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CEO Update | 45

Written by Administrator on . Posted in CEO Updates.

Commonwealth Fund Summarizes Care Programs for Patients with Complex Needs The Commonwealth Fund has released a Quick Reference Guide to Promising Care Models for Patients with Complex Needs, which summarizes the target populations and key features of 28 care models for adults with complex needs, including behavioral health. This guide was updated this year using the original version of the Quick Reference Guide that was developed in December 2016, data from a survey that the Center for Health Care Strategies conducted for the Better Care Playbook’s State Map, and literature searches. The Commonwealth Fund included models that targeted adults with complex needs; provided at least one element of patient-centered care; and had strong, moderate, or promising evidence on at least one outcome related to quality, utilization, or cost. Massachusetts to Help Test New Addiction Treatment Rating System Massachusetts will participate in a new rating system developed to measure the quality of addiction treatment programs, the Associated Press reported earlier this week. Health officials for the commonwealth said the rating system will use data from insurance claims, provider surveys, and consumer-experience surveys. The information will be made public to those seeking addiction treatment, as well as to public and private payers, states, and referral sources. The national not-for-profit organization Shatterproof is developing the rating system. If successful, the pilot program will be launched nationwide. Pew Research Center Reports Teens See Anxiety, Depression Among Their Peers Seven in 10 teens today see anxiety and depression as major problems among their peers, says a new report from the Pew Research Center. Anxiety and depression top the list of problems teens see among their peers, ahead of bullying, drug addiction, alcohol, poverty, teen pregnancy, and gangs, according to the survey of U.S. teens between the ages of 13 and 17. The study also noted that mental health concerns cross income boundaries, while teen pregnancy is seen as a much bigger problems by teens in lower-income households. Stanford Study Finds Opioids Less Effective for Patients on SSRI Antidepressants Patients who take the most common form of antidepressant and are given the most widely prescribed opioid experience less pain relief, according to a study this month from the Stanford University School of Medicine. Researchers say the finding could help address the nation’s opioid crisis because poorly managed pain may lead to opioid misuse. The study noted that as many as 1 in 6 American takes antidepressants, mostly selective serotonin reuptake inhibitors (SSRIs). Stanford’s research team found that SSRIs reduce the effectiveness of hydrocodone and codeine, which are often prescribed to patients who recently had surgery. “This research is part of our effort to find ways to combat the opioid epidemic,” Tina Hernandez-Boussard, Ph.D., M.P.H., associate professor of medicine, of biomedical data science, and of surgery at Stanford, said in a statement. “We’re very interested in identifying how we can reduce opioid exposure while still managing patients’ pain.” CMS Presents Podcast Series to Inform Broader Audience The Centers for Medicare & Medicaid Services (CMS) this week presented CMS: Beyond the Policy, a new podcast series intended to provide important, timely information to a broad audience. Through its outreach and education, CMS learned from physicians that a podcast would be an effective way to present important and up-to-date information. The first episode in the series focuses on evaluation and management coding, and the agency will release new episodes in the coming months that highlight the agency’s new proposals, policies, and programs. HRSA Expects to Release Up to 10 percent of Nurse Corps Repayment Program Awards to Psychiatric Nurses In 2019 the Health Resources and Services Administration’s (HRSA) Nurse Corps Repayment Program expects to make up to 10 percent of loan repayment awards to psychiatric nurse practitioners, the skilled specialists helping to address the nation’s opioid crisis. The repayment program supports registered nurses, advanced practice registered nurses, and nurse faculty by paying up to 85 percent of their unpaid nursing education debt. In return, participants must serve for at least two years at a healthcare facility with a critical shortage of nurses, or, for nurse faculty, at an eligible school of nursing. HRSA will accept applications for its Nurse Corps Loan Repayment Program through March 28. Click here for more information. Remember to Register for the 2019 NABH Annual Meeting! Please register today for the 2019 NABH Annual Meeting if you haven’t yet! For complete Annual Meeting details, including preliminary program and speaker information, please visit NABH’s Annual Meeting homepage. For questions or comments about CEO Update, please contact Jessica Zigmond.

CEO Update | 44

Written by Administrator on . Posted in CEO Updates.

SAMHSA Reports Total Behavioral Health Spending Rose 62 Percent from 2006-2015 Total mental health and substance use disorder (SUD) treatment spending rose about 62 percent to $212 billion in 2015 from $131 billion in 2006, according to a new report from the Substance Abuse and Mental Health Services Administration (SAMHSA). The federal health agency noted in its 72-page analysis that SUD spending was more pronounced than mental health spending, particularly between 2010-2015, when spending climbed to $56 billion from $23 billion. Spending growth for mental health, meanwhile, generally matched total healthcare spending growth between 2006 and 2015. “Public versus private spending on mental health was relatively constant, with private spending accounting for 42 percent of spending in 2015,” the report noted. “Conversely, spending on SUD treatment saw greater growth and major shifts in payer sources and care settings compared with mental and total health spending,” it continued. “Private insurance and Medicaid both became larger payers of SUD treatment.” NIDA Releases 2018 Monitoring the Future Survey Results Prescription opioid misuse has dropped significantly among the nation’s 12th graders in the last five years, while vaping rates are second only to alcohol among substances surveyed, the National Institute on Drug Abuse (NIDA) reported in the 2018 Monitoring the Future (MTF) survey released this week. Researchers at the Institute for Social Research at the University of Michigan conduct the annual survey of 8th, 10th, and 12th graders under a grant from the National Institute on Drug Abuse. Since 1975, the survey has measured how 12th graders report their drug and alcohol use; the survey added 8th and 10th graders to the survey in 1991. In 2018, 44,482 students from 392 public and private schools participated. The report noted there has been a significant decline in monthly cigarette use among 12thgraders since 1993, while the rate of monthly marijuana use has increased. Monthly cigarette use among 12th graders was 7.6 percent in 2018, compared with a rate of 36.5 percent in 1997, the peak year for cigarette use among teams. Meanwhile, the rate for monthly marijuana use among teens was 22.2 percent in 2018, compared with a rate of 15.5 percent in 1993. CMS and ONC Propose Rules to Improve Electronic Health Information Interoperability The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) this week proposed rules intended to support the secure access, exchange, and use of electronic health information seamlessly. CMS has proposed that Medicaid, the Children’s Health Insurance Program, Medicare Advantage plans and Qualified Health Plans in the federal health insurance exchanges must provide enrollees with immediate electronic access to medical claims and other health information electronically by 2020. To support patient-centered healthcare, CMS would require these healthcare providers and plans to implement open data sharing technologies to support transitions of care as patients move between these plan types. “Today’s announcement builds on CMS’ efforts to create a more interoperable healthcare system, which improves patient access, seamless data exchange, and enhanced care coordination,” CMS Administrator Seema Verma said in an announcement.  “By requiring health insurers to share their information in an accessible, format by 2020, 125 million patients will have access to their health claims information electronically. Kaiser Family Foundation Releases Data on Medicaid Coverage of Behavioral Health Services The Kaiser Family Foundation (KFF) this week released data on Medicaid coverage of behavioral health services across the country based on a survey of Medicaid directors in all 50 states and Washington, D.C. KFF contracted with Health Management Associates for the survey, which asked Medicaid directors to identify the behavioral health services covered for adult beneficiaries in their programs. The survey gathered information about services covered, cost-sharing requirements, and notable limits on those services as of July 1, 2018. All but four states—Illinois, Iowa, New York, and South Carolina—submitted survey responses. The Medicaid Behavioral Health Services Database breaks down information in five categories: Institutional Care and Intensive Services; Outpatient Facility Services and/or Provider Services; Other Behavioral Health Services; Substance Use Disorder Services; and Naloxone. To view a summary table, see page 3 here. California Attorney General Xavier Becerra Urges Insurers to Improve Access to Care California Attorney General Xavier Becerra this week pressed insurance providers to remove prior authorization requirements for medication assisted treatment (MAT) for individuals with an opioid use disorder.   In his letter to 17 health insurance executives, Becerra noted that authorization requirements for MAT burdens individuals suffering from opioid use disorder by creating barriers to treatment. “I urge insurance providers to join us in our efforts to give patients the treatment they need and deserve,” Becerra said in an announcement, “without the burdens of lengthy medical paperwork and processes.” American Psychiatric Association Names Jeffrey Geller, M.D., M.P.H. as President-Elect The American Psychiatric Association (APA) announced this week that its members have chosen Jeffrey Geller, M.D., M.P.H. as the medical society’s next president-elect. Geller is the professor of psychiatry and director of public sector psychiatry at the University of Massachusetts Medical School. He has held a number of APA leadership positions and serves on the SAMHSA National Advisory Council, according to the APA. “I plan to focus on improving the profession, partly by easing the administrative, documentation and certification burdens placed on our members as they work to deliver high-quality care and treatment to our patients,” Geller said in the APA’s announcement. “I will also strive to advocate for equal coverage of mental illnesses as mandated by law, but not enforced, and to combat the terribly harmful discrimination against both psychiatric patients and psychiatrists.” Geller’s appointment will become official after the APA Board of Trustees confirms the association’s election results at its March meeting.   Federal Grant Available to Fuel Research for Improving Employment Outcomes for People with Psychiatric Disabilities The Rehabilitation Research and Training Center on Improving Employment Outcomes for People with Psychiatric Disabilities—under HHS’ Administration on Community Living—has announced a grant opportunity to conduct research, training, and other related activities to contribute to better employment outcomes for adults with psychiatric disabilities. The funding opportunity is part of an ongoing collaboration between SAMHSA and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). Click here to learn more about the grant funding opportunity. Applications are due by Saturday, April 13, 2019. Learn About American Addiction Centers in NABH’s Latest Member Profile NABH members can learn about the work that American Addiction Centers (AAC) is doing in the area of pharmacogenetics in the association’s latest Member Profile. American Addiction Centers’ Addiction Labs—one of the few labs in the United States dedicated solely to addiction treatment—applies a personalized approach to ensure patients receive the right medication and dosage with fewer side effects and faster results. Part of AAC’s approach includes pharmacogenetic testing, which combines the study of medications and genetic traits. Through genetic testing, physicians can develop personalized treatment protocols to improve therapeutic initiatives and ensure that patients receive proper medication at the earliest point in their treatment. If you would like your organization to be featured in a Member Profile on NABH’s website, please contact Cemal Ozgur at (cemal@nabh.org). Please Join Us for Hill Day 2019! Building on last year’s success, NABH is pleased to present Hill Day 2019 at the association’s Annual Meeting in Washington, DC next month. The NABH team will schedule Capitol Hill meetings and briefings for interested Annual Meeting attendees during Hill Day on Tuesday, March 19, 2019 from 1:30 to 5 p.m. ET. NABH will provide background materials and legislative priority documents to attendees before Hill Day, and will also conduct advocacy training during the Annual Meeting. To take advantage of this free opportunity, please indicate that you want to participate in Hill Day when you register for the 2019 NABH Annual Meeting, or contact Julia E. Richardson, director of advocacy and senior counsel, at julia@nabh.org or 202.393.6700, ext. 103. Please visit NABH’s Annual Meeting homepage to view the meeting’s preliminary program and learn about the meeting’s speakers, exhibitors, and sponsors. We look forward to seeing you in Washington!   For questions or comments about CEO Update, please contact Jessica Zigmond.

CEO Update | 43

Written by Administrator on . Posted in Uncategorized.

SAMHSA Expands Capacity for Substance Use Disorder The Substance Abuse and Mental Health Services Administration (SAMHSA) has announced it will invest $8.3 million for community projects that target a specific population for substance use disorder (SUD) treatment In its announcement, SAMHSA said the program will make 22 awards of up to $375,000 per year for three years and will allow each community to identify the specific need or population it wishes to address through evidence-based SUD treatment and/or recovery-support services. NIMH Director Provides Update on HEAL Initiative to Address the Nation’s Opioid Crisis The director of the National Institute of Mental Health this week highlighted the efforts of the Helping End Addiction Long-term, or HEAL, initiative to address the nation’s opioid crisis that the National Institutes of Health launched last April. In his message, NIMH Director Joshua Gordon, MD, PhD wrote that among the millions of adults who misused opioids in the prior year, about 40 percent had a mental illness, and about 15 percent had a serious mental illness. He also emphasized some of the research that NIMH has supported to help people with both mental illness and SUD. “These efforts include those by the Biomedical Development Corporation to explore the role of mHealth efforts in treating opioid use disorder,” Gordon wrote. “These researchers are studying the effectiveness of a software platform that helps patients tracks their symptoms and delivers evidence-based information through web- and smartphone-based channels,” he continued. “NIMH supports this project through out Small Business Innovation Research program, which aims to speed discovery, dissemination, and implementation of effective mental health treatments.” Meanwhile, the NIMH also sponsors the Mental Health Research Network, which leverages electronic health records at major not-for-profit healthcare providers to conduct large-scale research on a range of topics, including the intersection among opioid use, depression, and suicide. Wall Street Journal Reports Twitter May Help Identify Spikes in Drug Overdoses Twitter may help researchers predict upticks in drug misuse and overdoses, The Wall Street Journal reported this week. According to the story, research shows the social media site provides a quick—and reliable—snapshot of who is using what drugs and where nationwide. By comparison, traditional epidemiological studies can take years to gather similar information. “Experts hope that by analyzing tweets for drug-related content, they will be able to anticipate spikes in overdoses and prevent them with public health campaigns,” the story noted. “Such research is beginning to pick up as machine-learning algorithms get better at combing through hundreds of thousands of tweets and identifying areas at risk for an imminent increase in opioid overdose deaths.” Please Participate in the 2019 NABH Annual Survey Consulting firm Dobson DaVanzo & Associates this week sent NABH members a personalized link to NABH’s 2019 Annual Survey. Please participate in the survey and share it with others in your organization. Your participation is essential in helping NABH report accurately on the U.S. behavioral healthcare field today. The e-mail message includes detailed instructions. Thank you for your cooperation! Please Visit our Exhibitors and Sponsors at the 2019 NABH Annual Meeting! NABH thanks all of the companies that will serve as exhibitors and sponsors at the 2019 NABH Annual Meeting in March. Please take a moment to view our Exhibitors & Sponsors page on our Annual Meeting homepage, where you can click on each organization to learn more. Also, please be sure to network with our exhibitors at the Annual Meeting next month. For complete Annual Meeting details—including the preliminary program and speaker information— please visit NABH’s Annual Meeting homepage. We look forward to seeing you in Washington! For questions or comments about CEO Update, please contact Jessica Zigmond.

CEO Update | 42

Written by Administrator on . Posted in CEO Updates.

NABH Alerts Governors about CMS Opportunity to Address Mental Health and SUD NABH and Mental Health America (MHA) this week sent a letter to the nation’s 50 governors about a new opportunity from the Centers for Medicare and Medicaid Services (CMS) for states to address mental health and substance use disorder (SUD). As part of the 21st Century Cures Act, CMS will allow states to implement 1115 (i) Medicaid demonstrations to offer additional inpatient mental health services, bypassing the Institutions for Mental Diseases (IMD) exclusion of coverage for inpatient mental health services for facilities with more than 16 beds in the Medicaid statute. In particular, CMS has indicated the agency is interested in reviewing demonstration proposals that achieve the following goals: reduced utilization and lengths of stay in emergency departments among Medicaid beneficiaries with SMI or SED while awaiting mental health treatment in specialized settings; reduced preventable readmissions to acute care hospitals and residential settings; improved availability of crisis stabilization services, including services made available through call centers and mobile crisis units, intensive outpatient services, as well as services provided during acute short-term stays in residential crisis stabilization programs, psychiatric hospitals, and residential treatment settings throughout the state; improved access to community-based services to address the chronic mental healthcare needs of beneficiaries with SMI or SED including through increased integration of primary and behavioral healthcare; and improved care coordination, especially continuity of care in the community following episodes of acute care in hospitals and residential treatment facilities. NABH will submit comments on the proposed regulations. ONDCP Releases National Drug Control Strategy The Office of National Drug Control Policy (ONDCP) late this week released its National Drug Control Strategy, a 23-page report meant to guide the federal government’s efforts on saving lives and working toward a drug-free nation. The report maps out three areas of effort that include reducing the size of the drug-using population by preventing initiates to illicit drug use through education and evidence-based prevention programs; reducing barriers to treatment services so that access to long-term recovery is available for those suffering from SUD; and significantly reducing the availability of these drugs in the United States through law enforcement and cooperation with international partners to lessen the negative effects of drug trafficking that affect the safety of citizens and communities. “Providing treatment services leading to long-term recovery for those suffering from substance use disorder, often using medication-assisted treatment (MAT) combined with therapy, moves people out of the active user population and on the path to recovery,” the report noted, underscoring an NABH priority. Regarding metrics to evaluate the strategy, the report emphasized the importance of effects, and not only performance. “While a performance measure represents the specific characteristic or aspect of the program or policy used to gauge successful performance of a specific task, effectiveness represents the aggregate progress, of multiple agencies contributing to achieving tangible improvement through their programs, initiatives, and policies,” the report noted. “Doing so requires linking actions taken on the front end of the global supply chain to reduce the availability of illicit drugs in the United States with measurable effects on the health and safety of our communities.” Veterans Affairs Announces Proposed Access Standards to Take Effect in June The Veterans Affairs (VA) department this week announced its proposed access standards for community care and urgent care provisions under last year’s MISSION Act that will take effect in June 2019. As part of the law, the VA has proposed a 30-minute average driving standard for primary care, mental healthcare, and non-institutional extended care services. The department also proposed appointment wait-time standards of 20 days for primary care, mental healthcare, and non-institutional extended care services, and 28 days for specialty care from the date of request, with certain exceptions. “VA’s current patchwork of seven separate community care programs is a bureaucratic maze that’s hard to navigate for veterans, their families, and VA employees,” VA Secretary Robert Wilkie said in a statement. “Our new access standards will form the basis of a federal regulation that will consolidate VA’s community care efforts into a single, simple-to-use program that puts veterans at the center of their VA healthcare decisions. Bloomberg Law Story Reports Earlier Mental Healthcare Treatment Can Save Employers Money Earlier treatment for mental health can lead to better outcomes for employers when it comes to lowering healthcare costs, Bloomberg Law reported in a story on Feb. 1. The article cites an October 2018 report from Catalyst, a not-for-profit organization that represents about 30 employers, that said mental illness costs about $193 billion in lost earnings and productivity each year. Meanwhile, mental health problems can be hard to identify in medical claims, the story noted. “Behavioral health doesn’t show up under its own category,” Lee Lewis, a vice president in the Dallas office of risk management first Arthur J. Gallagher & Co., told Bloomberg Law. “Instead, it shows up under other categories, like emergency room claims for problems—think chest pain—that are really anxiety attacks.” The story was published days after Kaiser Family Foundation President and CEO Drew Altman noted in a column that employers were the primary source of health insurance for 156 million non-elderly Americans in 2017, making employer-provided insurance by far the single largest form of coverage in the United States. JAMA Study Shows Some Traumatic Brain Injury Patients at Greater Risk for PTSD After a traumatic brain injury (TBI), some patients—based on their education, race/ethnicity, history of mental health problems, and cause of injury—were at a substantially higher risk for post traumatic stress disorder (PTSD) and/or major depressive disorder (MDD), according to a new study in JAMA. In a cohort study of 1,155 patients with a TBI and 230 patients with orthopedic injuries not involving the head, patients with TBI were more likely to report PTSD and/or major depressive symptoms three to six months after their injury, the data showed. Among those patients with TBI, a number of pre-injury (for example, before mental health problems) and injury-related characteristics were associated with an increased risk of mental health problems. Click here for the study. JAMA Study Examines Neonatal Abstinence Syndrome, Economic Conditions and Services Babies born after they have been exposed to opioids before birth are more likely to be delivered in regions of the United States with high rates of long-term unemployment and lower levels of mental health services, according to new findings from researchers at Vanderbilt University Medical Center and the RAND Corporation. Published this week in JAMA, the study examined more than 6.3 million births in a diverse group of eight states and found that rural counties with long-term unemployment had significantly higher rates of babies born with neonatal abstinence syndrome (a term used to describe a group of problems a baby experiences when withdrawing from exposure to narcotics) when compared with urban counties with lower unemployment rates. Meanwhile, counties with shortages of mental healthcare providers also had higher levels of neonatal abstinence syndrome when compared with other counties. To learn more, read the study and view an infographic about the findings. AHRQ Study Shows Opioid Crisis May Have a Greater Effect on Women, Especially in Rural Areas The nation’s opioid crisis might be having a greater effect on women, especially those who live in rural areas where the healthcare infrastructure is limited, according to a new report from the Agency for Healthcare Research and Quality (AHRQ). Compared with men, the data showed, women are more likely to be prescribed painkillers; are likely to be prescribed higher doses; and likely to become dependent on them more quickly. Meanwhile, the percentage of opioid-related stays with a co-occurring pregnancy/childbirth increased with rurality of patient residence location to 10.1 percent in micropolitan, “non-core” areas from 6.8 percent in large, metropolitan areas. The full report examines opioid use and hospitalization trends for demographic subdivisions among women including age, race, public and private health insurance, and metropolitan-rural geography. CDC Reports Opioid Prescribing is Higher in Rural Areas Primary care providers’ opioid-prescribing rates were significantly higher in nonmetropolitan counties than metropolitan counties, according a recent analysis from the Centers for Disease Control and Prevention (CDC). The CDC reports that drug overdose is the leading cause of unintentional injury-associated death in the United States. Among 70,237 fatal drug overdoses in 2017, the Atlanta-based agency reported, prescription opioids were involved in 17,029, or about 24 percent of those cases. And in that same year, 14 rural counties were among the 15 counties with the highest opioid-prescribing rates. This recent analysis examined how prescribing practices varied among six urban-rural classification categories of counties, before and after the CDC released Guideline for Prescribing Opioids for Chronic Pain in March 2016. “Patients in noncore (the most rural) counties had an 87 percent higher chance of receiving an opioid prescription compared with persons in large central metropolitan counties during the study period,” the report said. Register for The Joint Commission’s Behavioral Healthcare Conference in October The Joint Commission’s Behavioral Healthcare Conference in late October will feature topics such as measurement-based care and suicide-risk assessment to eating disorder recovery. The two-day conference will be held Oct. 23-24, 2019 at the Crowne Plaza O’Hare and is open to psychologists, social workers, nurses, counselors, administrators, and professionals who specialize in quality improvement and risk management. Click here to register. Participate in the 2019 NABH Annual Survey Consulting firm Dobson DaVanzo & Associates will conduct NABH’s 2019 Annual Survey and will e-mail NABH members a personalized link to the survey during the week of Monday, Feb. 4. Please be sure to participate in the survey and share it with others in your organization. Your participation is essential in helping NABH report accurately on the U.S. behavioral healthcare field today. The e-mail message will include detailed instructions. Thank you for your cooperation! 2019 NABH Annual Meeting Hotel Cut-Off Date is Approaching! The hotel cut-off date for the 2019 NABH Annual Meeting is Monday, February 11, 2019. Please be sure to reserve your hotel room today at the Mandarin Oriental Washington, DC. And please be sure to register for the Annual Meeting if you have not done so yet. For complete Annual Meeting details—including the preliminary program and speaker information— please visit NABH’s Annual Meeting homepage. We look forward to seeing you in Washington! For questions or comments about CEO Update, please contact Jessica Zigmond.

CEO Update | 41

Written by Administrator on . Posted in CEO Updates.

Message from the President and CEO We are pleased to present a new and improved design for CEO Update, your weekly summary of industry and association news! This electronic newsletter serves the same purpose, and we hope you like the updated format. You will also see a new design in our other NABH communication pieces that we send our members via e-mail. At our recent staff retreat, our team discussed what information we share with our members; how we present that information; and how we want to share that information in the future. We decided to keep what works and add some new forms of communication in 2019. In addition to your weekly CEO Update, you will receive the following communication pieces throughout the year: NABH Alert: This message will contain urgent news briefs. NABH Inside Scoop: This message is meant to share inside information about what our team is hearing on Capitol Hill, at the regulatory agencies and accrediting bodies, and within the industry. NABH Issue Brief: This message will include all major points of an issue with some analysis. NABH Analysis: The message is the longest form of communication we will share and is meant for in-depth summaries of bills and regulations. We hope these resources will help you in your work as you advance NABH’s mission. As always, we welcome your feedback! —Mark Covall, NABH President and CEO Davos 2019 Spotlights Mental Health The World Economic Forum in Davos, Switzerland this week highlighted mental health as a growing global challenge that is both a health issue and an economic one. According to one London-based report of the annual conference in the Swiss alps, mental health is especially a challenge in low- and middle-income countries where numbers are rising but services lag behind. The story cited the World Health Organization’s estimates that more than three quarters of people with mental disorders in those countries receive no treatment. Meanwhile, mental health is responsible for 13 percent of the global burden of disease, and the World Economic Forum estimates it will cost the global economy $16 trillion by 2030 in lost productivity and healthcare costs. Even so, countries spend an average of less than 2 percent of their health budgets on mental health, the story noted. And less than 1 percent of global health aid—about $132 million a year—was directed to mental health between 1995 and 2015. Bipartisan Policy Center Releases Report on Integrating Clinical and Mental Health NABH’s top advocacy priorities were included in Integrating Clinical and Mental Health: Challenges and Opportunities, a 46-page report from the Bipartisan Policy Center this week that examines the barriers to integrating clinical and mental health services and identifies potential policy solutions to achieve integration. According to the report, nearly 45 million American adults suffered some form of mental illness in 2016, and at least 25 states experienced at least a 30-percent increase in suicide rates between 2014 and 2016. Meanwhile, 20.1 million Americans experienced a substance use disorder (SUD) and 8.2 million experienced both a mental illness and SUD in that same year. NABH is pleased that the Bipartisan Policy Center recommendations include repealing the Institutions for Mental Diseases (IMD) exclusion in Medicaid; eliminating the 190-day lifetime limit; and providing resources for behavioral health IT. The report is organized by the following topic areas: use of grant programs in treating mental illness and the transition to integrated care; insurance coverage barriers and policy options; workforce barriers and policy options; and federal administrative barriers and policy options. NABH and Six Other Hospital Associations Present HIT Interoperability Agenda NABH was one of seven national hospital associations this week that urged public and private stakeholders to support a six-point agenda that would help the United States achieve the secure exchange of patient health information. NABH joined America’s Essential Hospitals, the American Hospital Association, the Association of American Medical Colleges, Catholic Health Association of the United States, Children’s Hospital Association and Federation of American Hospitals in presenting the health information technology (HIT) agenda to “support optimal individual health, healthcare, and value.” Included in the report Sharing Data, Sharing Lives, the agenda identifies six pathways to exchange patient health information securely: security and privacy; efficient, usable solutions; cost-effective, enhanced infrastructure; standards that work; connecting beyond electronic health records; and shared best practices. An infographic accompanied the Sharing Data, Sharing Lives report that the seven organizations released on Jan. 22. CMS Seeks Public Comment on the Follow-Up After Psychiatric Hospitalization Measure The Centers for Medicare and Medicaid Services’ (CMS) Health Services Advisory Group (HSAG) is seeking comments from healthcare professionals and stakeholder organizations on the new Follow-Up After Psychiatric Hospitalization quality measure. After the measure is made final, it may be proposed to be included in the Inpatient Psychiatric Facility Quality Reporting program. The public comment period opens today, Friday, January 25, 2019, and will remain open through Wednesday, February 13, 2019 at noon ET. Click here for more information and here to submit comments. Please contact HSAG at PQM@hsag.com if you have trouble submitting comments. Thank you to Our 2019 NABH Annual Meeting Exhibitors and Sponsors! 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 & 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; register for the Annual Meeting; and reserve your hotel room! The hotel cut-off date is Monday, Feb. 11. We look forward to seeing you in Washington! For questions or comments about CEO Update, please contact Jessica Zigmond.

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Written by Administrator on . Posted in Uncategorized.

FDA Develops Drug Facts Label for Over-the-Counter Versions of Naloxone The Food and Drug Administration (FDA) this week announced it has developed a model Drug Facts label (DFL) with easy-to-understand, “pictogram” instructions on how to use over-the-counter (OTC) versions of the opioid antidote naloxone. FDA Commissioner Scott Gottlieb said in a statement that while FDA-approved prescription naloxone formulations have instructions for use in product labeling, they don’t have the consumer-friendly DFL that is required for OTC products. “Before submitting a new drug application or supplement for an OTC drug product, companies must develop a DFL and conduct studies to show that consumers can understand how to use the product without the supervision of a healthcare professional,” Gottlieb said. “Some stakeholders have identified the requirement to perform these studies as a barrier to development of OTC naloxone products.” Along with the announcement, the FDA posted two model DFLs—one for using with a nasal spray and one for using with an auto injector—and the supporting FDA review. Gottlieb noted that the agency expects these efforts to “jumpstart” development of OTC naloxone products to promote wider access to this medicine. CMS Uses Social Media to Regulate Hospital Price Transparency Rule CMS Administrator Seema Verma used Twitter this week to encourage the public to help oversee compliance with the agency’s new price transparency rules. Since Jan. 1, all hospitals, including psychiatric hospitals, have been required to establish, update, and publish publicly online a list of the hospital’s “standard charges” for services the hospital provides. CMS included this Affordable Care Act requirement in its final FY 2019 inpatient prospective payment system (IPPS) rule. In her tweet this week, Verma said, “[W]e’re asking the Twitterverse to help us make sure patients have access to the basic hospital pricing information (called the chargemaster) that is now required to be posted online.” The final rule did not include a definition of “standard charge,” but CMS noted that hospitals can make public a chargemaster “or another form of the hospital’s choice.” CMS has released two FAQ (here and here) documents on the requirement also said the form must be in a “machine-readable” format and added that PDF documents are not considered permissible under that definition. Quality Reporting Center to Host IPFQR Webinar on January 22 The Quality Reporting Center will host a webinar on Tuesday, January 22 to review updates to the latest version of the Inpatient Psychiatric Facility Quality Reporting Program manual and other tools for inpatient psychiatric facilities to meet IPFQR program requirements. The hourlong webinar will start at 2 p.m. ET. Click here to register. MACPAC to Examine Utilization Management of MAT Next Week The Medicaid and CHIP Payment and Access Commission will discuss utilization management of medication assisted treatment (MAT) in two separate sessions at its meeting next Friday, January 25 in Washington, DC. Panelists include Anika Alvanzo, medical director with Johns Hopkins Substance Use Disorders Consultation Service and assistant professor in the university’s division of general internal medicine; Kristin Hoover, clinical pharmacy manager at the Pennsylvania Human Services Department; and Mario San Bartolome, medical director in substance use disorders at Molina Healthcare Click here to see the agenda for the commission’s two-day meeting, which starts on Thursday, January 24. Register for the Rx Drug Abuse and Heroin Summit in April The annual Rx Drug Abuse and Heroin Summit will be held April 22-25 at the Hyatt Regency Atlanta. Click here to review the conference agenda and here to register. 2019 NABH Exhibitor & Sponsor Guide Ad Deadline is Today! The deadline to place an ad about your organization in the 2019 NABH Exhibitor & Sponsor Guide is today, Friday, January 18. Download the 2019 Advertising Opportunities form and reserve space now. For questions, please contact Maria Merlie at 202.393.6700 (ext. 104), or (maria@nabh.org). And for more details about the 2019 NABH Annual Meeting, please visit NABH’s Annual Meeting homepage. NABH to Welcome HHS Deputy Secretary Eric Hargan at Annual Meeting on March 19 NABH is pleased to announce that HHS Secretary Eric D. Hargan will serve as the keynote speaker during the 2019 NABH Annual Meeting on Tuesday, March 19. As the department’s deputy secretary, Mr. Hargan serves as the chief operating officer of the federal government’s largest department, which has an annual budget of more than $1.3 trillion and more than 80,000 employees in 26 divisions. From 2003 to 2007, Mr. Hargan served at HHS in a variety of capacities before he eventually held the position of acting deputy secretary. During his tenure there, Mr. Hargan has also served as the department’s regulatory policy officer, where he oversaw the development and approval of all HHS, CMS, and FDA regulations and significant guidance. Hargan is from Mounds, Ill.—a town with a population of about 800 people—where his mother worked at rural hospital for 58 years. He received his B.A. cum laude from Harvard University, and his J.D. from Columbia University Law School, where he was senior editor of the Columbia Law Review. In between his tours at HHS, Mr. Hargan taught at Loyola Law School in Chicago, focusing on administrative law and healthcare regulations. 2019 NABH Annual Meeting Online Preliminary Program Now Available! The online preliminary program for the 2019 NABH Annual Meeting is now available on NABH’s Annual Meeting homepage. Please take a moment to review the sessions and speakers, and revisit the page regularly for updates about our speakers, exhibitors, and sponsors. If you haven’t already, please register for the meeting today and reserve your hotel room at the Mandarin Oriental Washington, DC before the hotel cut-off date on Monday, Feb. 11. We look forward to seeing you at the Mandarin Oriental Washington, D.C. from March 18-20, 2019! For questions or comments about CEO Update, please contact Jessica Zigmond.

CEO Update | 39

Written by Administrator on . Posted in CEO Updates.

NEJM Article Reinforces Themes from NABH’s ‘Pathways to Care’ White Paper In a recent issue of The New England Journal of Medicine, authors of a study about the nation’s emergency departments echoed similar themes and recommendations that NABH provides in Pathways to Care: Treating Opioid and Substance Use Disorders. In their article “Emergency Departments—A 24/7/365 Option for Combating the Opioid Crisis,” Gail D’Onofrio, M.D. and Kathryn Hawk, M.D., M.H.S. of the Yale University School of Medicine, along with Ryan P. McCormack, M.D. of the New York University School of Medicine, recommend encouraging emergency departments to initiate buprenorphine as well as establish relationships with community treatment providers to expedite treatment referrals. Meanwhile, D’Onofrio notes that providing buprenorphine in the emergency department can reduce withdrawal within 20 minutes, thereby supporting adherence to a 60-90 minute benchmark for discharge in urgent care settings; buprenorphine can reduce violence in the emergency department that may result from the irritability of withdrawal; emergency departments that provide services/medications for opioid use disorder have not seen an influx of new patients, which helps alleviate concerns that patients might overuse the nation’s emergency departments as portals to treatment; and, lastly, that momentum is growing for hospitals to open clinics to continue emergency department-initiated medication treatment.   Vaping the Most Common Use of Any Tobacco-Like Product Among Adolescents in 2017 Vaping was the most common use of any tobacco-like product among adolescents in 2017, reflecting a rapid increase from a near-zero prevalence of vaping in 2011, according to a recent analysis from researchers at the University of Michigan and University of Minnesota. Data for the study came from Monitoring the Future, which surveys nationally representative independent samples of students in the 8th, 10th, and 12th grades each year. The study’s authors wrote about their findings in a recent letter to the editor of The New England Journal of Medicine. “The rapid entry of new vaping devices on the market, the latest example of which is the Juul, will require continual updates and modification of strategies to keep adolescents from vaping and its associated negative health effects,” the authors noted. Register Now for National Drug and Alcohol Facts Week There is still time to register for National Drug and Alcohol Facts Week, which connects students with scientists and other experts to counteract myths about drugs and alcohol. This year’s National Drug and Alcohol Facts Week will be held from Jan. 22 through Jan. 27, with a Chat Day scheduled for Jan. 24. Click here to learn more and register an event. NABH Immediate Past Board Chair Brent Turner Provides Year in Review for 2018 The SUPPORT for Patients and Communities Act, NABH’s Pathways to Care white paper, and the association’s rebrand were among the industry highlights and association improvements that 2018 Board Chair Brent Turner highlighted this week in his Year in Review for members. “We still have more work to do to repeal the IMD exclusion completely. At the same time, we should be proud of the work we have done individually and collectively on this issue since 2013,” wrote Turner, president of Acadia Healthcare. “Back then, some industry stakeholders opposed changes to the IMD because they argued it would lead to less community-based care and more institutionalized care. By 2018, many more people recognized that patients need access to the full behavioral healthcare continuum, from inpatient to residential to outpatient care,” he continued. “NABH has been at the forefront advocating this message to policymakers, and the message is getting through.” Turner completed his term as Board Chair on Dec. 31. Pat Hammer, president and CEO of Rogers Behavioral Health, succeeded him as 2019 Board Chair on Jan. 1. 2019 NABH Exhibitor & Sponsor Guide Ad Deadline is One Week Away! The deadline to place an ad about your organization in the 2019 NABH Exhibitor & Sponsor Guide is next Friday, January 18. Download the 2019 Advertising Opportunities form and reserve space now. For questions, please contact Maria Merlie at 202.393.6700 (ext. 104), or (maria@nabh.org). And for more details about the 2019 NABH Annual Meeting, please visit NABH’s Annual Meeting homepage. We look forward to seeing you at the Mandarin Oriental Washington, D.C. from March 18-20, 2019! NABH Establishes Managed Care Committee NABH has established a Managed Care Committee to address the behavioral healthcare industry’s growing concern that health plans are micromanaging behavioral health services so intensely that they are restricting patient access to medically necessary care. The new committee will work with the NABH Board and management team—as well as external consultants who specialize in health plans, regulations, and the parity law—to develop a focused strategy that addresses this issue. Click on NABH’s Managed Care Committee webpage to learn more and to see a list of committee members.   For questions or comments about CEO Update, please contact Jessica Zigmond.
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Behavioral Health Update: January 7, 2019

Written by Administrator on . Posted in Resources.

============================= BEHAVIORAL HEALTH UPDATE A Monthly Report for Members of the American Hospital Association and the National Association for Behavioral Healthcare www.aha.org www.nabh.org January 2019    Updates:
  1. CMS Reports Healthcare Spending Growth Slowed Last Year
  2. HRSA Releases Behavioral Health Workforce Projections
  3. CMS Features FAQ on Price Transparency Provision in IPPS
  4. CMS Requests Feedback on Conflict of Interest at Accrediting Organizations
  5. Behavioral Health IT Coalition Sends Letter to CMS
  6. RAND Report Analyzes Heroin-Assisted Treatment and Supervised Drug Consumption Sites
  7. AMA Study Examines Association Between Psychotic Experiences and Risk of Suicide
  8. MACPAC Releases 2018 Edition of MACStats: Medicaid and CHIP Data Book
  9. PwC Health Research Institute Previews Top Health Industry Issues for 2019
  10. CDC’s NVSR Reports on Drugs Most Frequently Used in Overdoses: 2011-2016
  11. PCORI Board Approves $12.7 million for Mental Health Research Study
  12. U.S. Preventive Services Task Force Seeks Comments on Opioid Interventions
  13. CMMI Posts Fact Sheet on Integrated Care for Kids and Maternal Opioid Misuse Models
  14. Manatt, AMA & Pennsylvania Medical Society Release Report on Practices to End Opioid Crisis
  15. CHCS and ACAP Release Report on Social Determinants of Health via Medicaid Managed Care
  16. Associations Among Motor Activity, Sleep, Energy & Mood Could Suggest New Focus for Depression Treatment
  17. NIDA Highlights Details for National Drug and Alcohol Facts Week
  18. World Congress to Host Opioid Management Summit in February
  19. Register Today for 2019 Annual Meetings
Stories: 1. CMS Reports Healthcare Spending Growth Slowed Last Year Total nominal U.S. healthcare spending increased 3.9 percent to $3.5 trillion in 2017, slowing down from growth of 4.8 percent in 2016, the Centers for Medicare and Medicaid (CMS) reported last month. The new statistics were published in an article in Health Affairs which reported that the rate of growth in 2017 was similar to the increases between 2008 and 2013, which preceded a faster growth rate between 2014 and 2015—a period that included insurance coverage expansion and large increases in prescription drug spending. According to the analysis, nearly all major sources of insurance and sponsors of healthcare experienced slower growth last year. Meanwhile, the share of gross domestic product devoted to healthcare spending was 17.9 percent in 2017, similar to the share in 2016.   2. HRSA Releases Behavioral Health Workforce Projections About 276,400 people are expected to enter the behavioral health workforce during the five-year period between 2016 and 2021, HHS’ Health Resources and Services Administration (HRSA) estimates in a new analysis. The findings are part of HRSA’s Behavioral Health Workforce Projections that the agency compiled following a mandate from the 21st Century Cures Act. In the analysis, HRSA provides national-level workforce estimates for the following occupations between 2016 and 2030: addiction counselors, marriage and family therapists, mental health and school counselors, psychiatric technicians and psychiatric aides, psychiatric nurse practitioners and psychiatric physician assistants, psychiatrists, psychologists, and social workers. According to a 2017 report from the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly one in five adults in the United States—or about 44.7 million people—suffered from a mental illness in the last year, and in 2016 about 28.6 million people aged 12 and older used an illicit drug in the past 30 days. “Beyond the direct toll on individuals and families,” HRSA noted on its website, “mental illness and substance use disorders are well-established drivers of disability, mortality, and healthcare costs.” The HRSA analysis also included state-level behavioral health workforce estimates.   3. CMS Features FAQ on Price Transparency Provision in IPPS  CMS has released two FAQ (here and here) documents on the Affordable Care Act (ACA) requirement that all hospitals establish, update, and publish publicly online a list of the hospital’s “standard charges” for services the hospital provides. CMS included this ACA provision—which becomes effective Jan. 1, 2019—in its final FY 2019 inpatient prospective payment system (IPPS) rule. The final rule did not include a definition of “standard charge,” but CMS noted that hospitals can make public a chargemaster “or another form of the hospital’s choice.” CMS also said the form must be in a “machine-readable” format and added that PDF documents are not considered permissible under that definition.   4. CMS Requests Feedback on Conflict of Interest at Accrediting Organizations The Centers for Medicare and Medicaid Services (CMS) last month requested public comment about the appropriateness of some Medicare-approved accrediting organizations (AO) offering fee-based consultative services to providers and suppliers they also accredit as part of their business model. “CMS is seeking to receive stakeholder input which can help us determine whether the AO practices of consulting with the same facilities which they accredit could create actual or perceived conflicts of interest between the accreditation and consultative functions of the AO,” the agency said in its announcement, adding that it will consider the information it receives to help with future rulemaking.   5. Behavioral Health IT Coalition Sends Letter to CMS In a letter to CMS last month, the Behavioral Health IT Coalition said mental health and addiction treatment providers participating in the Centers for Medicare and Medicaid Innovation (CMMI) MAT bundled payment models outlined in the new law must show e-prescribing capacity. It also said behavioral health facilities must provide evidence that they can exchange clinical data successfully with medical-surgical providers in order to be eligible for funding through these demonstrations. The final recommendation said CMS should incorporate health IT financial incentives into each of the three MAT demonstrations to urge behavioral health and substance use disorder (SUD) providers to adopt 2015 certified electronic health record technology.   6. RAND Report Analyzes Heroin-Assisted Treatment and Supervised Drug Consumption Sites A new report from RAND Corp. examines how four countries use two interventions that the United States does not apply to address opioid use disorder: heroin-assisted treatment (HAT) and supervised consumption sites (SCSs). “Give the severity of the opioid crisis, there is urgency to evaluate potential tools that might reduce its impact and save lives,” the report said. “This working paper is part of a series of reports assessing the evidence on and arguments made about HAT and SCSs and examining some of the issues associated with implement in the United States.”   7. JAMA Study Examines Association Between Psychotic Experiences and Risk of Suicide Individuals with psychotic experiences are at increased risk of suicidal ideation, suicide attempts, and suicide death, according to a new JAMA study.   Recent research has shown a particularly strong association between psychotic experiences and suicidal behavior. This study’s purpose was to provide a quantitative synthesis of the literature examining the longitudinal association between psychotic experiences and subsequent “suicidal ideation, suicide attempts, and suicide deaths in the general population.”   8. MACPAC Releases 2018 Edition of MACStats: Medicaid and CHIP Data Book The Medicaid and CHIP Payment and Access Commission (MACPAC) last month released the December 2018 edition of its MACStats: Medicaid and CHIP Data Book, which has updated data on national and state Medicaid and CHIP enrollment, spending, benefits, and more. This year’s edition shows total enrollment growth in Medicaid and the State Children’s Health Insurance Program (CHIP) decreased 2.2 percent nationally from July 2017 to July 2018.   9. PwC Health Research Institute Previews Top Health Industry Issues for 2019 In its annual forecast, PwC Health Research Institute predicts that providers and payers that have served Medicaid patients will have a significant effect on the healthcare industry in the New Year. “In 2019 the health industry will see value lines created by innovative providers and payers that have figured out how to subsist—comfortably, thank you very much—by serving almost entirely Medicaid or cash-strapped patients,” the report noted. PwC’s 54-page analysis—The New Health Economy Comes of Age—also predicts that life sciences companies will market digital therapeutics and connected devices targeting atrial fibrillation, hemophilia, substance abuse, birth control, depression, diabetes, epilepsy and other conditions. “Once thought to operate outside the greater U.S. economy, the industry—with its byzantine payment system, complicated regulatory barriers and reliance on face-to-face interactions—is being disrupted,” the report noted. “Finally, there’s robust evidence that what PwC calls the New Health Economy is kicking into gear.” According to PwC’s analysis, 84 percent of Fortune 50 companies are involved with healthcare, and venture capital funding for digital health startups is projected to top $6.9 billion in 2018, reflecting a 230-percent increase from five years ago. Meanwhile, the report noted that “American consumers have told PwC’s Health Research Institute since 2013 that they’re “eager to embrace more convenient, digitally enabled and affordable care; finally, they’re finding it, with options that resemble the choices they have in other parts of their lives.”   10. CDC’s NSVR Reports on Drugs Most Frequently Used in Overdoses: 2011-2016 Fentanyl, heroin, hydrocodone, methadone, morphine, oxycodone, alprazolam, diazepam, cocaine, and methamphetamine were the 10 most frequently mentioned drugs among drug overdose deaths that noted at least one specific drug between 2011 and 2016, according to the Centers for Disease Control and Prevention’s (CDC) National Vital Statistics Report (NVSR). Oxycodone ranked first in 2011; heroin during 2012-2015; and fentanyl in 2015. During the study period, cocaine consistently ranked second or third, researchers found. The report’s conclusion said these findings highlight “the importance of complete and accurate reporting in the literal text on death certificates.” 11. PCORI Board Approves $12.7 million for Mental Health Research Study The Patient-Centered Outcomes Research Institute (PCORI) Board of Governors last month approved $12.7 million to fund a study that will examine the effectiveness of different strategies to treat anxiety and depression in expectant and new mothers. Funding will go to researchers in Chapel Hill, N.C.; Chicago; and Toronto to study four different methods of providing treatment, in-person sessions with either a specialist provider or nurse, or the same sessions delivered via telemedicine. “Depression and anxiety symptoms pose a significant burden and lead to high costs among mothers worldwide,” PCORI noted in an announcement about the study. “Psychological treatments—also known as talk therapies, including behavioral, cognitive and interpersonal therapies—have a robust evidence base and are preferred by women and their families over pharmacological treatments,” the announcement continued. “Unfortunately, as few as one in five women can access these effective treatments due to a dearth of available specialists and barriers including cost, transportation, and access. There is therefore a need for widely accessible, low-cost, and innovative psychological treatments for depression and anxiety during pregnancy and postpartum.” Click here to learn about the project’s details. 12. U.S. Preventive Services Task Force Seeks Comments on Opioid Interventions The U.S. Preventive Services Task Force (USPSTF) last month opened the public comment period for its draft research plan on interventions to prevent opioid use disorder. The USPSTF notes clearly that the plan is in draft form and has been distributed for the sole purpose of gaining feedback. The task force will accept public comments through Wednesday, Jan. 16, 2019 at 8 p.m. ET. 13. CMMI Posts Fact Sheet on Integrated Care for Kids and Maternal Opioid Misuse Models The Center for Medicare and Medicaid Innovation (CMMI) has posted a fact sheet on its Integrated Care for Kids (InCK) and Maternal Opioid Misuse, or MOM, Models designed to improve care delivery and reduce expenditures for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries affected by the nation’s opioid crisis. “By catalyzing state-driven care transformation and aligning financial incentives, both models aim to improve health outcomes and address fragmentation of care for affected beneficiaries,” the Innovation Center noted. “Ultimately, the InCK and MOM models aim to enable better coordination of clinical care and the integration of other services critical for health, wellbeing, and recovery.” 14. Manatt, AMA & Pennsylvania Medical Society Release Report on Practices to End Opioid Crisis Manatt Health, the American Medical Association (AMA), and the Pennsylvania Medical Society last month released a report that examines what Pennsylvania has accomplished in the areas of substance use disorder treatment, pain management, and harm reduction to combat the opioid crisis. The report focuses on the work of two agencies—the Pennsylvania Medicaid agency and the Pennsylvania Insurance Department—and highlights in particular Pennsylvania’s broad support for Medication Assisted Treatment (MAT), parity law enforcement, and comprehensive naloxone access. Researchers also included recommendations on how Pennsylvania can “build on its successes, including expanding efforts in emergency departments and law enforcement to link patients to high-quality care, and requiring insurers to enhance access to non-opioid care so that patients have alternative treatments as opioid prescriptions are reduced.” 15. CHCS and ACAP Release Report on Social Determinants of Health via Medicaid Managed Care The Center for Health Care Strategies (CHCS) and the Association for Community Affiliated Plans (ACAP) last month released findings of a nationwide review of Medicaid managed care contracts and section 1115 demonstrations to identify common themes in state approaches to incentivizing and requiring social determinant of health-related activities (SDOH). Addressing Social Determinants of Health via Medicaid Managed Care Contracts and Section 1115 Demonstrations includes five specific policy recommendations from CHCS to support SDOH activities: make  it easier for vulnerable populations to access needed health services; enhance agency collaboration at the federal level; provide guidance on addressing SDOH through managed care; approve section 1115 demonstrations that test strategies to address SDOH; and support outcomes-based payment for SDOH interventions.   16. Associations Among Motor Activity, Sleep, Energy & Mood Could Suggest New Focus for Depression Treatment Instability in activity and sleep systems could lead to mood changes—which could suggest new approaches for depression treatment, according to new findings published online in the journal JAMA Psychiatry. Current theories of depression suggest that sleep problems, low energy, and low activity levels result from depressed mood, but this new study that examines these factors among people with bipolar disorder or depression suggest the opposite may be true, the National Institute of Mental Health noted in its announcement about the study. Researchers “discovered a unidirectional relationship between motor activity and mood, suggesting that motor activity affects subsequent mood, but that mood does not affect subsequent motor activity and sleep systems could lead to mood changes,” the NIH posting said. 17. NIDA Highlights Details for National Drug and Alcohol Facts Week  The National Institute on Drug Abuse (NIDA) has posted information about National Drug and Alcohol Facts Week, a national health observance from Jan. 22–27, 2019 that will link teens to science-based facts about drugs. NIDA’s website features details about hosting an event, an online teaching guide, free materials, activity ideas and toolkits, and more. 18. World Congress to Host Opioid Management Summit in February World Congress—which hosts conferences and events in healthcare, life sciences, and pharmaceuticals—will host its third annual Opioid Management Summit at the Wink Hotel in Washington, D.C. from February 26-27, 2019. A panel discussion titled Ensure Resources and an Integrated Care Continuum Support Treatment and Recovery will be hosted on the second day of the conference. Click here to learn more and register for the meeting.   19. Register Today for 2019 Annual Meetings The National Association for Behavioral Healthcare (NABH) and the American Hospital Association (AHA) have posted the dates for their 2019 Annual Meetings in Washington, D.C. NABH will host its Annual Meeting from March 18-20, 2019 at the Mandarin Oriental Washington, DC, and the AHA will host its Annual Meeting from April 7-10, 2019 at the Marriott Marquis. Jessica Zigmond prepared this edition of Behavioral Health Update. Feel free to give us your feedback, stories, and suggestions:  NABH:  Jessica Zigmond, NABH, jessica@nabh.org, 202.393.6700, ext. 101; AHA:  Rebecca Chickey, AHA SPSAS, rchickey@aha.org, 312.422.3303 Copyright 2019 by the American Hospital Association and the National Association for Behavioral Healthcare. All rights reserved.  For republication rights, contact Jessica Zigmond.  The opinions expressed are not necessarily those of the American Hospital Association or of the National Association for Behavioral Healthcare.

CEO Update | 38

Written by Administrator on . Posted in CEO Updates.

Senate Confirms Jim Carroll as Nation’s ‘Drug Czar’ The Senate this week confirmed Jim Carroll as the director of the Office of National Drug Control Policy (ONDCP). Carroll had served as acting director at ONDCP since last February, and President Trump nominated him as permanent director in late April. This is the nation’s first permanent “drug czar” since Michael Botticelli held the post from 2014 until 2017 during the Obama administration. Carroll has served as White House Chief of Staff and earlier held positions at the Office of Management and Budget as well the Office of the White House Counsel. Joint Commission Publishes Report on Improving Depression Screening Depression is the leading cause of disability and often goes unaddressed, particularly for minorities, immigrants, and refugees, according to a new study published in the January 2019 issue of The Joint Commission Journal on Quality and Patient Safety. The article — “Not Missing the Opportunity: Improving Depression Screening and Follow-Up in a Multicultural Community”— also reports that although evidence-based guidelines recommend screening for the adequate diagnosis, treatment, and follow-up of depression, only seven states report depression screening and follow up. Researchers implemented the following four core interventions at a rural, federally qualified health center that were shown to improve results: using written, standardized Patient Health Questionnaire (PHW) screening tools in six languages; using a standardized tool to help clients who screen positive for depression to share what matters most to them; using a “right care” tracking log to assist providers in documenting follow-up phone calls and visits for clients who screen positive for depression; and hosting team meetings and in-services to support building capacity. Click here to access the article. Alcohol-related Deaths on the Rise Alcohol misuse accounted for 35,823 deaths in 2017, reflecting a nearly 46-percent increase over almost two decades, according to an investigative report in the Washington Examiner that used Centers for Disease Control and Prevention (CDC) data. The data showed that alcohol-related deaths have increased steadily since the 19,469 deaths related to alcohol misuse that were recorded in 1999. Meanwhile, deaths from misusing alcohol did not decline at any time since that period, and they included alcohol poisonings, alcoholic liver disease, and cirrhosis. The story noted that the figures do not include deaths from accidents people have while they are drinking, because in those cases the cause of death would be from drowning, a car accident, or a fall. Pat Hammer Begins Term as 2019 NABH Board Chair Congratulations to Pat Hammer, president and CEO of Oconomowoc, Wis.-based Rogers Behavioral Health, who began his term as 2019 NABH Board Chair on Jan. 1. Hammer succeeds Acadia Healthcare President Brent Turner in the position. Following the recent Board elections, Jim Shaheen, president of Strategic Behavioral Health in Memphis, Tenn., is now Board Chair-elect; and Jennifer Ziccardi-Colson, chief nurse executive and vice president for behavioral health at Atrium Health’s Behavioral Health Services in Charlotte, N.C., and John Hollinsworth, senior vice president at Universal Health Services, Inc. in Louisville, Ky., joined the Board as members through 2021. Register Now for the 2019 NABH Annual Meeting If you haven’t done so yet, please visit NABH’s Annual Meeting homepage today to register and reserve your hotel room for the 2019 NABH Annual Meeting — Behavioral Healthcare: Improving Coordination, Collaboration, Integration. And please watch for upcoming NABH Annual Meeting Alerts, which will keep meeting attendees informed about the latest speaker and programming information. This month, NABH will post the 2019 Annual Meeting preliminary program on the NABH website. This online preliminary program will replace the previous printed preliminary program. All meeting attendees will receive a final printed program on site at the Annual Meeting. We look forward to seeing you at the Mandarin Oriental Washington, D.C. from March 18-20, 2019! For questions or comments about CEO Update, please contact Jessica Zigmond.

CEO Update | 37

Written by Administrator on . Posted in CEO Updates.

CMS Requests Feedback on Conflict of Interest at Accrediting Organizations The Centers for Medicare and Medicaid Services (CMS) this week requested public comment about the appropriateness of some Medicare-approved accrediting organizations (AO) offering fee-based consultative services to providers and suppliers they also accredit as part of their business model. “CMS is seeking to receive stakeholder input which can help us determine whether the AO practices of consulting with the same facilities which they accredit could create actual or perceived conflicts of interest between the accreditation and consultative functions of the AO,” the agency said in its announcement, adding that it will consider the information it receives to help with future rulemaking.   CMS Features FAQ on Price Transparency Provision in IPPS CMS has released two FAQ (here and here) documents on the Affordable Care Act (ACA) requirement that all hospitals establish, update, and publish publicly online a list of the hospital’s “standard charges” for services the hospital provides. CMS included this ACA provision—which becomes effective Jan. 1, 2019—in its final FY 2019 inpatient prospective payment system (IPPS) rule. The final rule did not provide a definition of “standard charge,” but CMS noted that hospitals can make public a chargemaster “or another form of the hospital’s choice.” CMS also said the form must be in a “machine-readable” format and added that PDF documents are not considered permissible under that definition.   NIDA Highlights Details for National Drug and Alcohol Facts Week The National Institute on Drug Abuse (NIDA) has posted information about National Drug and Alcohol Facts Week, a national health observance from Jan. 22–27, 2019 that will link teens to science-based facts about drugs. NIDA’s website features details about hosting an event, as well as an online teaching guide, free materials, toolkits, and more. World Congress to Host Opioid Management Summit in February World Congress—which hosts conferences and events in healthcare, life sciences, and pharmaceuticals—will host its third annual Opioid Management Summit at the Wink Hotel in Washington, D.C. from February 26-27, 2019. Sarah A. Wattenberg, NABH’s director of quality and addiction services, will moderate a panel discussion titled Ensure Resources and an Integrated Care Continuum Support Treatment and Recovery on the second day of the conference. Click here to learn more and register for the meeting.   NABH Introduces 2019 Online Membership Directory This week NABH posted the digital edition of the 2019 NABH Membership Directory, which presents essential information about our members in an interactive format for the first time. Please click here to access the online directory. NABH will send the printed version of the 2019 NABH Membership Directory to members in January.   Register Now for the 2019 NABH Annual Meeting If you haven’t done so yet, please visit NABH’s Annual Meeting homepage today to register and reserve your hotel room for the 2019 NABH Annual Meeting — Behavioral Healthcare: Improving Coordination, Collaboration, Integration. This week NABH sent the first in a series of NABH Annual Meeting Alerts to keep meeting attendees informed about the latest speaker and programming information. In early January, NABH will post the 2019 Annual Meeting preliminary program on the NABH website. This online preliminary program will replace the previous printed preliminary program. All meeting attendees will receive a final printed program on site at the Annual Meeting. We look forward to seeing you at the Mandarin Oriental Washington, D.C. from March 18-20, 2019! Happy Holidays from NABH! NABH’s office will be closed from Monday, Dec. 24 through and including Tuesday, Jan. 1.CEO Update will not publish on Friday, Dec. 28 and will resume on Friday, Jan. 4. The entire NABH team wishes you and your families a very happy holiday season!   For questions or comments about CEO Update, please contact Jessica Zigmond.

CEO Update | 36

Written by Administrator on . Posted in CEO Updates.

HRSA Releases Behavioral Health Workforce Projections About 276,400 people are expected to enter the behavioral health workforce during the five-year period between 2016 and 2021, HHS’ Health Resources and Services Administration (HRSA) estimates in a new analysis. The findings are part of HRSA’s Behavioral Health Workforce Projections that the agency compiled following a mandate from the 21st Century Cures Act. In the analysis, HRSA provides national-level workforce estimates for the following occupations between 2016 and 2030: addiction counselors, marriage and family therapists, mental health and school counselors, psychiatric technicians and psychiatric aides, psychiatric nurse practitioners and psychiatric physician assistants, psychiatrists, psychologists, and social workers. According to a 2017 report from the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly one in five adults in the United States—or about 44.7 million people—suffered from a mental illness in the last year, and in 2016 about 28.6 million people aged 12 and older used an illicit drug in the past 30 days. “Beyond the direct toll on individuals and families,” HRSA noted on its website, “mental illness and substance use disorders are well-established drivers of disability, mortality, and healthcare costs.” The HRSA analysis also included state-level behavioral health workforce estimates.   PwC Health Research Institute Previews Top Health Industry Issues for 2019 In its annual forecast, PwC Health Research Institute predicts that providers and payers that have served Medicaid patients will have a significant effect on the healthcare industry in the New Year. “In 2019 the health industry will see value lines created by innovative providers and payers that have figured out how to subsist—comfortably, thank you very much—by serving almost entirely Medicaid or cash-strapped patients,” the report noted. PwC’s 54-page analysis—The New Health Economy Comes of Age—also predicts that life sciences companies will market digital therapeutics and connected devices targeting atrial fibrillation, hemophilia, substance abuse, birth control, depression, diabetes, epilepsy and other conditions. “Once thought to operate outside the greater U.S. economy, the industry—with its byzantine payment system, complicated regulatory barriers and reliance on face-to-face interactions—is being disrupted,” the report noted. “Finally, there’s robust evidence that what PwC calls the New Health Economy is kicking into gear.” According to PwC’s analysis, 84 percent of Fortune 50 companies are involved with healthcare, and venture capital funding for digital health startups is projected to top $6.9 billion in 2018, reflecting a 230-percent increase from five years ago. Meanwhile, the report noted that “American consumers have told PwC’s Health Research Institute since 2013 that they’re “eager to embrace more convenient, digitally enabled and affordable care; finally, they’re finding it, with options that resemble the choices they have in other parts of their lives.”   CDC’s NSVR Reports on Drugs Most Frequently Used in Overdoses: 2011-2016 Fentanyl, heroin, hydrocodone, methadone, morphine, oxycodone, alprazolam, diazepam, cocaine, and methamphetamine were the 10 most frequently mentioned drugs among drug overdose deaths that noted at least one specific drug between 2011 and 2016, according to the Centers for Disease Control and Prevention’s (CDC) National Vital Statistics Report (NVSR). Oxycodone ranked first in 2011; heroin during 2012-2015; and fentanyl in 2015. During the study period, cocaine consistently ranked second or third, researchers found. The report’s conclusion said these findings highlight “the importance of complete and accurate reporting in the literal text on death certificates.” PCORI Board Approves $12.7 million for Mental Health Research Study The Patient-Centered Outcomes Research Institute (PCORI) Board of Governors this week approved $12.7 million to fund a study that will examine the effectiveness of different strategies to treat anxiety and depression in expectant and new mothers. Funding will go to researchers in Chapel Hill, N.C.; Chicago; and Toronto to study four different methods of providing treatment, in-person sessions with either a specialist provider or nurse, or the same sessions delivered via telemedicine. “Depression and anxiety symptoms pose a significant burden and lead to high costs among mothers worldwide,” PCORI noted in an announcement about the study. “Psychological treatments—also known as talk therapies, including behavioral, cognitive and interpersonal therapies—have a robust evidence base and are preferred by women and their families over pharmacological treatments,” the announcement continued. “Unfortunately, as few as one in five women can access these effective treatments due to a dearth of available specialists and barriers including cost, transportation, and access. There is therefore a need for widely accessible, low-cost, and innovative psychological treatments for depression and anxiety during pregnancy and postpartum.” Click here to learn about the project’s details. U.S. Preventive Services Task Force Seeks Comments on Opioid Interventions The U.S. Preventive Services Task Force (USPSTF) this week opened the public comment period for its draft research plan on interventions to prevent opioid use disorder. The USPSTF notes clearly that the plan is in draft form and has been distributed for the sole purpose of gaining feedback. The task force will accept public comments through Wednesday, Jan. 16, 2019 at 8 p.m. ET. CMMI Posts Fact Sheet on Integrated Care for Kids and Maternal Opioid Misuse Models The Center for Medicare and Medicaid Innovation (Innovation Center) has posted a fact sheet on its Integrated Care for Kids (InCK) and Maternal Opioid Misuse, or MOM, Models designed to improve care delivery and reduce expenditures for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries affected by the nation’s opioid crisis. “By catalyzing state-driven care transformation and aligning financial incentives, both models aim to improve health outcomes and address fragmentation of care for affected beneficiaries,” the Innovation Center noted. “Ultimately, the InCK and MOM models aim to enable better coordination of clinical care and the integration of other services critical for health, wellbeing, and recovery.” Manatt, AMA & Pennsylvania Medical Society Release Report on Practices to End Opioid Crisis Manatt Health, the American Medical Association (AMA), and the Pennsylvania Medical Society this week released a report that examines what Pennsylvania has accomplished in the areas of substance use disorder treatment, pain management, and harm reduction to combat the opioid crisis. The report focuses on the work of two agencies—the Pennsylvania Medicaid agency and the Pennsylvania Insurance Department—and highlights in particular Pennsylvania’s broad support for Medication Assisted Treatment (MAT), parity law enforcement, and comprehensive naloxone access. Researchers also included recommendations on how Pennsylvania can “build on its successes, including expanding efforts in emergency departments and law enforcement to link patients to high-quality care, and requiring insurers to enhance access to non-opioid care so that patients have alternative treatments as opioid prescriptions are reduced.” CHCS and ACAP Release Report on Social Determinants of Health via Medicaid Managed Care The Center for Health Care Strategies (CHCS) and the Association for Community Affiliated Plans (ACAP) this week released findings of a nationwide review of Medicaid managed care contracts and section 1115 demonstrations to identify common themes in state approaches to incentivizing and requiring social determinant of health-related activities (SDOH). Addressing Social Determinants of Health via Medicaid Managed Care Contracts and Section 1115 Demonstrations includes five specific policy recommendations from CHCS to support SDOH activities: make  it easier for vulnerable populations to access needed health services; enhance agency collaboration at the federal level; provide guidance on addressing SDOH through managed care; approve section 1115 demonstrations that test strategies to address SDOH; and support outcomes-based payment for SDOH interventions.   Associations Among Motor Activity, Sleep, Energy & Mood Could Suggest New Focus for Depression Treatment Instability in activity and sleep systems could lead to mood changes—which could suggest new approaches for depression treatment, according to new findings published online in the journal JAMA Psychiatry. Current theories of depression suggest that sleep problems, low energy, and low activity levels result from depressed mood, but this new study that examines these factors among people with bipolar disorder or depression suggest the opposite may be true, the National Institute of Mental Health noted in its announcement about the study. Researchers “discovered a unidirectional relationship between motor activity and mood, suggesting that motor activity affects subsequent mood, but that mood does not affect subsequent motor activity and sleep systems could lead to mood changes,” the NIH posting said.   Register Now for the 2019 NABH Annual Meeting Please visit NABH’s Annual Meeting homepage today to register and reserve your hotel room for the 2019 NABH Annual Meeting — Behavioral Healthcare: Improving Coordination, Collaboration, Integration. Beginning next week, NABH will send periodic NABH Annual Meeting Alerts to keep meeting attendees informed about the latest speaker and programming information. And in January, NABH will post the 2019 Annual Meeting preliminary program on the NABH website. This online preliminary program will replace the previous printed preliminary program. All meeting attendees will receive a final printed program on site at the Annual Meeting. We look forward to seeing you at the Mandarin Oriental Washington, D.C. from March 18-20, 2019   For questions or comments about CEO Update, please contact Jessica Zigmond.

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CMS Reports Healthcare Spending Growth Slowed Last Year Total nominal U.S. healthcare spending increased 3.9 percent to $3.5 trillion in 2017, slowing down from growth of 4.8 percent in 2016, the Centers for Medicare and Medicaid (CMS) reported this week. The new statistics were published in an article in Health Affairs, which reported that the rate of growth in 2017 was similar to the increases between 2008 and 2013, which preceded a faster growth rate between 2014 and 2015—a period that included insurance coverage expansion and large increases in prescription drug spending. According to the analysis, nearly all major sources of insurance and sponsors of healthcare experienced slower growth last year. Meanwhile, the share of gross domestic product devoted to healthcare spending was 17.9 percent in 2017, similar to the share in 2016. Behavioral Health IT Coalition Sends Letter to CMS NABH signed on to a letter this week to CMS Administrator Seema Verma that applauded the recently signed SUPPORT Act and recommended three behavioral health IT proposals intended to enhance Medication Assisted Therapy (MAT) initiatives. The letter from the Behavioral Health IT Coalition noted that mental health and addiction treatment providers participating in the Centers for Medicare and Medicaid Innovation (CMMI) MAT bundled payment models outlined in the new law must show e-prescribing capacity. It also said behavioral health facilities must provide evidence that they can exchange clinical data successfully with medical-surgical providers in order to be eligible for funding through these demonstrations. The final recommendation said CMS should incorporate health IT financial incentives into each of the three MAT demonstrations to urge behavioral health and substance use disorder (SUD) providers to adopt 205 certified electronic health record technology. Mental Health America, the National Alliance on Mental Illness, and the American Psychological Association were among the groups that added their association names to the letter. RAND Report Analyzes Heroin-Assisted Treatment and Supervised Drug Consumption Sites A new report from RAND Corp. examines how four countries use two interventions that the United States does not apply to address opioid use disorder: heroin-assisted treatment (HAT) and supervised consumption sites (SCSs). “Give the severity of the opioid crisis, there is urgency to evaluate potential tools that might reduce its impact and save lives,” the report said. “This working paper is part of a series of reports assessing the evidence on and arguments made about HAT and SCSs and examining some of the issues associated with implement in the United States.” JAMA Study Examines Association Between Psychotic Experiences and Risk of Suicide Individuals with psychotic experiences are at increased risk of suicidal ideation, suicide attempts, and suicide death, according to a new JAMA study. Recent research has shown a particularly strong association between psychotic experiences and suicidal behavior. This study’s purpose was to provide a quantitative synthesis of the literature examining the longitudinal association between psychotic experiences and subsequent “suicidal ideation, suicide attempts, and suicide deaths in the general population.” MACPAC Releases 2018 Edition of MACStats: Medicaid and CHIP Data Book The Medicaid and CHIP Payment and Access Commission (MACPAC) this week released the December 2018 edition of its MACStats: Medicaid and CHIP Data Book, which has updated data on national and state Medicaid and CHIP enrollment, spending, benefits, and more. This year’s edition shows total enrollment growth in Medicaid and the State Children’s Health Insurance Program (CHIP) decreased 2.2 percent nationally from July 2017 to July 2018. Former NABH Board Chair Debra Osteen to Retire from UHS in January Debra Osteen, president of Universal Health Services’ (UHS) Behavioral Health Division, will retire effective Jan. 31, 2019 after 35 years with the company, UHS announced in a news release on Dec. 6. Osteen—who served as then-NAPHS Board Chair in 2004 and again in 2017— has led the King of Prussia, Pa.-based healthcare company’s behavioral division since 1999. Under her direction, the division expanded to more than 300 facilities from 23 and became the largest system of freestanding behavioral health facilities in the United States. “Debbie has been a leader in our industry a terrific supporter of NABH,” said Mark Covall, NABH President and CEO. “I will miss her active involvement and commitment to the NABH team—and to me personally.” Register Now for the 2019 NABH Annual Meeting In January, NABH will post the 2019 Annual Meeting preliminary program on the NABH website and send NABH Annual Meeting Alerts to apprise NABH members and other Annual Meeting attendees regularly about the Annual Meeting. The broadcast e-mail NABH Annual Meeting Alerts will include updated information about speakers and programming, and will replace a printed preliminary program. All meeting attendees will receive a final printed preliminary program on site at the Annual Meeting. If you haven’t done so yet, please visit NABH’s Annual Meeting homepage today to register and reserve your hotel room for the 2019 NABH Annual Meeting — Behavioral Healthcare: Improving Coordination, Collaboration, Integration. We look forward to seeing you at the Mandarin Oriental Washington, D.C. from March 18-20, 2019! For questions or comments about CEO Update, please contact Jessica Zigmond.

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Joint Commission Updates National Patient Safety Goal for Suicide Prevention The Joint Commission this week updated its National Patient Safety (NPS) Goal for Suicide Prevention that takes effect on July 1, 2019. According to the Joint Commission, the accrediting body made the revisions because there has been no improvement in lowering the U.S. suicide rate, even though suicide is the 10th leading cause of death in the country. The changes came after the Joint Commission held five technical expert panel (TEP) meetings between June 2017 and March 2018. The updated NPS Goal for Suicide Prevention is part of the Joint Commission’s broader effort to minimize ligature risk. NABH has played a role in that effort, as five NABH members served on the 26-member TEP. CDC Reports Suicide Rate Among Working Age Population Rose 34% Between 2000-2016 The U.S. suicide rate among working aged (16–64 years) adults increased 34 percent to 17.3 per 100,000 people in 2016 from 12.9 per 100,000 in 2000, the Centers for Disease Control and Prevention (CDC) has reported. Construction and Extraction was the occupational group with the highest male suicide rate in 2012 and 2015, while the Arts, Design, Entertainment, and Sports was the occupational group with the highest female suicide rate for those same years. The CDC recommended a comprehensive approach to prevention and said strategies might include enhancing social connectedness; expanding access to relevant resources; strengthening state or local economic supports; implementing practices that encourage help-seeking and decrease stigma; and providing referrals to mental health and other services. CMS Proposes Expanding Coverage for VNS Devices The Centers for Medicare and Medicaid Services (CMS) has proposed changes that would expand Medicare coverage for Food and Drug Administration (FDA)-approved vagus nerve stimulation (VNS) devices for treatment resistant depression (TED). In a decision memo, CMS specified this would happen through Coverage Evidence Development, or CED, when offered in a CMS-approved, double-blind, randomized, placebo-controlled trial with a follow-up duration of at least one year with the possibility of extending the study to a prospective longitudinal study when the CMS-approved, double-blind, randomized placebo-controlled trial has completed enrollment, and there are positive interim primary endpoint findings. Learn more about the proposal and coverage indications here. USA Today Reports on Rise in Alcohol-related Deaths The number of deaths attributable to alcohol increased 35 percent and the death rate rose 24 percent between 2007 and 2017, USA Today reported recently, citing a new analysis from the University of Washington’s Institute for Health Metrics and Evaluation. “One alarming statistic: Deaths among women rose 85 percent,” the article noted. “Women once drank far less than men, and their more moderate drinking helped prevent heart disease, offsetting some of the harm,” adding that deaths among men rose 29 percent. The article features personal stories, as well as a map of the United States that provides statistics about the changes in alcohol-related deaths for each state during this 10-year period. CMS Report Shows Considerable Increase in Telemedicine for Medicare Beneficiaries A majority of all Medicare beneficiaries using telehealth (85.4 percent) had at least one mental health diagnosis, and psychotherapy is among the services most commonly provided through telehealth, CMS concluded in its recent report to Congress on telehealth. The 21st Century Cures Act required CMS to provide information on the populations of Medicare beneficiaries—such as those who are dually eligible for Medicare and Medicaid—and those with chronic conditions whose care “may be improved most in terms of quality and efficiency by the expansion” of telehealth. According to the report, data showed that telehealth services is concentrated in states that have large rural areas, many of which are designated as Health Professional Shortage Areas (HPSAs). The 10 states with the highest use of telehealth are California, Georgia, Iowa, Kentucky, Michigan, Minnesota, Missouri, Texas, Virginia and Wisconsin. Latest Kaiser Health Tracking Poll Finds Slight Uptick in ACA Favorability The latest health tracking poll from the Kaiser Family Foundation found that 53 percent of the public view the 2010 Affordable Care Act favorably, compared with four in 10 who have an unfavorable view of the landmark healthcare law. The slight uptick came after this month’s midterm elections, in which Democrats regained a majority in the U.S. House of Representatives for the first time since 2010, months after President Obama signed the Affordable Care Act. Meanwhile, the midterm elections also resulted in Medicaid expanding in three additional states, which brings the total number of states that have expanded their Medicaid programs to 37 (including Washington, D.C.). “And as a possible indicator of how some other states may expand their Medicaid programs in the future, most of those living in a non-expansion state say that if their state government chooses not to expand, voters themselves should be able to decide if their state expands their Medicaid program,” the tracking poll noted. HRSA Launches SUD Workforce Loan Repayment Program HHS’ Health Resources and Services Administration (HRSA) has launched its National Health Service Corps Substance Use Disorder (SUD) Workforce Loan Repayment Program to help boost the SUD workforce in underserved areas. Participants are eligible to receive up to $75,000 in student loan repayment if they agree to a three-year work commitment at NHSC-approved sites. According to HRSA, this loan repayment program is separate from the loan repayment program in H.R. 6, the SUPPORT for Patients and Communities Act that President Trump signed recently. Click here to learn more about the program. SAMHSA Will Host ISMICC Meeting on Dec. 11 HHS has announced the Substance Abuse and Mental Health Services Administration (SAMHSA) will host a meeting of the Interdepartmental Serious Mental Illness Coordinating Committee at SAMHSA on Monday, Dec. 11 from 9 a.m. until 5 p.m. ET. The notice said the meeting will feature information on federal efforts related to serious mental illness (SMI) and serious emotional disturbance (SED), including federal coordination, strategies, data evaluation, and recommendations for action. Register Now for the 2019 NABH Annual Meeting Please visit NABH’s Annual Meeting homepage today to register and reserve your hotel room for the 2019 NABH Annual Meeting — Behavioral Healthcare: Improving Coordination, Collaboration, Integration. We look forward to seeing you at the Mandarin Oriental Washington, D.C. from March 18-20, 2019! For questions or comments about CEO Update, please contact Jessica Zigmond.

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CMS Announces Demonstration Projects for SMI and SED The Centers for Medicare and Medicaid Services (CMS) this week announced opportunities for demonstration projects under section 1115(a) of the Social Security Act to improve care for adults with serious mental illness (SMI) and children with Serious Emotional Disturbances (SED). The 21st Century Cures Act required these demonstration projects, and NABH was instrumental in ensuring that the Cures Act included this provision. Section 1115(a) of the Social Security Act states that the HHS secretary may authorize a state to conduct experimental, pilot, or demonstration projects as long at the overall demonstration is budget neutral. A budget-neutral demonstration means that the Medicaid costs for a demonstration project do not exceed what the federal government’s Medicaid costs likely would have been absent the demonstration. This SMI/SED demonstration authority will allow states—upon CMS approval of their demonstrations—to receive Medicaid federal financial payments (FFP) for services furnished to Medicaid beneficiaries during short-term stays for acute care in psychiatric hospitals or residential treatment settings that qualify as IMDs. This SMI/SED demonstration opportunity is comparable with the recent section 1115 (a) demonstration opportunity to improve treatment for SUDs, including opioid use disorder (OUD). States may participate in the SUD demonstration opportunity and the SMI/SED demonstration opportunity at the same time. Under this demonstration, NABH members will be required to show that, statewide, the average length of stay for beneficiaries receiving care in Institutions of Mental Diseases (IMDs) does not exceed 30 days. This length-of-stay limit is higher than the current 15-day cap that applies to states that use the managed care authority to contract with IMDs. In fact, the 1115 limit is a statewide average length of stay, rather than a hard per-beneficiary cap of 15 days under the managed care contracting authority. It is not clear from this letter how states would use the managed care contracting authority together with a 1115 demonstration project if a state chose both approaches. NABH will work with CMS on ways to coordinate the 1115 demonstration authority with the managed care contracting authority, especially related to the 15-day cap versus the 30 day statewide average cap. States participating in the SMI/SED demonstration opportunity will be expected to implement efforts to improve community-based mental healthcare. Some of the goals regarding community-based care include: improving connections to community-based care following stays in acute care settings; ensuring a continuum of care available to address more chronic, ongoing mental healthcare needs of beneficiaries with SMI or SED; providing a full array of crisis stabilization services; and engaging beneficiaries with SMI or SED in treatment as soon as possible. The agency’s letter also outlines some specific objectives for the demonstrations, such as reducing utilization and lengths of stay in emergency departments; reducing preventable readmissions; improving availability of crisis stabilization services; improving access to community-based services, including integration of primary and behavioral healthcare; and improving care coordination, especially continuity of care in the community after episodes of acute care in hospitals and residential treatment facilities. States will also be required to conduct independent interim and final evaluations that will draw on data collected and will need to describe the demonstration’s effectiveness using quantitative and qualitative outcomes and cost analysis. NABH encourages its members to contact their respective state Medicaid director(s) to offer help in applying for this 1115 waiver for IMD services to SMI and SED beneficiaries. Click here to read the letter from CMS to state Medicaid directors. The NABH team will continue to keep members apprised of any changes and activities regarding this demonstration authority and any other matters related to the IMD exclusion. AHIP Finds Medicaid Enrollees with Serious Chronic Conditions Have Better Clinical Experiences than the Uninsured Population Medicaid enrollees experiencing mood disorders such as major depressive disorder or bipolar disorder were much more likely to receive a recommended combination of medication and psychotherapy treatments than uninsured individuals, according to a new report from America’s Health Insurance Plans (AHIP). The study—which concluded the same results for people with other chronic conditions—analyzed information from people who were uninsured, covered by a Medicaid private health plan, or covered by a commercial plan. Researchers then compared clinical care and prescription drug use patterns from 2013-2015 among people with one of three chronic conditions: asthma, diabetes, or mood disorders. According to the report, major depressive disorder affects about one out of 10 Americans each year, and about one out of five will experience at least one depressive episode throughout their lifetime. It also drives total annual costs of more than $211 billion. Meanwhile, the report estimated that bipolar disorder affects about 3 percent of the adult U.S. population and drives total annual medical costs of about $202 billion. “The proposition that having Medicaid coverage is somehow detrimental to one’s health is simply not supported by the clinical experiences described in this and other studies,” the report noted. “Indeed, results from this study suggest that quite the opposite is true.” GAO Report Describes the Top Practices for Certifying Peer Specialists Systematic screening of applicants, conducting core training in person, and incorporating physical health and wellness into training are among the six leading practices for certifying peer specialists that the Government Accountability Office (GAO) identified in a new report this week. The 21st Century Cures Act included a provision for GAO to study and identify best practices related to both training and certification in peer support programs in selected states that receive funding from the Substance Abuse and Mental Health Services Administration (SAMHSA). GAO researchers interviewed program officials in Florida, Georgia, Michigan, Oregon, Pennsylvania, and Texas, which are among the 41 states and Washington, D.C., that—as of July 2016—had programs to certify peer support specialists. Program officials in those six states generally cited six practices that have a basic set of competencies and have shown an ability to help support others. In addition to screening patients, conducting in-person core training, and incorporating physical health and wellness, the other best practices include preparing organizations to use peers effectively, ensuring continuing education requirements specific to peer support, and engaging peers in both leading and developing certification programs. U.S. Labor Department Announces Grant to Address Opioid Addiction in Rural California The U.S. Labor Department this week awarded California a National Health Emergency Dislocated Worker Grant to provide employment for eligible individuals in rural California counties that have been hit hard economically by the nation’s opioid crisis. The grant will provide employment for those seeking careers in healthcare professions related to addiction, treatment, prevention, and pain management. According to a news release from the Labor Department, California expects to serve participants in Amador, Calaveras, Humboldt, Inyo, Kern, Mariposa, Merced, Mono, and Tuolumne counties—all of which have had the highest opioid rates in the state. The Workforce Innovation and Opportunity Act of 2014 supports Dislocated Worker Grants, which temporarily expand the capacity of dislocated worker programs at the state and local levels as a response to unexpected economic events that cause significant job losses. Recovery Research Institute Finds Oxford Houses Offer Recovery Benefits and Cost Savings Oxford House participants had better outcomes over time across the board, even when models adjusted for participant gender, age, and the presence of a co-occurring psychiatric disorder, the Recovery Research Institute reported in a new study. Oxford Houses were first developed in 1975 and are a type of abstinence-focused recovery residence where residents are entirely responsible for house decisions and maintenance. According to the study, there are about 2,000 Oxford Houses in the United States and other countries that support about 24,000 people each year. This recent study analyzed whether Oxford House participation is helpful; who Oxford Houses are most helpful for; and if Oxford Houses can reduce the financial burden that substance use disorder causes. Click here to learn more. SAMHSA Announces Distress Helpline Information During California Wildfires SAMHSA posted its Distress Helpline information late last week to offer immediate counseling for those affected by the deadly wildfires in California. The resource is available 24 hours a day, seven days a week, and connects callers to trained professionals from the closest counseling center in a nationwide network of centers. Click here to access the helpline. As always, NABH thanks its members for providing quality behavioral healthcare services to those in need every day, especially during disasters and public health emergencies. Update Your System’s Information Today for the NABH 2019 Membership Directory Earlier this week the NABH team e-mailed all system members a link that provides access to update all system information for the 2019 NABH Membership Directory. The deadline to submit all data for the 2019 directory is Thursday, November 29, 2018. If you did not receive the link, or if you have questions, please contact Cemal Ozgur at cemal@nabh.org or 202-393-6700, ext. 106. Register Now for the 2019 NABH Annual Meeting Please visit NABH’s Annual Meeting homepage today to register and reserve your hotel room for the 2019 NABH Annual Meeting — Behavioral Healthcare: Improving Coordination, Collaboration, Integration. We look forward to seeing you at the Mandarin Oriental Washington, D.C. from March 18-20, 2019! For questions or comments about CEO Update, please contact Jessica Zigmond.

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What the 2018 Midterm Elections Could Mean for Behavioral Healthcare An incoming Democratic majority in the U.S. House of Representatives and an expanded Medicaid program will have implications for the nation’s healthcare system in general and behavioral healthcare in particular, although what those changes are remains to be seen. Although some races are still too close to call, Democrats regained majority control of the House for the first time since 2010 and Republicans slightly expanded their majority in the Senate after Tuesday’s highly anticipated midterm elections. Healthcare—particularly the issue of protections for pre-existing conditions—played an important role in this year’s elections, and the implications for behavioral healthcare are beginning to take shape. Voters in Idaho, Nebraska, and Utah passed ballot initiatives requiring their states to expand Medicaid, while voters in Maine and Kansas elected new governors who support Medicaid expansion—and whose respective state legislatures are expected to follow suit. Consequently, about 500,000 Americans are expected to obtain coverage, according to estimates. Medicaid expansions have produced the broadest expansion of behavioral healthcare services in decades. Meanwhile, the split control of Congress will likely prevent some of the more controversial and potentially negative legislative proposals that could affect the behavioral healthcare industry. These include efforts to repeal and replace the Patient Protection and Affordable care Act (ACA); turn Medicaid into a block grant program; and move the Medicare program toward a premium support model. NABH Champions fared very well in this election cycle, with only a handful of NABH Champions retiring or losing their bids for re-election. NABH staff is awaiting the results of several races and will update our Champion targets as additional races are settled. NABH Champion Rep. Frank Pallone (D-N.J.) is expected to serve as chairman of the influential House Energy and Commerce (E&C) Committee. Rep. Pallone has indicated that the priority issues for the next Congress should include protecting the ACA and addressing high prescription drug costs. He has also indicated interest in NABH-supported efforts to address the opioid epidemic and enact privacy protections and reforms. NABH Champion Rep. Anna Eshoo (D-Calif.) is expected to serve as chairman of the E&C Health Subcommittee. The California congresswoman has actively supported expanding telehealth services, an initiative NABH supports. NABH Champion Richard Neal (D-Mass.) is expected to lead the House Ways and Means (W&M) Committee as its chairman. Rep. Neal has indicated there is more to be done to address the nation’s opioid crisis, namely improving funding for many of the programs authorized in this year’s legislation.  This is a priority for the new chairman and a possible area for bipartisan compromise in the new Congress. Rep. Lloyd Doggett (D-Texas) is rumored to be interested in leading the W&M Health Subcommittee. In the past, Rep. Doggett has supported legislation to allow the Medicare program to negotiate drug prices. In the Senate, there will be few changes to key committees as Republicans maintain the majority. Sen. Orrin Hatch’s (R-Utah) retirement means the Senate Finance Committee will have a new chairman, reports indicate that NABH Champion Sen. Chuck Grassley (R-Iowa) is considering the post. Grassley’s healthcare interests in the past have included a focus on high drug prices and transparency in payments from pharmaceutical and device companies to physicians. If Grassley does not assume the role, another NABH Champion —Sen. Michael Crapo (R-Idaho) — is reportedly another possibility. Finally, NABH Champion Sen. Lamar Alexander (R-TN) will remain as chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee.   CMS Proposed Rule Could Help Telehealth Providers The Centers for Medicare and Medicaid (CMS) late this week proposed a rule that could help telehealth providers get approved for Medicaid and Children’s Health Insurance Program (CHIP) managed care. In the rule, CMS noted that states have alerted the agency to concerns about the appropriateness of applying time and distance standards uniformly. “In some situations, time and distance may not be the most effective type of standard for determining network adequacy and some states have found that time and distance analysis produces results that do not accurately reflect provider availability,” the rule said. “For example, a state that has a heavy reliance on telehealth in certain areas of the state may find that a provider to enrollee ratio is more useful in measuring meaningful access, as the enrollee could be well beyond a normal time and distance standard but can still easily access many different providers on a virtual basis,” it continued. “A 2017 Brookings/Schaefer Center report notes that in some clinical areas, telemedicine could make proximity measures obsolete, or counterproductive.” Consequently, the agency said it proposes deleting requirements for states to set time and distance standards and “adding a more flexible requirement.” The agency will accept public comments on the rule for the next 60 days.   The American Psychiatric Association Will Host Parity Briefing on Nov. 13 The American Psychiatric Association (APA) will host a briefing next week about enforcing mental health parity as an essential tool in fighting opioid addiction and preventing suicide. Moderated by APA President-elect Bruce J. Schwartz, M.D., the briefing next Tuesday from noon to 1:30 p.m. ET will feature Mike Hogan from Case Western Reserve University, who will discuss parity and suicide; and Kevin Roy, the chief policy officer at Shatterproof, and Tim Clement, M.P.H., APA’s regional field director, who will discuss parity and opioids. For those who will be in D.C. and can attend, the event will take place in the Senate Visitor Center room 210 of the U.S. Capitol. Please RSVP to advocacy@psych.org.   2019 NABH Membership Directory Ad Deadline Extended to Friday, Nov. 16th! NABH has extended the deadline to submit an ad for the 2019 NABH Membership Directoryto next Friday, Nov. 16. Each year NABH updates and publishes the NABH Membership Directory to help both consumers and providers find and access behavioral health services nationwide. Published in late fall 2018, the directory lists NABH member organizations geographically, alphabetically and by system/facility.The directory is widely distributed to state hospital associations, National Alliance on Mental Illness state affiliates, and NABH members. Now is the opportunity to highlight your organization’s specialized services through an ad in the 2019 edition. Download an advertising rate card or email maria@nabh.org. Register Today for the 2019 NABH Annual Meeting Please visit NABH’s Annual Meeting homepage today to register and reserve your hotel room for the 2019 NABH Annual Meeting — Behavioral Healthcare: Improving Coordination, Collaboration, Integration. We look forward to seeing you at the Mandarin Oriental Washington, D.C. from March 18-20, 2019.   For questions or comments about CEO Update, please contact Jessica Zigmond.

CEO Update | 31

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CMS Finalizes 2019 Payment Increases for PHPs In a final rule this week, the Centers for Medicare and Medicaid Services (CMS) set the 2019 hospital-based partial hospitalization program (PHP) payment rate at $220.86. This is above the $216.55 rate that the CMS had recommended in its Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (OPPS/ASC) proposed rule in July. The final rule also increased the 2019 payment rate for the nation’s community mental health centers (CMHCs) to $120.58, compared with earlier proposed rate of $117.35. CMS also finalized its controversial site-neutral payment policy, saying it will apply “a Physician Fee Schedule (PFS)-equivalent payment rate for the clinic visit service when provided at an off-campus provider-based department (PBD) that is paid under the OPPS.” NABH opposed this change in its comments to CMS. The association will work with other organizations to determine the best approach on addressing this policy change. CMS Addresses Opioid Crisis in OPPS/ASC Final Rule As part of this week’s final OPPS/ASC rule, CMS said it would pay the nation’s ambulatory surgery centers more for non-opioid painkillers and also remove pain questions from post-discharge hospital surveys to avoid potential unintended consequences. The agency also said it is adopting a policy to encourage increased use of non-opioid drugs after a surgical procedure in an ASC setting. Specifically, CMS said it would pay separately at the average sales price plus 6 percent for non-opioid pain management drugs that function as a supply when used in a covered surgical procedure performed in an ASC.   New Jersey General Assembly Approves Parity Bill The New Jersey General Assembly this week overwhelmingly passed a strong bill to improve transparency and enforce mental health parity. The legislation puts in place substantial portions of the Model State Parity Legislation that the Kennedy Forum, American Foundation for Suicide Prevention, Mental Health Association, National Alliance on Mental Illness, and other organizations developed. Click here for details about the bill.   IHS Announces Policy to Expand MAT Access in Remote Locations HHS’ Indian Health Service (IHS) this week released an Internet Eligible Controlled Substance Provide Designation Policy designed to increase access to opioid use disorder treatment for American Indians and Alaskan Natives living in rural areas. The new policy enables IHS, tribal, and urban Indian organization healthcare providers to apply for designation from IHS as Internet Eligible Controlled Substance Providers, which would allow them to prescribe controlled substances for Medication Assisted Treatment (MAT) through telemedicine. ASAM Introduces Continuing Medical Education Program in Addiction Medicine The American Society of Addiction Medicine has introduced The ASAM Fundamentals of Addiction Medicine 40-Hour Program, a continuing medical education (CME) program for primary care and other providers to diagnose and treat patients at risk for or with addiction. CME activities for the program include a fundamentals of addiction medicine workshop, a CO*RE/ASAM pain management and opioids course, the ASAM treatment of opioid use disorder course, and more. Click here to learn about registering for the live course in Chicago on Dec. 5. Place Your Ad in the 2019 NABH Membership Directory Today Each year NABH updates and publishes the NABH Membership Directory to help both consumers and providers find and access behavioral healthcare services nationwide. Scheduled for publication later this fall, the 2019 directory will list member organizations alphabetically, geographically, and by system/facility. The directory is widely distributed to state hospital associations, National Alliance on Mental Illness state affiliates, and NABH members. Please take the opportunity to highlight your organization’s specialized services with an ad in the 2019 edition.  Ads are due November 9. Download an advertising rate card or e-mail maria@nabh.org.   Register Today for the 2019 NABH Annual Meeting Please visit NABH’s Annual Meeting homepage today to register and reserve your hotel room for the 2019 NABH Annual Meeting — Behavioral Healthcare: Improving Coordination, Collaboration, Integration. We look forward to seeing you at the Mandarin Oriental Washington, D.C. from March 18-20, 2019!   For questions or comments about CEO Update, please contact Jessica Zigmond

CEO Update | 30

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President Signs H.R. 6, the SUPPORT for Patients and Communities Act This week President Trump signed the SUPPORT for Patients and Communities Act (H.R. 6), which includes the first significant change to the Medicaid program’s Institutions for Mental Diseases (IMD) exclusion since 1972. Other NABH priorities are part of the new law, including a provision that would consider opioid treatment programs as eligible providers under Medicare, as well as a measure that would allow the Centers for Medicare and Medicaid Services (CMS) to test behavioral healthcare information technology (BHIT). Hospitals, community mental health centers, and SUD providers would all be eligible to participate in the BHIT test. Report on State Medicaid Changes, Including IMD The results from the Kaiser Family Foundation’s “50-State Medicaid Budget Survey” were released this week. The survey looks at the changes taking place in Medicaid programs across all 50 states and the District of Columbia. Of note in the report are the changes occurring to the IMD exclusion: “The 2016 Medicaid MCO rule allows states to use “in lieu of” authority to cover services for adults who receive inpatient psychiatric or SUD treatment services in an IMD for no more than 15 days in a month. In this survey, 28 of the 39 MCO states reported that they are using this authority for both FYs 2018 and 2019, and three states reported plans to begin using this authority in FY 2019.”   CMS Model Addresses Opioid Misuse Among Expectant and New Mothers The Centers for Medicare & Medicaid Services (CMS) announced the Maternal Opioid Misuse (MOM) model to better align and coordinate care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder (OUD). The primary goals of the model are to: improve quality of care and reduce expenditures for pregnant and postpartum women with OUD as well as their infants; increase access to treatment, service-delivery capacity, and infrastructure based on state-specific needs; and create sustainable coverage and payment strategies that support ongoing coordination and integration of care. The CMS Innovation Center will establish 12 cooperative agreements with states and the MOM model will serve pregnant Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries with OUD who have elected to participate.   Former ONDCP Director Outlines Improvements to the Drug War In the Journal of the American Medical Association’s Forum Michael Botticelli, former director of the White House Office of National Drug Control Policy, along with Howard K. Koh, MD, MPH, and Gil Kerlikowske, MA discuss a “smarter war on drugs.” Their approach includes “having law enforcement officials collaborate more closely with health professionals to provide care and treatment.” The short piece discusses 4 specific areas where this collaboration should occur: drug courts, Naloxone use, diversion from arrest and treatment referral, and post-overdose outreach.   Behavioral Health Care Report from AHA and HRET The American Hospital Association (AHA) and the Health Research & Educational Trust (HRET) released a report this week titled Delivering High Quality Behavioral Health Care: Practices and Innovations from Leading Organizations. The report explores the current state of the behavioral health field and highlights practices that organizations have employed to provide high-quality care. A technical expert panel which contributed to the report included NABH members and several NABH facilities were included in the report.   Deadline: NQF Fall 2018 Measure Submission The NQF measure submission deadlines for the Fall 2018 review cycle are approaching. This year the Behavioral Health and Substance Use deadline will be November 1, 2018 at 6:00pm ET. Click here to find more information on submitting measures to NQF and for reference information on the submission requirements and the measure steward agreement, please click here.   PLACE YOUR AD IN THE 2019 MEMBERSHIP DIRECTORY TO DRAW YEAR-ROUND ATTENTION. Each year, NABH updates and publishes the NABH Membership Directory to help both consumers and providers find and access behavioral health services nationwide. The directory, which will be published in fall 2018, lists NABH member organizations by system/facility, geographically, and alphabetically. The directory is widely distributed to state hospital associations, National Alliance on Mental Illness state affiliates, and NABH members. Now is the opportunity to highlight your organization’s specialized services through an ad in the 2019 edition.  Ads are due November 9. Download an advertising rate card or email maria@nabh.org. (NABH Contact: Maria Merlie) For questions or comments about CEO Update on Oct. 26, please contact Scott Dziengelski.

CEO Update | 29

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ASAM and CARF Announce New SUD Treatment Delivery Certification The American Society of Addiction Medicine (ASAM) and the Commission on Accreditation of Rehabilitation Facilities (CARF) have announced a new national certification program for addiction treatment programs that will “provide an independent, comprehensive assessment of an individual treatment program’s fidelity to a specific level of care as outlined in The ASAM Criteria.” This new certification, which ASAM and CARF anticipate piloting in early 2019, will be based on Level 3 (3.1, 3.5, and 3.7) of the ASAM Criteria which covers residential treatment programs. To obtain certification, programs will need to demonstrate to CARF that they have the capacity to deliver services at the level of care defined by The ASAM Criteria based on a scoring methodology developed by ASAM and CARF. Programs will then submit applications to CARF directly and CARF will independently perform the certification process, including reviewing individual provider applications and conducting site visits. Each certification will be valid for up to three years, at which time the program may reapply. NABH and Hospital Groups Send Letter on Interoperability of Health Information This week NABH joined with other major hospital associations in sending a letter to Health and Human Services (HHS) Secretary Alex Azar which expressed concerns about the use of the Medicare and Medicaid Conditions of Participation (CoPs) and Conditions for Coverage (CfCs) to promote interoperability of health information.   The letter reads in part “While we applaud the agency’s work to promote interoperability, we believe that revisions to the CoPs that require health information exchange between hospitals and community providers and between hospitals and patients are not the appropriate mechanism to advance interoperability… the use of the CoPs/CfCs runs counter to the administration’s important efforts to reduce regulatory burdens and advance patients’ access to information, improve quality and reduce costs.”   In addition to asking HHS to not pursue this approach, the letter urges Secretary Azar to work with the provider community to bolster the advances already underway in information exchange among providers, between providers and community entities, and with patients and their families, rather than imposing new regulatory requirements on providers. Click here to read to full letter.   Mary Mayhew Named New Director of Federal Medicaid A former top aide to the Governor of Maine, Mary Mayhew, has been selected by the Trump administration to be the deputy administrator and director of Medicaid and the Children’s Health Insurance Program. Mayhew served as the health commissioner for six years in Maine and lost her recent bid to succeed Paul LePage as governor in the June Republican primary. She now replaces Brian Neale, the Trump appointee who left in February. FDA Considers Increasing Number of Over-The-Counter Drugs The FDA plans to release a proposed rule next summer that would allow more drugs to be available to consumers without a prescription from a healthcare professional (also known as non-prescription or over-the-counter drugs). The proposal, which was mentioned in the semiannual update on regulatory actions, would permit some products to be over-the-counter if companies take additional steps to ensure consumers can appropriately decide whether the medicine is right for them and how to use the treatment. Naloxone, the overdose reversal medication, is among those that the FDA has indicated may become available in this manner. California Governor Signs New SUD Treatment Laws Late last month California Governor Jerry Brown signed four new addiction treatment laws which ban patient brokering, strengthen licensure requirements, and increase penalties against SUD treatment facilities. Nominations Due October 31 for 2019 Board Chair-Elect and Board Members This week NABH sent a nomination form to members that seeks nominations in the single-slate ballot for NABH Board positions in 2019. NABH asks members to help identify potential candidates for the Board Chair-Elect position and for two Board seats that will become available next year. The Selection Committee is particularly interested in identifying senior managers who represent the broad diversity within the NABH membership, including different levels of care, organizational structures, and geographical locations. In your nomination, please attach a curriculum vita (CV) for each person you recommend. You are welcome to nominate yourself or others. Please return the form (and all nominees’ CVs) by Wednesday, Oct. 31 to maria@nabh.org, or mail your materials to NABH, ATTN: Maria Merlie, 900 17th Street, NW, Suite 420, Washington, DC 20006. For questions or comments about CEO Update, please contact Scott Dziengelski.
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NABH Seeks 2019 Board Nominations

Written by Administrator on . Posted in Resources.

As the Selection Committee prepares to consider possible nominees, we would like you to help us identify potential candidates for:
  • the position of Board Chair-Elect and
  • two Board seats that will become available in 2019.
The Selection Committee is particularly interested in identifying senior managers who represent the broad diversity within the NABH membership, including diverse levels of care, organizational structures, and more. Please download a nomination form to share your recommendations of individuals who you would like to see the Selection Committee include in the single-slate ballot for 2019. Please attach a curriculum vita (CV) for each individual you recommend. This will help the Selection Committee in its deliberations. You are welcome to suggest yourself or others.
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2019 Board Nominations Form

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Please return this form (and candidates’ CVs) by Wednesday, October 31, 2018, to maria@nabh.org (or mail to NABH, ATTN: Maria Merlie, 900 17th Street, NW, Suite 420, Washington, DC 20006). Immediate Past Board Chair Debbie Osteen will chair the NABH Selection Committee, which will meet this fall to develop the final slate.  

CEO Update | 28

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Lancet Report Estimates Global Mental Health Crisis Could Cost $16 trillion by 2030 Mental health disorders are increasing around the world and could cost the global economy $16 trillion by 2030, a team of 28 global experts concluded in a report published this week in The Lancet. Vikram Patel, a professor at Harvard Medical School and the report’s co-author, said that while some of the costs will be the direct costs of healthcare and medicines or other therapies, most are indirect costs in the form of productivity loss and spending on social welfare, education, and law and order, according to a Reuters story. The report was released before the second Global Summit on Mental Health Culture Change in London this week and concluded that more than 13 million lives could be saved every year if mental illness was treated properly. U.S. Surgeon General Adams and Labor Secretary Acosta Cite MAT in White House Blog Helping Americans “sidelined by drug addiction” into the workforce is good for communities and American business, U.S. Surgeon General Jerome Adams, M.D. and Labor Secretary R. Alexander Acosta wrote in a White House blog post this week. The federal officials cited a strong economy while also noting that too many Americans are not participating in the workforce. In discussing the nation’s opioid crisis, they recognized the value of medication assisted treatment, or MAT. “Effective treatment is available for opioid use disorder,” Jerome and Acosta wrote. “The gold standard is the use of medication in combination with ongoing behavioral therapy, also known as Medication Assisted Treatment. Comprehensive treatment should also include efforts to enable these individuals to rejoin the workforce,” they added. “There is strong evidence that a job can help sustain long-term recovery.” Pennsylvania and Health Insurers Approve Deal to Remove Prior Authorization to Treat SUD Seven major health insurers and the commonwealth of Pennsylvania on Friday agreed to remove prior authorization requirements for treating substance use disorders (SUD), which the American Medical Association and Pennsylvania Medical Society say could have the potential to save thousands of lives. Insurers also committed to including a “comprehensive range of medications” to treat SUD on the lowest cost-sharing tier of a health plan’s pharmacy benefit as part of the agreement. “We have long advocated for the removal of prior authorization and other barriers to increase access to medication-assisted treatment (MAT) for substance use disorders,” AMA President-elect Patrice A. Harris, MD, MA said in a news release about the deal. “The leadership shown by the governor and his administration to reach this agreement should act as a call for all states to demonstrate that they support patients’ access to care over needless administrative burdens.” Senate Resolution Marks 10th Anniversary of Mental Health Parity and Addiction Equity Act The Senate this week passed a resolution that recognizes the 10th anniversary of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act’s enactment. Introduced by Sens. Bill Cassidy, M.D. (R-La.) and Amy Klobuchar (D-Minn.), the resolution also honors the late Sens. Paul Wellstone (D-Minn.) and Pete Domenici (R-N.M.), who fought for access to mental health treatment and whose names are on the bill that became law on Oct. 3, 2008. Wellstone died in a plane crash in October 2002 and Domenici died in September 2017 following complications from abdominal surgery. “Senators Wellstone and Domenici worked to ensure access to mental health treatment,” Cassidy said in a news release. “Passing the Mental Health Reform Act of 2016 continued this bipartisan effort to remove stigma surrounding mental illness and increase access to treatment.” SAMHSA Introduces Early Serious Mental Illness Treatment Locator The Substance Abuse and Mental Health Services Administration (SAMHSA) this week launched its Early Serious Mental Illness Treatment Locator to help connect people experiencing a first onset of serious mental illness to effective care. According to SAMHSA, programs that treat serious mental illness—including first episode psychosis programs—are becoming more available. In two years, the number has increased to more than 270 programs in 49 states from a few programs in 17 states. The locator is a confidential and anonymous source of information for persons and their family members who are seeking treatment in the United States and U.S. territories for a recent onset of serious mental illness, such as psychosis, schizophrenia, bi-polar disorder, and other conditions. CDC Highlights Emergency Preparedness and Children for World Mental Health Day The Centers for Disease Control and Prevention (CDC) earlier this week published a blog post about the Atlanta-based agency’s experiences to help inform mental health interventions and improve outcomes for children after public health emergencies and disasters. The post focused on World Mental Health Day’s theme this year—”Young People and Mental Health in a Changing World”—and shared the lessons the CDC learned from the 2017 hurricane season. “Mental stress from a disaster can be harder on children,” the authors wrote. “Children are more vulnerable in emergencies because of their physical, developmental, behavioral, and emotional differences from adults,” they said, adding that children may also have difficulty or may not be able to communicate their symptoms or feelings. Click here to learn more. SAMHSA Releases Disaster Distress Hotline Reminder for Hurricane Michael Survivors The Substance Abuse and Mental Health Services Administration (SAMHSA) posted information regarding immediate crisis counseling for those affected by Hurricane Michael. SAMHSA’s Helpline, 1-800-985-5990, is available 24 hours a day, seven days a week, for anyone who needs counseling after a natural or human-made tragedy. NABH thanks its members in the region who have provided and will continue to provide care for those who need it. Register Today for the NABH 2019 Annual Meeting! Please visit NABH’s Annual Meeting homepage today to register and reserve your hotel room for the 2019 NABH Annual Meeting — Behavioral Healthcare: Improving Coordination, Collaboration, Integration. We look forward to seeing you at the Mandarin Oriental Washington, D.C. from March 18-20, 2019! For questions or comments about CEO Update, please contact Jessica Zigmond.

CEO Update | 27

Written by Administrator on . Posted in CEO Updates.

Senate Passes Bipartisan Opioid Legislation The Senate on Thursday passed the SUPPORT for Patients and Communities Act, the opioid-response legislative package that the House passed last week. Ninety-eight senators voted for the legislation, while Sen. Mike Lee (R-Utah) voted against it and Sen. Ted Cruz (R-Texas) did not vote. As reported in CEO Update last week, the final legislation provides an optional benefit for states to pay IMDs for substance use disorder (SUD) treatment for patients between the ages of 21-64 for 30 days each year. In addition, patients with mental illness could be treated under this provision as long as they have at least one SUD, although the bill does not specify if SUD must be a primary or secondary condition. The provision is scheduled to take effect in October 2019 and end in September 2023. Congressional action is required to extend the measure beyond that four-year period. The SUPPORT Act includes a maintenance-of-effort provision that would require states to maintain their current funding levels for both inpatient and outpatient services. In addition, a state would need to show the federal government that it has the full continuum of services, including early intervention, outpatient, intensive outpatient, partial hospitalization, and inpatient/residential transitions of care. All of these requirements are consistent with the recommendations NABH made in Pathways to Care: Treating Opioid and Substance Use Disorder. In addition, eligible IMDs would be required to follow “reliable, evidence-based practices” and offer at least two forms of medication assisted treatment, including one antagonist and one partial agonist. Other NABH priorities are part of the agreement, including a provision that would consider opioid treatment programs as eligible providers under Medicare, as well as a measure that would allow the Centers for Medicare and Medicaid Services (CMS) to test behavioral healthcare information technology (BHIT). Hospitals, community mental health centers, and SUD providers would all be eligible to participate in the BHIT test. The legislation will move to the White House for the president’s signature. SAMHSA’s McCance-Katz Highlights Problem with Fentanyl Test Strips The nation should resist the urge to adopt quick solutions for the opioid crisis and instead focus on strong prevention strategies, Assistant Secretary for Mental Health and Substance Use Elinore McCance-Katz, M.D., Ph.D. wrote in a blog post this week. In For Beating the Opioid Crisis, America has Better Weapons than Fentanyl Test Strips, McCance-Katz described how some states and communities use fentanyl test strips and questioned if “encouraging people who use drugs to test them first for ‘safety’ is the answer.” According to the Centers for Disease Control and Prevention, deaths due to synthetic opioids (other than methadone) and primarily driven by illicit fentanyl doubled between 2015 and 2016. Meanwhile, provisional data from 2017 indicate that 29,000 of the 49,000 opioid-related deaths involved fentanyl. “As a physician who has spent most of my career treating opioid use disorder, I find a fundamental problem in the justification for using such strips,” McCance-Katz wrote. “The purpose of the test strip is for an individual who is about to use a drug to first test the drug to detect fentanyl’s presence. If fentanyl is detected, the idea is, either the individual will not use or will change the way he or she uses (e.g., will use the more potent drug at a slower rate to try to avoid overdose),” she added. “On the surface, given the trends in deaths, this seems like a valid step to take.” The problem with this approach, McCance-Katz continued, is that it’s based on the premise that a drug user poised to use a drug is making rational choices, weighing pros and cons, and thinking logically about his or her drug use. “Based on my clinical experience,” she noted, “I know this could not be further from the truth.” McCance-Katz concluded by saying the Substance Abuse and Mental Health Services Administration has released more than $2 billion to address the crisis and that additional resources are coming. She specified that those funds should be used to enhance prevention strategies, ensure that people gain access to medication-assisted treatment and psychosocial therapies, and provide needed community recovery supports. Kennedy Forum Launches “Don’t Deny Me” Campaign on MHPAEA’s 10th Anniversary Behavioral health advocacy organization the Kennedy Forum this week kicked off Don’t Deny Me, a national campaign designed to spur a consumer-driven movement that pressures elected officials, insurance commissioners, and attorneys general to enforce parity laws. NABH is pleased to support Don’t Deny Me, which launched on Oct. 3, the 10-year anniversary of the Mental Health Parity and Addiction Equity Act. Please visit the website for a fact sheet, infographic, and shareable social media graphics. CMS Administrator Verma Says Better Data Will Modernize Medicaid As Medicaid program costs continue to grow, the federal government has failed to deliver a level of transparency and accountability for achieving positive outcomes that is commensurate with its investment, the head of the Centers for Medicare and Medicaid Services (CMS) announced in a blog post this week. But that practice is beginning to change, wrote CMS Administrator Seema Verma, who noted that her agency has collaborated with states to improve how CMS collects and uses data to modernize the Medicaid and Children’s Health Insurance Program (CHIP). “As one example, CMS has worked with stakeholders to identify two core sets of healthcare quality measures that can be used to assess the quality of healthcare provided to children and adults enrolled in Medicaid and CHIP,” Verma wrote. “These core sets are tools states can use to monitor and improve the quality of healthcare provided to Medicaid and CHIP enrollees.” Verma added that states have worked with CMS in recent years to modernize how administrative data are collected by moving to the Transformed-MSIS from the Medicaid Statistical Information Systems (MSIS). “T-MSIS modernizes and enhances the way states submit operational data about beneficiaries, providers, claims, and encounters,” Verma said. “It is the foundation of a national analytic data infrastructure to support programmatic and policy improvements and program integrity efforts and will help advance reporting on outcomes.” RAND Corp. Study Analyzes Vaping and Cigarette Patterns Among Youth Adolescents who use vaping products are more likely to smoke cigarettes and increase their use of both products over time, according to a new RAND Corp. study. More than 2,000 youth in California completed three surveys during a three-year period for this study, which allowed researchers to model e-cigarette use from ages 16 to 20. The findings showed that the increased use of both e-cigarettes and cigarettes over time cannot be attributed to other risk factors, such as consuming alcohol or marijuana. “Our work provides more evidence that young people who use e-cigarettes progress to smoking cigarettes in the future,” Michael Dunbar, a Rand behavioral scientist and the study’s lead author, said in an announcement. “This study also suggest that teens don’t substitute vaping products for cigarettes,” he added. “Instead, they go on to use both products more frequently as they get older.” NIMH Calls for Abstracts for Global Mental Health Research Conference The National Institute for Mental Health is seeking abstracts for the 10th anniversary of the Global Mental Health Research without Borders conference. For the first time, researchers are invited to submit abstracts to present original and innovative global mental health research. The NIMH Center for Global Mental Health Research will co-host the event with Grand Challenges Canada from April 8-9, 2019 at the Natcher Center on the National Institutes of Health campus in Bethesda, Md. The conference will focus on the following six research tracks: root causes of mental illness and key targets and times for intervention; preventing mental illness and delivering early interventions; improved treatment quality, value, and effectiveness; integrating mental health services into existing healthcare platforms (e.g., HIV/AIDS, primary care); implementing sustainable, evidence-based mental healthcare; and sustainable research capacity where it is underdeveloped. Abstracts are due by Saturday, Dec. 1, 2018. Registration Now Open for the NABH 2019 Annual Meeting! Registration for the 2019 NABH Annual Meeting — Behavioral Healthcare: Improving Coordination, Collaboration, Integration — is now available on the Annual Meeting homepage. We look forward to seeing you at the Mandarin Oriental Washington, D.C. from March 18-20, 2019! For questions or comments about CEO Update, please contact Jessica Zigmond.

CEO Update | 26

Written by Administrator on . Posted in CEO Updates.

House Passes Bipartisan Bill to Address Opioid Crisis     The House of Representatives on Friday overwhelmingly passed the SUPPORT for Patients and Communities Act, an opioid-response legislative package that House and Senate negotiators agreed to earlier in the week. In a 393-8 vote, House members approved a comprehensive bill that includes the first substantive change to Medicaid’s Institutions for Mental Diseases (IMD) exclusion since the early 1970s. Twenty-seven members did not vote on the bill. The measure will now move to the Senate, where it’s expected to pass. The legislation provides an optional benefit for states to pay IMDs for substance use disorder (SUD) treatment for patients between the ages of 21-64 for 30 days each year. In addition, patients with mental illness could be treated under this provision as long as they have at least one SUD, although the bill does not specify if SUD must be a primary or secondary condition. The provision is scheduled to take effect in October 2019 and end in September 2023. Congressional action is required to extend the measure beyond that four-year period. The SUPPORT Act includes a maintenance-of-effort provision that would require states to maintain their current funding levels for both inpatient and outpatient services. In addition, a state would need to show the federal government that it has the full continuum of services, including early intervention, outpatient, intensive outpatient, partial hospitalization, and inpatient/residential transitions of care. All of these requirements are consistent with the recommendations NABH made in Pathways to Care: Treating Opioid and Substance Use Disorder. In addition, eligible IMDs would be required to follow “reliable, evidence-based practices” and offer at least two forms of medication assisted treatment, including one antagonist and one partial agonist. Other NABH priorities are part of the agreement, including a provision that would consider opioid treatment programs as eligible providers under Medicare, as well as a measure that would allow the Centers for Medicare and Medicaid Services (CMS) to test behavioral healthcare information technology (BHIT). Hospitals, community mental health centers, and SUD providers would all be eligible to participate in the BHIT test. After Congress reached a deal earlier this week, NABH distributed a news release and posted a message on Twitter to highlight the efforts of House Energy and Commerce Committee Chairman Greg Walden (R-Ore.), Reps. Mimi Walters (R-Calif.) and Paul Tonko (D-N.Y.), and Sens. Rob Portman (R-Ohio) and Ben Cardin (D-Md.) on this important legislation. The NABH team will continue to analyze the bill’s provisions and will send a summary to NABH members next week. NABH Submits FY 2019 OPPS Comments to CMS The NABH team this week submitted comments to the Centers for Medicare and Medicaid Services (CMS) on the fiscal 2019 outpatient prospective payment system rule. NABH’s comments focused on partial hospitalization programs, site-neutral payments, and behavioral health information technology interoperability. “In previous comment letters, NABH urged CMS to adopt a clear policy that the provisions of Section 603 of the Bipartisan Budget Act of 2015 and the law’s subsequent regulation do not apply to the PHPs,” NABH President and Mark Covall wrote in the letter to CMS. “In those letters we explained that absent such an exemption, CMS risks placing a moratorium on new programs, which have no comparable ‘physician office’ service and are a critical and cost-effective level of care for Medicare beneficiaries living with mental illness and SUD,” he continued. “There are sound policy reasons for our position and CMS has the clear legal authority to adopt this policy.” Report Shows One-Third of Americans Received an Opioid Prescription in the Past Two Years About thirty-two percent of American adults have received a prescription for opioids in the past two years, according to a new survey from NORC at the University of Chicago. Results from the new AmeriSpeak® Spotlight on Health survey also found that nearly one in five adults, or about 18 percent, have received a prescription for opioids in the last year. Meanwhile, among adults who ever received an opioid prescription, 91 percent reported that they filled the prescription when they received it, and 29 percent refilled it more than once. Click here to read the news release and learn more. NABH Committees Discuss Priority Areas at Fall Leadership Forums Three of NABH’s four standing committees discussed top priority areas for their groups when they convened this past week in Naperville, Ill. and Washington, D.C. Meeting at Linden Oaks Behavioral Health in Naperville, Ill. from Sept. 20-21, the Behavioral Health Services within General Healthcare Systems Committee hosted House Ways and Means Health Subcommittee Chairman Peter Roskam (R-Ill.), as well as speakers from the Joint Commission and the American Hospital Association. The group focused on the environment of care and social determinants of health. NABH’s Quality Committee and Addiction Treatment Committees followed with their meetings in Washington, D.C. earlier this week, where the Quality Committee agreed to work on developing new measures for the Inpatient Psychiatric Facility Quality Reporting Program, and the Addiction Treatment Committee discussed emerging services, payment, and quality initiatives taking place at the national level. All three committees heard updates on the federal opioid legislation and discussed the bill’s implications for their facilities and programs. NABH’s Youth Services Committee will meet in Washington in late October. Save the Date for the NABH 2019 Annual Meeting! Please plan to join us at the Mandarin Oriental Washington, D.C. from March 18-20, 2019 for the 2019 NABH Annual Meeting. NABH will provide more information in the coming weeks. For questions or comments about CEO Update, please contact Jessica Zigmond.

CEO Update | 25

Written by Administrator on . Posted in CEO Updates.

House and Senate to Reconcile Opioid Legislation after Senate Passes Opioid Crisis Response Act The Senate this week passed the Opioid Crisis Response Act of 2018, a substantially different opioid  package from the SUPPORT Patients and Communities Act that the House passed in June. The Senate bill lacks several NABH-supported provisions, including one from the House-passed bill that would repeal the Institutions for Mental Diseases (IMD) exclusion for patients with opioid or cocaine use disorders for five years. In addition, the Senate bill does not include a provision that would allow Medicare part B to reimburse opioid treatment programs for using methadone in a medication assisted treatment program. The bill also does not include any reforms to 42 CFR part 2, which the House addressed separately (not as part of the SUPPORTAct). The next step is for the two chambers to reconcile these and other differences in their bills. NABH has learned from congressional staff that this will happen most likely through negotiations in the coming days, rather than the more formal conference committee process. If the House and Senate do not agree on a combined bill soon, the process will likely be delayed until November following this year’s mid-term elections. NABH continues to urge Senate staff to support the House bill. The NABH team has also been an active member within the Partnership to Reform 42 CFR Part 2 and signed onto a letter this week that encouraged House and Senate leaders to include reforms to 42 CFR part 2 in any opioid legislative agreement. To influence the process, Sens. Rob Portman (R-Ohio) and Dick Durbin (D-Ill.) introduced the Improving Coverage for Addiction Recovery Expansion Act, bipartisan legislation that would repeal the IMD exclusion for all patients with substance use disorders if state Medicaid programs offer at least six of nine criteria from the American Society of Addiction Medicine. The NABH team continues to work closely with Sen. Portman’s office and also continues to urge policymakers to include a provision that would ensure Medicare part B covers methadone treatment. HHS Awards More than $1 billion for Opioid Crisis HHS this week awarded more than $1 billion in grant funding to address America’s opioid crisis. An announcement from HHS said the grants support the department’s five-point opioid strategy, which was launched last year and focuses on better addiction prevention, treatment, and recovery services; better data, better pain management; better targeting of overdose-reversing drugs; and better research. “This week, HHS updated its strategic framework for tackling the opioid crisis, which uses science as a foundation for our comprehensive strategy,” Admiral Brett Giroir, M.D., assistant secretary for health and senior advisor for opioid policy, said in the announcement. “With these new funds, states, tribes, and communities across America will be able to advance our strategy and continue making progress against this crisis.” SAMHSA awarded more than $930 million in state opioid response grants, and about $90 million to other programming for states and communities to expand access to medication assisted treatment; increase distribution and use of overdose-reversal drugs; and increase workforce-development activities. U.S. Surgeon General Urges ‘Cultural Shift’ in How Americans Talk About Opioids No area of the country has been spared from the opioid crisis, yet only 53 percent of the public consider opioid addiction a major concern, according to a new Spotlight on Opioids from U.S. Surgeon General Jerome Adams, M.D., M.P.H. Consequently, the U.S. Surgeon General has asked the public to take specific actions that could ultimately help shift the dialogue on this public health emergency. These include: talking about opioid misuse; taking opioid medications only as prescribed; storing medication in a secure place; understanding pain and talking with a healthcare provider about non-opioid treatments to manage pain; understanding that addiction is a chronic disease; and learning how to use naloxone, an opioid overdose-reversing drug. Also this week, HHS announced it has developed materials to help clarify how clinicians can use telemedicine as a tool to expand buprenorphine-based medication assisted treatment for opioid use disorder treatment. Click here to learn more. CMS Seeks Comment on Special Conditions of Participation In a proposed rule this week, the Centers for Medicare and Medicaid Services (CMS) clarified a requirement that would allow for the use of non-physician practitioners or doctors of medicine or osteopathy to document progress notes of patients who receive services in psychiatric hospitals. The agency is seeking comment on the proposed rule for the next 60 days. NABH will submit comments during this process. SAMHSA Posts Disaster Distress Hotline for Hurricane Florence Survivors The Substance Abuse and Mental Health Services Administration (SAMHSA) posted information regarding immediate crisis counseling for those affected by Hurricane Florence in the Carolinas and Virginia. SAMHSA’s Helpline, 1-800-985-5990, is available 24 hours a day, seven days a week, for anyone who needs counseling after a natural or human-made tragedy. Click here for more information. NABH thanks its members in the region who have provided and will continue to provide care for those who need it. Save the Date for the NABH 2019 Annual Meeting! Behavioral Healthcare: Improving Coordination, Collaboration, Integration is the theme for the NABH 2019 Annual Meeting. Please save the date and plan to join us at the Mandarin Oriental Washington, D.C. from March 18-20, 2019. For questions or comments about CEO Update, please contact Jessica Zigmond.

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Senate Reschedules Opioid Legislation Vote for Monday, Sept. 17 Senate Majority Leader Mitch McConnell (R-Ky.) on Wednesday delayed an expected vote on the Senate’s opioid package, citing the risk of Hurricane Florence as the reason why he canceled this week’s remaining votes. The Senate’s bill, the Opioid Crisis Response Act of 2018, is expected to pass. If it does, the Senate and House plan to quickly resolve the differences between their respective opioid bills in a conference committee. The House passed the SUPPORT for Patients and Communities Act in June. The House and Senate opioid packages share several Medicare-related and drug provisions, such as requiring the Centers for Medicare and Medicaid Services (CMS) to test a bundled payment model to expand Medicare coverage for opioid treatment programs, and improving providers’ ability to prescribe medication assisted therapy drugs by expanding physician authorization. But on Medicaid, the two packages differ greatly. For instance, the House-passed bill partially repeals Medicaid’s Institutions for Mental Diseases (IMD) exclusion; establishes a demonstration program to expand provider capacity for substance use disorder treatment; and ensures Children’s Health Insurance Program (CHIP) coverage for substance use disorder services for children and pregnant women—none of which the Senate package offers. The Senate is expected to vote on its measure on Monday, Sept. 17. SAMHSA Releases 2017 National Survey on Drug Use and Health Report The Substance Abuse and Mental Health Services Administration (SAMHSA) this week released the 2017 National Survey on Drug Use and Health (NSDUH) Annual National Report, which summarizes key findings for national indicators of substance use and mental health among people aged 12 or older in the civilian, non-institutionalized population of the United States. According to the annual report, 30.5 million people aged 12 or older used an illicit drug in the past 30 days, which relates to about 1 in 9 Americans, or 11.2 percent. Meanwhile, an estimated 46.6 million adults aged 18 or older, or about 18.9 percent, had any mental illness in the past year, and about 11.2 million adults nationwide had a serious mental illness, which represents about 4.5 percent of all U.S. adults. Click here to access the annual report and detailed tables based on the survey’s results. The Joint Commission Releases First Data-Driven Estimate of Suicides in U.S. Hospitals About 49 to 65 hospital inpatient suicides occur in the United States each year, far fewer than a widely circulated estimate of about 1,500, according to new data published in The Joint Commission Journal on Quality and Patient Safety. The study, “Incidence and Method of Suicide in Hospitals in the United States,” analyzed national data sets that included the Centers for Disease Control and Prevention’s National Violent Death Reporting System (NVDRS) – Restricted Access Data for 2014-2015, and the Joint Commission’s Sentinel Event database from 2010–2017. According to the findings, about 49 to 65 hospital inpatient suicides occur each year in the United States. Of these, 75 percent to 80 percent were among psychiatric inpatients. Hanging accounted for more than 70 percent of suicides in both databases. About half of suicides occurred in the bathroom; one third occurred in the bedroom; and the remainder occurred in the closet. ““Hospitalization is intended to provide patients a safe, protected environment designed to heal and stabilize them during periods of crisis, and suicides that occur within a hospital are considered to be sentinel events,” Scott C. Williams, Psy.D., director of the Joint Commission’s research department and the study’s lead author, said in a news release about the findings. “The Joint Commission is improving its methods for analyzing inpatient suicides to collect more detailed information so we can provide better guidance on how hospitals can mitigate suicide risk more effectively.” CMS to Host Webinar on a Community Approach to Follow-Up Care CMS will host a webinar on Monday, Sept. 17 to highlight approaches for successful patient transitions from an inpatient psychiatric facility into the community. Titled “A Community Approach to Follow-Up Care,” the webinar will discuss Behavioral Health Charlotte’s strategies for successful patient transitions into the community, as well as community partnerships to optimize patient follow-up care and outcome metrics to track and improve transitions in case. The hourlong webinar is scheduled for 2 p.m. Eastern time. Click here to register.   Save the Date for the NABH 2019 Annual Meeting! Please save the date and plan to join us at the Mandarin Oriental Washington, D.C. fromMarch 18-20, 2019 for the 2019 NABH Annual Meeting. NABH will provide additional information in upcoming editions of CEO Update. For questions or comments about CEO Update, please contact Jessica Zigmond.

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Senate Expected to Vote on Opioid Package Next Week The Senate has agreed on a bipartisan opioids package to address the nation’s public health crisis, according to Senate Majority Leader Mitch McConnell’s (R-Ky.) office this week. Sen. Rob Portman (R-Ohio)—whose opioid-related bills are included in the package—said in a statement that a Senate floor vote is likely next week. The Senate package is similar in scope to the SUPPORT for Patients and Communities Act, or H.R. 6, which the House passed in June and includes many provisions that NABH supports. The Senate version includes new funding for states for a variety of opioid-related issues and would provide $500 million a year through the year 2021 to address substance use disorder (SUD) through grants that the 21st Century Cures Act established. The Senate’s legislation would also provide expanded access to MAT; increase the use of telemedicine for SUD; allow the CMS Innovation Center to test incentive payments for providers to adopt behavioral health electronic health records; and reauthorize the Office of National Drug Control Policy (ONDCP). This opioid package does not include NABH-supported initiatives on the Institutions for Mental Diseases (IMD) exclusion and reforms to 42 CFR Part 2, both of which the House has passed. After the Senate passes its legislative package, the House and Senate will settle differences between their respective bills through a conference committee. NABH staff will continue to consult with House and Senate leaders and their staff to address NABH’s interests throughout the conference committee process.   GAO Examines How Federal Agencies Use Grants to Address Adolescent and Young Adult Substance Use A new Government Accountability Office (GAO) study has found there are too few studies about drug addiction treatment for adolescents, too few providers to treat these patients, and too few services to sustain their recovery. The study examined how federal agencies, through grants, are addressing substance use prevention, treatment, and recovery among adolescents and young adults. According to the study, about 16 percent of adolescents and 38 percent of young adults used illicit substances in 2016, and most young adults who develop substance use disorders start using during adolescence. GAO researchers interviewed officials from four federal agencies—HHS, ONDCP, the Justice Department, and the Education Department—and 20 stakeholder groups (including advocacy groups, research organizations, and state agencies) about gaps in services or research, and agency efforts to address them. GAO identified 12 federal grant programs within three federal agencies that funded substance use prevention, treatment, and recovery services in 2017 and targeted adolescents’ and young adults’ use of illicit substances such as marijuana and non-medical use of prescription opioids. HHS’ National Institute on Drug Abuse (NIDA), the agency that is the primary funder of research on illicit substance use, had 186 active grant-funded research projects that received a total of about $61 million from NIDA in 2017. “There are federal grants that fund drug addiction treatment for adolescents and young adults,” the GAO noted in a brief summary of the report. “But most of the stakeholders we talked to believed that there are too few studies about drug addiction treatment for adolescents, too few providers to treat these patients, and too few services to sustain their recovery.” NIH Study Finds Daily Use of Marijuana Among Non-College Students at All-Time High Daily, or near daily, marijuana use among non-college young adults has reached its highest level, according to the Monitoring the Future (MTF) survey results released this week from NIDA at the National Institutes of Health (NIH). As a result, daily, or near daily, marijuana use is now nearly three times as high among non-college young adults as among college students. In 2017—for the first time— the MTF included questions about vaping marijuana. According to the results, past month use appears to be higher among non-college young adults than amount college students (7.8 percent versus 5.2 percent). More data and an infographic are available on NIDA’s College-Age & Young Adults webpage, which also includes links to statistics and trends, and a list of more than 400 college programs in addiction science, information about the Addiction Medicine Subspecialty, and other materials, including a toolkit for those hosting events during National Drug & Alcohol Facts Week ® early next year. Separately this week, a study published in Nature Neuroscience found that some of the same genes associated with the use of cannabis are also associated with certain personality types and psychiatric conditions.   The Lancet Study Finds Alcohol Use a Leading Risk Factor for Global Disease Burden Alcohol use is a leading risk factor for global disease burden and causes substantial health loss, according to results in the The Lancet’s Global Burden of Diseases, Injuries, and Risk Factors Study 2016. Researchers found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimizes health loss is zero. “These results suggest that alcohol control policies might need to be revised worldwide,” the study noted, “refocusing on efforts to lower overall population-level consumption.” Duke-Margolis Center for Health Policy Workshop Will Explore Therapies to Treat OUD The Duke-Margolis Center for Health Policy will host a workshop at the National Press Club in Washington next week to generate a discussion with providers and stakeholders about therapies to treat opioid use disorder (OUD). Sarah Wattenberg, NABH’s director of quality and addiction services, will present at that the workshop, which will also examine current barriers to using these medications appropriately and opportunities to further reduce stigma and expand access to effective pharmacotherapies as part of an evidence-based approach to OUD treatment. The U.S. Food and Drug Administration’s Center for Drug Evaluation and Research provided funding for this workshop, and Janet Woodcock, M.D., the center’s director, will serve as the workshop’s first speaker.   Save the Date for the NABH 2019 Annual Meeting! Please save the date and plan to join us at the Mandarin Oriental Washington, D.C. fromMarch 18-20, 2019 for the 2019 NABH Annual Meeting. NABH will provide additional information in upcoming editions of CEO Update. For questions or comments about CEO Update, please contact Jessica Zigmond.

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CMS Announces Model to Address the Effect of the Opioid Crisis on Kids The Centers for Medicare and Medicaid Services (CMS) this week announced the Integrated Care for Kids (InCK) Model as part of the agency’s approach to addressing America’s opioid crisis. InCK is a service delivery and state payment model designed to reduce costs and improve care quality for children covered by Medicaid and the Children’s Health Insurance Program (CHIP) through prevention, early identification, and treatment of priority health issues such as behavioral health challenges and physical health needs. According to CMS, the new model will help state Medicaid agencies and their local health and community-based partners identify and address risk factors for behavioral health conditions. The CMS Innovation Center plans to release a detailed “notice of funding” opportunity this fall that describes how state Medicaid agencies and local health and community-based organizations can apply to participate in the model. CMS expects to award funding for up to eight states at a maximum of $16 million as early as next spring. Separately this week, a new study in the journal Pediatrics found that learning disabilities and other special education needs are common in children born with opioid-related symptoms from their mother’s drug use while pregnant. The study involved about 7,200 children aged 3 to 8 enrolled in Tennessee’s Medicaid program. Of those children, nearly 2,000 were born with “newborn abstinence syndrome,” a collection of symptoms caused by withdrawal from their pregnant mother’s use of opioid drugs such as prescription painkillers, heroin, or fentanyl. Mary-Margaret Fill, M.D., the study’s lead author and a researcher with Tennessee’s health department, said these children “are definitely not doomed,” according to an Associated Press story about the study. “There are great programs and services that exist to help these children and their families,” Fill added. “We just have to make sure they get plugged in.” U.S. Preventive Services Task Force Posts Final Research Plan on Preventing Illicit Drug Use in Kids and Young Adults The U.S. Preventive Services Task Force has posted a final research plan on interventions to prevent illicit and non-medical drug use in children, adolescents, and young adults. The Task Force posted a draft plan for public comment from May 10 through June 6 and considered the comments it received before finalizing the plan. Click here to read the final research plan. The National Academies Publishes Summary on Intersection of OUD and Infectious Disease Epidemics The National Academies of Sciences, Engineering, and Medicine has published a summary of its March 2018 workshop, Integrating Responses at the Intersection of Opioid Use Disorder and Infectious Disease Epidemics. Between 1999 and 2016, the number of drug overdoses spiked by 300 percent, with injection drug use increasing by 93 percent between 2004 and 2014, and opioid-related hospital admissions rising by 58 percent in the last decade. The National Academies hosted the spring workshop to address the infectious disease consequences of the nation’s opioid crisis. During the workshop, participants discussed strategies to prevent and treat infections in people who inject drugs, especially ways to work efficiently through the existing public health and medical systems. Click here to purchase the summary. U.S. Preventive Services Task Force Seeks Comment on Draft Review of Interventions to Prevent Prenatal Depression The U.S. Preventive Services Task Force is seeking public comment on a draft recommendation statement and evidence review on interventions to prevent prenatal depression. According to its announcement, the Task Force found that counseling can help prevent prenatal depression in women at increased risk. The draft recommendation statement and draft evidence review are available for review and public comment from Aug. 28, 2018 through Sept. 24, 2018. Click here for information about how to submit comments. JAMA Study Examines Risk Factors Associated with Attempted Suicide Among Soldiers Without History of Mental Health Diagnosis A new JAMA study suggests that personnel, medical, legal, and family services records could help identify suicide attempt risk among soldiers with unrecognized mental health problems. According to the study’s abstract, the U.S. Army suicide attempt rate rose sharply during the wars in Afghanistan and Iraq. This study sought to examine the factors for suicide attempt among U.S. Army soldiers with no history of mental health diagnosis. The findings showed that among 9,650 enlisted soldiers with a document suicide attempt, 3,507, or 36.6 percent, did not have a previous mental health diagnosis. It also found that risk factors for attempt—including sociodemographic, service-related, physical healthcare, injury, subjection to crime, crime perpetration, and family violence—were similar, regardless of previous diagnosis, although the strength of associations differed. Save the Date for the NABH 2019 Annual Meeting! Please save the date and plan to join us at the Mandarin Oriental Washington, D.C. from March 18-20, 2019 for the 2019 NABH Annual Meeting. NABH will provide additional information in upcoming editions of CEO Update.   For questions or comments about CEO Update, please contact Jessica Zigmond.

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FDA Awards Contract to National Academies of Sciences to Develop Opioid-Prescribing Guidelines U.S. Food and Drug Administration (FDA) Commissioner Scott Gottlieb, M.D. announced this week his agency has awarded a contract to the National Academies of Sciences, Engineering, and Medicine (NASEM) to help develop evidence-based guidelines for appropriate opioid analgesic prescribing for acute pain. In his announcement, Gottlieb said the work’s primary scope is “to understand what evidence is needed to ensure that all current and future clinical practice guidelines for opioid analgesic prescribing are sufficient, and what research is needed to generate that evidence in a way that is both practical and feasible. “Our analyses suggest that the first prescription for many common, acute indications could typically be for many fewer pills—maybe just a day or two of medication rather than a 30-day supply, which is typically prescribed,” Gottlieb said in his announcement. “In some cases, the excess pills that aren’t used by patients may end up being diverted to illicit markets or misused or abused by friends or family members.” Gottlieb noted that this contract is separate from the National Academy of Medicine’s new Action Collaborative on Countering the U.S. Opioid Epidemic. Senators Introduce Bipartisan Bill to Promote Awareness of Synthetic Drug Use Four U.S. senators introduced the Synthetic Drug Awareness Act of 2018, a bipartisan bill to help address addiction and substance misuse, including the growing use of synthetic drugs. The bill from Senators Maggie Hassan (D-N.H.), Bill Cassidy, M.D. (R-La.), Doug Jones (D-Ala.) and Todd Young (R-Ind.) would require the U.S. Surgeon General to report to Congress on the health effects of new psychoactive substances—including synthetic drugs—on young adults between the ages of 12 and 18. Click here to read the text of the bill. Separately in the Senate this week, Senate Majority Leader Mitch McConnell (R-Ky.) said a bipartisan bill to address the nation’s opioid crisis will be a top priority in the Senate after Labor Day. Illinois Gov. Bruce Rauner Signs Laws to Expand Mental Health and Addiction-Treatment Services Illinois Gov. Bruce Rauner (R) this week signed five laws to expand mental health and addiction-treatment services and Medicaid coverage of them. Over two days, Rauner signed bills that will broaden the state’s mental health and addiction-treatment services, including measures that will: allow providers to give immediate access to outpatient treatment by removing prior-authorization barriers; expand access to behavioral and mental health experts for Medicaid patients by allowing them to use telehealth technology; partner law enforcement agencies with substance abuse service providers; improve insurance companies’ coverage of mental health and substance use disorder treatments; and provide the state’s Department of Healthcare and Family Services the opportunity to apply for a waiver that would allow treatment for serious mental illness on the first episode of psychosis. “I applaud the Illinois legislature and Gov. Rauner for enacting this landmark parity legislation,” former U.S. Rep. Patrick Kennedy (D-R.I.) said in a statement. Kennedy is the co-founder of The Kennedy Forum, which advocates for improving the lives of individuals living with mental illness and addiction, and promoting behavioral health for all. “By increasing access to treatment amid skyrocketing rates of overdoses and suicides in this country, S.B. 1707 will save lives!” he added. “I call on other states to follow Illinois’ lead in demanding insurer and regulator transparency and accountability to help end coverage discrimination against people with mental health and addiction challenges.” PCORI Awards $85 million in Research Grants The Patient-Centered Outcomes Research Institute (PCORI) Board of Governors this week approved $85 million to fund 16 new studies that will compare two or more approaches to improve care and outcomes for a range of conditions, including unsafe opioid use, cancer, depression, and stroke. That funding includes $5 million for a University of Washington natural experiment study that will compare two approaches to reducing unsafe opioid prescribing in the workers’ compensation system in two states: Ohio and Washington. “These new awards will help answer significant questions about treatment and care delivery that are important to patients and those who care for them,” PCORI Executive Director Joe Selby, M.D., M.P.H. said in a statement. “They reflect the best ideas for urgently needed research on topics prioritized based on input from patients, caregivers, clinicians and other stakeholders,” he added. “The results will give healthcare decision-makers evidence they need to make better-informed health and healthcare decisions.” Additional details about the projects is available here. SAMHSA Provides Behavioral Health Resources for First Responders The Substance Abuse and Mental Health Services Administration (SAMHSA) has posted new behavioral health resources to help first responders. According to SAMHSA, a recent national survey of firefighters and emergency medical services (EMS) personnel showed that 19 percent reported having thoughts of suicide, 27 percent reported struggling with substance use issues, and 81 percent said they feared being seen as weak or unfit for duty if they asked for help. The new resources include an online train course called Service to Self: Behavioral Health for Fire and EMS Personnel. NABH Members Participate in Shatterproof’s Payer Initiative Focus Group NABH members participated this week in a focus group for Shatterproof’s Payer-Based Strategies Initiative, which was created to help improve insurance coverage of addiction treatment. Shatterproof—a not-for-profit organization focused on ending the devastation that addiction causes families—has 19 insurers working on this initiative to develop and implement payer strategies within different markets and lines of business. The research will examine both private insurance companies and state regulations around addiction treatment, and the assessment will identify areas where insurance policies and payments can and should be changed. It will also identify ways to track this information across the industry. Save the Date for the NABH 2019 Annual Meeting! Please save the date and plan to join us at the Mandarin Oriental Washington, D.C. from March 18-20, 2019 for the 2019 NABH Annual Meeting. NABH will provide additional information in upcoming editions of CEO Update.   For questions or comments about CEO Update, please contact Jessica Zigmond.

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HHS Secretary Alex Azar Pushes for Mental Health in Schools HHS Secretary Alex Azar said his agency wants to support mental health integration in schools after he applauded the state of Wisconsin’s efforts on a recent visit there. Last month, Azar visited Adams-Friendship Middle School in Adams, Wis., along with Assistant Secretary for Mental Health and Substance Use Elinore McCance-Katz and U.S. Education Secretary Betsy DeVos (see CEO Update, July 27, 2018). He reflected on that visit as a guest columnist recently in the Wisconsin State Journal. “Over 7 million American children suffer from serious emotional disturbance, which can impede key life activities like being able to learn in school,” Azar wrote in his column. “We need to be identifying signs of these conditions not only to help these children, but also because early identification and treatment can make these conditions much less severe down the road,” he added. “Given the amount of time children spend in school, as many teachers and school personnel as possible should be trained in identifying warning signs and symptoms.”   CDC Data Show Continued Increases in Opioid Morbidity and Mortality More than 72,000 Americans died from drug overdoses in 2017, reflecting a nearly 7-percent increase from the year before, according to provisional death data from the Centers for Disease Control and Prevention this week. Of those deaths, about 49,000 were caused by opioids, the data showed, although provisional death data can often be incomplete and underestimated.   The Atlanta-based agency also reported an upward trend in the number of Emergency Medical System (EMS) naloxone administration events, as the agency reported a 75.1 percent increase in the rate of these events from 2012 through 2016. Meanwhile, the number of pregnant women with opioid use disorder (OUD) at labor and delivery more than quadrupled from 1999 through 2014, according to the CDC’s first multi-state analysis of trends in OUD in labor and delivery. OUD during pregnancy has been associated with a number of negative health outcomes for both mothers and babies, including maternal death, pre-term birth, stillbirth, and neonatal abstinence syndrome, or NAS. JAMA Study Links Brain Injury to Suicide Risk Traumatic brain injury may be associated with an increased risk of suicide, according to new research from Denmark that was published in JAMA. Traumatic brain injuries, or TBIs, can have serious long-term consequences, including psychiatric disorders. Using data from the Danish Cause of Death Register—that included 34,529 deaths by suicide over 35 years—researchers found that individuals with medical contact for traumatic brain injury, compared with the general population without traumatic brain injury, had an increased risk of suicide. Click here to read the study. PHP PEPPER Review Webinar Recording Now Available The recording and transcription for the Aug. 2 PEPPER Review webinar, along with a handout and questions-and-answers document, is now available. Click here to find the materials on the PHP “Training and Resources” page. CMS to Host Webinar to Better Understand Medicaid Populations with Serious Mental Illness The Centers for Medicare and Medicaid Services’ (CMS) Innovation Accelerator Program (IAP) will host a webinar next month that features a new technical resource that could help state Medicaid agencies gather information about Medicaid beneficiaries who have a serious mental illness. The webinar will provide an overview of the technical resource, example analyses, and a discussion with state Medicaid leaders from Pennsylvania, Virginia, and West Virginia who will share their insights. It’s intended to help states understand key demographic attributes of this population, their Medicaid use, and costs related to that use. Click here to register for the webinar that is scheduled for Thursday, Sept. 6 from 3 p.m. to 4:30 p.m. ET. SAMHSA Announces CSAT National Advisory Council Meeting in September The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Treatment (CSAT) National Advisory Council will meet on Monday, Sept. 17 to discuss and evaluate grant applications. Although the meeting is closed to the public, more information about the CSAT National Advisory Council—including Council biographies—is available here. Save the Date for the NABH 2019 Annual Meeting! Please save the date and plan to join us at the Mandarin Oriental Washington, D.C. from March 18-20, 2019 for the 2019 NABH Annual Meeting. NABH will provide additional information in upcoming editions of CEO Update. For questions about CEO Update, please contact Jessica Zigmond.

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NABH Releases ‘Pathways to Care’ White Paper on America’s Addiction Treatment System NABH on Thursday released Pathways to Care: Treating Opioid and Substance Use Disorders, a white paper that highlights America’s fragmented addiction treatment system and maps out ways to improve access to our nation’s quality behavioral healthcare services. In Pathways, NABH Director of Quality and Addiction Services Sarah A. Wattenberg writes that the nation’s current addiction treatment system is characterized by limited integration between specialty addiction care and the general medical community; low use of evidence-based practices; poorly organized services that often confuse the public; limited, inconsistent, and unpredictable financing; and insufficient workforce capacity to meet consumer demand. The paper emphasizes a strong need to improve access to America’s highly skilled clinicians and first-rate behavioral healthcare systems and programs to treat people with SUDs. “As we build a better system to address the opioid crisis, we must look to strengthen and sustain the entire system of care,” Wattenberg writes in Pathways. “Only then will we realize our full potential—and save lives in the process.” NABH also released a Pathways to Care toolkit with Wattenberg’s paper. The toolkit includes an executive summary, infographic, provider practice checklist, and shareable graphics to post on Twitter and LinkedIn. Please visit www.nabh.org/pathways for the white paper and toolkit, and be sure to read Wattenberg’s LinkedIn article about the paper. In addition, a news release about Pathways is available on the NABH homepage, and NABH has launched a Pathways ad campaign on Twitter. Please remember to follow us @NABHbehavioral and also on LinkedIn. FDA Announces Draft Guidance on Defining Effectiveness of MAT to Treat Opioid Use Disorder The Food and Drug Administration announced it has posted draft guidance that addresses the “clinical endpoints” that are acceptable to demonstrate the effectiveness of drugs for medication assisted treatment of opioid use disorder. In its announcement, the FDA requested comments on when the use of placebo or active controls is most appropriate in clinical trials for such drugs. Click here to read the draft guidance and here for information on how to submit comments. Comments are due by October 9, 2018. CMS to Incorporate Outcomes of the Joint Commission’s Suicide Panel in Ligature Risk Guidance The Centers for Medicare and Medicaid Services (CMS) has announced it will incorporate the outcomes of the TJC (the Joint Commission) Suicide Panel into its ligature-risk guidance for state survey agencies and accrediting organizations. CMS also noted that it will not proceed with plans to establish its Proposed Psychiatric Task Force to address the environmental risks associated with caring for psychiatric inpatients. Click here to read the recent memo from CMS to state survey agency directors.  AHRQ’s Evidence-based Practice Center Releases Report on Bipolar Disorder in Adults For adults with any bipolar disorder type, cognitive behavioral therapy may be no better than other psychotherapies for improving acute bipolar symptoms, and systematic/collaborative care may be no better than other behavioral therapies for preventing relapse of any acute symptoms, according to new findings from the Agency for Healthcare Research and Quality (AHRQ). Those conclusions were included in an evidence review on Treatment for Bipolar Disorder in Adults from AHRQ’s Evidence-based Practice Center Program. According to AHRQ, the review was conducted to assess the effect of drug and non-drug interventions for treating acute symptoms associated with bipolar disorder—and preventing relapse. STAT to Host Live Chat on Challenges and Innovations in College Mental Healthcare Health news website STAT will host a live online conversation about mental health issues on college campuses on Tuesday, August 14 at noon ET. The live chat will feature Stephanie Pinder-Amaker, a psychiatry professor at Harvard Medical School and director of the College of Mental Health Program at McLean Hospital, and STAT reporter Megan Thielking. They will discuss approaches to better addressing student mental health needs, the barriers that keep students from seeking and receiving treatment, and how to improve relationships between schools and providers off campus. Click here to register for the live chat. Bipartisan Policy Center to Host Panel Discussion on Integrating Behavioral and Clinical Healthcare The Bipartisan Policy Center will host and webcast a panel discussion next week that will examine both the promise and challenges of integrating behavioral health into the country’s broader healthcare system. Moderated by the Bipartisan Policy Center’s Marilyn Serafini, the discussion will feature John Auerbach from the Trust for America’s Health; Tom Betlach from the Arizona Health Care Cost Containment System; Patrick Gordon from Rocky Mountain Health Plans; and Angela Kimball from the National Alliance on Mental Illness. The panel discussion is scheduled for Thursday, August 16 from 10 a.m. until 11:30 a.m. ET. Click here to register. Save the Date for the NABH 2019 Annual Meeting! Please save the date and plan to join us at the Mandarin Oriental Washington, D.C. from March 18-20, 2019 for the 2019 NABH Annual Meeting. NABH will provide additional information in upcoming editions of CEO Update. For questions or comments about CEO Update, please contact Jessica Zigmond
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NABH Maps Out Pathways to a Better Addiction Treatment System

Written by Administrator on . Posted in News Releases.

FOR IMMEDIATE RELEASE CONTACT: Jessica Zigmond 202.393.6700, ext. 101 jessica@nabh.org WASHINGTON, DC (August 9, 2018)— The National Association for Behavioral Healthcare (NABH) today released Pathways to Care: Treating Opioid and Substance Use Disorders, a white paper that offers practical and applicable approaches to fixing America’s frayed substance use disorder treatment delivery system. In 2016, more than 20 million individuals in the United States had a substance use disorder (SUD), and 89 percent of individuals who needed treatment did not receive it. This is known as the treatment gap, and it exists for individuals with all types of SUDs, including opioid use disorder. The treatment gap is literally killing us and reducing life expectancy in the United States. The current system is characterized by limited integration between specialty addiction care and the general medical community; low use of evidence-based practices; poorly organized services that often confuse the public; limited, inconsistent, and unpredictable financing; and insufficient workforce capacity to meet consumer demand. The good news is the United States has highly skilled clinicians and first-rate health systems and programs to treat people with SUDs. Now we need to improve access to those providers and services. “As we build a better system to address the opioid crisis, we must look to strengthen and sustain the entire system of care,” Sarah A. Wattenberg, director of quality and addiction services at NABH, writes in Pathways to Care. “Only then will we realize our full potential—and save lives in the process.” Wattenberg’s paper is a landscape review that presents information about unhealthy substance use and how the delivery system often fails to connect people to treatment; provide the correct evidence-based services; monitor patient recovery during and after treatment; and re-engage patients whose symptoms recur. Along with the paper, NABH released a Pathways to Care provider checklist, an infographic that identifies key Pathways milestones, and shareable graphics to post on Twitter and LinkedIn. To access these materials, please visit www.nabh.org/pathways. Also be sure to follow us on Twitter (@NABHbehavioral), LinkedIn, and YouTube. To schedule interviews with Sarah A. Wattenberg, please contact Jessica Zigmond using the contact information at the top of this news release.

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About NABH The National Association for Behavioral Healthcare (NABH) advocates for behavioral healthcare and represents provider systems that are committed to delivering responsive, accountable, and clinically effective prevention, treatment, and care for children, adolescents, adults, and older adults with mental and substance use disorders. Its members are behavioral healthcare provider organizations that own or manage more than 1,000 specialty psychiatric hospitals, general hospital psychiatric and addiction treatment units and behavioral healthcare divisions, residential treatment facilities, youth services organizations, and extensive outpatient networks. The association was founded in 1933.

CEO Update | 18

Written by Administrator on . Posted in CEO Updates.

CMS Releases Final IPF Prospective Payment System Rule for 2019 The Centers for Medicare and Medicaid Services (CMS) announced a Medicare payment increase of 1.1 percent next year for inpatient psychiatric facilities in the final Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) rule the agency released on July 31. Compared with the 2018 payment rate, the increase reflects a total increase of $50 million for Medicare-participating inpatient psychiatric facilities in fiscal year 2019. The payment update aligns with the agency’s proposed rule earlier this year. CMS removed five of the eight Inpatient Psychiatric Facility Quality Reporting (IPFQR) program measures that it had proposed to eliminate. These include Influenza Vaccination Coverage Among Healthcare Personnel, Alcohol Use Screening (SUB-1), Tobacco Use Screening (TOB-1), Use of an Electronic Health Record, and Assessment of Patient Experience of Care. NABH led the effort to remove these measures, which will take effect in fiscal year 2020. Three other measures that CMS had proposed to remove—Physical Restraint Use, Seclusion Use, and Tobacco Use Treatment at Discharge—will not be removed from the IPFQR program. NABH, along with many other groups, encouraged CMS to keep the Physical Restraint Use and the Seclusion Use measures because they are critical to patient safety. Click here to read the CMS fact sheet on the final rule and  here to read the complete text of the final rule. National Academy of Medicine Launches Collaborative to Address Opioid Crisis The National Academy of Medicine (NAM)—in partnership with the Aspen Institute—has launched the NAM Action Collaborative on Countering the U.S. Opioid Epidemic, a public-private partnership of more than 35 organizations to address the nation’s deadly opioid crisis. “It is clear that no single institution nor sector can solve the opioid crisis alone,” Admiral Brett Giroir, M.D., HHS’ assistant secretary for health and the collaborative’s co-chair, said in an announcement about the collaborative. “The only viable approach to addressing the opioid misuse epidemic, the most pressing public health challenge of our time, is through multi-sector collaboration and a patient-centered approach,” he continued. “This collaborative brings the best from academia, industry, nonprofits, and public service to identify opportunities and recommend bold action plans to yield results.” Giroir also serves as HHS’ senior advisor for mental health and opioid policy. The National Academy of Medicine has posted Admiral Giroir’s video and slides from his presentation. SAMHSA Accepting Applications for State Opioid Response Grants The Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting applications for $930 million in State Opioid Response Grants. The funds are meant to increase access to medication assisted treatment (MAT), close treatment gaps, and ultimately reduce overdose deaths. States must apply for the grants by Monday, August 13 to receive funding. Click here for more information. FDA Issues Warning about Emergencies Caused by Synthetic Cannabinoid Products Laced with Brodifacoum The U.S. Food and Drug Administration (FDA) has issued a warning statement about a number of health emergencies, primarily in Midwestern states, caused by consuming synthetic cannabinoid products laced with brodifacoum, a blood-thinning compound commonly used in rat poison. “These unapproved products are being sold in convenience stores and gas stations as substitutes for marijuana under names such as “K2” and “Spice,” the FDA said in its statement. “Use of these illegal products post significant public health concerns for both individuals who may use the contaminated products and the U.S. blood supply, as there is the potential for contamination of blood products donated by individuals who have used these substances.” Click here to read the warning statement from FDA Commissioner Scott Gottlieb, M.D.; Peter Marks, M.D., Ph.D., director of the Center for Biologics Evaluation and Research; and Janet Woodcock, M.D., director of the Center for Drug Evaluation and Research. Partial Hospitalization Program PEPPER Review Resources Available The TMF Health Quality Institute has posted handouts from its webinar this week to review the most recent Partial Hospitalization Program (PHP) PEPPER (version Q4CY17). The resources are located in the “Training and Resources” section at PEPPERresources.org. Morning Consult Issues Reports about Americans’ Views on Smoking and Drinking Technology company Morning Consult has released three new reports about U.S. consumer views on alcohol, marijuana, and tobacco and vaping use following surveys of more than 2,200 adults conducted in July. The surveys included questions on consumer preferences—such as what type of alcohol consumers prefer and why—as well as why consumers use substances. Among users in the marijuana survey, 71 percent said they use it to relax, while 46 percent said they use it to help them sleep.   For questions or comments about CEO Update, please contact Jessica Zigmond

CEO Update | 17

Written by Administrator on . Posted in CEO Updates.

CMS Proposes Payment Increases for PHPs and CMHCs in 2019 The Centers for Medicare and Medicaid Services (CMS) has proposed a hospital-based partial hospitalization program (PHP) payment rate of $216.55 for 2019, up from the 2018 rate of $205.36, in the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (OPPS/ASC) proposed rule the agency released on July 25. CMS also proposed an increase for community mental health centers (CMHCs), which could see a payment rate of $123.84 in 2019 if the rule is made final. By comparison, CMHCs received a payment rate of $117.35 in 2018. The 2019 OPPS/ASC proposed rule updates Medicare payment rates for PHP services provided in hospital outpatient departments and CMHCs. The PHPs are structured, intensive outpatient programs that consist of a group of mental health services paid on a per diem basis under the OPPS, based on the PHP per-diem costs. In its rule for Calendar Year (CY) 2018, CMS considered changing its long-standing policy on 20 hours per week of programming for patients in PHPs. The existing policy requires patient care plans to include 20 hours of programing per week. CMS wanted to change this by placing provider reimbursement at risk if a healthcare provider’s patient did not participate in all 20 hours of programing. NABH sent CMS a comment letter in September 2017 that highlighted the flaws with this approach and the negative consequences that would likely result from it. Based on public comments, CMS decided not to pursue this change for CY 2019. CMS will accept comments on the CY 2019 proposed rule until September 24. House Passes National Suicide Hotline Improvement Act The U.S. House this week passed the National Suicide Hotline Prevention Act, the same bill that the Senate approved unanimously in October 2017. If signed into law, this legislation would call for a study that would evaluate: a) the feasibility of designating a three-digit dialing code for a national suicide prevention and mental health crisis hotline system, and b) the effectiveness of the current National Suicide Prevention Lifeline (1-800-273-TALK), including how well it addresses veterans’ issues. NABH joined more than three dozen groups in February to sign a letter from the Mental Health Liaison Group to Congress that expressed strong support for this legislation. Aligning for Health Coalition Establishes Advisory Board Aligning for Health—a coalition focused on the need for efficient, integrated, and coordinated programs to better improve health outcomes for all Americans—has established an Advisory Board of experts on social determinants and groups representing states and counties, consumers, and housing, nutrition, public health, and mental health programs. The Advisory Board will provide advice and recommendations to the coalition as it works to advance policy proposals that “test the idea that the health and well-being of vulnerable populations can be improved by better aligning programs and services addressing the social determinants of health,” the coalition noted in an announcement. Andrew Sperling of the National Alliance on Mental Illness (NAMI) is a member of the new Advisory Board, which also includes representatives from Trust for America’s Health, the National Academy for State Health Policy, Tufts University and the University of Illinois, the National Coalition on Health Care, and the American Public Human Services Association. “In order to advance the health and well-being of all people, we must work together to influence modern approaches to sound policy,” said Tracy Wareing-Evans, president and CEO of the American Public Human Services Association, said in the announcement. “Utilizing frameworks like social determinants of health can help us move the health and human services systems upstream to focus on prevention and early interventions that enable all families to live healthy lives and thrive in their communities.” Federal Officials Tour Wisconsin School to Explore Behavioral Health Integration in Schools HHS Secretary Alex Azar, Assistant Secretary for Mental Health and Substance Use Elinore McCance-Katz, and Education Secretary Betsy DeVos this week joined representatives from the Federal Commission on School Safety on a field visit to examine behavioral health integration in schools. The visit to Friendship Middle School in Adams County, Wis., focused on the state’s mental health framework, which allows local school districts to provide integrated behavioral health best practices to students. After the tour, the visit included two panel discussions so commission members and administration officials could hear from state officials about Wisconsin’s School Mental Health Initiative’s efforts to enhance behavioral health components in day-to-day school activities. Click here to watch a video from the event. President Trump Issues Declaration on Anniversary of the Americans with Disabilities Act President Trump this week issued a declaration that proclaimed July 26, 2018 as a day to celebrate the 28th anniversary of the Americans with Disabilities Act (ADA) that President George H.W. Bush signed on July 26, 1990. In the nearly three decades since the ADA passed, the law has promoted equal access to employment, government services, public accommodations, commercial facilities, and public transportation for millions of Americans living with disabilities. “Our nation must continue to build upon this foundation and continue to further the participation of the more than 56 million Americans living with disabilities,” the president said in the declaration. “My Administration continues to encourage research that will lead to advancements in technology, medicine, and other fields and better enable independent living.” Politico-Harvard T.H. Chan School of Public Health Conduct Poll on Opioid Crisis A new poll from Politico and the Harvard T.H. Chan School of Public Health found that only 26 percent of Americans are satisfied with federal spending on addiction treatment. Meanwhile, 37 percent of Americans say opioid addiction is a “personal weakness” despite efforts to reduce stigma around addiction. And only one-third of Americans said they considered medication assisted treatment, or MAT, to be effective. The poll was conducted months after Congress appropriated $4 billion in funding to address the deadly crisis. Click here to read the findings. Morning Consult Survey Examines Women’s Perspectives and Experiences with Opioids A new Morning Consult poll of more than 1,000 women between the ages of 25-59 found that few women are screened for substance use disorder, and yet many are prescribed opioids. According to the findings, this combination happens frequently around surgical procedures, “with the operating room having become an unintentional gateway to the opioid epidemic.” In 2016, the results found, 3 million patients transitioned to persistent opioid use after surgery, which mean they were still taking opioids three to six months after their surgical procedure. The survey also found that only 20 percent of women who underwent surgery and required pain medication after the procedure said they were screened for substance use disorder through a consultation of their patient history. Click here to learn more results from the study. For questions or comments about CEO Update, please contact Jessica Zigmond
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NABH Commends Policymakers for Introducing Bill to Boost Behavioral Healthcare Workforce

Written by Administrator on . Posted in Letters, Statements.

NABH has sent letters to policymakers in the House and Senate who introduced respective versions of the Opioid Workforce Act of 2018 to expand and improve addiction medicine, addiction psychiatry, or pain management residency positions to address America’s opioid crisis.

Letter to Representative Crowley

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Representative Crowley Letter

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Letter to Senator Nelson

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Senator Nelson Letter

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CEO Update | 14

Written by Administrator on . Posted in CEO Updates.

NABH Launches Redesigned Website We are pleased to announce NABH has launched a redesigned website at www.nabh.org! The website’s updated design will make it easier for NABH members to access their member benefits, resources and industry news. At the same time, the redesigned site will show policymakers, advocates, and members of the media how the association is working to improve behavioral healthcare services in the United States—and how these stakeholders can engage in that effort. As you navigate the new site, please note the following features:
  • Watch our video Behavioral Healthcare is Everyone’s Concern and access it from a slide on the homepage.
  • Navigate news and resources by category in seven tabs at the top of the homepage: Home, About NABH, NABH Resources, News & Insights, Be An Advocate, Policy Issues, and Annual Meeting.
  • Click on an interactive Impact Map of the United States for key information about NABH member locations in every congressional district throughout the country.
  • Learn what NABH members are doing nationwide in our Member Profile section.
  • Get to know the association’s leadership in the Board of Trustees & Staff page.
  • Follow the Annual Meeting Countdown on the homepage for a reminder about the association’s signature event every March.
We hope you like the redesigned website, and that you visit often! As always, we welcome your feedback. If you have comments, please e-mail NABH. Senate Appropriations Committee Approves HHS Funding for 2019 The Senate Committee on Appropriations this week passed the FY 2019 Labor, Health and Human Services, and Education (Labor-HHS) Appropriations Act, which provides $3.7 billion to address the opioid crisis and $3.4 billion for mental health treatment, prevention, and research. According to a summary, the opioid funding is targeted toward improving treatment and prevention efforts; finding alternative pain medications; workforce needs; and behavioral health. Funding to address the opioid crisis has increased by $3.5 billion—or about 1,300 percent—since fiscal year 2015. Click here to learn more about the funding levels.  House-Passed Opioid Package Moves to Senate The House late last week passed H.R. 6: SUPPORT for Patients and Communities Act, a massive bill to address the nation’s opioid crisis. The legislation combined 58 individually approved House-passed bills, including many NABH-supported proposals—such as the IMD CARE Act and the Overdose Prevention and Patient Safety Act— in one package. House members passed the measure in an overwhelmingly bipartisan vote of 396-14, and the legislation now moves to the Senate for its consideration. Senate Majority Leader Mitch McConnell (R-Ky.)  has indicated the Senate will consider opioid legislation later this summer or in the fall. In the upper chamber, the Senate Health, Education, Labor & Pensions (HELP) Committee approved a bipartisan package of proposals in the Opioid Crisis Response Act, which includes provisions that mirror those in the House’s opioid package. NABH Sends Comments on FY 2019 Proposed IPF PPS Rule to CMS Earlier this week NABH sent comments to the Centers for Medicare and Medicaid Services (CMS) about the agency’s proposed rule to update Medicare payment policies and rates for the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) in FY 2019. The rule proposed eliminating eight quality measures, many of which NABH has advocated for removing previously. With help from the NABH Quality Committee, NABH commented on several provisions for next year and focused primarily on two issues: 1) adopting a policy that would permit CMS to remove measures from the IPFQR set if the costs associated with a measure outweigh the benefit of its continued use in the program; and 2) encouraging CMS to keep the measure related to hours of seclusion and restraint. NABH Commends Policymakers for Introducing Bill to Boost Behavioral Healthcare Workforce NABH has sent letters to policymakers in the House and Senate who introduced respective versions of the Opioid Workforce Act of 2018 to expand and improve addiction medicine, addiction psychiatry, or pain management residency positions to address America’s opioid crisis. “A major driver of this increase in deaths is an inadequate number of professionals and paraprofessionals who are trained in substance use and addictions,” NABH President and CEO Mark Covall wrote in letters to Rep. Joseph Crowley (D-N.Y.) and Sen. Bill Nelson (D-Fla.). “Federal estimates project a workforce deficit of up to 250,000 workers by the year 2025,” Covall continued. “The Opioid Workforce Act of 2018 will add 1,000 residency positions in addiction medicine, addiction psychiatry, or pain management.” IPFQR Program FY 2018 Data Submission Period Begins July 1 The Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program Fiscal Year (FY) 2018 data submission period is scheduled to begin on Sunday, July 1, 2018, and end on Wednesday, August 15, 2018, at 11:59:59 p.m. Pacific Daylight Time (PDT). The opportunity to correct or otherwise modify your data ends on the data submission deadline of Wednesday, August 15, 2018, at 11:59:59 p.m. PDT. Refer to the IPFQR Program Manual, version 3.1, for more information about the IPFQR Program requirements described in this email. The manual is available at: Also, please note that the IPFQR Program Resources and Tools page on the Quality Reporting Center website now includes the IPFQR checklists for submission, review, and verification of FY 2019 data and administrative requirements. The checklists will be available on the QualityNet website’s IPFQR Program Resources page at a later date. These checklists are meant to help inpatient psychiatric facilities (IPFs) meet the August 15, 2018 data submission deadline. They provide guidance on submitting data via the QualityNet Secure Portal and checking the IPF Participation Report for the completion of IPFQR Program administrative requirements via the QualityNet Secure Portal. Shatterproof Receives Funding to Identify Ways to Improve Coverage for Addiction Treatment The Leonard Davis Institute of Health Economics recently awarded funding to Shatterproof so the advocacy organization can identify strategies for insurance carriers to improve coverage for evidence-based addiction treatment, including the use of medications for opioid use disorder. The strategies will be based on the Shatterproof National Principles of Care. SAMHSA to Award Opioid-Related Funding Awards The Substance Abuse and Mental Health Services Administration (SAMHSA) will award 59 grants to state governments for prevention, treatment and recovery efforts for opioid use disorder (OUD). Grantees of the program will use data to identify gaps in availability of treatment by geographic, demographic and service-level terms, and use evidence-based implementation strategies “to identify which system design models will most rapidly and adequately address the gaps in their systems of care.” The application deadline is August 13. Click here for more information. SAMHSA will also award 263 grants to supplement current activities for federally recognized American Indian/Alaska Native tribes or tribal organizations to increase access to culturally appropriate and evidence-based treatment of OUDs. The deadline is August. 20. Click here for more information. We will not publish CEO Update on Friday, July 6 and will resume on Friday, July 13. For questions or comments about CEO Update, please contact Jessica Zigmond.

CEO Update | 13

Written by Administrator on . Posted in CEO Updates.

U.S. House Passes First Stand-Alone IMD Exclusion Repeal Bill In a 261-155 vote, the House of Representatives this week passed the IMD CARE Act, which partially repeals the Medicaid program’s Institutions for Mental Diseases (IMD) exclusion. The move marks the first time either chamber of Congress has voted on a freestanding IMD bill. Before passing this NABH-supported bill, House members considered and adopted two amendments, which: 1) add cocaine to the list of “targeted SUDs” (substance use disorders) and apply a minimum loss ratio of 85 percent for Medicaid managed care plans, and 2) add two requirements to the report that states are required to submit. The first of those requirements asks for information about the number of individuals suffering from co-occurring disorders and the type of disorders; and the second requires information regarding access to community care for individuals suffering from a mental illness other than substance use disorder. The legislation limits eligible patients under the provision to no more than 30 days of treatment in an IMD in a year (whether or not those days are consecutive). While the provision applies to patients with opioid use disorder or cocaine disorder, the bill also includes patients with those conditions and other co-occurring mental health or SUDs. NABH has advocated to repeal the IMD exclusion for decades, and The Hill newspaper this week published a letter to the editor from NABH President and CEO Mark Covall and behavioral healthcare champion and former U.S. Rep. Patrick Kennedy (D-R.I.). Meanwhile, the Henry J. Kaiser Family Foundation released a document that highlights key questions about payment for services in IMDs. Moments after passing the IMD CARE Act, the House passed the Overdose Prevention and Patient Safety Act, which amends the Public Health Service Act to align federal privacy standards for SUD patient records more closely with standards under the Health Insurance Portability and Accountability Act (HIPAA). Specifically, this bill—which passed in a 357-57 vote—authorizes the disclosure of SUD patient records without a patient’s written consent to: 1) a covered entity for the purposes of treatment, payment and healthcare operations, as long as the disclosure is made in accordance with HIPAA; and 2) a public health authority, as long as the content of the disclosure meets HIPAA standards regarding de-identified information. The bill also repeals and replaces criminal penalties for violations involving SUD patient records with the HIPAA civil penalty structure. It also expands the existing prohibition against SUD patient records in criminal proceedings to include any use in specified federal, state, and local criminal and civil actions. Earlier this week, the White House released a Statement of Administration Policy supporting these critical behavioral healthcare reforms.   CMS Issues Bulletin on EPSDT in 21st Century Cures Act The Center for Medicare and Medicaid Services (CMS) this week issued an information bulletin about the section of the 21st Century Cures Act (Cures) that requires Medicaid reimbursement for Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services for children under age 21 in IMDs. This provision in Cures—which had been a legislative priority for NABH—corrects a long-standing oversight in the “psych under 21” benefit. Historically under EPSDT, CMS had denied coverage for medically necessary services, such as prescription drugs or practitioner services, for children in IMDs. Section 12005 of Cures ends that policy and allows children full access to EPSDT regardless of whether they are placed in an IMD. The EPSDT provision becomes effective on Jan. 1, 2019.   Federal Office of Rural Health Policy to Host Webinar on Opioid Response Funding The Federal Office of Rural Health Policy will hold a technical assistance webinar for those who want to apply for the Rural Communities Opioid Response Program on Thursday, June 28 at 1 p.m. ET. Dial-in information is available on page (ii) in the grant program guidance. To find the guidance, visit the Grants.gov, click on the Package tab, then Preview, then choose “Download Instructions.” A recording will be made available for those who cannot attend. Please contact ruralopioidresponse@hrsa.gov if you have questions. Meanwhile, the Rural Health Information Hub updated its website to highlight a guide with initiatives and funding opportunities, as well as rural-specific program examples, tools, and resources that focus on prevention, harm reduction, and treatment.   SAMHSA to Host Webinar on Preventing Suicides Among Service Members, Veterans and Their Families The Substance Abuse and Mental Health Services Administration (SAMHSA) will host a two-hour webinar to discuss “military culture-informed strategies” that can be applied to reduce access to lethal means—including poisoning and firearms—for those who are at high risk for suicide on Thursday, June 28 at 2 p.m. ET. The event is the first in a series on suicide from SAMHSA’s Service Members, Veterans and Their Families Technical Assistance Center.   World Congress Opioid Management: Treatment and Recovery Summit is Aug. 13-14 in Nashville Sarah Wattenberg, NABH’s director of quality and addiction services, will co-chair the World Congress Opioid Management: Treatment and Recovery Summit in Nashville from Aug. 13-14 in Nashville. Healthcare executives nationwide will discuss effective strategies to address the opioid epidemic across the continuum of care. Key topic areas include payer-provider partnerships, recovery support services, opioid use disorder medications, neonatal abstinence syndrome protocols, drug courts, successful organizational strategies, and more. Michael Botticelli, the former director of the White House Office of National Drug Control Policy, will also speak at conference. NABH members can register here and receive $200 off the meeting’s registration fee by using the following promotional code: SPEAKER.   Prepare Early for National Recovery Month in September SAMHSA’s toolkit to prepare for National Recovery Month in September is available here. Now in its 29th year, National Recovery Month is meant to promote awareness and understanding about mental and substance use disorders and to celebrate individuals living in recovery. This year’s theme is Join the Voices for Recovery: Invest in Health, Home, Purpose and Community.   For questions or comments about CEO Update, please contact Jessica Zigmond

CEO Update | 12

Written by Administrator on . Posted in CEO Updates.

U.S. House Passes Dozens of Opioid-Related Bills House members this week approved nearly three dozen pieces of legislation to address America’s opioid crisis and will likely consider several other opioid-related bills in the coming days. Next week the House is expected to focus on two NABH-supported bills. The first is the IMD CARE Act, which would partially repeal Medicaid’s Institutions for Mental Diseases (IMD) exclusion for patients with opioid use disorder or with co-occurring behavioral health conditions. And the second is the Overdose Prevention and Patient Safety Act, which would align 42 CFR (Part 2) with the Health Insurance Portability and Accountability Act of 1996. These individual bills will likely be included in a broader opioid package that the House will then send to the Senate for its consideration. Meanwhile, the influential Senate Finance Committee this week passed the Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018. Several amendments related to NABH’s key issues were not included in this bill, but NABH staff has learned those measures could be offered as amendments when the full Senate considers the legislation. The NABH team will continue to engage legislators on the association’s legislative priorities and will keep members apprised of any developments.   FDA Approves Generic Versions of Suboxone The Food and Drug Administration (FDA) this week approved the first generic versions of Suboxone (buprenorphine and naloxone) sublingual film—which is applied under the tongue—to treat opioid dependence. “The FDA is taking steps to advance the development of improved treatments for opioid use disorder, and to make sure these medicines are accessible to the patients who need them,” FDA Commissioner Scott Gottlieb, M.D., said in the public announcement. “That includes promoting the development of better drugs, and also facilitating market entry of generic versions of approved drugs to help ensure broader access.”   SAMHSA Announces $930 Million in Grant Funding to Address Opioid Crisis The Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting applications $930 million in the agency’s State Opioid Response Grants program. According to a SAMHSA announcement, the federal funding is meant to address the crisis by expanding access to evidence-based, medication-assisted treatment; reducing unmet treatment needs; and lowering opioid-related overdose deaths. In a statement, Assistant Secretary for Mental Health and Substance Use Elinore McCance-Katz, M.D., Ph.D., said the grants were designed to meet the specific needs of communities. “The grants will expand capacity to provide much-needed, evidence-based care to people who haven’t yet been reached,” McCance-Katz said.   MACPAC Highlights Substance Use Disorder in June 2018 Report The Medicaid and CHIP Payment and Access Commission (MACPAC) included two chapters related to substance use disorder (SUD) treatment in the June 2018 Report to Congress on Medicaid and CHIP that the commission released on Friday, June 15. In the report’s chapters Substance Use Disorder Confidentiality Regulations and Care Integration in Medicaid and CHIP and Access to Substance Use Disorder Treatment in Medicaid, MACPAC commissioners examine reforming 42 CFR Part 2 (Part 2) and the IMD exclusion, both NABH priorities. Regarding Part 2, MACPAC recommended the HHS secretary issue sub-regulatory guidance to clarify key provisions and offer information about education and technical assistance for Part 2. The commission did not make any recommendations about the IMD exclusion. Commissioners acknowledged that “the IMD exclusion is not the only reason gaps in coverage exist.” They also noted that the “largest gaps in state clinical service coverage are for partial hospitalization and residential treatment” and added that “the institutions for mental diseases (IMD) exclusion is often cited as a barrier to paying for residential services.” MACPAC commissioners noted that some states—such as the commonwealth of Virginia—are reimbursing IMDs for SUD treatment through 1115 waivers. The report also said Virginia has seen a significant increase in the number of providers participating in Medicaid, as the total jumped to 77 from 4.   CMS Releases Roadmap to Address Opioid Crisis Prevention, treatment, and data are the Centers for Medicare and Medicaid Services’ three areas of focus to address the nation’s opioid crisis, according to a new roadmap the agency released this week. Presented as an infographic with key data points, analytic tools, and recommendations, the four-page roadmap also highlights best practices and a summary of CMS activities to date. For instance, the agency noted that as of this month, it has approved a dozen Medicaid 1115 demonstrations to improve access to opioid use disorder treatment, “including new flexibility to cover inpatient and residential treatment while ensuring quality of care.” Looking ahead, CMS noted in the roadmap it will focus its data efforts and provide tools for states, plans and providers to monitor success of prevention measures related to reducing overuse and misuse of prescription opioids; improve data transparency and interoperability, and expand tools such as the Medicare “heat map” of prescribing rates that help determine where to target safe prescribing efforts; analyze prescription opioid use patterns across CMS programs and in special populations; and support state Medicaid program capacity to track and report data.   Prepare Early for National Recovery Month in September SAMHSA has announced that its toolkit to prepare for National Recovery Month in September is now available. Now in its 29th year, National Recovery Month is meant to promote awareness and understanding about mental and substance use disorders and to celebrate individuals living in recovery. This year’s theme is Join the Voices for Recovery: Invest in health, Home, Purpose and Community, and more information—including SAMHSA’s toolkit—is available here.   For questions or comments about CEO Update, please contact Jessica Zigmond.
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News Release

Written by Administrator on . Posted in News Releases.

NABH issued a news release about the need for wider access to behavioral healthcare services in the United States after the Centers for Disease Control and Prevention (CDC) reported this week that suicide rates have increased in nearly every state from 1999 to 2016.

CEO Update | 11

Written by Administrator on . Posted in CEO Updates.

NABH Comments on Rise in U.S. Suicide Rates NABH issued a news release about the need for wider access to behavioral healthcare services in the United States after the Centers for Disease Control and Prevention (CDC) reported this week that suicide rates have increased in nearly every state from 1999 to 2016. The CDC’s report was released days after designer Kate Spade, 55, died by suicide at her home in New York, and a day before it was reported that celebrity chef Anthony Bourdain, 61, died by suicide in France. “Our country has faced a difficult week filled with very sad news and grim statistics,” NABH President and CEO Mark Covall said in the news release. “We know that with suicide, hope lies in effective mental health and substance use disorder services—at inpatient psychiatric hospitals, residential treatment facilities, addiction treatment centers, and outpatient settings.” According to the CDC, suicide is a leading cause of death in the United States, and nearly 45,000 people died by suicide in 2016. Overall, suicide rates increased by 25 percent across the country and rose more than 30 percent in half of the states since 1999. The Substance Abuse and Mental Health Services Administration (SAMHSA) provides tools and resources through its Suicide Preventionpage and National Suicide Prevention Lifeline, which is available 24 hours a day, 7 days a week. As always, NABH appreciates the hard work of its members each day to care for people with mental health and substance use disorders. Please learn more from Mark Covall in his LinkedIn article about this week’s news and NABH’s advocacy efforts to widen access to behavioral healthcare services for people who need it.   National Governors Association Supports House Opioid Legislation The nation’s governors this week sent a letter to House Speaker Paul Ryan (R-Wis.) and House Minority Leader Nancy Pelosi (D-Calif.) that supports several House bills to address the nation’s opioid crisis, including the IMD CARE Act. “We ask that any bills considered by Congress ensure that federal strategies preserve state flexibility allowing governors to meet the specific needs of their state,” said the June 7 letter from the National Governors Association. “Governors need increased financial and technical support to address this crisis and we urge Congress to avoid burdensome requirements on state programs.” On Friday, the Congressional Budget Office (CBO) estimated that enacting the IMD CARE Act would increase direct federal spending by $991 million between 2019 and 2028. The bill—which NABH supports—would expand Medicaid coverage for people experiencing opioid use disorder who are in institutions for mental diseases, or IMDs, for up to 30 days per year. The House Energy and Commerce Committee passed the bill last month. In the upper chamber, the Senate Finance Committee will consider an opioid legislative package next week.   SAMHSA Names Director of the Center for Substance Abuse Treatment In a letter to colleagues this week, Assistant Secretary for Mental Health and Substance Use Elinore McCance-Katz, MD, PhD announced that Capt. Chideha Ohuoha, MD, MPH, will join SAMHSA to lead the Center for Substance Abuse Treatment. Since 2008, Ohuoha has been stationed at Fort Belvoir in Fairfax County, Va. as an officer in the U.S. Public Health Service. He has served as director of addiction medicine there since 2015. “Capt. Ohuoha completed his psychiatric residency at St Elizabeth’s Hospital in Washington, D.C. and completed a three-year addiction psychiatry fellowship at NIMH,” McCance-Katz wrote to her staff, adding that Ohuoha earned a master’s degree in public health from Harvard. “Capt. Ohuoha’s experience in addiction psychiatry will be a great asset to SAMHSA and CSAT. His official start date here at SAMHSA will be June 11.”   Addiction Policy Forum Launches Resource Center to Address Opioid Crisis Not-for-profit organization the Addiction Policy Forum (APF) this week launched the Addiction Resource Center—which features a phone line and online portal—to support the millions of Americans battling substance use disorder as well as their families. The online portal is an interactive website intended to help individuals and families learn about substance use disorders and access help. The platform features a database of vetted local treatment providers and provides a self-assessment tool to help individuals develop a proposed action plan. Meanwhile, the hotline—1-833-301-HELP (4357)—is available Monday through Friday from 9 a.m. until 6 p.m. ET to provide confidential support and information about local treatment and recovery services.   Prepare Early for National Recovery Month in September SAMHSA announced this week that its toolkit to prepare for National Recovery Month in September is now available. Now in its 29th year, National Recovery Month is meant to promote awareness and understanding about mental and substance use disorders and to celebrate individuals living in recovery. This year’s theme is Join the Voices for Recovery: Invest in health, Home, Purpose and Community, and more information—including SAMHSA’s toolkit—is available here.   For questions or comments about CEO Update, please contact Jessica Zigmond.

CEO Update | 10

Written by Administrator on . Posted in CEO Updates.

Illinois House of Representatives Passes Comprehensive Mental Health Parity Bill The Illinois House of Representatives this week passed mental health parity legislation that mental health advocacy organization the Kennedy Forum has described as the “strongest mental health parity law in the nation.” In a vote of 106-9, Illinois’ House members approved Senate Bill 1707, which, along with other provisions, addresses the opioid crisis by expanding access to addiction treatment; prohibits prior authorization and step-therapy requirements for Food and Drug Administration (FDA)-approved medications to treat substance use disorders; requires health plans to submit parity compliance analyses to the Illinois Department of Insurance and Illinois Department of Healthcare and Family Services that comply with federal parity rules; and also requires plans and managed care organizations to make parity compliance information available to those departments and to individuals through a public website. An announcement from the Kennedy Forum—founded by behavioral healthcare champion and former U.S. Representative (D-R.I.) Patrick Kennedy—noted that this bill “represents a major milestone, not just for Illinois, but for the country as a whole.”   The Joint Commission to Change How it Cites Ligature/Self-Harm Deficiencies in July The Joint Commission will start to cite ligature/self-harm deficiencies under Patient’s Rights of Condition of Participation (CoP) 482.13 on July 1. Previously, Joint Commission surveyors cited these deficiencies under Physical Environmental CoP 482.41 and under the Joint Commission’s Environment of Care (EC) standard EC.02.06.01, element of performance 1. The Joint Commission noted that it decided to make the change after consulting with Centers for Medicare & Medicaid Services. Click here for additional information about the change.   Updated Inpatient Psychiatric Facility Quality Reporting Program Resources Now Available Earlier this week, the Centers for Medicare & Medicaid Services (CMS) and the Hospital Inpatient Value, Incentives and Quality Reporting (VIQR) support contractor announced updates to two Inpatient Psychiatric Facility Quality Reporting (IPFQR) resources. The IPFQR Program Manual provides a comprehensive overview of the IPFQR program and measure specifications. It also offers detailed instructions to register on the QualityNet Secure Portal, submit data using the web-based measures application, and understand IPFQR Program Preview Report processes. Separately, the IPFQR Program Paper Tools provide an optional, informal abstraction mechanism to help IPFs collect data for the IPFQR program. These resources are located on the QualityNet website’s IPFQR Program Resources page.   CDC Reports on Outbreak of Life-threatening Coagulopathy Associated with Synthetic Cannabinoids Use The Centers for Disease Control and Prevention (CDC) has posted information for clinicians following a multi-state outbreak of coagulopathy from exposure to synthetic cannabinoid products that has resulted in more than 200 cases and five deaths. Synthetic cannabinoids (sometimes referred to as synthetic marijuana, fake weed, legal weed, K2, and Spice) are types of New Psychoactive Substances (NPS) that are misused for recreational purposes. In March, the Illinois Department of Public Health reported cases of unexplained bleeding among patients who reported using synthetic cannabinoids. Subsequent testing of drug and biological samples from case-patients detected brodifacoum, a long-acting vitamin K-depending antagonist that is used as a rodenticide, the CDC reported. The Atlanta-based agency noted that hundreds of different synthetic cannabinoid chemicals are manufactured and sold, and that new ones with unknown health risks become available every year. Based on its findings, the CDC posted recommendations for healthcare providers, starting with a suggestion to “maintain a high index of suspicion for vitamin K-dependent antagonist coagulopathy in patients with a history or suspicion of using synthetic cannabinoids” and concluding with a recommendation to contact the local poison control center (800.222.1222) for questions about diagnostic testing and managing these patients. Speciality providers of substance use and mental health services could alert patient populations to the potential adverse health risks of current batches of NPS, as patients may not be aware of the contents of the drugs they are using.   FDA’s Next Priority: Proactive Pharmacovigilance The FDA has invested new resources to develop the capacity to monitor emerging trends in the addiction landscape to help the agency intervene more quickly and protect the public from related risks, physician leaders at the FDA wrote in The New England Journal of Medicine this week. According to the article from the FDA’s Douglas Throckmorton, M.D., Scott Gottlieb, M.D., and Janet Woodstock, M.D., the agency has taken steps to address the opioid crisis, such as launching efforts to inform more appropriate prescribing and developing new therapeutics that can help patients in pain. Now the agency will focus on “proactive pharmacovigilance” so it can intervene more quickly when it anticipates changes in drug use and misuse. “The FDA has invested new resources in developing these capabilities,” the authors wrote, “including convening a group of professionals to evaluate epidemiologic signals that may presage new usage trends.”   Prescription Drug Monitoring Program Administrators Offer Recommendations in PEW Study A new study from the PEW Charitable Trusts highlights recommendations from Prescription Drug Monitoring Program (PDMP) administrators to enhance these programs, including the ability to sort data and better collaboration among stakeholders at the state level. PDMPs are electronic databases that allow healthcare professionals to view their patients’ controlled-substance prescription histories to better inform prescribing, dispensing and treatment decisions, the study noted. Ultimately, the programs can help reduce the misuse and diversion of prescription opioids and other controlled substances. “Although several important concerns were identified, the PDMP administrators encouraged enhancements such as the ability to sort data; maps that show distances between patients, prescribers, and pharmacies; and graphical displays of patients’ controlled-substance prescription use,” the study said. “Moving forward, states should collaborate with all stakeholders in an interdisciplinary way to determine optimal risk indicators and thresholds that are reported to prescribers.”   SAMHSA to Host Webinars on Peer Specialists, Mobile Apps and Lived Experience The Substance Abuse and Mental Health Services Administration (SAMHSA) will host three webinars on a range of behavioral healthcare topics next week. On June 5, SAMHSA will host “Peer Specialists and Police as Partners Preventing Behavioral Health Crisis” from 11:30 a.m. until 1 p.m. ET. Click here to register. Also that day, the agency will host a webinar from noon until 1 p.m. ET to review the current state of mental health apps as they related to evidence-based treatment strategies. Click here to register. Later in the week, SAMHSA will co-host “Enhancing Recovery Through Lived Experience” with the National Alliance on Mental Illness (NAMI). The June 7 webinar from 2 p.m. until 3:30 p.m. ET will explore the lived-experience approach that drives NAMI’s peer and family delivered education, support and presentation programs. Click here to register.   NABH to Host Hot Topics Call on Monday, June 4 Please join the National Association for Behavioral Healthcare (NABH) team for a members-only Hot Topics call on Monday, June 4 at 4 p.m. ET to learn about some recent developments and upcoming activities at NABH. In this hourlong call, NABH President and CEO Mark Covall and his team will provide a series of updates and also answer questions from NABH members. The call will follow this brief agenda:
  • NABH Rebrand: The association rebranded to the National Association for Behavioral Healthcare from the former National Association of Psychiatric Health Systems (NAPHS) on March 19. If you were unable to attend the 2018 NABH Annual Meeting, please be sure to watch our brief video that we showed to kick off the meeting. Learn more about our rebranding, social media channels, and exciting changes ahead during this call.
  • Mental Health Month Recap: The country has recognized May as Mental Health Month since 1949. Learn how NABH commemorated Mental Health Month in 2018 with its first paid social media campaign, which focused on repealing the Institutions for Mental Diseases (IMD) exclusion in Medicaid.
  • Federal Policy Update: Congress continues to pay close attention to the nation’s deadly opioid crisis. Learn how the NABH team has worked with committees in both chambers of Congress to address this issue. Also learn about some important regulatory updates related to the inpatient psychiatric facility prospective payment system (IPF PPS).
For questions or comments about CEO Update, please contact Jessica Zigmond.

CEO Update | 09

Written by Administrator on . Posted in CEO Updates.

Congress Sends Veterans Bill to President Trump The Senate passed sweeping legislation this week to overhaul medical care options for the nation’s veterans. In a 92-5 vote, senators approved the VA Mission Act, a package totaling more than $50 billion that is intended to give veterans more access to private physicians and hospitals. “The Senate passage of the VA MISSION Act is a major victory for our nation’s veterans who will benefit from more choice and fewer barriers to care,” Sen. Johnny Isakson (R-Ga.), chairman of the Senate Committee on Veterans’ Affairs, said in a news release after the bill passed. According to a summary, the bill consolidates seven Veterans Affairs (VA) community care programs into on streamlined program; removes barriers for VA healthcare professionals to practice telemedicine; strengthens the process for VA and partnering healthcare providers who prescribe opioids to veterans; and requires VA to implement an information technology system to better support, assess and monitor the program. Senators Bob Corker (R-Tenn.), Jeff Merkley (D-Ore.), Mike Rounds (R-S.D.), Bernie Sanders (I-Vt.) and Brian Schatz (D-Hawaii) voted against the legislation, which President Trump is expected to sign in the coming days.   Senate Judiciary Approves Five Opioid Bills The Senate Judiciary Committee on Thursday passed five pieces of legislation to address the nation’s opioid crisis. Among the bills is the Substance Abuse Prevention Act, which would raise public awareness about opioid and heroin addiction (which the existing Comprehensive Addiction and Recovery Act (CARA) authorizes); provide resources for families to stay together when a family member is fighting addiction; and require the Attorney General and HHS to complete a plan for educating and training healthcare providers in best practices for controlled substances. Another bill — the Opioid Quota Reform Act—would allow the Drug Enforcement Administration (DEA) to consider additional factors when setting annual quotas for opioid drug production in the United States. Currently, DEA can consider only past sales and estimated demand. This legislation would allow the agency to consider diversion, abuse, overdose deaths and public health impacts when setting quotas, a summary noted.   House Majority Leader Pens Op-ed on Opioid Crisis House Majority Leader Kevin McCarthy (R-Calif.) this week summarized Congress’ efforts to fight America’s opioid crisis in an op-edpublished in USA Today. McCarthy highlighted Republican efforts to address the crisis and noted that although Congress’ legislative agenda is important, “healing the wounds of drug abuse” will take more than government action. “It will take a commitment by every citizen to fulfill our duties to one another,” McCarthy wrote. “That means supporting people near us who are struggling with drug addiction—and supporting their families and loved ones as well.”   FDA Approves First Non-Opioid Medication to Treat Opioid Withdrawal Symptoms The Food and Drug Administration (FDA) has approved the first non-opioid medication to treat opioid withdrawal symptoms after an advisory panel recommended its approval earlier this year. Lucemyra—the generic name is lofexidine—has been shown to result in less severe withdrawal symptoms and also to facilitate completion of a withdrawal protocol in two placebo-controlled studies, according to a story in Addiction Professional. The drug suppresses the neurochemical surge that produces withdrawal symptoms that include muscle spasms, stomach cramps and heart pounding. It is expected to be available on the U.S. market in August.   GAO Reports Need for Improvement in SAMHSA’s State Protection and Advocacy Programs In a new report, the Government Accountability Office (GAO) found that the Substance Abuse and Mental Health Services Administration (SAMHSA) should improve its procedures to oversee its state Protection and Advocacy for Individuals with Mental Illness (PAIMI). Established by Congress in 1986, the PAIMI grant awards totaled about $36 million in 2016. SAMHSA administers the grants to support state programs that protect and advocate for the rights of individuals with significant mental illness by investigating reports of incidents of abuse and neglect in facilities such as hospitals and also in the community. “GAO recommends that SAMHSA take steps to ensure that changes to performance benchmarks are examined over time, and to ensure onsite reviews are completed—and findings are provided to state programs— in a timely manner,” the report noted.   Separate NIH Studies Examine Depression Risk and Opioid Therapy for Chronic Pain A study published in the May 2018 issue of Preventive Medicine shows that African Americans and Latinos are “significantly more likely to experience serious depression” than Whites, although chronic stress does not appear to explain the differences. The study from the National Institute on Minority Health and Health Disparities (part of the National Institutes of Health) also found that African Americans and Latinos were more likely to have higher levels of chronic stress and more unhealthy behaviors. Researchers examined data on 12,272 participants between the ages of 40 and 70 from 2005 until 2012. Separately, a study from scientists at NIH and McGill University in Montreal found that pain-induced changes in the rat brain’s opioid receptor system may help explain the limited effectiveness of opioid therapy in chronic pain—and may play a role in the depression that often goes with it. “It’s well known that there’s a link between chronic pain and depression,” said M. Catherine Bushnell, Ph.D., scientific director of the National Center for Complementary and Integrative Health’s (NCCIH) Division of Intramural Research and one of the study’s authors. “The results of this study indicate that pain-induced changes in the brain’s opioid system may play a role in this association,” she added. “Animals with the greatest decrease in opioid receptor availability showed the greatest increase in depression-like symptoms after experiencing chronic pain.   Save the Date: NABH to Host 2019 Annual Meeting from March 18-20 in Washington, D.C. Please mark your calendars for March 18-20, 2019 and plan to attend the 2019 NABH Annual Meeting at the Mandarin Oriental Washington, D.C.! Also, please take a moment to view a brief photo gallery from the 2018 NABH Annual Meeting. For questions or comments about CEO Update, please contact Jessica Zigmond.

CEO Update | 07

Written by Administrator on . Posted in CEO Updates.

House Energy and Commerce Committee Approves 25 Opioid Bills The House Energy and Commerce Committee this week approved 25 bills that address the nation’s deadly opioid crisis. All of the legislation received bipartisan support, and the committee is scheduled to examine another set of opioid-related measures next week. The Comprehensive Opioid Recovery Centers Act of 2018 is among the bills the committee passed this week. Co-sponsored by Reps. Brett Guthrie (R-Ky.) and Gene Green (D-Texas), the legislation would award grants on a competitive basis to entities that would establish or operate comprehensive opioid recovery centers. The centers would need to provide a range of services, including periodic patient assessments, detoxification, counseling, residential rehabilitation and more. Earlier this spring, Congress appropriated about $4 billion to fight the country’s drug abuse crisis as part of a large spending bill. It’s not certain if federal lawmakers will appropriate more money to address the problem.   SAMHSA Highlights Communities, Partnerships & Resource Sharing for National Prevention Week National Prevention Week starts on Sunday, May 13 to increase public awareness and action around substance abuse and mental health issues. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), National Prevention Week has three primary goals: to involve communities in raising awareness about behavioral health issues and implementing strategies; foster partnerships with federal agencies and national organizations dedicated to behavioral and public health; and promote and disseminate quality behavioral health resources and publications. National Prevention Week takes place each year during the third week of May—in the middle of Mental Health Month—close to the start of summer, which SAMHSA notes is a critical time for schools, communities and professionals to focus on prevention. Click here for more information. Also, please remember to follow NABH on Twitter @NABHbehavioral and on LinkedIn, where our theme throughout Mental Health Month emphasizes repealing the Institutions for Mental Diseases (IMD) exclusion.   New England Journal of Medicine Examines Link Between Suicide and Opioid Overdoses Solutions to address America’s opioid crisis require that “we tailor interventions to preventing opioid-overdose deaths due to suicidal intent,” according to a recent article in the New England Journal of Medicine. As the physician authors report, interventions to prevent opioid deaths in suicidal people will differ from interventions targeted toward accidental overdose. But most strategies for reducing opioid-overdose deaths do not include screening for suicide risk, nor do they address the need to adjust interventions for suicidal persons. Meanwhile, the authors continued, two populations that are more likely than others to receive opioid prescriptions—patients with chronic pain and those with mood disorders—are also at greater risk for suicide. Separately, the April 26th issue also includes an article that explores improving electronic health record (EHR adoption in psychiatric care. In it, the authors note the implications for patients and providers due to a lag in EHR use in psychiatric care.   U.S. Preventive Services Task Force Seeks Comment on Draft Plan to Reduce Drug Use in Children and Adolescents The U.S. Preventive Services Task Force is seeking comment on its draft plan on interventions to reduce illicit drug and nonmedical prescription drug use in children and adolescents.Released this week, the plan is available for review through Wednesday, June 6. The task force notes that anyone can comment on the plan, although the task force writes these types of documents for researchers, primary care physicians and other healthcare providers. Click here to review the research plan and submit a comment.   DOJ’s Bureau of Justice Assistance to Highlight COAP Grant Program in Webinar on May 15 Leaders from the U.S. Justice Department’s Bureau of Justice Assistance will host a webinar on Tuesday, May 15 from 1 p.m. to 2:30 p.m. ET to review the fiscal year 2018 Comprehensive Opioid Abuse Program (COAP) solicitation. The bureau created COAP as a response to the Comprehensive Addiction and Recovery Act, or CARA, which Congress passed in July 2016. COAP’s purpose is to provide financial and technical assistance to states, local governments, and Indian tribal governments to plan, develop, and implement efforts to identify and treat those affected by the opioid crisis. The program includes the following six grant categories: first responder partnerships; technology-assistant treatment projects; system-level diversion projects; statewide planning, coordination and implementation projects; the Harold Rogers Prescription Drug Monitoring Program implementation and enhancement projects; and public safety, behavioral health, and public health information sharing partnerships. Click here to register for the webinar.   HRSA to Host Webinar about Treating Pregnant Women with Opioid Use Disorder on May 16 The Health Resources and Services Administration (HRSA) will host an hourlong webinar on Wednesday, May 16 at 1 p.m. ET to provide guidance on treating pregnant and parenting women with opioid use disorder. The webinar will discuss the Substance Use Warmline, a resource that provides free and confidential clinician-to-clinician consultation for substance use evaluation and management. Click here to register.   SAMHSA to Address Behavioral Health Needs of Older Veterans in Webinar on May 22 To recognize both Mental Health Month and Older Americans Month in May, SAMHSA will host an hourlong webinar on May 22 to help community service providers understand the behavioral health needs of older veterans; identify Veterans Health Administration resources; and discuss the importance of collaborating across mental health, aging and veterans services. Click here to register.   IPF PEPPER Review Webinar Recording Now Available The recording and transcription from the PEPPER Review webinar on May 2 is now available here on the PEPPER Training and Resources page. The early May webinar reviewed the release of the Q4FY17 PEPPER that was released in April.   For questions or comments about the CEO Update, please contact Jessica Zigmond.

CEO Update | 06

Written by Administrator on . Posted in CEO Updates.

NABH Focuses on IMD Repeal Exclusion During May’s Mental Health Month NABH on Friday kicked off a monthlong social media campaign centered on urging lawmakers to repeal the Institutions for Mental Diseases (IMD) exclusion. Mental Health Month in May provides an opportunity for NABH to promote its message that the IMD exclusion blocks access to mental healthcare within a heightened national conversation about mental health. Please follow NABH on Twitter @NAHBbehavioral and on LinkedIn at the National Association for Behavioral Healthcare. And please engage in the conversation by retweeting our messages using the hashtags #MentalHealthMonth and #MHM2018 on Twitter and sharing our messages with your connections on LinkedIn.   House Energy and Commerce Committee to Consider Opioid Legislation Next Week House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) announced his full committee will begin to markup legislation to fight the nation’s opioid crisis next week. Walden’s full panel will review the opioid-related bills in its first markup on Wednesday, May 9, and the bills will be posted here on Monday, May 7. The committee announced the second markup is scheduled for Thursday, May 17. In late April, the House Energy and Commerce Health Subcommittee advanced 57 bills to address the opioid crisis and passed 48 of those bills by voice vote.   HSAG Invites Comments on Proposed Screening for Pregnancy Quality Measure On behalf of the Centers for Medicare & Medicaid Services (CMS), the Health Services Advisory Group (HSAG) is inviting healthcare professionals, stakeholder organizations, and individuals to provide comments on the Screening for Pregnancy measure. HSAG’s announcement noted that after the measure is made final, CMS could propose that it be adopted in the Inpatient Psychiatric Facility (IPF) Quality Reporting program. The IPF Outcome and Process Measure Development and Maintenance Project is developing the measure, which assesses the percentage of female patients of childbearing age (15-44 years) admitted to an IPF who have had a pregnancy status in their medical record. The public comment period begins Friday, May 4 and extends through Thursday, May 31 at noon ET. Click here for more information, and click here to submit comments. Please contact Marie Hall at mhall@hsag.com if you have trouble submitting comments.   NIH Launches ‘All of Us’ Research Program The National Institutes of Health (NIH) has announced its All of Us research program, which is meant to engage 1 million or more volunteers in the United States to contribute their health data to improve health outcomes and stimulate development of new treatments for diseases. The program is a piece of the Precision Medicine Initiative, or PMI, a research effort to transform how we improve health and treat disease. According to the NIH, PMI is intended to leverage advances in genomics; emerging methods for managing and analyzing large data sets while also protecting privacy; and health information technology to hasten biomedical discoveries.   Study Shows Improved Performance in Hospitals Reporting Inpatient Psychiatric Services Measures to The Joint Commission The Joint Commission announced this week that a study in the July 2018 issue of Psychiatric Services shows hospitals reporting inpatient psychiatric services measures to The Joint Commission demonstrated improved performance on measures related to admission screening, multiple antipsychotic medication justification, discharge planning, and restraint and seclusion use.   For questions or comments about the CEO Update, please contact Jessica Zigmond.
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Signature Healthcare Services’ Aurora San Diego Hospital Hosts Congressional Site Visit

Written by Administrator on . Posted in Resources.

NABH Member Hosts Congressional Site Visit

NABH member Signature Healthcare Services’ Aurora San Diego hospital recently hosted Rep. Scott Peters (D-Calif.), who toured the facility and met with hospital leaders to discuss some the biggest challenges facing the behavioral healthcare industry.

Aurora San Diego provides mental health and substance abuse services both on an inpatient and outpatient basis for children, adolescents, adults and older adults. Aurora also has a highly regarded military treatment program for active duty members who are working through combat-related trauma, general mental health issues and substance use disorders.

Rep. Peters and hospital leaders discussed addressing the opioid crisis and removing some outdated federal barriers to care, including the Institutions for Mental Diseases (IMD) exclusion that prevents adult Medicaid beneficiaries from accessing acute care in facilities with more than 16 beds, and Medicare’s 190-day lifetime limit on inpatient care in a psychiatric hospital.

Following his tour, Rep. Peters hosted a Town Hall-style meeting with about 50 Aurora employees from across all disciplines to discuss the need for more resources to address mental health for service members and veterans.

For information and help coordinating a congressional site visit, please contact Julia E. Richardson, NABH’s director of advocacy and senior counsel, at julia@nabh.org.