21 percent to +23 percent and remained positive after accounting for recreational cannabis laws. “A more plausible interpretation is that this association is spurious,” the researchers noted. “Moreover, if such relationships do exist, they cannot be rigorously discerned with aggregate data,” they added. “Research into therapeutic potential of cannabis should continue, but the claim that enacting medical cannabis laws will reduce opioid overdose death should be met with skepticism.” NABH Submits Comment Letters to CMS and FCC Extending an Electronic Health Record (EHR) incentive to behavioral healthcare providers and repurposing a national “N11” number for a suicide hotline were the topics of two comment letters that NABH sent recently to CMS and the Federal Communications Commission (FCC). In a letter to CMS, NABH said only a small portion of behavioral healthcare providers are using EHRs. According to data from CMS’ IPFQR program, about 30 to 40 percent of psychiatric hospitals use EHRs, a level that has remained constant. The fiscal year 2019 (FY19) Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) rule emphasizes this, noting: “performance on this measure [use of and electronic health record] has remained relatively static for the past two program years.” NABH urged CMS to establish a program—perhaps within the Innovation Center— that would extend EHR incentives to the behavioral healthcare providers who were excluded from the Health Information Technology for Economic and Clinical Health Act. Extending this funding to behavioral healthcare providers will do far more to improve care for Medicare beneficiaries than any change to conditions of participation, NABH President and CEO Mark Covall noted. The association also sent a letter this month to FCC Secretary Marlene Dortch asking the agency to establish a national number, or N11 number, for a national suicide prevention and mental health crisis hotline system. “Based on the urgency of the suicide crisis and the nature of suicidal ideation, the potential positive outcomes outweigh any costs associated with changing an existing N11 number,” Mark Covall wrote. “This is why we strongly encourage the FCC to move forward immediately and repurpose an existing N11 number for a national suicide prevention and mental health crisis hotline system.” Call for Presentations Now Open for Rx Drug Abuse & Heroin Summit 2020 The Rx Drug Abuse & Heroin Summit is now accepting submissions for its meeting in Nashville, Tenn. from April 13-16, 2020. The Summit will accept presentation proposals in two formats: breakout sessions lasting 75 minutes (including a question-and-answer period), and posters, which will be featured in the exhibit hall. All submissions are due by midnight ET on Friday, August 23. Click here for submission details. Learn about Recovery Centers of America in NABH’s Latest Member Profile! NABH member Recovery Centers of America has created a specialized program called Promoting Recovery through Intensive Support and Education, or PRISE, at its facility in Devon, Pa. to address the problem of multiple relapses for patients seeking addiction treatment. PRISE relies on a three-pronged, therapeutic, evidence-based approach to help patients who have relapsed. Click here to learn more. For questions or comments about CEO Update, please contact Jessica Zigmond.

FAIR Health Analyzes Claims to Determine Behavioral Health Trends from 2007-2017 Claim lines with behavioral health diagnoses increased 108 percent over 10 years, rising to 2.7 percent of all medical claim lines in 2017 from 1.3 percent of all medical claim lines in 2007, according to a new report from not-for-profit organization FAIR Health. Analyzing data from its database of more than 28 billion private healthcare claim records, FAIR Health found that in 2007 and 2017, major depressive disorder (MDD) was the most common diagnosis in the distribution of claim lines with mental health diagnoses, but its share of the distribution fell to 26 percent in 2017 from 28 percent in 2007. Meanwhile, opioid dependence overtook alcohol dependence to occupy the largest share of claim lines with substance use disorder diagnoses, the report said. Although opioid dependence claim lines increased overall during that 10-year period (1,180 percent, growing to 0.252 percent of all medical claim lines from 0.016 percent), they fell 50 percent between 2015 and 2017, the study showed. “FAIR Health conducted this study to provide a strong foundation of key indicators of behavioral health services rendered to the commercial healthcare population,” the report said. “We look forward to providing additional layers to this analysis, including the nature of the services rendered, the type of venue where services were rendered (including telehealth access) and the specialties of the healthcare professionals providing the services.” FAIR Health is a national, independent organization that collects data for and manages the nation’s largest database of privately billed health insurance claims and has Medicare parts A, B, and D claims data from 2013 to the present. Lancet Study Identifies Alcohol Use as a Leading Risk Factor for Global Disease Burden Alcohol use is a leading risk factor for global disease burden, and data on alcohol exposure are crucial to evaluate progress in achieving global, non-communicable disease goals, says a recent modelling study published in The Lancet. The study presents estimates on the main indicators of alcohol exposure in 189 countries from 1990 through 2017 and includes forecasts up to the year 2030. “Based on these data, global goals for reducing the harmful use of alcohol are unlikely to be achieved,” the study’s abstract noted, “and known effective and cost-effective policy measures should be implemented to reduce alcohol exposure. The Joint Commission Releases Standards FAQ Details on Suicide Risk Reduction The Joint Commission this week released a series of Standards FAQ Details related to suicide risk reduction. This series of six Standards FAQ Details center on hospital emergency departments, and include assessing suicide risk, monitoring patients, ligature-resistant requirements, ligature risks that cannot be removed, and safe rooms. NABH Submits Comments to MACPAC on Regulatory Environment in IMDs NABH on Friday sent comments to the Medicaid and CHIP Payment and Access Commission about the regulatory environment for Institutions for Mental Diseases (IMDs). In it, NABH highlighted its recent regulatory report, The High Cost of Compliance: Assessing the Regulatory Burden on Inpatient Psychiatric Facilities, and discussed how the bulk of regulatory costs imposed on the nation’s inpatient psychiatric facilities relate to B-tags and ligature-risk requirements. “Psychiatric providers care first and foremost about keeping patients safe, which includes protecting patients from self-harm or suicidal behaviors,” NABH President and CEO Mark Covall wrote to MACPAC. “However, it’s not feasible for providers to create “ligature-free” environments that are completely devoid of potential ligature-attachment points,” he continued. “Nonetheless, some surveyors demand major changes to psychiatric facilities’ infrastructure or staffing to address perceived issues that carry a minimal risk for patient harm. In our study, NABH facilities reported that, on average, it costs more than $15,600 per psychiatric bed in physical plant and equipment costs to address ligature-related issues.” Read the full letter here. Thank You for Supporting Mental Health Month NABH thanks all its members who helped support our Access to Care campaign during Mental Health Month throughout May. Launched in March, NABH’s Access to Care initiative focuses on two major challenges that too often prevent providers from offering patients a full range of behavioral healthcare services: unjust managed care contracts and countless regulations. Please continue to share our Access to Care video, Board resolution, and regulatory report with those who haven’t seen it yet. NABH Wants to Hear from Your Organization! NABH is eager to feature our member organizations’ good work and innovative programs to help other NABH members learn about new care and business models and practices. Please share with us a best practice or new program that your organization uses to improve patient care, manage your workforce, streamline costs, or all of the above. We will feature your story—along with a photo or other images you provide—in the Member Profile section of our website. If you have a story to share, please contact Cemal Ozgur at cemal@nabh.org for details. As always, thank you for your good work and commitment to advancing NABH’s mission and vision! For questions or comments about CEO Update, please contact Jessica Zigmond.

Mental Health Liaison Group Supports Behavioral Health Coverage Transparency Act NABH and more than 40 other organizations that comprise the Mental Health Liaison Group this week sent letters to House and Senate lawmakers that expressed strong support for the Behavioral Health Coverage Transparency Act of 2019. “In unity, we advocated tirelessly for the enactment of the Paul Wellstone and Pete Domenici Mental Health and Addiction Equity Act of 2008 and recognize that increased transparency and improved accountability of health insurers is essential to fully realizing both the letter and spirit of this landmark law, and its application to the Affordable Care Act,” the letter said. The legislation would require issuers to disclose the analysis they perform in making parity determinations, as well as their denial rates for mental health versus medical/surgical claims and reasons for those denials. In addition, the bill would require federal regulators to conduct a minimum of 12 random audits of health plans per year, and it would create a central online portal for consumers to access publicly available material, such as information about their parity rights and information insurers submit about how they make parity decisions. NABH will keep members apprised of the legislation’s progress. SAMHSA Releases Report on Older Adults Living with Serious Mental Illness The needs and growth of America’s older population with serious mental illness (SMI) exceeds the number of behavioral health providers who are trained in geriatric care, according to a new report from the Substance Abuse and Mental Health Services Administration (SAMHSA). The analysis, Older Adults Living with Serious Mental Illness: The State of the Behavioral Health Workforce, notes that of the 49.2 million adults over the age of 65 years old in the United States, 1.4 to 4.8 percent suffer from SMI. Meanwhile, the U.S. Census Bureau’s National Population Projections show that by 2030, all Baby Boomers— those born between the years 1946-1965—will be older than age 65. At that point, the number of older adults will exceed the number of children. SAMHSA’s report also includes information about workforce barriers, ideas for strengthening the geriatric workforce to address SMI, programs and resources that address the needs of older Americans, and recommendations. Sen. Tina Smith Shares Experience with Depression During Mental Health Month In conjunction with Mental Health Month, Sen. Tina Smith (D-Minn.) shared her personal experience with depression in remarks she gave last week on the U.S. Senate floor. Smith, a member of the Senate Health, Education, Labors and Pensions (HELP) Committee, noted that de-stigmatizing and de-mystifying mental illness is just the beginning, and that everyone can help those in need by urging them to take advantage of available resources. “But the 100 of us here in the Senate have a responsibility to make sure those resources are available to everyone,” Smith said. “We can’t afford to leave holes in the net we build to catch people when they fall.” Click here to read Sen. Smith’s remarks as prepared for delivery and to download the video of her remarks. U.S. News Analysis Shows Link Between Racial Bullying and Risky Health Behavior in Kids Students in California’s public high schools who said they had been bullied because of their race, ethnicity, or national origin were twice as likely to have smoked cigarettes, says a new analysis from U.S. News & World Report. Analyzing data from the California Healthy Kids Survey, U.S. News found that alcohol consumption also was higher—40 percent—among students who had suffered bias-related bulling, compared with 29 percent among those who had not, as were reported usage rates for marijuana, cocaine, and heroin, and for prescription opioids, sedatives, and tranquilizers. More than 395,000 students between ninth and 12^th grades took the survey for the 2017-2018 school year, and nearly 53,000 reported they experienced bullying because of their race, ethnicity, or national origin in the last 12 months. Black students were most likely to experience this type of bias-related bullying, according to the analysis, with more than one in five reporting it had happened to them. Meanwhile, nearly 70 percent of those students who said it happened to them said it happened more than once. Neuroscientist Tom Insel to Serve California as Advisor on Mental Health Issues California Gov. Gavin Newsom (D) this week named psychiatrist and neuroscientist Tom Insel as a key advisor to help the state develop strategies that address mental health issues. A nationally recognized mental health leader, Insel served as director of the National Institute of Mental Health (NIMH), the institute within the National Institutes of Health that conducts research on mental health disorders. Insel has also served as a professor of psychiatry at Emory University, where he was the founding director of the Center for Behavioral Neuroscience in Atlanta. Dr. Insel has led the Mental Health Team at Verily (formerly Google Life Sciences) and most recently served as co-founder and president of Mindstrong Health. Insel served as an Annual Meeting speaker when NABH was known as NAPHS. AATOD 2019 Conference to Highlight Issues and Challenges of Medicated Assisted Treatment This October, the American Association for the Treatment of Opioid Dependence, Inc. (AATOD) will focus on the issues and challenges of medication assisted treatment (MAT) at its annual conference. AATOD said in a conference announcement that it intends to “educate and promote acceptance and integration of MAT options by patients, families, clinicians, the medical system, judicial systems, government, policymakers, social service administrations, and the general public.” AATOD will host its conference October 19-23 at Disney’s Coronado Spring Resort. Click here for more information, and here to register. Separately, AATOD this week released a 20-page analysis of the National Academies of Sciences, Engineering, and Medicine’s report, Medications for Opioid Use Disorder Save Lives, which was released in March. Help Support Mental Health Month: Promote NABH’s Access to Care Initiative There is one week left of Mental Health Month, which the United States has observed throughout May since 1949 to promote awareness about the importance of mental health as a part of overall health. This year, NABH asks its members to promote this important national observance by supporting the association’s Access to Care initiative. Launched in March, NABH’s Access to Care initiative focuses on two major challenges that too often prevent providers from offering patients a full range of behavioral healthcare services: unjust managed care contracts and countless regulations. Please visit our Access to Care page, where you can find resources to post and share with your followers, including our Access to Care video (which you can post directly to your organization’s website and share with others), our Access to Care resolution, our regulatory report, The High Cost of Compliance: Assessing the Regulatory Burden on Inpatient Psychiatric Facilities, and social media messages, including a LinkedIn article from NABH President and CEO Mark Covall. Thank you for your help and support! NABH Wants to Hear from Your Organization! NABH is eager to feature our member organizations’ good work and innovative programs to help other NABH members learn about new care and business models and practices. Please share with us a best practice or new program that your organization uses to improve patient care, manage your workforce, streamline costs, or all of the above. We will feature your story—along with a photo or other images you provide—in the Member Profile section of our website. If you have a story to share, please contact Cemal Ozgur at cemal@nabh.org for details. As always, thank you for your good work and commitment to advancing NABH’s mission and vision! For questions or comments about CEO Update, please contact Jessica Zigmond.  

America’s Health Rankings’ Senior Report Shows Rise in Excessive Drinking and Depression Excessive drinking increased 12 percent from 2016 to 2019 among the nation’s seniors, while the percentage of seniors who reported a health professional has told them they have depression has risen 19 percent in the last year alone, according to America’s Health Rankings’ Senior Report  for 2019. Produced by the United Health Foundation, UnitedHealth Group’s not-for-profit arm, America’s Health Rankings has provided an analysis of national health for 30 years and relies on health, environmental, and socioeconomic data to determine national health benchmarks and state rankings. This year’s Senior Report included a special comparison of data from 2002 and 2017 to show how the health of younger seniors aged 65 to 74 has changed in the last 15 years. Younger seniors now represent 9.1 percent of the U.S. population compared with 6.4 percent of the U.S. population in 2002. Comparing 2017 with 2002, the report showed that excessive drinking is 42 percent higher, obesity is 36 percent higher, and death by suicide is 16 percent higher. All of the results were not negative, however. The findings also showed that among younger seniors today, the death rate is 22 percent lower, smoking is 16 percent lower, and reporting of “very good or excellent health” is 11 percent higher. HRSA Awards $24 million to 120 Rural Organizations for Opioid Response HHS’ Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy this week awarded $24 million for the second round of Rural Communities Opioid Response Program (RCORP) planning grants. Award recipients across 40 states will receive $200,000 for one year to formalize partnerships with local stakeholders, conduct needs assessments, and develop plans to implement and sustain substance use disorder (SUD), including opioid use disorder (OUD) prevention, treatment, and recovery interventions. The goal, according to a statement from HRSA Administrator George Sigounas, M.S., Ph.D., is to reduce the morbidity and mortality of the diseases in high-risk, rural communities. A complete list of all grant recipients is available here. For more information about the RCORP initiative, please contact the Federal Office of Rural Health Policy. Separately, the American Farm Bureau Federation this month sponsored a Morning Consult poll that surveyed rural adults and farmers/farmworkers to better understand factors that affect the mental health of farmers, availability of resources, perceptions of stigma, personal experiences with mental health challenges, and other relevant topics. According to the poll, farmers and farmworkers said financial issues (91 percent), farm or business problems (88 percent), and fear of losing the farm (87 percent) affect farmers’ mental health. Other factors included stress, weather, the economy, isolation, and social stigma. DEA Online Form Available for Physicians Reporting Phone Scams Physicians should be aware of a reported uptick in phone scams from people posing as U.S. Drug Enforcement Administration (DEA) or other federal agents, and report these practices in the DEA’s online form. Earlier this year, the DEA—an agency under the U.S. Justice Department—warned DEA-registered practitioners and members of the public to be cautious of telephone calls from criminals posting as DEA or other law enforcement personnel threatening arrest and prosecution for supposed violations of federal drug laws or involvement in drug-trafficking activities. The DEA’s warning listed more than a handful of types of phone scams, including callers who threaten arrest, prosecution, and imprisonment, and in the case of medical practitioners, revocation of their DEA numbers; as well as callers who demand thousands of dollars via wire transfer or, in some instances, in the form of untraceable gift cards taken over the phone. HRSA Accepting Applications for 2019 Graduate Psychology Education and Nurse Corps Programs The Health Resources and Services Administration (HRSA) is accepting applications for its Nurse Corps Scholarship Program (NCSP) through May 21. The NCSP awards funds to students enrolled in a diploma, associate, baccalaureate, or graduate degree nursing program accept applications for this program if those students commit to serving in high-need, underserved communities. Scholarship support covers tuition, required fees, other reasonable educational costs, and a monthly living stipend. Help Support Mental Health Month: Promote NABH’s Access to Care Initiative This week marked the midway point for Mental Health Month, which the United States has observed throughout May since 1949 to promote awareness about the importance of mental health as a part of overall health. This year, NABH asks its members to promote this important national observance by supporting the association’s Access to Care initiative. Launched in March, NABH’s Access to Care initiative focuses on two major challenges that too often prevent providers from offering patients a full range of behavioral healthcare services: unjust managed care contracts and countless regulations. Please visit our Access to Care page, where you can find resources to post and share with your followers, including our Access to Care video (which you can post directly to your organization’s website and share with others), our Access to Care resolution, our regulatory report, The High Cost of Compliance: Assessing the Regulatory Burden on Inpatient Psychiatric Facilities, and social media messages, including a LinkedIn article from NABH President and CEO Mark Covall. Thank you for your help and support! NABH Wants to Hear from Your Organization! NABH is eager to feature our member organizations’ good work and innovative programs to help other NABH members learn about new care and business models and practices.Please share with us a best practice or new program that your organization uses to improve patient care, manage your workforce, streamline costs, or all of the above. We will feature your story—along with a photo or other images you provide—in the Member Profile section of our website. If you have a story to share, please contact Cemal Ozgur at cemal@nabh.org for details. As always, thank you for your good work and commitment to advancing NABH’s mission and vision! For questions or comments about CEO Update, please contact Jessica Zigmond.

SUPPORT Act Expands Access to Medication Assisted Treatment The Substance Abuse and Mental Health Services Administration (SAMHSA) announced this week that several sections of last year’s SUPPORT Act made changes to the Controlled Substance Act that affords practitioners with greater flexibility in providing medication assisted treatment, or MAT, to patients. Signed into law in October 2018, the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act  allows qualified physicians who are board-certified in addiction medicine or addiction psychiatry, or practitioners who provide MAT in a qualified practice setting,  start treating up to 100 patients in the first year of MAT practice with a waiver. According to SAMHSA, current practitioners with an approved waiver from the agency that authorizes them to treat a maximum of 30 patients at one time are permitted to increase that number to 100 patients if they provide SAMHSA with a notification of their intention to treat 100 patients. Rep. Tonko Expected to Introduce Bill to Deregulate Addiction Treatment Rep. Paul Tonko (D-N.Y.) is expected to introduce legislation next week that would allow physicians to prescribe the addiction-treatment drug buprenorphine without restrictions. Life sciences and medical news outlet STAT reports that about 5 percent of U.S. physicians have undergone the eight-hour training required to prescribe buprenorphine (commonly marked as Suboxone). The bill from Tonko follows a recent announcement that the U.S. Justice Department filed suit again buprenorphine’s best-known manufacturer, Indivior, the British firm that has been accused of marketing Suboxone fraudulently as being safer than generic alternatives. Health Systems Commit to Transforming Behavioral Health in 100 Communities Nationwide Twenty-eight health systems met this week to kick off a new effort to transform the country’s behavioral healthcare resources especially in underserved communities. The collective effort is part of the Medicaid Transformation Project, a national initiative announced last year that is intended to transform healthcare and related social needs for the nearly 75 million Americans who are Medicaid beneficiaries. The announcement came from AVIA, a network of health systems. Citing statistics from SAMHSA, the National Institute of Mental Health, and the Kaiser Family Foundation, Avia noted in its announcement that 44.7 million American adults—including 10 million adults covered by Medicaid—experienced a mental health illness as of 2016, a number that is likely underestimated due to stigma issues. Meanwhile, about 35 percent of adults with a serious mental illness are not receiving mental health treatment. “As jarring as the national behavioral health statistics are, they only serve as the tip of the iceberg for the long-term consequences that we risk if we don’t take wide-reaching, decisive action to address this crisis today,” Andy Slavitt, chair for the Medicaid Transformation Project and former acting administrator at the Centers for Medicare & Medicaid Services, said in a news release. “Twenty-eight healthcare organizations have stepped up to proclaim with a singular, unmistakable voice that enough is enough,” Slavitt continued. “Within the next year, I expect dozens of new positive initiatives to launch. Within five to seven years, we could spark the transformation the country needs.” Last month, Molly Joel Coye, MD, MPH, physician leader in Medicaid transformation at AVIA, addressed attendees at the 2019 NABH Annual Meeting. Please click here for her presentation. Federal Officials Highlight Addiction Treatment Concerns at National Rx Drug Abuse & Heroin Summit The nation’s federal health agencies are concerned about substance use disorder policies that promote short-term medication treatment and premature tapering that could increase the risk of overdose and death, officials told attendees at this the annual Rx Drug Abuse & Heroin Summit in Atlanta this week. Therefore, representatives from the National Institutes of Health (NIH) and the National Institute on Drug Abuse emphasized that expanding the use of medications to treat opioid use disorders—including both access to medication and retention on medication—are essential for long-term recovery. The speakers from NIH also discussed the Healing Communities grants that were awarded to academic institutions in Massachusetts, Kentucky, Ohio, and New York. These studies will test interventions across healthcare, behavioral healthcare, law enforcement, and other community settings, with an emphasis on the impact of coordinated systems of care on reducing overdoses and fatalities; decreasing the incidence of OUD; increasing the numbers who receive opioid medications and are retained in treatment; use of recovery support services; and distributions of naloxone. In addition, the Centers for Disease Control and Prevention (CDC) is cautioning providers against over-generalizing the agency’s guideline on opioid prescribing to settings and populations for which the guideline was not intended. CDC officials noted that many physicians are terminating opioids inappropriately for cancer and other conditions, and also precipitating withdrawal and pushing patients to obtain opioids illegally. Speakers from this week’s summit also expressed concerns about the growing prevalence of stimulant use disorders, the use of cocaine with opioids (also known as speedballing), and the need for medication-based treatment research to better treat these conditions. Law enforcement officials, meanwhile, raised warnings about fentanyl-laced cocaine and fentanyl that is disguised to look like cocaine. They also expressed their concerns that illicit synthetic drug production is growing because the practice has become more profitable—as well as easier to manufacture and distribute. Recently, I was appointed to the National Quality Forum Opioid Technical Expert Panel. This panel was convened as part of last year’s SUPPORT Act to review the landscape of quality measures related to opioids and opioid use disorders, and to recommend measures for inclusion in value-based payment and reporting models under Medicare. A series of web-based meetings will take place through January 2020 and will be open to the public. If you have questions about the National Rx Drug Abuse & Heroin Summit specifically, or addiction treatment more generally, please contact me at sarah@nabh.org. —Sarah Wattenberg, NABH Director of Quality and Addiction Services Drug Enforcement Administration’s National Rx Take-Back Day is April 27 The U.S. Drug Enforcement Administration (DEA) will partner with federal, state, local, and tribal law enforcement agencies and businesses on Saturday, April 27 to host events to collect and safely dispose unwanted medications. Unused prescriptions thrown in the trash can be retrieved, abused, and/or sold illegally, DEA cautioned, and removing unwanted or expired medications from the medicine cabinet is an easy step Americans can take to make a difference in the nation’s opioid crisis. National Rx Take Back Day will take place from 10 a.m. until 2 p.m. ET, and the DEA has provided a Collection Site Locator on its Take Back Day homepage. Mental Health Month Starts Next Week 2019 marks the 70^th anniversary of Mental Health Month, which Mental Health America and its affiliates have observed each May since 1949. This year, Mental Health America will build on its 2018 theme—#4Mind4Body—as it explores the topics of animal companionship (including both pets and support animals), spirituality, humor, work-life balance, recreation, and social connections as ways to boost mental health and general wellness. See Mental Health America’s Mental Health Month toolkit for information and resources. HRSA Accepting Applications for 2019 Graduate Psychology Education and Nurse Corps Programs The Health Resources and Services Administration (HRSA) is accepting applications for its Graduate Psychology Education (GPE) program and its Nurse Corps Scholarship Program (NCSP) until May. HRSA’s GPE program trains doctoral health psychology students, interns, and post-doctoral residents to provide integrated, interdisciplinary, behavioral health and substance use prevention and treatment services in high-need and high-demand areas. The program also supports faculty development of health service psychology. According to HRSA, there is about $18 million in funding for about 40 awards, and it will accept applications through May 7. The NCSP awards funds to students enrolled in a diploma, associate, baccalaureate, or graduate degree nursing program accept applications for this program if those students commit to serving in high-need, underserved communities. Scholarship support covers tuition, required fees, other reasonable educational costs, and a monthly living stipend. HRSA will accept applications through May 21. 2019 NABH Annual Meeting Recorded Presentations Now Available! Recorded presentations, photos, and an updated attendance list from the 2019 NABH Annual Meeting in Washington are now available on NABH’s Annual Meeting homepage. The recorded presentations—along with copies of the speakers’ slide decks—are also available on NABH’s Annual Meeting Speakers & Presentations page. We look forward to seeing you at the 2020 NABH Annual Meeting next March!   For questions or comments about CEO Update, please contact Jessica Zigmond.

OTPs to Follow Standard Care Recommendations for People with Suicide Risk The nation’s opioid treatment programs will be begin following the National Action Alliance (Action Alliance) for Suicide Prevention’s recommended guidelines to care for people with suicide risk in June, the news outlet Stateline reported this week. The story cited statistics from the Centers for Disease Control and Prevention (CDC) that found people with an opioid addiction are at much higher risk for suicide than the rest of the population, and that opioid use was a contributing factor in more than 40 percent of all suicide and overdose deaths in 2017. Guidelines from the Action Alliance will become facilities’ minimum standard of care for patients in both inpatient and outpatient addiction-treatment settings, Michael Johnson, managing director for the Commission on Accreditation of Rehabilitation Facilities, which oversees opioid treatment programs, said in the story. “Right now, there’s no real standards for suicide prevention in addiction treatment programs,” Johnson told Stateline. “We want to change that.” The Action Alliance is a public-private partnership that works to advance the National Strategy for Suicide Prevention and reduce the nation’s suicide rate 20 percent by 2025. Report Finds Older Americans Turning to Suicide in Long-Term Care Settings A six-month investigation from Kaiser Health News (KHN) and the PBS NewsHour has found older Americans are dying by suicide in the nation’s nursing homes, assisted living centers, and adult care homes. KHN analysis of new data from the University of Michigan data suggests that hundreds of suicides by older adults each year, or nearly one per day, are related to long-term care. Meanwhile, thousands more people may be at risk in those settings, where up to a third of residents report suicidal reports, the research found. “Each suicide results from a unique blend of factors, of course,” the study noted. “But the fact that frail older Americans are managing to kill themselves in what are supposed to be safe, supervised havens raises questions about whether these facilities pay enough attention to risk factors like mental health, physical decline, and disconnectedness—and events such as losing a spouse or leaving one’s home,” it continued. “More controversial is whether older adults in those settings should be able to take their lives through what some fiercely defend as ‘rational suicide.’” CDC Finds Kratom Has Caused Nearly 100 Overdose Deaths in the United States The CDC has reported the herbal supplement kratom has caused 91 overdose deaths in 27 states from July 2016-December 2017. Kratom, a plant native to Southeast Asia, contains the alkaloid mitragynine, which the CDC reports can produce stimulant effects in low doses and some opioid-like effects at higher doses when consumed. “As of April 2019, kratom was not scheduled as a controlled substance,” the CDC report noted. “However, since 2012, the Food and Drug Administration has taken a number of actions related to kratom, and in November 2017 issued a public health advisory; in addition, the Drug Enforcement Administration has identified kratom as a drug of concern,” it added. “During 2011–2017, the national poison center reporting database documented 1,807 calls concerning reported exposure to kratom.” FDA Announces Reports of Seizures from Vaping The U.S. Food and Drug Administration (FDA) has announced it has learned some people who use e-cigarettes have experienced seizures, with most reports involving youth or young adult users. “Seizures or convulsions are known potential side effects of nicotine toxicity and have been reported in the scientific literature in relation to intentional or accidental swallowing of e-liquid,” the announcement said. “However, a recent uptick in voluntary reports of adverse experiences with tobacco products that mentioned seizures occurring with e-cigarette use (e.g., vaping) signal a potential emerging safety issue.” The FDA said it continues to monitor all adverse experiences reported to the agency about the use of e-cigarettes and urges the public to report any cases of individuals who use e-cigarettes and have had seizures to the online Safety Reporting Portal. DOJ Reverses Course on Funding for Drug Courts that Reject MAT The U.S. Justice Department (DOJ) has reversed course on its grant announcement earlier this year that rolled back an Obama administration policy that cut funding to courts denying entry to people on medication assisted treatment (MAT), the news outlet Politico reported this week. A clarification from DOJ this week said it will continue following the 2015 funding requirement after the department received a series of inquiries about the policy. HRSA Accepting Applications for 2019 Graduate Psychology Education and Nurse Corps Programs The Health Resources and Services Administration (HRSA) is accepting applications for its Graduate Psychology Education (GPE) program and its Nurse Corps Scholarship Program (NCSP) until May. HRSA’s GPE program trains doctoral health psychology students, interns, and post-doctoral residents to provide integrated, interdisciplinary, behavioral health and substance use prevention and treatment services in high-need and high-demand areas. The program also supports faculty development of health service psychology. According to HRSA, there is about $18 million in funding for about 40 awards, and it will accept applications through May 7. The NCSP awards funds to students enrolled in a diploma, associate, baccalaureate, or graduate degree nursing program accept applications for this program if those students commit to serving in high-need, underserved communities. Scholarship support covers tuition, required feeds, other reasonable educational costs, and a monthly living stipend. HRSA will accept applications through May 21. IPF PEPPER Review Webinar Scheduled for April 24 A webinar to review the Inpatient Psychiatric Facility (IPF) PEPPER (version Q4FY18)—released on Friday, April 5—will be held on Wednesday, April 24 at 3 p.m. ET. Click here to register. For those unable to participate, the session will be recorded and posted on PEPPER.CBRPEPPER.org in the “Training and Resources” section. 2019 NABH Annual Survey Available Online Until April 19 The 2019 NABH Annual Survey is available on the association’s website for members who have not completed it yet. Please take a moment to review the instructions for the survey before completing it. Respondents will not be able to pause the survey and start again. Thank you for your time Learn About Baymark Health Services in NABH’s Latest Member Profile! NABH’s latest member profile features Baymark Health Services, which provides evidence-based opioid use disorder treatment. Baymark focuses on providing individualized treatment options that integrate pharmacotherapy, clinical counseling, recovery support, and medical services. The Baymark system treats more than 50,000 patients each day in the United States and Canada. Learn more about Baymark here. For questions or comments about CEO Update, please contact Jessica Zigmond.

China Bans All Types of Fentanyl, Cutting U.S. Supply China this week announced it would ban all types of the opioid fentanyl, a decision that could slow the supply of the deadly drug to the United States. The decision fulfills a pledge that Chinese leader Xi Jinping made to President Trump in December. House Energy and Commerce Republicans hailed the move in a blog post, noting that fentanyl analogues—synthetic opioids that are 50 times more potent than heroin and 100 times more potent than morphine—are the leading cause of opioid overdose deaths in the United States. ONC Issues Proposed Rule to Revise Conditions of Participation HHS’ Office of the National Coordinator for Health Information Technology (ONC) has issued a proposed rule that would revise the conditions of participation for psychiatric hospitals and require facilities that have electronic health record (EHR) systems “to send electronic patient event notifications of a patient’s admission, discharge, and/or transfer to another health care facility or to another community provider.” The proposal would limit this requirement to only those Medicare- and Medicaid-participating hospitals that possess EHRs systems with the technical capacity to generate information for electronic patient event notifications. NABH is drafting comments on the proposed rule. House and Senate Introduce Bipartisan Bills to Align 42 CFR Part 2 With HIPAA Identical, bipartisan bills were introduced in the House and Senate this week to align 42 CFR Part 2, commonly referred to as Part 2, with the Health Insurance Portability and Accountability Act (HIPAA) for treatment, payment, and healthcare operations, while also strengthening protections against the use of addiction records in criminal, civil, or administrative proceedings. Reps. Earl Blumenauer (D-Ore.) and Markwayne Mullin (R-Okla.) introduced the Overdose Prevention and Patient Safety Act, or OPPS Act, while Senators Shelley Moore Caputo (R-W.V.) and Joe Manchin (D-W.V.) introduced Protecting Jessica Grubb’s Legacy Act, or the Legacy Act. NABH, a member of the Partnership to Amend 42 CFR Part 2, supports both pieces of legislation. GAO Finds Nearly 40 Million American Adults Have Untreated Substance Use Disorders or Mental Health Conditions A recent Government Accountability Office (GAO) report found that nearly 40 million American adults have untreated substance use disorders or mental health conditions, such as depression. According to the national survey, many of these Americans don’t think they need treatment, while others say it’s hard to get care. Left untreated, these behavioral health conditions can cause other health complications—such as drug overdoses—which, in turn, can raise healthcare costs. The GAO noted that the studies it reviewed were limited to specific conditions or locations, and most found higher healthcare costs for adults who didn’t receive behavioral healthcare treatment. There is no generally accepted estimate of the overall costs, the report said. Emergency Medicine News Releases Special Report on Psychiatric Patient Boarding The decline in the number of inpatient psychiatric beds available nationwide could be the most significant factor to help explain the increase in Emergency Department (ED) wait times for psychiatric patients, according to a special report published in Emergency Medicine News. “Those dropped 35 percent between 1998 and 2013,” the report noted, citing JAMA, “And the drop wasn’t just confined to the late 1990s and early aughts; a June 2016 report from the Treatment Advocacy Center, a national nonprofit focusing on making treatment available for severe mental illness, found that the United States had 37,679 state psychiatric beds in 2016, down about 13 percent from 2019,” the report continued. “That comes out to an average of 11.7 psychiatric beds for every 100,00 people, a number far below the 40-60 beds per 100,000 people the center recommends.” CMS Introduces Hospital Provider Burden Tool in April Newsletter The Centers for Medicare and Medicaid Services (CMS) this week introduced its Complexity and Burden of Hospital Reporting Ecosystem map to provide a visual representation of essential reporting interactions between hospital staff and external regulatory agencies, payers, and accrediting organizations. Featured in the April edition of the agency’s Patients Over Paperwork newsletter, the new map is the result of the agency’s work in the field, where CMS made more than 2,000 observations after meeting with 200 hospital leadership, management, and clinical staff last summer. From that research, CMS identified examples of burden, which it narrowed down to 130 themes and 16 insights, such as “hospital staff feel they spend too much time resolving misaligned requirements and interpreting conflicting guidance,” and “hospitals are required to send the same information to different places in slightly different formats. This means hospitals have to hire staff and consultants to manage this complexity.” Federal Leaders to Headline Rx Drug Abuse and Heroin Summit The directors of the National Institutes for Health (NIH) and Centers for Disease Control and Prevention (CDC) are among the plenary speakers at the Rx Drug Abuse and Heroin Summit in Atlanta from April 22-25. Francis Collins, MD, PhD of the NIH and the CDC’s Robert Redfield, MD, as well as Nora Volkow, MD, the director of the National Institute on Drug Abuse (NIDA), will address meeting attendees at this year’s conference. Click here to register for the meeting. IPF PEPPER Review Webinar Scheduled for April 24 A webinar to review the release of the Inpatient Psychiatric Facility (IPF) PEPPER (version Q4FY18)—released today, Friday, April 5—will be held on Wednesday, April 24 at 3 p.m. ET. Click here to register. For those unable to participate, the session will be recorded and posted on PEPPER.CBRPEPPER.org in the “Training and Resources” section. 2019 NABH Annual Survey Available Online The 2019 NABH Annual Survey is available on the association’s website for members who have not completed it yet. Please take a moment to review the instructions for the sruvey before completing it. Respondents will not be able to pause the survey and start again. Thank you for your time! For questions or comments about CEO Update, please contact Jessica Zigmond.

Centene Will Acquire WellCare for $17.3 billion Centene Corp. will acquire WellCare Health Plans, Inc. for $17.3 billion in a deal the two companies announced this week will create a new venture focused on government-sponsored healthcare programs that will have about 22 million members across all 50 states and combined revenue of about $100 billion. News outlet Politico reported that while Centene’s major focus is Medicaid managed care—where it had about 14 million members at the end of 2018—the health insurer has also emerged as a significant player in the Obamacare markets, with about 2 million members across 21 states, or nearly one in five exchange enrollees nationwide, at the start of this year. In 2016, Centene acquired Health Net, another Medicaid managed care plan, for $6.3 billion. Centene and WellCare said in a joint news release the board of the combined company will consist of 11 members, including nine members from Centene’s board and two from WellCare’s board. Centene’s Michael Neidorff will lead the combined company as chairman and chief executive officer, while Ken Burdick and Drew Asher from WellCare are expected to join Centene’s senior management team in new positions as a result of the acquisition. The National Academies Says Medications to Treat OUD Are Effective, but Barriers Prevent Access and Use Three U.S. Food and Drug Administration (FDA)-approved medications to treat opioid use disorder (OUD) are both safe and effective, but most people who would benefit from these treatments do not receive them and access is inequitable, according to a new report from the National Academies of Sciences, Engineering, and Medicine. According to Medications for Opioid Use Disorder Saves Lives, withholding or failing to have available these medications to treat OUD in any care or criminal justice setting is denying appropriate medical treatment. The report identified misunderstanding and stigma, inadequate education and training, current regulations, and the fragmented system of care for people with OUD as the barriers to treatment. “The United States is experiencing a public health crisis of almost unprecedented scale — an epidemic of opioid use disorder and related overdose deaths,” Alan Leshner, chief executive officer emeritus of the American Association for the Advancement of Science, and chair of the committee that conducted the study, said in a news release. “The factors impeding full use of FDA-approved medications to treat OUD must be addressed, including stigma surrounding both addiction and the medications used to treat it as well as counterproductive ideologies that consider addiction simply a failure of will or a moral weakness, as opposed to understanding that opioid use disorder is a chronic disease of the brain that requires medical treatment,” he continued. “Curbing the epidemic will require an ‘all hands on deck’ strategy across every sector — healthcare, criminal justice, people with OUD and their family members, and beyond — in order to make meaningful progress in resolving this crisis.” ASTHO Recommends Approaches to SUD Prevention and Treatment The Association of State and Territorial Health Officials (ASTHO) and the National Academy for State Health Policy (NASHP) have released four recommendations on how public health and Medicaid agencies can engage in cross-agency work to prevent and treat substance use disorder (SUD). In 2018, the two groups convened the Cross-Agency Leaders Roundtable—a group of 10 Medicaid and public health officials—to develop the recommendations. The roundtable included representatives from the state health departments in Alaska, California, Massachusetts, New York, Ohio, Oregon, Pennsylvania, Virginia, and Washington. According to the report, the leaders recommend that public health and Medicaid agencies determine an appropriate mechanism to catalyze cross-agency collaboration and create a unified administrative structure; optimize the use of state resources, including funding and staff, to maximize reach and impact; align policies across agencies for prescribing, treatment, training, and use of evidence-based best practices among providers; and utilizes a range of data sources to measure progress, inform state leadership and the public, and develop policy. Click here to learn more. Veterans Affairs Partners with Objective Zero Foundation on Suicide Prevention The Veterans Affairs Department announced this week that it has partnered with the not-for-profit Objective Zero Foundation to connect veterans with suicide prevention support and resources. The new partnership, which became formal in early December, provides a shared goal to prevent suicide among service members and veterans, and focuses especially on service members transitioning out of the military. Objective Zero offers a free mobile app that connects veterans, service members, their families and caregivers—instantly and anonymously—to suicide-prevention resources and a nationwide community of peer supporters via text, voice, and video chat. “At VA, we are working to prevent veteran suicide by using an approach that looks beyond our traditional health care settings,” VA Secretary Robert Wilkie said in a news release. “Our partnership with Objective Zero is an integral part of reaching veterans where they live, work, and thrive, and we are looking forward to working more closely with them.” NQF and AHA Release Telebehavioral Health Guide The National Quality Forum (NQF) and the American Hospital Association (AHA) have developed a guide to help hospitals and health systems deliver innovative, high-quality telebehavioral health services. Released at the NQF’s annual conference this week, Redesigning Care: A How-To Guide for Hospitals and Health Systems Seeking to Implement, Strengthen and Sustain Telebehavioral Health focuses on six “success factors,” including leadership commitment; organizational policies and clinical workflows; staff education and training; patient, family, and caregiver engagement; measurement, and community partnerships. Click here for more information and to purchase the guide. Center on Addiction Study Reviews and Compares Addiction Benefits in ACA Plans More than half of the states offered Affordable Care Act (ACA) plans in 2017 that did not comply with the 2010 healthcare law’s requirements for covering SUD benefits, according to Uncovering the Gaps II: A Review and Comparison of Addiction Benefits in ACA Plans, a new report from the Center on Addiction. Meanwhile, about 20 percent of the states offered ACA plans that year that violated parity requirements. The 79-page report highlights the coverage gaps in ACA plans sold to Americans in 2017 and compares the benefits in these plans to the benefits in 2017 Essential Health Benefit (EHB) benchmark plans. “Once again, our research demonstrates the need to improve insurance coverage for addiction treatment,” the report noted. “Commercial insurers tout their role in addressing the opioid epidemic, but most of their initiatives have addressed inappropriate prescribing of prescription opioids,” it added. “This is important but insufficient. Too many patients continue to be denied access to life-saving care, and their families are forced to battle with their insurance companies in a time of crisis.” Vista Research Group Releases Report on State of Addiction Treatment Vista Research Group, which focuses on improving treatment outcomes, has released The State of Addiction Treatment, a report that provides an overview of addiction treatment in the United States and also examines both commercial payer and regulatory trends, measurement outcomes, and the evolving landscape of SUD mergers and acquisitions. According to the report, in a small, informal study of 73 addiction treatment center leaders, 23 percent reported that they’re concerned about their ability to stay in business. When asked to identify their respective treatment center’s biggest challenge, respondents reported a range of issues, such as being paid sufficiently to cover their costs; keeping their census up; finding qualified staff; managing regulatory requirements; and dealing with rapid growth or acquisitions. CMS’ Medicaid Innovation Accelerator Program to Host SUD Webinar on April 3 The Centers for Medicare & Medicaid Services (CMS) Innovation Accelerator Programs Reducing Substance Use Disorder program area will host a national learning webinar on Wednesday, April 3 from 3 p.m. to 4 p.m. ET. The webinar is meant to help participants identify and treat complex conditions, the unique challenges and needs of the SUD population with these conditions, and reasons why customizing approaches for this population is necessary.Click here to register. IPF PEPPER Review Webinar Scheduled for April 24 A webinar to review the release of the Inpatient Psychiatric Facility (IPF) PEPPER (version Q4FY18)—which is scheduled for April 5—will be held on Wednesday, April 24 at 3 p.m. ET. Click here to register. For those unable to participate, the session will be recorded and posted on PEPPER.CBRPEPPER.org in the “Training and Resources” section. For questions or comments about CEO Update, please contact Jessica Zigmond.

NABH Launches Access to Care Initiative at 2019 Annual Meeting NABH this week kicked off Access to Care, the association’s new initiative that will provide information and resources to help inform policymakers, regulators, payers, and patient advocates that only true access can lead to recovery. Access to Care focuses on two major challenges: unjust managed care contracts and countless regulations, both of which often prevent behavioral healthcare providers from offering patients a full range of services. As part of this initiative, the NABH Board of Trustees on March 18 adopted the Access to Care resolution, which addresses unfair managed-care practices and recommends guiding principles for providers and payers to incorporate in contracts with managed care organizations (MCOs). NABH’s provider systems are committed to ensuring patient access to behavioral healthcare treatment across the entire behavioral healthcare continuum, which includes inpatient, residential, partial hospitalization, intensive outpatient, outpatient, and recovery and support services. Too often, MCOs limit coverage to crisis stabilization or short-term, acute-care services for all levels of care because they use internally developed and/or proprietary and non-transparent, medical-necessity criteria. “As our Access to Care resolution states, ‘Fair and appropriate coverage for behavioral healthcare services must ensure—not solely offer—access to the entire behavioral healthcare continuum,” NABH Board Chair Pat Hammer, president and CEO of Oconomowoc, Wis.-based Rogers Behavioral Health, said in a news release about the resolution. “For this to happen, fair and reasonable managed care contracts must include and apply generally accepted standards of professional practice.” NABH created a Managed Care Committee last fall to identify problems and propose solutions in managed care contracts. The association shared copies of the resolution with attendees at the meeting and NABH Board Chair Pat Hammer introduced NABH’s Access to Care video—which personalizes behavioral healthcare services—at the Annual Meeting’s opening session. On March 19, NABH released The High Cost of Compliance: Assessing the Regulatory Burden on Inpatient Psychiatric Facilities, a comprehensive report that examines the burdens that certain regulations impose on the nation’s inpatient psychiatric facilities. commissioned Manatt Health to conduct this first-of-its-kind study that focuses on three federal regulatory domains attached to participation in the Medicare program: the so-called “B-tag” requirements, a detailed set of standards for patient evaluations, medical records, and staffing in inpatient psychiatric facilities; “ligature risk points,” or those aspects of the physical environment that a patient could use to attempt self-strangulation; and the Emergency Medical Treatment and Labor Act (EMTALA), which obligates a hospital to screen all patients for emergency medical conditions, and, if an emergency condition is identified, to stabilize the patient before the patient may be discharged or transferred. The findings estimate that, taken together, these three regulatory areas impose $1.7 billion in compliance costs nationwide each year. Put another way, these regulatory burdens represent about 4.8 percent of an average facility’s annual revenue for all inpatient services from all sources. NABH President and CEO Mark Covall presented a copy of the report to HHS Deputy Secretary Eric Hargan on Tuesday before the deputy secretary addressed Annual Meeting attendees. In his presentation, Deputy Secy. Hargan called the report “timely” and later tweeted about how he had the opportunity to discuss HHS’ efforts to fund substance use disorder treatment and recovery services—and examine the regulatory barriers that stand in the way of improvement—with NABH. NABH urges its members to visit the Access to Care for these resources, to post the new Access to Care video online, and to share it on Twitter and LinkedIn. And please remember to follow us @NABHBehavioral and on LinkedIn at the National Association for Behavioral Healthcare! 2019 NABH Annual Meeting Materials Available Online NABH thanks its members, exhibitors, sponsors, and other guests who traveled to Washington this week for the 2019 NABH Annual Meeting. Please visit the Speakers & Presentations tab on NABH’s Annual Meeting homepage to download the presentations that included PowerPoint slide decks, the Access to Care page for all materials related to the association’s new initiative, and NABH’s Be an Advocate page for all Hill Day materials. Video recordings of the presentations will be posted to NABH’s website at a later date. The NABH team looks forward to seeing you again in 2020! For questions or comments about CEO Update, please contact Jessica Zigmond.

President’s Budget Maintains Opioid Funding Levels and Cuts Behavioral Healthcare Funding In his Fiscal Year 2020 budget released this week, President Donald Trump proposed $4.8 billion—which maintains congressional funding levels—to combat the nation’s opioid crisis and proposed hundreds of millions in funding cuts to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) budget and to behavioral healthcare research. According to the president’s proposal, SAMHSA would see a $65 million cut to its total budget, while the behavioral healthcare-related institutes within the National Institutes of Health would see even more severe funding decreases with $436 million in cuts to behavioral healthcare research. For the third year in a row, the president has proposed cutting the Office of National Drug Control Policy’s by more than 95 percent and repealing the Patient Protection and Affordable Care Act’s Medicaid expansion. The budget proposal would also require states to choose between a per-capita cap or a block grant for their Medicaid programs. Each year, the president’s budget is important because it provides a blueprint for the president’s priorities and policy recommendations to Congress. The president’s budget is also significant because it marks the start of the legislative appropriations process. Watch HHS Secretary Alex Azar’s testimony about the Trump administration’s Fiscal Year 2020 budget here. National Survey Shows More Teens and Young Adults Experiencing Mental Health Issues A new nationwide survey found a 50-percent increase in depressive episodes for individuals between the ages of 12 and 17 between 2005 and 2017. Published in the Journal of Abnormal Psychology, the study examined 200,000 people aged 12–17 and 400,000 people aged 18 and older at various points between 2005 and 2017 about any psychological distress and depressive episodes they had experienced. The findings showed a slightly bigger increase—63 percent—in young adults aged 18–25 than in the younger age group. “Cultural trends contributing to an increase in mood disorders and suicidal thoughts and behaviors since the mid-2000s, including the rise of electronic communication and digital media and declines in sleep duration, may have had a larger impact on younger people, creating a cohort effect,” the study said. In its general scientific summary, the study noted that more “U.S. adolescents and young adults in the late 2010s (versus the mid-2000s) experienced psychological distress, major depression, and suicidal thoughts, and more (people) attempted suicide, and took their own lives.” SAMHSA Releases Guidance on Strategies to Promote Best Practice in Antipsychotic Prescribing for Children and Adolescents SAMHSA has released its Guidance On Strategies to Promote Best Practice in Antipsychotic Prescribing for Children and Adolescents. The new resource offers six key principles for system-level strategies, including youth and family engagement, a multi-modal approach, prescribing clinician engagement, consideration for the unique needs of special populations, coordination with other youth-serving systems, and sustainable financing mechanisms. SAMHSA Releases Principles of Community-Based Behavioral Health Services for Criminal Justice Involved Individuals SAMHSA recently released Principles of Community-Based Behavioral Health Services for Criminal Justice Involved Individuals to provide a framework for a quality, community-based behavioral health treatment system that responds to individuals with mental and substance use disorders. The guide is meant to help community-based behavioral healthcare providers in their clinical and case management practices with people who have mental and substance use disorders and are currently involved with or have been involved in the adult criminal justice system. It’s also intended for agency leaders and program developers responsible for shaping how their organizations deliver community-based services. The guide is composed of eight guiding principles, as well as frequently asked questions, resources for additional reading, and a glossary of terms for behavioral healthcare providers and criminal justice professionals. HRSA to Host Webinar on Opioid Response Program Funding Opportunity on March 27 The Health Resources and Services Administration’s (HRSA) Rural Communities Opioid Response Program (RCORP) has released a funding opportunity for implementation grants. HRSA will make available about 75 awards of up to $1 million each to networks and or/consortia to enhance substance use disorder (SUD), including opioid-use disorder (OUD). HRSA will host a webinar about this opportunity on Wednesday, March 27 from 11:30 a.m. ET until 1 p.m. ET. Click here for the weblink. Separately, the Centers for Medicare & Medicaid Services updated its opioid prescribing mapping tool. For the first time, the tool includes data for opioid prescribing in the Medicaid program. The tool also makes geographic comparisons of Medicare part D opioid prescribing rates over time for both urban and rural communities. Join Us! The 2019 NABH Annual Meeting—Behavioral Healthcare: Improving Coordination, Collaboration, Integration— kicks off on Monday, March 18. If you haven’t done so yet, please take a moment to read our updated preliminary program and visit our speakers page. Also, NABH thanks all of the companies that will serve as exhibitors or sponsors at this year’s Annual Meeting. Please take a moment to view our exhibitors and sponsors on our Annual Meeting homepage, where you can click on each organization to learn more. Also, please remember to visit with our exhibitors and sponsors during at the Mandarin Oriental Washington, DC next week. We look forward to seeing you in Washington! For questions or comments about CEO Update, please contact Jessica Zigmond.

NABH Applauds Landmark Behavioral Healthcare Coverage Ruling in California NABH applauded the decision filed in California’s Northern District earlier this week that will open access to behavioral healthcare services for those who need it. “It has been 10 years since President George W. Bush signed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, and we have yet to achieve full parity,” NABH President and CEO Mark Covall said in a statement on March 5. “Today’s decision in California’s Northern District is a turning point. The federal court’s ruling made it clear that insurance companies must use generally accepted standards in the full behavioral healthcare continuum to help patients gain access to the care they need for recovery.” In a nationwide class action lawsuit, the U.S. District Court for the Northern District of California on Tuesday held that United Behavioral Health (UBH) — the country’s largest managed behavioral healthcare organization — developed restrictive medical-necessity criteria that it used to deny coverage for outpatient, intensive outpatient, and residential treatment services. According to the decision, the Court found that UBH’s internal guidelines limited coverage to acute care services, disregarding highly prevalent, chronic, and co-occurring disorders that required greater intensity and/or duration. The Court also found that UBH failed to meet a requirement related to children and adolescents, asserting that although generally accepted standards of care do not require UBH to “create an entirely separate set of guidelines to address the needs of children and adolescents… they do, however, require that UBH’s guidelines instruct decision-makers to apply different standards when making coverage decisions involving children and adolescents, where applicable, including relaxing the criteria for admission and continued stay to take into account their stage of development and the slower pace at which children and adolescents generally respond to treatment.” NABH is especially pleased to see the Court acknowledge that mental health and substance use disorders are chronic illnesses, and that managed care organizations must cover care that not only stabilizes the acute aspects of a patient’s illness, but also addresses a patient’s underlying condition. President Trump Creates Task Force to Develop Blueprint for Suicide Prevention Among Veterans President Trump this week signed an executive order creating a Cabinet-level task force to draft a blueprint for suicide prevention among veterans within one year. The new President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide (PRESENTS) initiative will work to develop a grant system that extends funding to state and local programs and coordinate suicide-prevention research across agencies in the Veterans Affairs, Defense, and Homeland Security departments. Bipartisan Group of Senators Ask HHS to Update Part 2 Thirteen U.S. senators this week sent a letter to HHS Secretary Alex Azar asking his department to initiate a rulemaking process to update the Confidentiality of Alcohol and Drug Abuse Patient Records 42 Code of Regulations 2, known as Part 2. “Part 2 provisions are not compatible with the way health care is delivered currently,” said the letter from 7 Republicans and 6 Democrats. “In order to bring them in line with 21^st Century medicine, it is imperative to modernize the regulations,” the letter continued. “Initiating a rulemaking process will open the door for necessary reforms, allowing for better coordination, safer and more effective treatment for patients, and stronger patient protections.” Mental Health Liaison Group Sends Senate HELP Committee Behavioral Healthcare Priorities Strengthening parity enforcement and compliance, stabilizing the health insurance marketplace, and integrating behavioral healthcare are the top three steps the federal government and the states could take to lower U.S. healthcare costs, the Mental Health Liaison Group said in a letter to the Senate Committee on Health, Education, Labor and Pensions (HELP) this week. “In order to make meaningful, effective and long-lasting change within the U.S. healthcare system, we need to make long-term investments,” the letter said. “If we continue to look for cost-saving measures in the short-term, we will continue to fall short for American families, providers, and employers.” NABH has been a longtime member of the Mental Health Liaison Group. Missouri Hospital Association Examines Suicidality Rates After Psychiatric Hospitalizations Among Children The 60-day suicidality rate following a psychiatric hospitalization nearly doubled for children and adolescents with insurance coverage that shifted from Medicaid fee for service to Medicaid managed care organizations in Missouri following statewide expansion of managed care in May 2017, according to a new report from the Missouri Hospital Association. The report said the average length of stay at psychiatric hospitals for children and adolescents with Medicaid managed care coverage is 7.3 days, while the average duration is 12.5 for Medicaid fee-for-service patients “— a difference of 5.2 days, or 71 percent — which can be critical time needed to stabilize the child or adolescent before discharge back into the community.” Child and adolescent suicide is a pervasive problem in Missouri, where it is the second-leading cause of death among children ages 5 to 19. Missouri had the 11^th-highest rate of child and adolescent suicide in the country during 2017 with 6.4 suicide deaths per 100,000 children in this age group. The Joint Commission Issues Ligature Risk and Suicide Risk Reduction Alerts The Joint Commission this week sent two alerts regarding ligature risk and suicide risk reduction. Both the National Patient Safety Goals alert and Environment of Care alert examines if video monitoring and electronic sitters can be used to watch patients at high risk for suicide. Thank you to Our 2019 NABH Annual Meeting Exhibitors and Sponsors! The 2019 NABH Annual Meeting—Behavioral Healthcare: Improving Coordination, Collaboration, Integration— is a little more than one week away! NABH thanks all of the companies that will serve as exhibitors or sponsors at the 2019 NABH Annual Meeting in March. Please take a moment to view our exhibitors and sponsors on our Annual Meeting homepage, where you can click on each organization to learn more. Also, please remember to visit with our exhibitors and sponsors during the Annual Meeting from March 18-20 at the Mandarin Oriental Washington, DC. And if you haven’t done so yet, please take a moment to read our updated preliminary program and visit our speakers page. We look forward to seeing you in Washington! For questions or comments about CEO Update, please contact Jessica Zigmond.