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CEO Update 111

NABH and Other Healthcare Advocacy Groups Provide Feedback on Latest Covid-19 Legislation NABH this week weighed in on issues specific to behavioral healthcare providers in the $1 trillion Covid-19 stimulus package that Senate Majority Leader Mitch McConnell (R-Ky.) released on Monday, July 27. Referred to collectively as the HEALS Act, the legislation includes a total of eight bills from Senate Republicans. For detailed information on this latest Covid-19 bill, please see this section-by-section summary from the law firm Brownstein Hyatt Farber Schreck. On Thursday, NABH joined the American Hospital Association, the Federation of American Hospitals, the Catholic Health Association of the United States, the Children’s Hospital Association, the Association of American Medical Colleges, Premier Healthcare Alliance, and Vizient, Inc. in a letter regarding surprised medical billing. “Legislative proposals that would dictate a set payment rate for unanticipated out-of-network care are neither market-based nor equitable, and do not account for the myriad inputs that factor into payment negotiations between insurers and providers,” the organizations noted in the letter. “These proposals will only incentivize insurers to further narrow their provider networks and would also result in a massive financial windfall for insurers,” it continued. “As such, we oppose the setting of a payment rate in statute and are particularly concerned by proposals that would undermine hospitals and front-line caregivers during the Covid-19 pandemic.” And on Tuesday, NABH joined a handful of other advocacy groups—including Advocates for Opioid Recovery, the American Association for Opioid Dependence, Inc., and the MAT Leadership Council—in sending a letter to congressional leaders that calls for a total of $400 million in federal funding to support opioid treatment programs (OTPs) and recovery support services. “To ensure that the 450,000 OTP patients around the country continue to have access to this lifesaving care, we request that $300 million be included in the next COVID-19 stimulus package for opioid treatment programs,” the organizations said in the letter, adding later, “We also request that Congress set aside an additional funding stream of $100 million for recovery support services. Recovery support services can cover myriad types of programming including online and call-in All Recovery Meetings that support multiple pathways to recovery, peer support services, and evidence-supported programs that teach life skills and/or job skills and training for those in recovery or who are involved in the criminal justice system.” NABH will continue to keep members apprised of congressional developments on the latest coronavirus stimulus package. CMS Approves DNV GL Healthcare USA as a Psychiatric Accreditation Program The Centers for Medicare and Medicaid Services (CMS) announced in a final rule that it has approved an application from DNV GL Healthcare USA for initial recognition as an accrediting organization for   psychiatric hospitals that wish to participate in Medicare or Medicaid. According to the rule, CMS has approved DNV GL as a national accrediting organization for these facilities effective July 30, 2020 through July 30, 2024. CDC Releases New Covid-19 Guidance for Behavioral Healthcare  New guidance from the Centers for Disease Control and Prevention (CDC) this week clarified that the federal agency’s infection prevention and control guidance applies to all settings where healthcare is delivered, which […]
HHS Temporarily Suspends Quarterly Reports from Provider Relief Fund Recipients HHS on June 13 updated previous guidance to say recipients of Provider Relief Fund payments do not need submit a separate quarterly report to HHS or the Pandemic Response Accountability Committee. The Coronavirus Aid, Relief, and Economic Security Act (CARES) had included the requirement, but HHS updated a Frequently Asked Questions document and said the agency will develop a report containing all information necessary for recipients of the payment to comply with this provision. HHS also indicated it would require reports in the future. “However, the Terms and Conditions for all Provider Relief Fund payments also require recipients to submit any reports requested by the Secretary that are necessary to allow HHS to ensure compliance with payment Terms and Conditions,” the updated guidance noted. “HHS will be requiring recipients to submit future reports relating to the recipient’s use of its PRF money.  HHS will notify recipients of the content and due date(s) of such reports in the coming weeks.” NABH Sends Youth Education Funding Recommendations to Congressional Committees   NABH this week sent a letter to two congressional committees that recommends how to allocate money from the Elementary and Secondary School Emergency Fund that the CARES Act authorized. In the letter to the Senate Health, Education, Labor & Pensions Committee and the House Committee on Education & Labor, NABH President and CEO Shawn Coughlin asked Congress to clarify that funding for state education agencies from the Elementary and Secondary School Emergency Relief Fund be allocated equitably to both non-profit and for-profit residential and other therapeutic settings, including specialized day schools that provide care for children and adolescents with serious behavioral and/or emotional conditions. In addition, NABH recommended that Congress dedicate funding in any upcoming legislation that addresses the Covid-19 pandemic to provide education services and supports for children and adolescents with these conditions. “An appropriation of $37.5 million for education services in residential and other treatment settings and specialized day schools would ensure these settings are able to provide digital devices, internet access, and online school content to these children and adolescents with special needs,” the letter said. “There are approximately 500 residential facilities serving 25,000 children and adolescents with serious behavioral and/or emotional conditions nationwide, and this would ensure that this population is also included and treated equitably.” Kaiser Family Foundation Issue Brief Highlights Options for Medicaid Providers During Covid-19   In a new issue brief, the Kaiser Family Foundation provides an overview of how states currently reimburse providers and the challenges for Medicaid providers that have resulted from the Covid-19 pandemic. The brief notes that although Congress enacted legislation with $175 billion in provider relief grants, the initial allocation of funds was “disadvantageous” to Medicaid providers. “HHS recently announced that $15 billion has been set aside to more directly support Medicaid providers, and an unspecified amount has been allocated to reimburse providers for COVID-19 treatment costs for the uninsured,” the issue brief said. “However, it is not clear if the current provider relief fund allocations will be sufficient to meet providers’ needs resulting from the pandemic. Congress will […]
NABH Letter to Lawmakers Outlines How to Address Covid-19’s Effects on Behavioral Health NABH’s Covid-19 task force on Tuesday sent a letter to Vice President Mike Pence and senior congressional leaders that lists behavioral healthcare providers’ top challenges and recommendations as America prepares for a surge in mental health and addiction issues resulting from the Covid-19 pandemic. “Epidemics, even those of lesser magnitude than the Covid-19 pandemic, cause significant detrimental effects on mental health and substance use among affected populations often for years following an outbreak,” the letter noted. “Recent polls have found that half or more of Americans say the coronavirus pandemic is affecting their mental health with many reporting symptoms of anxiety and depression with high degrees of distress.” The letter lists key steps to address the behavioral health effects from Covid-19, including: maintaining and improving expansions of tele-behavioral health; maintaining other coverage expansions critical to improving access to behavioral healthcare; improving access to addiction services; increasing access to urgent and acute care for behavioral health conditions; and improving access to care and education for youth with serious behavioral health conditions. Click here to learn about NABH’s Covid-19 task force and to access behavioral healthcare resources during the pandemic. United Nations Releases Policy Brief on Covid-19 and Mental Health United Nations (UN) Secretary-General António Guterres this week said mental health services are an essential part of all government responses to Covid-19 that must be expanded and fully funded. Guterres emphasized that message when he announced the UN’s policy brief on Covid-19 and mental health and urged the international community to do much more to protect all those who face rising mental pressures. “After decades of neglect and underinvestment in mental health services, the Covid-19 pandemic is now hitting families and communities with additional mental stress,” Guterres said in a video message. “Those most at risk are frontline healthcare workers, older people, adolescents and young people, those with pre-existing mental health conditions, and those caught up in conflict and crisis,” he added. “We must help them and stand by them. Even when the pandemic is brought under control, grief, anxiety, and depression will continue to affect people and communities.” Devora Kestel, director of the World Health Organization’s (WHO) Department of Mental Health and Substance Use, reiterated Guterres’s message when she said past economic crises had “increased the number of people with mental health issues, leading to higher rates of suicide for example, due to their mental health condition or substance abuse.” Kestel also said it’s critical to take measures that protect and promote care for the existing situation “so that we can prevent things becoming worse in the near future.” House to Vote Friday on Latest Coronavirus Stimulus Package The House on Friday is expected to vote on a nearly $3 trillion coronavirus economic stimulus package that includes several behavioral healthcare provisions. According to a bill summary, the House bill includes $200 million for the National Institute of Mental Health to support research on the mental health consequences of Covid-19, including the effect on the nation’s healthcare providers. The legislation also includes $20 million to establish an emergency mental […]
CMS Expects FY 2021 IPF Payments to Increase by 2.4% The Centers for Medicare & Medicaid Services (CMS) on April 10 said it expects payments to inpatient psychiatric facilities to increase by 2.4% in fiscal year 2021, boosting the federal per diem base rate to $817.59 from $798.55. An announcement about CMS’ proposed inpatient psychiatric facility prospective payment system (IPF-PPS) rule said the agency estimates total IPF payments to increase by $100 million next year. The rule was published in the Federal Register on Tuesday, April 14.  According to the proposed rule, CMS will adopt the Office of Management and Budget guidelines regarding geographic delineation of statistical areas, which CMS said should result in wage index values better representing the actual labor costs in a given area. “CMS is proposing that all IPF providers negatively impacted in their wage index, regardless of the circumstance causing the decline, be capped at a 5-percent decrease for FY 2021,” the announcement said. Table 6 at the start of page 57 in the proposed rule shows changes in 2021 from 2020 for different facility types. The agency said it is not making changes to the IPF Quality Reporting Program. NABH is analyzing the proposed rule and will submit comments by the June 9 deadline. HHS Opens CARES Act Emergency Fund Attestation Portal HHS has opened its Coronavirus Aid, Relief, and Economic Security (CARES) Act emergency fund attestation portal for healthcare providers who receive funds from the $100 billion Public Health and Social Services Emergency Fund within 30 days of receipt to attest that they received the funds and agree to payment terms and conditions. HHS began distributing the first $30 billion from the fund on April 10 to reimburse providers for healthcare-related expenses and lost revenue related to Covid-19. New Coalition Launches Initiative to Match PPE Donors with Hospitals A coalition of organizations including the American Hospital Association (AHA), Kaiser Permanente, UPS, and Microsoft has launched the Protecting People Everywhere initiative to support a national exchange that matches personal protective equipment (PPE) donors with the hospitals in greatest need. Powered by the HealthEquip™ app, the initiative is meant to ensure these critical supplies are distributed equitably. Click here to learn more. NABH Sends Urgent OTP Requests to HHS and SAMHSA NABH this week asked HHS and the Substance Abuse and Mental Health Services Administration (SAMHSA) to make changes in telehealth service delivery and payment rates for opioid treatment programs (OTPs) during Covid-19. In a letter to HHS Secretary Alex Azar and SAMHSA Administrator Elinore McCance-Katz, M.D., Ph. D., NABH requested that the Trump administration support an NABH-proposed telehealth service-delivery model for new patients that addresses SAMHSA’s clinical concerns while also protecting patients and physicians. The letter also asked the federal health officials to support OTP providers at a standardized rate during the pandemic period to mitigate the loss in revenue and increase in expenditures for OTPs during Covid-19. Click here to read the letter, which is posted on NABH’s Covid-19 resources page. AHA to Host Behavioral Health Webinar Featuring Sheppard Pratt Leaders Next Week The AHA will host a webinar about behavioral health challenges […]
President Trump Signs $2 Trillion Stimulus Bill to Address Covid-19 Pandemic President Trump on Friday signed a $2 trillion stimulus package to address the Covid-19 pandemic’s devastating effects on the nation. Earlier Friday, the House passed the Senate-approved Coronavirus Aid, Relief, and Economic Security Act (CARES), which includes several provisions to address costs and other burdens on healthcare providers related to Covid-19—and improve access for mental health and substance use disorder treatment. The legislation includes tax rebates, expanded unemployment benefits, tax relief provisions, and grants focused on financially supporting individuals, families, businesses, and states. It also includes $100 billion for healthcare providers who provide care for individuals who may have or are diagnosed with Covid-19. These funds can be used for expenses or lost revenues that are attributable to the coronavirus. This funding is allocated to the Public Health and Social Services Emergency Fund that HHS’ Office of the Secretary manages. Here are other key provisions from the CARES Act for behavioral healthcare providers: $16 billion is included for the Strategic National Stockpile for personal protective equipment and other medical supplies for federal and state response efforts. $3.5 billion is included for childcare with a clarification that states can use these funds to provide childcare for healthcare workers, including those who may not ordinarily qualify for services at federally funded sites. $425 million to the Substance Abuse and Mental Health Services Administration (SAMHSA), including: $250 million for the Certified Community Behavioral Health Center (CCBHC) grant program; $50 million for suicide prevention programs; and $100 million for emergency response grants—flexible funding to address mental health, substance use disorders and provide resources and support to local communities. Extends original CCBHC demonstration program funding for participating sites through November 2020 and directs HHS to select two additional states to include in the demo. Additional flexibility for Medicare to cover telehealth—eliminating the limitation on telehealth coverage to providers that had treated the patient in the last three years. Lifting this restriction will enable beneficiaries to access services via telehealth from a broader range of providers. Improved care coordination for patients with substance use disorders. This provision allows patients to consent to their records being shared for healthcare treatment, payment, and operations in accordance with the privacy requirements established through the Health Insurance Portability and Accountability Act (HIPAA). Patients will still be able to restrict disclosure by withholding consent, and the legislation contains anti-discrimination provisions and restrictions on law enforcement use of the records. The NABH team will continue to analyze the bill and advocate for several unresolved behavioral healthcare issues, such as ensuring that providers have access to the emergency funds as soon as possible; repealing the Institutions for Mental Diseases (IMD) exclusion in Medicaid and 190-day lifetime limit in Medicare to allow psychiatric hospitals to serve patients who have been displaced from other healthcare settings; and continuing to request guidance on telehealth related to IOP and PHP settings, EMTALA waivers, staffing ratios, and OTP services. Please visit NABH’s Covid-19 resources page for guidance and links, and be sure to follow us on Twitter @NABHBehavioral and on LinkedIn to learn best practices from fellow NABH […]
WHO Declares COVID-19 a Pandemic; NABH Cancels 2020 Annual Meeting The World Health Organization this week declared the coronavirus disease 2019 (COVID-19) a pandemic as the virus has spread to more than 100 countries and killed more than 4,200 people. After careful consideration, NABH this week cancelled the 2020 NABH Annual Meeting and all related events to protect the health and safety of all meeting participants and minimize unnecessary risks to exposure of the COVID-19. NABH will reimburse all meeting registrants in full, including the $50 cancellation fee for any meeting registrant who has cancelled already. All meeting registrants are responsible for covering and cancelling their hotel and transportation costs. In addition, NABH sent a message to all exhibitors and sponsors regarding reimbursement. The entire NABH team looks forward to seeing the association’s members and other meeting participants at the 2021 NABH Annual Meeting at the Mandarin Oriental Washington, DC from March 1-3, 2021! CMS Issues Guidance for Healthcare Workers During COVID-19 Pandemic The Centers for Medicare & Medicaid Services (CMS) this week issued a series of guidance notices to ensure healthcare workers are protecting themselves and patients during the COVID-19 pandemic. On March 9, CMS delivered guidance on the screening, treatment, and transfer procedures healthcare workers must follow when interacting with patients to prevent the spread of the COVID-19 virus, as well as guidance that highlights the benefits of telehealth in the Medicare and Medicaid programs. The following day CMS issued a memorandum to state survey agencies—which are responsible for inspecting nursing homes and other facilities that serve Medicare and Medicaid beneficiaries—that includes guidance about protective mask guidance for healthcare workers. Click here for additional information from CMS and here for the situation summary on the virus from the Centers for Disease Control and Prevention. NABH Supports Recommendations for Strengthening Addiction Service Workforce NABH this week joined more than a dozen organizations that comprise the Coalition to Stop Opioid Overdose (CSOO) in sending a letter to Congress that outlines recommendations to strengthen the addiction service workforce. The letter—which includes specific appropriations recommendations—requests increased funding of important addition prevention, treatment, harm reduction, and recovery support programs aimed at strengthening the addiction service workforce in 2021. As the letter noted, an estimated 21.2 million Americans aged 12 or older needed treatment for substance use disorder (SUD) in 2018, but only about 3.7 million Americans aged 12 or older received any form of treatment for SUD. “By advancing sustainable, comprehensive public policies and expanding federal investment throughout our health care system for SUD, we will move closer to a future where all Americans living with addiction receive the high-quality care they need and deserve,” the letter said. IPFQR Webinar on Navigating Hospital Compare Website Scheduled for March 24 CMS will host a webinar for participants in the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program about how to navigate the Hospital Compare website on Tuesday, March 24 at 2 p.m. ET. The webinar will highlight the steps to use the Hospital Compare website to compare IPFQR program data for up to three providers at a time and review the ways to download complete facility-, […]
White House Proposes Changes to IMD Exclusion in 2021 Budget Proposal to Congress The White House this week released a $4.8 trillion budget for 2021 that would modify Medicaid’s Institutions for Mental Diseases (IMD) exclusion to provide states with flexibility to provide inpatient mental health services to beneficiaries with serious mental illness (SMI). The budget requests $94.5 billion for HHS, a 10-percent decrease from the 2020 enacted level. Although Congress is likely to reject President Trump’s proposal, the budget is significant for outlining the president’s top policy priorities as he seeks re-election in November. Notably for NABH, those priorities include mental health and addiction treatment services. That includes changes to the IMD exclusion, which under current law states Medicaid cannot pay for certain inpatient stays at IMDs. The president’s budget would provide more than $5 billion in new federal funding to states to ensure the full continuum of care exists to provide help to people with SMI. These changes—which appear in summary tables at the end of the budget proposal—would also exempt Qualified Residential Treatment Programs (QRTPs) from the IMD exclusion. The budget also includes $225 million for Certified Community Behavioral Health Clinics (CCBHC) expansion grants, and would extend, through 2021, the CCBHC Medicaid demonstration programs to improve community mental health services for the eight states participating currently in the demonstration. In addition, the White House has proposed $25 million to expand primary healthcare services to address homelessness. These provisions, together with the changes to the IMD exclusion, are “part of a comprehensive strategy that includes improvements to community-based treatment,” the budget proposal noted. Meanwhile, the president’s 2021 budget would continue 2020 funding to expand medication assisted treatment (MAT) from a small pilot program to half of all eligible Bureau of Prisons (BOP) facilities and provide an additional $37 million to complete MAT expansion to all eligible BOP facilities. The proposal also includes $1.6 billion—an $85 million increase from the 2020 enacted level—for State Opioid Response grants, which support prevention, treatment, and recovery support services. States would be given flexibility to use these funds to address the increasing number of overdoses related to psychostimulants, in­cluding methamphetamines. NABH will continue to analyze the Trump administration’s budget proposal and keep NABH apprised of any additional details regarding the IMD exclusion, MAT funding, and other topics related to the association’s policy priorities. CMS Recommends 2020-2021 Policy Changes to Several Programs in Proposed Rule The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule that would revise regulations for Medicare Advantage (Part C), the Medicare Prescription Drug Benefit (Part D) program, the Medicare Cost Plan, Programs of All-Inclusive Care for the Elderly (PACE), and the Medicaid program in 2020 and 2021. According to a summary, the rule would implement certain sections of the Bipartisan Budget Act of 2018, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT), and the 21st Century Cures Act. The rule aims to improve Medicare’s Part C and D programs, codify several existing CMS policies, and implement other technical changes. For Medicare Part D’s mandatory drug management programs (DMPs), the […]
ONDCP Issues 2020 National Drug Control Strategy and Treatment Plan The Office of National Drug Control Policy (ONDCP) this week issued its national 2020 National Drug Control Strategy (Strategy) and accompanying National Treatment Plan (NTP) that includes action items for federal agencies and external stakeholders to increase access to care and close the addiction treatment gap.    The Strategy is presented using the domains of prevention, treatment and recovery, and supply-side strategies for reducing the availability and consumption of illicit drugs. These domains are established as ‘pillars’ that undergird the following federal initiatives of “expanding the early intervention, treatment and recovery infrastructure; improving the delivery system; and improving quality.” Specifically, the NTP calls for treatment expansion and improved quality by: Developing protocols for medically managed withdrawal including MAT to prevent relapse and promote stabilization; Increasing emergency department use of addiction medicine specialty services; Exploring the inclusion of stimulant disorder treatment in opioid treatment programs; Increasing access to all medication and psychosocial services, promoting syringe exchange, interim methadone, mobile methadone vans, and peer outreach (one objective of the federal Performance and Reporting System is to make sure 100% of all specialty providers offer MAT by 2020); Adopting model state specialty SUD treatment licensing laws; Developing mobile and online platform with updated information on treatment slot availability with online appoint capacity; Encouraging public and private payers to cover comprehensive services and improve reimbursement rates where out-of-network rates are higher; Urging providers to subsidize and provide treatment scholarships; and Exploring the idea of developing national consensus standards for addiction treatment to consolidate treatment quality standards. Please contact Sarah Wattenberg, NABH’s director of quality and addiction services, if you have questions about the Strategy or NTP. OIG Report Finds More Than One-Third of New Jersey’s Federal Medicaid Reimbursement for Providing Community-Based Treatment Services Was Unallowable HHS’ Office of Inspector General (OIG) has recommended the state of New Jersey refund the federal government $14.8 million after the OIG concluded more than a third of the state’s federal Medicaid reimbursement for providing community-based treatment services was unallowable.   The OIG’s report said that of New Jersey’s 100 sampled claims for federal Medicaid reimbursements of payments for Programs of Assertive Community Treatment (PACT), 50 complied with federal and state requirements, but 50 did not. Meanwhile, of the 100 claims, 21 contained more than 1 deficiency.   “We found PACT program services provided were not adequately supported or documented (36 claims), plan of care requirements were not met (17 claims), PACT teams did not include staff from required clinical disciplines (8 claims), and providers did not obtain prior authorization for beneficiaries (5 claims), among other findings,” the report said.   The OIG’s other recommendations include the state improving procedures to identify deficiencies similar to those identified in the report, and considering regulations for periodic reassessments to determine whether beneficiaries enrolled in PACT continue to require PACT services. The National Academies Releases Report to Improve OUD and Infectious Disease Services The National Academies of Sciences, Engineering, and Medicine (NASEM) has released Opportunities to Improve Opioid Use Disorder and Infectious Disease Services: Integrating Responses to a Dual Epidemic, which identifies […]
CMS Announces New Survey and Certification Process for Psychiatric Hospitals The Centers for Medicare & Medicaid Services (CMS) this week announced it has streamlined the process to survey the nation’s psychiatric hospitals to review for compliance with participation requirements in one comprehensive survey.   Beginning in March, CMS will send psychiatric hospitals one survey to evaluate their compliance with both general hospital and psychiatric hospital participation requirements. CMS is not making any changes to the special psychiatric Conditions of Participation (CoPs) in this process. Under this change, CMS will move the interpretive guidelines from State Operations Manual (SOM) Appendix AA, or the special psychiatric CoPs, into Appendix A, the CoPs for general hospitals. Subsequently CMS will delete Appendix AA. This change will allow CMS to issue a single survey and report to hospitals, rather than two. “We appreciate CMS’ attention on the special psychiatric CoPs, which is long overdue,” NABH President and CEO Shawn Coughlin said in a news release NABH issued about the announcement. “At the same time, shifting these components into a single survey without reforming these CoPs does not provide relief to providers,” he added. “The special psychiatric CoPs are no longer appropriate in today’s environment of care. CMS should update the interpretive guidance to reflect modern methods of psychiatric services.” Click here to read the Jan. 13 announcement from CMS. NABH Responds to CMS’ Request for Information on Reducing Administrative Burden NABH on Friday submitted recommendations to CMS on how to reduce the administrative burden for behavioral healthcare providers. The letter to CMS Administrator Seema Verma was NABH’s response to CMS’ request for information as part of the agency’s Patients Over Paperwork initiative. In it, NABH made recommendations regarding special Conditions of Participation, B-Tags, and the Emergency Medical Treatment and Labor Act (EMTALA). “Adopting fewer burdensome requirements would benefit the healthcare system by reducing unnecessary costs and providing greater stability and predictability for providers as they navigate the regulatory environment,” NABH President and CEO Shawn Coughlin wrote in the letter. “In addition, patients would benefit as clinicians would be able to shift more of their attention, and facilities would be able to shift more of their resources, away from compliance for compliance’s sake and toward initiatives that meaningfully contribute to safe, high-quality care.” NABH Sends Support Letter for Expanding Access to Inpatient Mental Health Act NABH sent a letter this week to Rep. Tom Emmer (R-Minn.) supporting the Minnesota Republican’s Expanding Access to Inpatient Mental Health Act, a bill that would make changes to Medicaid’s 15-day cap for inpatient stays. In 2016 CMS changed how the Institutions for Mental Diseases (IMD) exclusion applies to managed Medicaid programs. Since then, that change has permitted Medicaid managed care states to receive payments for an enrollee in an IMD if the patient’s stay is no longer than 15 days in a month. While NABH is pleased this change has allowed thousands of new low-income patients to receive treatment, the arbitrary 15-day cap too often prevents patients from receiving the care they need if those patients lack coverage beyond 15 days. NABH strongly supports Expanding Access to Inpatient Mental Health Act […]
CMS Releases Fact Sheet for Medicare-Enrolled OTPs The Centers for Medicare & Medicaid Services (CMS) has released an 18-page fact sheet about Medicare billing and payment for opioid treatment programs (OTPs) that participate in the federal program. CMS began paying for enrolled OTPs to deliver opioid use disorder (OUD) treatment services to Medicare beneficiaries on Jan. 1. The fact sheet includes information about a host of issues, including covered OUD treatment services, enrollment in Medicare Electronic Data Interchange, Medicare beneficiary eligibility, claims services, payment and remittance advice, payment issues, and other resources. The agency is now accepting and processing OTP enrollment applications. For more information, review the Medicare enrollment fact sheet. IPFQR Program Manual Version 5.1 Now Available CMS announced this week that the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program Manual version 5.1 and the Release Notes version 5.1 are now available. The manual, which provides an overview of the IPFQR program and measure specifications, 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. CMS also issued the Release Notes version 5.1, which describes changes to the manual compared with the previous version. These resources are available on the Quality Reporting Center’s IPFQR Program Resources and Tools webpage. MACPAC Releases Report to Congress on Oversight of IMDs Fulfilling a SUPPORT Act requirement, the Medicaid and CHIP Payment and Access Commission (MACPAC) has released its report to Congress on the oversight of Institutions for Mental Diseases (IMDs). “The IMD exclusion is one of the few instances in Medicaid where federal funding is not available for covered services based on the setting in which they are provided,” MACPAC noted in the 128-page overview. “It is important to note that, despite this longstanding payment exclusion, there are several other Medicaid authorities that states are using to make Medicaid payments for services provided in IMDs.” There were no recommendations in the report, which is intended instead to identify and describe IMDs in selected states—California, Colorado, Florida, Massachusetts, New Jersey, Ohio, and Texas—and provide a summary of state licensure, certification, or accreditation requirements, and Medicaid clinical and quality standards. Organized by five chapters, the report examines the history and federal policies related to the IMD exclusion, services provided in IMDs, regulation of facilities that are subject to the IMD exclusion, Medicaid standards for behavioral health facilities, and protections for patients in those facilities. SAMHSA Accepting Applications for Mental Health Grants The Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting grant applications for programs that would address suicide prevention as well as planning and development to promote the mental health of children, youth, and families in American Indian/Alaska Natives (AI/AN) communities. SAMHSA plans to issue one grant of up to about $7.6 million each year for up to five years for its Suicide Prevention Resource Center grant. This program is intended to build national capacity for preventing suicide by providing technical assistance, training, and resources to assist states, tribes, communities, providers, practitioners, and members of the public on suicide-prevention strategies and best practices. The agency is also accepting […]
Congress Agrees to $5.9 Billion for SAMHSA in FY 2020 Spending Bill Package Federal lawmakers this week agreed to fund the Substance Abuse and Mental Health Services Administration (SAMHSA) at $5.9 billion in fiscal year (FY) 2020, $140 million above the 2019 enacted level and $205 million above the president’s budget request. The funding is part of the two legislative packages that include all 12 FY 2020 funding bills, which the House passed on Tuesday, Dec. 17. The Senate is scheduled to vote on the spending bills Friday. SAMHSA’s funding included $3.8 billion for substance abuse treatment, $206 million for substance abuse prevention, $16 million for suicide prevention, $19 million for the Suicide Lifeline, and an increase in funding for mental health resources for children. President Trump is expected to sign the full funding package. NABH Participates in White House Mental Health Summit NABH participated in the White House Mental Health Summit on Dec. 19, where President Trump underscored his administration’s commitment to addressing serious mental illness in the United States. Shawn Coughlin, NABH’s executive vice president for government relations and public policy, and Scott Dziengelski, director of policy and regulation, attended the summit, where attendees heard from HHS Secretary Alex Azar and SAMHSA Assistant Secretary Ellie McCance-Katz moderated a panel discussion with mental health advocates about the need for reform. NABH also submitted questions, and part of the discussion centered on Medicaid’s Institution for Mental Diseases (IMD) exclusion. NABH Calls on Congress to Examine Insurers and Parity Following GAO Report  NABH this week called on Congress to hold oversight hearings to examine whether the nation’s insurers are complying with parity following the release of a Government Accountability Office (GAO) report on Dec. 13. The GAO’s 67-page report evaluated the practices, policies, and guidance from the U.S. Health and Human Services (HHS) and the U.S. Labor Department (DOL), the two federal offices that oversee compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. In its review, GAO found that both HHS and DOL “conduct targeted reviews of certain employer-sponsored group plans when they receive information—such as consumer complaints—about possible noncompliance with MH/SU parity requirements or other federal healthcare requirements.” Consequently, NABH is urging federal lawmakers to hold congressional hearings early in the New Year to study the issue and learn more. “For years, NABH has heard from our members—who receive complaints from patients and withstand parity violations every day—that the current compliance process is woefully inadequate to determine whether health plans are following the law,” NABH’s Shawn Coughlin said in a news release. “This is unacceptable.” CMS Releases Informational Bulletin on Dual Eligibles Receiving OTP Services  The Centers for Medicare & Medicaid Services (CMS) this week released an Informational Bulletin that provides guidance on coverage for Medicare and Medicaid dual-eligible beneficiaries who receive opioid treatment program (OTP) services. Revisions to the Physician Fee Schedule (CY 2020) allow for a new OTP bundled payment benefit under Medicare, which replaces Medicaid as the primary payer for OTP services for the dual-eligible population. The new benefit is effective January 1, 2020; however, not all OTP providers will have completed Medicare enrollment by […]
FCC Chairman Proposes ‘988’ for National Suicide Prevention Hotline Federal Communications Commission Chairman (FCC) Ajit Pai this week proposed rulemaking to establish 988 as a new, nationwide, three-digit phone number for a suicide prevention and mental health hotline. “The suicide rate in the United States is at its highest level since World War II and designating 988 as the suicide prevention and mental health hotline would be a major boost for our nation’s suicide prevention efforts,” Pai said at an event with federal agency partners on Nov. 19. “When it comes to saving lives, time is of the essence, and we believe that 988 can be activated more quickly than other possible three-digit codes,” he said, adding that 988 also “has an echo of the 911 number” that is universally recognized as an emergency number. In early June, NABH sent a letter to the FCC asking the agency to immediately repurpose a nationwide, three-digit phone number for suicide prevention. The Commission will vote on Pai’s proposal at its public meeting on Thursday, Dec. 12. National Action Alliance for Suicide Prevention Releases ‘Best Practices in Care Transitions’ The National Action Alliance for Suicide Prevention has released Best Practices in Care Transitions for Individuals with Suicide Risk: Inpatient Care to Outpatient Care, a 25-page report intended to help health systems and providers close gaps in care, improve patient experience and outcomes, and prevent suicide deaths. Research shows that in the month after patients leave inpatient psychiatric care, their suicide death rate is 300 times higher in the first week and 200 times higher in the first month than in the general population, but nearly a third of these patients do not make it to outpatient care in this timeframe. The report aims to advance two goals of the Action Alliance’s National Strategy for Suicide Prevention: promote suicide prevention as a core component of healthcare, and promote and implement effective clinical and professional practices for assessing and treating those identified as being at risk for suicidal behaviors. Milliman Disparities Report Highlights Need for NABH’s Access to Care Initiative A report this week from Milliman, Inc. about disparities between physical and behavioral healthcare for both in-network access and provider reimbursement rates underscores NABH’s position that unnecessary barriers continue to deny access to behavioral healthcare for patients who need it. The Bowman Family Foundation commissioned Milliman to produce Addiction and Mental Health vs. Physical Health: Widening disparities in network use and provider reimbursement, a 140-page report that shows the gap in disparities for employees and their families seeking mental health and addiction treatment versus treatment for physical health conditions widened in 2016 and 2017. According to the report, inpatient out-of-network use for behavioral health was over five times more likely than for medical/surgical services, worsening from 2.8 times more likely in 2013 to 5.2 times more likely in 2017, reflecting an 85% increase in disparities over five years. Meanwhile, office visit disparities were already five times higher in 2013 and worsened to 5.4 times in 2017, the report said. In news releases from both Milliman and NABH, Mark Covall said the report’s findings emphasize what […]
2.2 Million Kids Impacted by the Opioid Crisis 2.2 million children experienced neonatal withdrawal, entered foster care, or were addicted to opioids themselves in 2017, according to a new report from the United Hospital Fund. The report found that 54 out of 1,000 children in West Virginia were impacted by the opioid crisis and 20 out of 1,000 children in California. If the course of the opioid crisis is not changed, the report concluded that by 2030, there will be 4.3 million children affected annually. “Increase the availability of family-based mental health services” was among the proposed strategies to help kids. New Price Transparency Rule for Hospitals Today the Centers for Medicare and Medicaid Services (CMS) issued new rules, effective January 2021, requiring facilities to disclose rates negotiated with insurers; what the hospital is willing to accept in cash from a patient, and the minimum and maximum negotiated charges. NABH commented in September on the proposed changes and questioned CMS’ legal authority to make these changes. Shortly following the rule, the American Hospital Association, the Federation of American Hospitals, Association of American Medical Colleges and the Children’s Hospital Association announced they intend to challenge the new rule in court. CMS Proposes Regulations on Fiscal Integrity in Medicaid CMS has proposed a Medicaid Fiscal Accountability Rule (MFAR) that focuses on eliminating impermissible financing arrangements. CMS stated in a press release that the “proposed rule aims to strengthen accountability, increase transparency of Medicaid payments, and improve program integrity to ensure the Medicaid program is sustainable for future generations.” Singled out in the proposal are “states that generate extra payments for private nursing facilities that enter into arrangements with local governments to bypass tax and donation rules, and the use of a loophole to tax managed care entities 25 times higher for Medicaid business than for similar commercial business. States can then use that tax revenue to generate additional payments, with no commiserate increase in state spending.” NABH is planning to submit comments on the proposal. White House Meeting on “Addressing Overdose and Response at Colleges and Universities” Sarah Wattenberg, NABH Director of Quality and Addiction Services, moderated a panel at the White House Office of National Drug Control Policy’s meeting, ‘Addressing Overdose and Response at Colleges and Universities.’ The panel focused on federal privacy laws that operate on campuses, which protect students’ privacy but will allow campus officials to inform parents and others when necessary. Panelists included HHS Assistant Secretary for Mental Health and Substance Use, Elinore F. McCance-Katz M.D. P.H.D, who spoke about the prevalence of mental health and substance use on campuses, and clarified that the substance abuse confidentiality law (42 CFR Part 2) did not typically apply to campus health care. Deputy Assistant Secretary for Higher Education Programs, Chris McCaghren, from the Department of Education, discussed how the Family Educational Rights and Privacy Act (FERPA) applies to student education and treatment records. He emphasized the importance of training all staff on how the law worked. CMS Issues Final OTP Rule CMS issued the final regulation on the CY2020 Physician Fee Schedule, which included detailed information about Medicare Enrollment for […]
CMS Finalizes OTP Provisions in 2020 Physician Fee Schedule The Centers for Medicare & Medicaid Services (CMS) finalized provisions for the nation’s opioid treatment programs (OTPs) in the 2020 Physician Fee Schedule regulation that the agency released on Nov. 1. NABH released an NABH Analysis that provides a summary of those provisions, which provide for the treatment of opioid use disorders with new bundled service codes for OTPs, and for telehealth and opioid use treatment services in office-based settings. The final rule will be published in the Federal Register on Nov. 15. CMS Releases Guidance on IMDs Providing Treatment to Medicaid Beneficiaries with AT Lease One SUD CMS this week released guidance to state Medicaid directors that clarifies how section 5052 of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act permits institutions for mental diseases (IMDs) to provide treatment to Medicaid beneficiaries with at least one substance use disorder (SUD). NABH released an NABH Issue Brief that summarizes the following five key areas that the CMS guidance focuses on: requirement for beneficiaries, requirements for IMDs, requirements for states, maintenance of effort, and interaction with existing IMD policies. CDC Says Efforts to Prevent Adverse Childhood Experiences Could Potentially Prevent Adult Chronic Conditions A new Vital Signs report from the Centers for Disease Control and Prevention (CDC) this week found that efforts to prevent adverse childhood experiences could also potentially prevent adult chronic conditions, depression, health risk behaviors, and negative socioeconomic outcomes. According to the CDC, nearly one in six adults in the study population (15.6 percent) reported four or more types of adverse childhood experiences, which were significantly associated with poorer health outcomes, health risk behavioral, and socioeconomic challenges. Meanwhile, nearly 61 percent of adults experienced at least one adverse childhood experience. Women, American Indian/Alaska Native, blacks, and the racial/ethnic group categorized as “Other” were more likely to experience four or more types of adverse childhood experiences than were men and whites, the report noted. In addition, younger adults reported exposure to more adverse childhood experience types than did other adults, particularly those aged 65 or older. “States can use comprehensive public health approaches derived from the best available evidence to prevent childhood adversity before it begins,” the Vital Signs report said. “By creating the conditions for healthy communities and focusing on primary prevention, it is possible to reduce risk for adverse childhood experiences while also mitigating consequences for those already affected by these experiences.” JAMA Reports Cost-Sharing from Out-of-Network Care Among Those with Behavioral Health Conditions was Higher than Payments for Physical Conditions  A study in JAMA this week reported that cost-sharing from out-of-network (OON) care among people with behavioral health conditions was significantly higher than for those with other prevalent chronic physical conditions. Researchers analyzed a large commercial claims database from 2012 to 2017 that included adults with mental health conditions, with alcohol disorders, with drug use disorders, with congestive heart failure, and with diabetes who were between the ages of 18 and 64 and enrolled in employer-sponsored insurance plans. “Although the parity law has improved access to OON care […]
Psych-Appeal Files Class Action Complaint Against Health Care Service Corp. and MCG Health The firm Psych-Appeal this week filed a class-action complaint in the U.S. District Court for the Northern District of Illinois alleging that Health Care Service Corporation (HCSC)—a mutual legal reserve company and an independent licensee of the Blue Cross and Blue Shield Association— is denying medically necessary residential mental health treatment based on overly restrictive guidelines that MCG Health developed. HCSC is the fourth largest U.S. health insurer operating through its Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma, and Texas. Psych-Appeal affiliates with the nation’s law firms, policy groups, and individuals to curb discrimination against mental illness and to expand access to meaningful treatment. Psych-Appeal filed the complaint, Smith v. Health Care Service Corporation, together with Zuckerman Spaeder LLP and Miner, Barnhill & Galland, P.C., on behalf of HCSC insureds. “In the mental health context, where regulatory oversight is lax, it is all too easy for insurers to discriminate against patients by denying medically necessary care based on clinical guidelines that reference authoritative sources yet distort or omit their content,” Meiram Bendat, Psych-Appeal founder, co-counsel for the plaintiff, and an NABH consultant, said in a news release about the complaint. “Psych-Appeal is committed to exposing and curbing this insidious practice.” Earlier this year, a federal court found that United Behavioral Health (UBH operating as Optum) developed and applied clinical guidelines to deny coverage for mental health and substance use treatment to more than 50,000 individuals. That case was also brought by Psych-Appeal and Zuckerman Spaeder. CMS Analyzes Medicaid Coverage for SUD in New Report NABH this week sent members an NABH Analysis of the Transformed Medicaid Statistical Information System (T-MSIS) SUD Data Book  that the Centers for Medicare & Medicaid Services (CMS) released on Oct. 24. The data book is the agency’s first annual report to Congress that is meant to improve analysis of Medicaid coverage and service utilization for individuals with substance use disorders (SUDs). Last year’s Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) required the report. The NABH Analysis provides an overall summary as well as highlights of the data book’s findings on beneficiaries treated, services/setting, length of stay, and funding mechanisms. Partnership to Amend CFR 42 Part 2 Submits Comments to SAMHSA NABH was one of nearly 50 organizations in the Partnership to Amend 42 CFR Part 2 (Partnership) that submitted comments to the Substance Abuse and Mental Health Services Administration (SAMHSA) late last week about the agency’s Confidentiality of SUD Patient Records proposed rule. The six-page comment letter covers a host of provisions in the proposed rule, including consent requirements, disclosures for payment and healthcare operations, audit and evaluation, and non-Part 2 providers. “SAMHSA’s proposed change focuses on non-Part 2 providers, and we ask SAMHSA to clarify whether this would also apply to other entities such as health plans, healthcare clearinghouses and business associates that receive information from Part 2 providers for non-treatment purposes,” the letter noted. “For example, a payer entity may receive information for insurance claims, and then […]
NABH, MHA, and NAMI Send Letter to Congress About Citizens Commission on Human Rights NABH, Mental Health America (MHA), and the National Alliance on Mental Illness (NAMI) this week sent a letter to Congress about the work of the Citizens Commission on Human Rights (CCHR), an activist organization representing Scientology that questions the legitimacy of psychiatric categories, diagnostic practices, and common forms of behavioral healthcare treatment. News outlets have reported for years that the Scientology movement’s goal is to replace mental health treatment with rituals that adhere to Scientology’s beliefs and practices. The letter from NABH, MHA, and NAMI is meant to inform federal lawmakers and their staff members that CCHR represents Scientology, and also to make them aware that CCHR’s goal is to discredit the mental health segment and undermine public faith in this field of medicine. The letter is also intended to debunk CCHR’s claims and highlight the positive effects of behavioral healthcare treatment. “When behavioral healthcare conditions are compared with other chronic conditions, behavioral healthcare outcomes are similar, and, in some cases, slightly better,” the letter said. “Consider these statistics: 30 percent to 50 percent of adults with type 1 diabetes (a chronic condition) will experience recurrence of symptoms each year, and approximately 50 percent to 70 percent of adults with hypertension or asthma will have a recurrence requiring additional medical care each year. By comparison, “40 percent to 60 percent of patients treated for alcohol or other drug dependence return to active substance use within a year following treatment discharge.” NABH, MHA, and NAMI concluded the letter by offering to serve as trusted resources for policymakers, journalists, patient advocates, and the general public to ensure that America’s most vulnerable patients can access the high-quality, evidence-based behavioral healthcare they need. MACPAC Examindes Access to Medication-Assisted Treatment Under Medicaid Medicaid utilization management policies for medication-assisted treatment (MAT) vary widely nationwide and the extent to which these policies build barriers to addiction treatment is unclear, the Medicaid and CHIP Payment and Access Commission (MACPAC) concluded in its report to Congress this week. The Report to Congress: Utilization Management of Medication-Assisted Treatment in Medicaidis based on analysis of available data on how MAT utilization management is used nationally. It is also based on interviews with industry experts, clinicians, and state officials to study how eight states—Arkansas, Illinois, Maine, Missouri, Tennessee, Utah, Washington, and West Virginia—apply preferred status, prior authorization, step therapy, prescription limits, quantity or dose limits, and lifetime limits to their Medicaid fee-for-service and managed care programs. “Our review found a trend among states to eliminate prior authorization,” MACPAC Chair Melanie Bella said in an announcement about the report. “This is encouraging, since it removes one potential barrier to MAT access,” she added. According to the report, the number of states requiring prior authorization for MAT medications declined to 30 in 2018 from 48 in 2011-2013. SAMHSA Releases First-Episode Psychosis and Co-Occurring SUD The Substance Abuse and Mental Health Services Administration (SAMHSA) has released First-Episode Psychosis and Co-Occurring Substance Use Disorders, a new guide to help healthcare providers, systems, and communities address first-episode psychosis and co-occurring substance use disorders […]
New Analysis Shows Opioid Crisis Cost the U.S. Economy $631 Billion Over Four Years America’s opioid crisis has cost the U.S. economy at least $631 billion from 2015 to 2018, according to a new analysis from the Society of Actuaries on non-medical opioid use. The report also projected future costs of the opioid crisis for 2019 based on three scenarios reflecting how the crisis may move forward, with a midpoint cost estimate of $188 billion and the low- and high-cost estimates ranging from $172 billion to $214 billion. Nearly one-third of the economic burden, or $205 billion, is attributable to excess healthcare spending for individuals with opioid use disorder (OUD), infants born with neonatal abstinence syndrome or neonatal opioid withdrawal syndrome, and for other family members of those diagnosed with OUD. Premature mortality, criminal justice activities, child and family assistance and education programs, and lost productivity accounted for the remainder of the economic toll. Gallup Reports Nearly Half of U.S. Adults Have Dealt with Substance Abuse in Their Family Nearly half of U.S. adults, 46 percent, have dealt with substance abuse problems in their family, according to results from a Gallup poll released this week. The findings are based on 2018-2019 data from Gallup’s annual Consumption Habits poll that is conducted each July. Across the two polls, 36 percent of Americans reported that drinking has been a cause of trouble in their family, while 28 percent reported the same about drug abuse. Both questions are lifetime measures, meaning they asked Americans if drinking or drug abuse has ever been a problem in their family. The findings showed that reported family problems with drinking are similar among adults of all age groups—at or near 35 percent. Meanwhile, a higher percentage of adults under 55 (31 percent) than of those 55 and older (24 percent) said there has ever been a problem with drug abuse in their family. The study also highlighted some regional differences, as residents of the West are more likely than those in the East to report drinking problems. Westerners are also more likely than Easterners and Southerners to report family drug problems, the findings showed. National Addiction Treatment Week is October 21-27, 2019 The American Society of Addiction Medicine (ASAM) will host National Addiction Treatment Week next week to raise awareness about the gap in certified addiction medicine care and treatment. The week is also meant to expand the qualified workforce and build awareness around the important need for clinicians to enter the field of addiction medicine. To participate, follow @TreatmentWeek on Twitter and use #hashtag #TreatmentWeek to share your messages about addiction care and treatment. NABH President and CEO Mark Covall to Speak at Treatment Center Investment & Valuation Retreat NABH President and CEO Mark Covall will present on industry trends in the addiction treatment sector at the Treatment Center Investment & Valuation Retreat on Tuesday, Dec. 10 in Scottsdale, Ariz. Covall will also discuss federal policy changes that could affect addiction treatment centers, as well as collaborative opportunities with payers and employers. The three-day educational, business, and networking event will be held Dec. 9-11 at the […]
SAMHSA Releases Recovery Home Best Practices and Guidance The Substance Abuse and Mental Health Services Administration (SAMHSA) this week releasedbest practices and suggested guidelines for recovery housing. Last year’s Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act requires the HHS secretary to identify or facilitate developing best practices for recovery housing. SAMHSA’s report this week identifies 10 guiding principles to help states and federal policymakers both define and understand what comprises safe, effective, and legal recovery housing. In its guidance, SAMHSA noted the document is intended to provide a framework that builds on and extends the policy and practice work that has guided the development of recovery housing until now. The guidelines’ 10 areas include having a clear operational definition, recognizing that a substance use disorder (SUD) is a chronic condition that requires a range of recovery supports, promoting and using evidence-based practices, and ensuring quality, integrity, and patient safety. MACPAC Releases Draft Report on Oversight of IMDs The Medicaid and CHIP Payment Access Commission (MACPAC) recently released its draftreport on the oversight of Institutions for Mental Diseases (IMDs) a few months ahead of the commission’s January 2020 deadline for its final report to Congress. Divided into five chapters— 1) history and federal regulation, 2) services provided, 3) regulation and oversight of IMDs and outpatient behavioral health facilities, 4) Medicaid standards for behavioral health facilities, and protections for patients in IMDs, and 5) outpatient behavioral health facilities—the 24-page report includes key findings but does not offer recommendations. NABH sent MACPAC a letter about the regulatory environment at IMDs in late May as part of the commission’s process to develop the report. Kaiser Permanente Pledges $2.75 Million in Research Funding to Prevent Childhood Trauma Not-for-profit health plan Kaiser Permanente this week announced it will invest $2.75 million in new research to study childhood trauma and its effect on total health. In an announcement, Kaiser noted the study’s purpose is prevent and mitigate the health effects of adverse childhood experiences, or ACEs. ACEs are traumatic childhood events that occur before the age of 18 across multiple categories, including abuse, neglect, household dysfunction, systemic racism, and living in a high-crime neighborhood. “Our landmark research on ACEs brought new understanding to the long-term impacts of childhood trauma, and we are now expanding our work with the bold ambition to prevent and minimize ACEs— and create healthier and more resilient generations in the future,” Kaiser Permanente Chairman and CEO Bernard Tyson said in the announcement. One main goal for the new research effort is to provide insights for both clinical and community-based interventions to help address ACEs. Health Affairs Examines the Effects of Violence on Health In its latest issue, the journal Health Affairs this week examined the many ways violence affects health and concluded it is the “daily burden of violence in its many forms” that takes a greater toll on people. Introducing the Violence & Health issue, editor Alan Weil noted there were 2.3 million violence-related emergency department visits in 2017, of which 5 percent were due to firearms. He added that healthcare is the sector […]
NABH President and CEO Mark Covall to Retire; Shawn Coughlin Named as Successor NABH President and CEO Mark Covall announced this week his plans to retire on Dec. 31, 2019 after more than 35 years with the association and 24 years as its president and CEO. The NABH Board of Trustees subsequently named Shawn Coughlin, the association’s executive vice president for government relations and public policy, as NABH’s next president and CEO, effective Jan. 1, 2020. “It has been a privilege to work closely for decades with people who manage and provide life-saving behavioral healthcare services to some of the most vulnerable citizens in our country,” Covall said in a news release this week about the transition. “For years, I’ve also enjoyed working with skilled and dedicated teams here in Washington who have helped expand our services and change U.S. public policy.” After he retires, Covall will serve as executive vice chairman of the NABH Board of Trustees for a two-year term. “I am honored to serve as NABH’s president and CEO after Mark’s long and impressive tenure,” Coughlin said in the news release. “Mark has been a mentor to me for nearly 20 years. His knowledge of—and passion for—improving mental health and addiction treatment services in the United States is unmatched.” NABH Submits Recommendations to CMS on Bundled Rates for OTPs NABH outlined a series of recommendations to the Centers for Medicare & Medicaid Services (CMS) in its Sept. 27 comment letter about the agency’s proposed physician fee schedule rule for 2020 that implements the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act. In the letter, NABH President and CEO Mark Covall highlighted that the value of a payment bundle is to simplify payment mechanisms in a way that treatment providers receive adequate compensation for treatment and patients receive the right care, in the right setting, at the right time. “Bundles that are highly prescriptive tend to disempower providers by directing medical decision-making,” Covall wrote. “At the same time, highly prescriptive bundles disempower patients by forcing them to engage in unnecessary and potentially burdensome care.” Covall also noted that because CMS’ proposed service model exceeds workforce capacity, “…the CMS proposal would put all OTPs at risk of not complying with the terms of the bundle and threaten the existing infrastructure and constrict treatment capacity at a time when more treatment is needed.” NABH Submits Comments to CMS on PHP Rates and Price Transparency NABH has recommended that CMS establish a task force to review and discuss improving the availability of partial hospitalization programs (PHPs) for Medicare beneficiaries. This suggestion was part of NABH’s Sept. 27 public comment letter to CMS on the agency’s proposed Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems (OPPS) and Quality Reporting Programs for 2020. Currently, 47.9 percent of NABH members offer PHP services, and more than 32.5 percent offer PHP addiction services. “We recommend that CMS include NABH, the Association for Ambulatory Behavioral Healthcare, the National Council for Behavioral Health, a sampling of PHP providers from the membership of each organization, Mental Health America, and […]
NIH Has Awarded $945 Million to Address Nation’s Opioid Crisis in 2019 The National Institutes of Health (NIH) announced this week it has awarded $945 million in fiscal year 2019 to 41 states nationwide as part of its Helping to End Addiction Long-term Initiative, or NIH HEAL. NIH said its agency-wide research effort is meant to improve treatments for chronic pain; curb the rates of opioid use disorder (OUD) and overdose; and achieve long-term recovery from opioid addiction. The effort leverages the skills and expertise from nearly every NIH institute in the areas of translation of research to practice for opioid addiction, new strategies to prevent and treat opioid addiction, enhanced outcomes for infants and children exposed to opioids, novel medication options for OUD and overdose, clinical research in pain management; and pre-clinical and translational research in pain management. “It’s clear that a multi-pronged scientific approach is needed to reduce the risks of opioids, accelerate development of effective non-opioid therapies for pain, and provide more flexible and effective options for treating addiction to opioids,” NIH Director Francis Collins, M.D., Ph.D., said in an announcement. Collins launched the HEAL initiative in 2018. VA Releases National Suicide Prevention Report The number of U.S. Veteran suicide deaths per year rose to 6,139 in 2017 from 5,787 in 2005, increasing alongside the rise in suicide deaths in the United States broadly, according to the U.S. Veterans Affairs Department’s (VA) 2019 National Veteran Suicide Prevention Report. Released Sept. 20, the report includes findings from the VA’s most recent analysis of Veteran suicide data from 2005 to 2017. The analysis showed that the number of Veteran suicide deaths has exceeded 6,000 every year between 2008 and 2017. The report also noted 69 percent of all Veteran suicide deaths resulted in a firearm injury, and that males between the ages of 18 and 34 experienced the highest rates of suicide. Meanwhile, the VA reported that the rate of suicide was 2.2 times higher among female Veterans than non-Veteran adult women and 1.3 times higher among male Veterans than non-Veteran adult men. “VA is working to prevent suicide among all Veterans, whether they are enrolled in VA healthcare or not,” VA Secy. Robert Wilkie said in an announcement about the report. “That’s why the department has adopted a comprehensive public health approach to suicide prevention, using bundled strategies that cut across various sectors — faith communities, employers, schools and health care organizations, for example — to reach Veterans where they live and thrive.” Study Shows Veterans with Mental Illness at Higher Risk for Cardiovascular Disease A new study sponsored by the VA showed multiple mental illnesses were associated with an increased risk of cardiovascular disease (CVD) outcomes, which is consistent with the hypothesis that chronic stress leads to greater CVD. Published in the American Heart Association’s journal Circulation: Cardiovascular Quality and Outcomes, the study found that more severe mental illnesses—such as primary psychotic disorders—have the largest effect sizes even after controlling for other psychiatric diagnoses, conventional CVD risk factors, and psychotropic medication use. Among men, the study noted, depression, anxiety, psychosis, and bipolar disorder were all associated with […]
CMS Releases FAQ on Qualified Residential Treatment Programs The Centers for Medicare & Medicaid Services (CMS) on Friday released a Frequently Asked Questions document that clarifies how the Institutions for Mental Diseases (IMD) Exclusion affects Qualified Residential Treatment Programs (QRTPs). CMS released the document following the Family First Prevention Services Act— included in theBalance Budget Act of 2018—which stipulated restrictions on room and board support for foster children in group care settings. The new law limited that support to 14 days unless the child was in certain settings, including the newly defined QRTP. Here are some important highlights from the agency’s FAQ on Sept. 20: CMS has not made a determination that all QRTPs will be IMDs; rather, there are several options for states to consider regarding QRTPs. QRTPs may qualify as IMDs if they are primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases including medical attention, nursing care, and related services, and have more than 16 beds. State Medicaid agencies must review each QRTP, if over 16 beds, to make a determination if the facility meets the definition of an IMD according to Medicaid statute, regulation and guidance in the State Medicaid Manual. QRTPs also likely would not meet the requirements to qualify as Psychiatric Residential Treatment Facilities (PRTFs), which have more stringent standards… If, however, a QRTP meets the applicable requirements and conditions of participation to qualify as a PRTF, then Federal Financial Participation (FFP) would be available. Medicaid managed care rules permit FFP for monthly capitation payments to managed care plans for enrollees that are inpatients in a residential setting that may qualify as an IMD when the stay is for no more than 15 days during the period of the monthly capitation payment and certain other conditions are met. States may consider an existing section 1115 option, which we further clarify in this document, for states to receive Medicaid reimbursement for services to individuals in QRTPs that would be considered IMDs. Under the 1115 waiver, FFP will not be available for room and board costs in QRTPs, unless they are also certified as PRTFs. States interested in including QRTPs in their section 1115(a) demonstrations will need to determine how best to include stays in QRTPs, recognizing that overall the state will be expected to achieve a statewide average of 30 days as part of these demonstrations. For questions about the FAQ, contact Scott Dziengelski, NABH’s director of policy and regulatory affairs. CMS Awards Nearly $48.5 Million to State Medicaid Agencies for SUD Treatment Services CMS this week announced planning grant awards to 15 state Medicaid agencies to increase providers’ treatment capacity to offer substance use disorder (SUD) treatment and recovery services. The agency awarded nearly $48.5 million in awards to Alabama, Connecticut, Delaware, District of Columbia, Illinois, Indiana, Kentucky, Maine, Michigan, Nevada, New Mexico, Rhode Island, Virginia, Washington, and West Virginia as part of the Substance-Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act. NABH Supports Senate Bill to Address Nation’s Shortage of Mental Health Professionals NABH was one of more than 50 organizations this […]
NABH Endorses Legislation For a 3-Digit Suicide Prevention Line NABH joined nearly 50 mental health organizations in endorsing The National Suicide Hotline Designation Act (HR 4194), which would establish a national 3-digit suicide prevention line. The legislation has nearly 70 congressional co-sponsors and a bipartisan Senate companion bill is currently being drafted. NABH previously sent a letter to FCC Secretary Marlene Dortch asking the agency to establish a hotline. “Based on the urgency of the suicide crisis and the nature of suicidal ideation, the potential positive outcomes outweigh any costs associated with changing an existing N11 number,” Mark Covall wrote. “This is why we strongly encourage the FCC to move forward immediately and repurpose an existing N11 number for a national suicide prevention and mental health crisis hotline system.” Labor Department Releases More Information on Parity Recently the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) released a series of documents designed to help stakeholders understand the parity provisions included in the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), the 21st Century Cures Act, the SUPPORT for Patient and Communities Act, and the Employee Retirement Income Security Act (ERISA). The documents do not provide a new interpretation of those laws but do provide examples and illustrations of how the laws work. Here are the documents that were released: FAQs about Mental Health and Substance Use Disorder Parity Implementation and the 21st Century Cures Act. Final MHPAEA Disclosure Template. MHPAEA Enforcement Fact Sheet for FY 2018. Appendix to the MHPAEA Enforcement Fact Sheet for FY 2018. Introduction to the MHPAEA Enforcement Fact Sheet for FY 2018. Suicide Rates Continue to Climb A Journal of the American Medical Association (JAMA) report on trends in suicide found that rates have “increased across the nation and most rapidly in rural counties.” Of those who died by suicide (from 1999 to 2016) 77 percent were male and primarily between the ages of 45 to 54 years. The report also found that suicide rates were higher and increased more rapidly in rural counties. New Publication on The Sequential Intercept Model The Sequential Intercept Model (SIM) is a “strategic planning tool that helps communities better understand the gaps and resources they have in helping those with mental illness or substance use disorders who are in the criminal justice system.” This week SAMHSA released a newbrochure that provides an overview of SIM. SAMHSA has been working to expand the use of SIM and previously released Data Collection Across the Sequential Intercept Model (SIM): Essential Measures, a manual for using data to improve outcomes for people with behavioral healthcare conditions in the criminal justice system. Federal Report on Achieving Population-Level Effects for Behavioral Healthcare in Children In a follow up to their 1994 and 2009 reports, the National Academies of Sciences, Engineering, and Medicine released a new report this week: Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth. The report made a series of recommendation including the development of a national agenda on youth behavioral health. Additional recommendations include: Federal agencies should collaborate with state and local agencies, as well as national […]
HHS Announces $1.8 billion in Funding to States to Fight Opioid Crisis HHS this week announced more than $1.8 billion in funding to states to combat America’s deadly opioid crisis by expanding access to treatment and supporting near real-time data on the drug overdoses. As part of the funding, the Centers for Disease Control and Prevention (CDC) announced more than $900 million in new funding for a three-year cooperative agreement with states, territories, and localities to better understand the opioid crisis and build prevention and response activities. The Atlanta-based CDC will release $301 million in the first year. The funding will support the work of 47 states, Washington, D.C., two territories, and 16 counties and cities. Awardees will use these funds to strengthen prescription drug monitoring programs, improve state-local integration, establish links to care, and support healthcare providers and health systems. HHS said it will have awarded more than $9 billion in grants to states and local communities by the end of 2019 to help increase access to treatment and prevention services. HRSA and SAMHSA Team Up on Medication Assisted Treatment The Health Resources and Services Administration’s (HRSA) National Health Service Corps (NHSC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) are partnering to connect qualified clinicians with free medication assisted treatment (MAT) training and professional development resources. The new partnership will provide the opportunity to obtain the DATA 2000 waiver, which is meant to increase access to quality substance use disorder or opioid use disorder treatment in rural and underserved areas. Click here to learn more about the new partnership, MAT training, and the DATA 2000 waiver. SAMHSA Introduces New Logo to Commemorate National Recovery Month’s 30thAnniversary This year marks the 30th anniversary of National Recovery Month, which SAMHSA commemorates each September. As part of the anniversary, SAMHSA unveiled a new logo featuring an “r” symbol to represent Recovery and the need to support the millions of individuals who are living in recovery—as well as their family members and loved ones. The 2019 National Recovery Month theme is Join the Voices for Recovery: Together We Are Stronger, and SAMHSA has created resources for providers to use and share. September is also Suicide Prevention Awareness Month, with National Suicide Prevention Week kicking off this Sunday, Sept. 8 and ending on Saturday, Sept. 14. The National Alliance on Mental Illness (NAMI) has developed its own set of resources, including social media posts, for providers and advocates to share. NABH will be tweet and post our messages about access to care—as well as important messages from NAMI and SAMHSA—during National Recovery Month and Suicide Prevention Awareness Month to build awareness around suicide prevention and the need for effective care to help patients on the road to recovery. Please be sure to follow us on Twitter and LinkedIn and share our messages with others. Thank you for your cooperation. National Addiction Treatment Week is October 21-27, 2019 The American Society of Addiction Medicine (ASAM) will host National Addiction Treatment Week from October 21-27, 2019 to raise awareness about the gap in certified addiction medicine care and treatment. The week is also […]
SAMHSA Releases 2018 National Survey on Drug Use and Health The United States saw a significant decrease in prescription opioid use among all age groups and a significant increase in serious mental illness last year, according to the 2018 National Survey on Drug Use and Health that the Substance Abuse and Mental Health Services Administration (SAMHSA) released this week. In the report, SAMHSA said the total number of Americans with opioid use disorder decreased to 2.0 million in 2018 from 2.1 million in 2017. The agency found that the majority of people continue to obtain prescription opioids from friends, relatives, and healthcare providers/prescribers, which the agency said underscores the need for ongoing education of practitioners, appropriate pain management, and partnerships with states to monitor opioid analgesic prescribing. Heroin use disorder also dropped significantly compared with 2017, but remained steady among people aged 26 and older, the study showed. Meanwhile, serious mental illness rose among both young adults (ages 18-25) and adults (ages 26-49) last year, and SAMHSA reported significant increases in suicidality in the 18-25 group. SAMHSA found that use of one substance—alcohol or other illicit substances—is strongly correlated with polysubstance use and with major depression and serious mental illness, which SAMHSA said highlights the need to screen for all substances and mental disorders. Report Shows Americans Spend Almost as Much on Illicit Drugs as Alcohol Researchers from RAND Corp. estimate that Americans spent between $120 billion and $145 billion on cocaine, heroin, marijuana, and methamphetamine between 2006 and 2016, while another analysis showed U.S. spending on alcohol in 2017 was about $158 billion. Released this week, What America’s Users Spend on Illegal Drugs, 2006-2016 examines how many people use cocaine, heroin, marijuana, and methamphetamine in the United States; how much they’re using; how much money they’re spending on these substances; and how the quantities have changed over time. “To better understand changes in drug use outcomes and the effects of policies, policymakers need to know what is happening in markets for these substances,” Greg Midgette, the study’s lead author and assistant professor at the University of Maryland, said in an announcement about the study. “But it is challenging to generate these estimates, and given that critical data sources have been eliminated, it will likely be harder to generate these figures in the future.” Study Says Former Cigarette Smokers Are Smoking Marijuana and Binge Drinking More Rates of cigarette smoking have decreased, but new research shows that cannabis and alcohol use among former smokers has increased, according to a new study in the American Journal of Preventive Medicine. According to the findings, about 44 percent of people who smoked previously were no longer smoking in 2002, and that number rose to 50 percent in 2016. Data from more than 67,000 former smokers between 2005 and 2016, meanwhile, show that marijuana use over the previous year nearly doubled to about 10 percent from a little more than 5 percent. Similarly, rates of binge drinking during the previous month also increased to more than 22 percent from about 17 percent. “It is conceivable that the prevalence of depression and substance use problems […]
Task Force Recommends Physicians Ask Adult Patients About Illicit Drug Use The U.S. Preventive Services Task Force this week recommended that physicians ask all U.S. adults aged 18 or older about possible illicit drug use—including opioid painkillers—as part of the federal government’s ongoing effort to address America’s opioid crisis. The recommendation from the independent panel of medical experts marks the first time the task force has determined there is enough evidence to support screening adults. According to the recommendation, an estimated 11.5 percent of Americans aged 18 or older reported current illicit drug use in a national survey. Illicit drug use is more commonly reported in young adults between the ages of 18-25 (24.2 percent) than in older adults (9.5 percent), or in adolescents between the ages of 12 and 17 (7.9 percent), the announcement noted. In a story about the recommendation, The Washington Post said the guidance is also important because the 2010 Patient Protection and Affordable Care Act requires that services recommended by the task force should be covered for free or with very small co-payments. Public comments on the task force’s draft recommendation are due Sept. 9. HHS Offers Resources to Providers During and After Mass Violence Events HHS has released tip sheets and other resources to help U.S. healthcare providers prepare for and respond to mass violence events. The resources are from HHS’ Assistant Secretary for Preparedness and Response’s (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) and include tip sheets on topics such as emergency medical system considerations, expanding traditional roles, fatality management, non-trauma hospital considerations, and more. Additional information includes topic collections on crisis standards of care, mental health, explosives, surge capacity, and information sharing. HRSA Awards About $400 Million to Fight Opioid Crisis HHS’ Health Resources and Services Administration (HRSA) recently released nearly $400 million in awards to combat the nation’s deadly opioid crisis. The investments are intended to help HRSA-funded community health centers, rural organizations, and academic institutions establish and expand access to integrated substance use disorder and mental health services. “HRSA programs play a key role in the Trump Administration’s efforts to battle the nation’s opioid crisis,” said HRSA Acting Administrator Tom Engels said in an announcement about the funding. “From implementing and expanding substance use disorder services at HRSA-funded health centers to increasing support and training to our nation’s behavioral health workforce to improving access to treatment in rural areas, today’s announcement demonstrates the administration’s commitment to ending this crisis.” According to HRSA, the agency is awarding more than $200 million to 1,208 health centers nationwide to increase access to high-quality, integrated behavioral health services, including the prevention or treatment of mental health conditions and/or substance use disorders, including opioid use disorder through the Integrated Behavioral Health Services (IBHS) program. NIMH Director Highlights Effects of Ketamine for Treatment-Resistant Depression The director of the National Institute of Mental Health (NIMH) this week examined the effects of the medication ketamine to reduce depressive symptoms. In his NIMH director’s column, Joshua Gordon, M.D., Ph.D noted previous research showing ketamine’s effectiveness in having “strong, rapid effects” on treatment-resistant depression (TRD) and bipolar disorder. […]
SAMHSA Highlights Disaster Distress Line Following Recent Spate of Shootings Following mass shootings in California, Texas, and Ohio within one week, the Substance Abuse and Mental Health Services Administration (SAMHSA) urged survivors and first responders to use the agency’s Disaster Distress Hotline Helpline for immediate crisis counseling. The helpline is available 24 hours a day, seven days a week, to anyone dealing with the traumatic effects of a natural or human-caused disaster. “People who have been through a traumatic even can experience anxiety, worry, or insomnia,” Elinore McCance-Katz, M.D., Ph.D., assistant secretary for mental health and substance use and the head of SAMHSA, said in a statement. “People seeking emotional help in the aftermath of a disaster can call 1-800-985-5990 or can text ‘TalkWithUs’ to 66746—and can begin the process of recovery.” NABH thanks its members and their teams for providing life-saving, behavioral healthcare services during and after disasters. Medical and Public Health Groups Urge Policymakers to Take Action on Gun Violence Seven medical and public health organizations this week called on policymakers to implement specific policy recommendations they say can reduce firearm-related injuries in the United States. The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Surgeons, the American Medical Association, the American Psychiatric Association, and the American Public Health Association—which together represent 731,000 U.S. physicians and 25,000 public health professionals—outlined their requests online in the Annals of Internal Medicine on Aug. 7. In it, the groups covered a range of issues, including background checks for firearm purchases, research on firearm injury and death, safe storage of firearms, and improved access to mental healthcare services. “The great majority of those with a mental illness or substance use disorder are not violent,” the article notes. “However, screening, access, and treatment for mental health disorders play a critical role in reducing risk for self-harm and interpersonal violence,” it continues. “This is particularly of concern for adolescents, who are at high risk for suicide as a consequence of their often impulsive behavior.” New Poll Examines Public Perception of Link Between Gun Violence and Mental Health A new Morning Consult/Politico poll this week found that of 1,960 registered voters, 48 percent place “a lot” of blame on mental illness for mass shootings, while another 35 percent place “some” blame on mental illness. The poll came days after back-to-back shooting sprees in El Paso, Texas, and Dayton, Ohio, and after President Trump referred to the shooters as “mentally ill monsters.” According to the results, the share of voters who blamed mental illness “a lot” is down from 54 percent in a survey taken a year ago, while the share who said mental illness plays “some” roll grew from 28 percent last year, which indicates a significant majority of the U.S. electorate sees a strong connection between mental health and mass shootings. A story about the poll in the Morning Consult said the slight change from last year is driven by a 12-point decrease in the share of Democrats and 9-point decrease in the share of Independents who heavily attribute mass shootings to mental illness. Among Republicans, about three in […]
CMS Announces 1.5-percent Increase for Inpatient Psychiatric Facilities for 2020 in Final Rule The Centers for Medicare and Medicaid Services (CMS) announced a Medicare payment increase of 1.5 percent next year for inpatient psychiatric facilities in the final Inpatient Psychiatric Facilities Prospective Payment Systems (IPF PPS) rule the agency released earlier this week. Compared with the 2019 payment rate, the increase reflects a total increase of $65 million for Medicare-participating inpatient psychiatric facilities in fiscal year 2020. The payment update aligns with the agency’s proposed rule earlier this year. The rule also adds one new claims-based measured starting in fiscal year 2021 payment determination and continuing in subsequent years. The measure—Medication Continuing Following Inpatient Psychiatric Discharge (National Quality Forum #3205)—assesses whether patients admitted to IPFs with diagnoses of Major Depressive Disorder, schizophrenia, or bipolar disorder filled at least one evidence-based medication within two days before discharge or during the 30-day, post-discharge period.   CMS Proposes Slight Payment Increase for PHPs and CMHCs in 2020 The CMS has proposed a hospital-based partial hospitalization program (PHP) payment rate of $228.20 for 2020, up from the 2019 rate of $220.86, in the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (OPPS/ASC) proposed rule the agency released on July 29. CMS also proposed an increase for community mental health centers (CMHCs), which could see a payment rate of $124.59 in 2020 if the rule is made final. By comparison, CMHCs received a payment rate of $120.58 in 2019. The rates set in the proposed CY 2020 rule are not based on the most recent average cost data from the PHP program, a deviation from CMS’ long-standing policy. When CMS calculated the average PHP program cost for the CY 2020 proposed rule, the agency found it had decreased by nearly 15 percent for CMHCs and 11 percent for hospitals-based PHPs. After finding this decrease, CMS reviewed the data sets and found that a single provider in the CMHC set and a single provider in the hospital-based set had such dramatically lower reported costs that it significantly skewed the average cost for both data sets. Because the lower average costs were the result of single providers and could significantly reduce access for beneficiaries, CMS decide to use the CY 2019 cost average as a floor for both type of PHP rates in the CY 2020 rule. If not for this change, the rate for both types of PHPs would have been significantly lower than what CMS proposed in the rule. It is important to note that CMS stressed that it does not intent to carry this policy forward: “To be clear, this policy would only apply for the CY 2020 rate setting,” the agency said in the rule. CY 2020 Rates Level 1 Health and Behavior Services                                                     $28.59 Level 2 Health and Behavior Services                                                     $81.06 Level 3 Health and Behavior Services                                                     $130.27 Partial Hospitalization (3 or more services) for CMHCs                            $124.59 Partial Hospitalization (3 or more services) for Hospital-based PHPs        $228.20   NABH will submit comments on the proposed rule to CMS by the Sept. 27 deadline.   CMS Addresses OUD Treatment in […]
Threat of Sequestration Ends with Bipartisan Budget Act White House and Congressional leaders agreed to large increases in base funding for defense and nondefense spending on Thursday, with the expectation of support by the Senate in a vote next week. The budget deal establishes a funding base above spending cap levels that could trigger mandatory automatic spending cuts, referred to as sequestration. The bipartisan compromise suspends the federal debt ceiling and spending caps for two years, thus marking the end of sequestration that was due to sunset in 2021. Defense spending was increased by $22 billion and nondefense spending was increased by $27 billion. As part of the negotiations, Congressional leadership agreed to avoid the inclusion of any contentious measures that do not have bipartisan support during the FY2020 appropriations process. This agreement will allow for a budget process that will avoid a government shutdown. Medicare Plans Dramatically Reduce Prior Authorization Rates A recent study published in a JAMA Research Letter found large reductions in the percentage of Medicare Part D and Medicare Advantage Plans using prior authorization for buprenorphine medications for opioid use disorder (OUD). In the two years between 2017 and 2019, the percentage of plans using preauthorization for generic buprenorphine-naloxone medications dropped from 96 percent to zero, and for brand buprenorphine-naloxone medication rates dropped from 88 percent to 3 percent. These findings follow two federal policy initiatives: a 2017 buprenorphine labeling change by the Food and Drug Administration, and a 2018 announcement by the Centers for Medicaid and Medicare Services (CMS) that they would no longer approve Medicare Part D formularies that preauthorize buprenorphine products more than once per year. Looking forward, the study states the importance of the data “because Medicare policy is often viewed as a standard that is subsequently adopted by private health plans and Medicaid.” Tami Mark, lead author of the study said, “Although Medicare has significantly reduced prior authorization for opioid use disorder medications, it is still in common use in Medicaid and private health plans.” Legal Action Center Calls for Removal of Prior Authorization in Medicaid The Legal Action Center (LAC) in a new report calls for Medicaid programs to adopt the successful “Medicare Model” of eliminating prior authorization for medications to treat opioid use disorder (OUD) and expanding coverage of all FDA-approved medications. Citing the success of a 2018 federal policy that virtually eliminated prior authorization for buprenorphine products in Part D and Medicare Advantage programs (see previous article), LAC reports that most Medicaid plans continue to require prior authorization for OUD medications. Specifically, buprenorphine-naloxone medication requires prior authorization in 40 Medicaid programs, and buprenorphine medication requires authorization in 35 Medicaid programs. Formulary restrictions and dose limitations also pose barriers to medication assisted treatment (MAT). MAT can reduce mortality by almost half. Medicaid covers four out of 10 adults with OUD and thus “plays a significant role in delivering effective OUD treatment and reducing barriers to FDA-approved medications,” the report states.  The Report recommends that CMS issue a guidance letter to State Medicaid Directors to increase the use of all medications for OUD. Arnold Ventures Funds Research on Insurance Fraud […]
House Energy and Commerce Committee Advances No Surprises Act The House Energy and Commerce Committee this week approved legislation to end “surprise” medical bills with the addition of third-party arbitration. House Energy and Commerce Committee Chairman Frank Pallone (D-N.J.) and Rep. Greg Walden (R-Ore.), the panel’s ranking member, co-sponsored the No Surprises Act, which advanced through the committee as part of the Reauthorizing and Extending America’s Community Health Act with amendments. Under the bill, healthcare facilities would be required to notify patients at least 24 hours before an elective treatment that an out-of-network provider would be involved in their care. The bill also would prohibit healthcare facilities and providers from balance-billing patients for that care and would establish rates for payments from commercial health plans to providers based on the local market. The initial bill did not include a process for providers and payers to challenge the basic median reimbursement, while the amended version that passed this week includes such a process. Overall hospital groups responded both favorably and cautiously to the news, suggesting that while the bill is significant for offering an arbitration option, the legislation could also set a precedent for the federal government to set private rates. The legislation now moves to the full House for a vote. JAMA Pediatrics Study Shows Parental Drug Use Has Led to Increase in Foster Care Cases A new JAMA Pediatrics study suggests that greater parental drug use has contributed to a rise in foster care caseloads and coincides with increasing trends in opioid use and overdose deaths. Researchers from Weill Cornell Medical College and Harvard Medical School examined data from the Adoption and Foster Care Analysis and Reporting System, a federally mandated collection system that receives case-level information on all children in foster care in the United States. They found that after more than a decade of declines in U.S. foster care caseloads, cases have risen steadily since 2012. Meanwhile, the number of foster care entries attributable to parental drug use rose substantially to 96,672 home removals from 39,130 removals between 2000 and 2017, reflecting a 147-percent increase during that period, according to the findings. “These findings suggest that greater parental drug use has contributed to increases in foster care caseloads and coincide with increasing trends in opioid use and overdose deaths nationwide during this period,” the study said. The authors noted the study’s limitations include potential reporting inconsistencies in parental drug use, and that it’s possible that factors other than drug use influenced entries for parental drug use. “Policymakers must ensure that the needs of this new wave of children entering foster care because of parental drug use are being met through [sic] high-quality foster care interventions,” the study said. “These have been shown to mitigate some of the adverse effects of early childhood deprivation and disruptions in attachment.” NQF Convenes Opioid Use Disorder TEP and Seeks Comment The National Quality Forum (NQF) will convene a Technical Expert Panel (TEP) to oversee a review of measures and concepts related to opioid use, opioid use disorder prevention, treatment, and recovery. In its announcement, the NQF said the move is meant […]
New Quality Summit to Assess HHS’ Quality Programs HHS Deputy Secretary Eric Hargan this week announced the department’s new Quality Summit, which will join government leaders and healthcare industry stakeholders to discuss how to adapt and streamline HHS’ current quality programs in a way that improves outcomes for patients. Hargan will co-chair the Quality Summit with Peter Pronovost, M.D., Ph.D., an internationally renowned expert on healthcare quality and patient safety. In March, Hargan discussed the regulatory barriers that often hinder treatment during his presentation at the 2019 NABH Annual Meeting in Washington. “Over the last decade we have seen efforts by HHS to incentivize the provision of quality care, only to be met with limited success,” Hargan said in a news release. “This is in part because patients have not been empowered with meaningful or actionable information to inform their decision making. At the same time, important quality programs across the department have remained uncoordinated among the various agencies and inconsistent in their demands on healthcare providers,” he added. “We believe the Quality Summit will not only strengthen the protections these programs afford patients, but also improve value by reducing costs and onerous requirements that are placed on providers and ultimately stand between patients and the high-quality care they deserve.” Late last month, President Trump signed the Improving Price and Quality Transparency in American Healthcare to Put Patients First executive order, which directs federal agencies to develop a Health Quality Roadmap intended to align and improve reporting on data and quality measures across federal health programs. OIG Report Finds Opioid Use Decreased and MAT Increased Among Medicare Part D Beneficiaries A new report from HHS’ Office of Inspector General (OIG) found a significant decrease in the number of Medicare Part D beneficiaries who received opioids in 2018 and a steady increase in the number of beneficiaries who received drugs for medication assisted treatment (MAT). Nearly three in 10 Medicare part D beneficiaries received opioids in 2018, the OIG reported, while at the same time the number of beneficiaries who received MAT for opioid use disorder reached 174,000. Meanwhile, about 354,000 beneficiaries received high amounts of opioids in 2018, with about 49,000 of them at serious risk of opioid misuse or overdose—which was also fewer than in the previous two years. “Progress has been made in decreasing opioid use in Part D, increasing the use of drugs for medication assisted treatment, and increasing the availability of naloxone,” the OIG reported noted. “It is imperative for the Department of Health and Human Services— including CMS (Centers for Medicare and Medicaid Services) and OIG— to continue to implement effective strategies and develop new ones to address this epidemic.” O’Neill Institute Evaluates Democratic Candidates’ Views on Addiction and Opioid Crisis The O’Neill Institute at Georgetown Law this week released an analysis of the 2020 Democratic presidential candidates’ plans to address America’s continued opioid crisis. In a post on the O’Neill Institute’s webpage this week, authors Regina LaBelle—a 2019 NABH Annual Meeting speaker—and Leigh Bianchi noted that most all of the presidential candidates have not issued detailed policy proposals on the topic. Instead, their positions on the […]
CDC Provisional Data Show Opioid Deaths Likely to Fall for First Time Since 1990 Provisional data from the Centers for Disease Control and Prevention (CDC) show drug-overdose deaths are on the brink of declining, but researchers are quick to caution the nation’s deadly opioid crisis is far from over. The CDC’s data predict there were nearly 69,100 drug deaths in the 12-month period ending in November 2018, down from almost 72,300 predicted deaths for the same 12-month period ending in 2017. If the trend continues through December— those data likely will be available next month—then annual drug deaths will fall for the first time since 1990, when about 8,400 people died from overdoses. “I think we’re probably looking at a decline,” Robert Anderson, Ph.D. chief of the Mortality Statistics branch at the CDC’s National Center for Health Statistics, told the Wall Street Journal this week. “We shouldn’t say oh, we’ve won and we’ve defeated the drug-overdose epidemic.” The story reported that health officials and epidemiologists say there is little cause for celebration, especially as the death rate remains “swollen by powerful synthetic opioids like fentanyl.” Meanwhile, the story noted one driving factor for the downward trend has been broadened access to the overdose-reversal drug naloxone, often known by the brand-name Narcan, according to officials in Ohio, Pennsylvania, and Rhode Island. Jim Hall, an epidemiologist at Nova Southeastern University in Florida, echoed Anderson’s measured optimism in his interview with the Wall Street Journal. “I’m ready to say that the opioid crisis in in early remission, yet at a high risk of relapse,” Hall said. CMS Announces Funding Opportunity for State Medicaid Agencies to Address SUD The Centers for Medicare & Medicaid Services (CMS) announced this week that up to $50 million is available to help increase capacity for Medicaid providers to deliver substance use disorder (SUD) treatment and recovery services. The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act authorized the planning grant funding, which is available to at least 10 states for 18 months, CMS announced in the funding opportunity notice. Meanwhile, up to five states that receive planning grants will be chosen to implement 36-month demonstration projects and receive enhanced federal reimbursement for increased expenditures for SUD treatment and recovery services. Click here to learn more and apply for a grant. Veterans with PTSD More Likely to Die from Suicide, Hepatitis Veterans with post traumatic stress disorder (PTSD) have a higher risk of dying from mental illness and other diseases than the general population, according to a new study published in the American Journal of Preventive Medicine. The study’s researchers analyzed mortality data from nearly 500,000 veterans who started treatment for their PTSD at a Veterans Affairs (VA) medical center between 2008 and 2013 and found that veterans with PTSD were about twice as likely to die from suicide, accidental injuries, and hepatitis than the general population. The study acknowledged a few limitations related to both the sample selection and follow-up. For one, the study’s approach did not account for relevant confounders, including race/ethnicity, psychiatric and medical comorbidity, and treatment. “Although […]
NABH Submits FY 2020 IPF PPS Rule Comments to CMS NABH this week urged the Centers for Medicare & Medicaid Services (CMS) not to include any new measures in the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program, but instead work with the behavioral healthcare provider community to improve existing measures. That was the broad message in NABH’s comment letter to CMS about the agency’s proposed fiscal year (FY) 2020 inpatient psychiatric facility prospective payment system (IPF PPS) rule. Commenting on CMS’ proposal to develop a new measure for a standardized patient perception of care, NABH President and CEO Mark Covall explained that the majority of NABH members participating in the IPFQR program use some version of a patient perception of care measure; however, there is not one single measure that all providers or a majority of providers use. “Therefore, we have strong concerns that CMS will make it mandatory for behavioral healthcare providers to adopt something such as the Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS) survey,” Covall wrote. NABH also recommended CMS work closely with the behavioral healthcare provider community to develop a safety-planning measure for patients who have suicidal ideation. Click here to read NABH’s letter. SAMHSA Releases The Behavioral Health Barometer, Volume Five The Substance Abuse and Mental Health Services Administration (SAMHSA) has released volume five of The Behavioral Health Barometer, one of a series of national, regional, and state reports that offer a glimpse of behavioral health in the United States. “Behavioral Health Barometers for the nation, 10 regions, and all 50 states and the District of Columbia are published as part of SAMHSA’s behavioral health quality improvement approach,” Elinore McCance-Katz, M.D., Ph.D., assistant secretary for mental health and substance use at SAMHSA, wrote in the report’s foreword. “Most importantly, the Behavioral Health Barometers provide critical information in support of SAMHSA’s mission of reducing the impact of substance abuse and mental illness on America’s communities.” The 74-page report examines youth, young adult, and adult mental health and substance use as well as adult mental health and mental health service use. SAMHSA also included a special focus on the misuse of prescription pain relievers, heroin use, and medication assisted therapy for opioid addiction. AMA Passes Opioid Policies that Address Barriers to Effective Treatment The American Medical Association (AMA) has approved several opioid-related policies meant to shift the focus of pain treatment back on patients and away from what the association referred to as “arbitrary third-party controls.” Physicians accepted the resolutions at the Chicago-based association’s annual meeting last week. In a news release, the AMA said the measures take aim at barriers to treatment that state and federal authorities, insurers, pharmacy benefit management (PBM) companies, and national pharmacy chains have enacted. ““The barriers include tactics such as prior authorization and step therapy – which can delay treatment – and misguided laws and other policies setting hard thresholds for prescriptions,” the announcement said. One proposal recommends developing treatment plans based on individual needs, rather than a one-size-fits-all approach of hard thresholds. Another measure opposes pharmacies, PBMs, and insurers using “high prescriber lists,” without due process, to keep […]
Representatives Porter, Bilirakis, and Norcross Introduce Mental Health Parity Compliance Act Reps. Katie Porter (D-Calif.), Gus Bilirakis (R-Fla.), and Donald Norcross (D-N.J.) this week introduced the Mental Health Parity Compliance Act, the House version of the bill that Sens. Bill Cassidy, M.D. (R-La.) and Chris Murphy (D-Conn.) introduced last week. The legislation is based on a best-practice approach that state legislatures in Delaware, Illinois, New Jersey, and Washington, D.C. have enacted and ensures that health insurance providers are following the 2008 Mental Health Parity and Addiction Equity Act. “As part of removing the stigma for treating mental illness, we must ensure that mental health needs are recognized as legitimate healthcare issues,” Bilirakis said in a news release. “One way to do that is to ensure parity between coverage for healthcare and mental healthcare services—which happens to be the law.” NABH, a Mental Health Liaison Group member, signed on to letters supporting both the House and Senate bills. CMS Issues Request for Information for its Patients Over Paperwork Initiative The Centers for Medicare & Medicaid Services (CMS) recently issued a Request for Information (RFI) seeking new ideas from the public about how to continue the agency’s Patients over Paperwork initiative. Launched in 2017, Patients over Paperwork has worked to streamline regulations in healthcare that often take clinicians away from their primary purpose of caring for patients. The new RFI provides an opportunity for the public to share ideas that were not suggested during the first RFI period two years ago. Specifically, CMS is looking for ways to improve reporting and documentation requirements; coding for Medicare and Medicaid payments; prior authorization procedures; policies and requirements for rural providers, clinicians, and beneficiaries; policies and requirements for dually enrolled beneficiaries; beneficiary enrollment and eligibility determination; and CMS processes for issuing regulations and policies. In its comments to CMS, NABH will highlight The High Cost of Compliance, the association’s report that assessed the regulatory burden on the nation’s inpatient psychiatric facilities. Released in March, the report found that three specific regulatory areas impose $1.7 billion in compliance costs each year nationwide, which represent 4.8 percent of an average facility’s annual revenue for all inpatient psychiatric services from all sources. NABH will continue to work with CMS to address the report’s key findings and recommendations. Comments are due by Monday, August 12. HHS’ Office of Adolescent Health Releases Updated Data on Nation’s Teens New data from HHS’ Office of Adolescent Health (OAH) show 31 percent of U.S. high school students in 2017 reported they felt sad or hopeless almost every day for at least two weeks in a row in the past year. The findings are part of OAH’s updated national and state data sheets, which OAH released June 10 to provide estimates on a range of measures related to adolescent health and behavior. The analysis draws on large, nationally representative surveys, and measures include physical activity and nutrition, mentorship, family meals, cigarette and e-cigarette use, driving under the influence, depression systems, bullying, dating violence, and more. ASPE and RTI Recruiting Organizations to Participate in Telehealth Case Studies HHS’ Office of the Assistant Secretary for Planning […]
FAIR Health Analyzes Claims to Determine Behavioral Health Trends from 2007-2017 Claim lines with behavioral health diagnoses increased 108 percent over 10 years, rising to 2.7 percent of all medical claim lines in 2017 from 1.3 percent of all medical claim lines in 2007, according to a new report from not-for-profit organization FAIR Health. Analyzing data from its database of more than 28 billion private healthcare claim records, FAIR Health found that in 2007 and 2017, major depressive disorder (MDD) was the most common diagnosis in the distribution of claim lines with mental health diagnoses, but its share of the distribution fell to 26 percent in 2017 from 28 percent in 2007. Meanwhile, opioid dependence overtook alcohol dependence to occupy the largest share of claim lines with substance use disorder diagnoses, the report said. Although opioid dependence claim lines increased overall during that 10-year period (1,180 percent, growing to 0.252 percent of all medical claim lines from 0.016 percent), they fell 50 percent between 2015 and 2017, the study showed. “FAIR Health conducted this study to provide a strong foundation of key indicators of behavioral health services rendered to the commercial healthcare population,” the report said. “We look forward to providing additional layers to this analysis, including the nature of the services rendered, the type of venue where services were rendered (including telehealth access) and the specialties of the healthcare professionals providing the services.” FAIR Health is a national, independent organization that collects data for and manages the nation’s largest database of privately billed health insurance claims and has Medicare parts A, B, and D claims data from 2013 to the present. Lancet Study Identifies Alcohol Use as a Leading Risk Factor for Global Disease Burden Alcohol use is a leading risk factor for global disease burden, and data on alcohol exposure are crucial to evaluate progress in achieving global, non-communicable disease goals, says a recent modelling study published in The Lancet. The study presents estimates on the main indicators of alcohol exposure in 189 countries from 1990 through 2017 and includes forecasts up to the year 2030. “Based on these data, global goals for reducing the harmful use of alcohol are unlikely to be achieved,” the study’s abstract noted, “and known effective and cost-effective policy measures should be implemented to reduce alcohol exposure. The Joint Commission Releases Standards FAQ Details on Suicide Risk Reduction The Joint Commission this week released a series of Standards FAQ Details related to suicide risk reduction. This series of six Standards FAQ Details center on hospital emergency departments, and include assessing suicide risk, monitoring patients, ligature-resistant requirements, ligature risks that cannot be removed, and safe rooms. NABH Submits Comments to MACPAC on Regulatory Environment in IMDs NABH on Friday sent comments to the Medicaid and CHIP Payment and Access Commission about the regulatory environment for Institutions for Mental Diseases (IMDs). In it, NABH highlighted its recent regulatory report, The High Cost of Compliance: Assessing the Regulatory Burden on Inpatient Psychiatric Facilities, and discussed how the bulk of regulatory costs imposed on the nation’s inpatient psychiatric facilities relate to B-tags and ligature-risk requirements. “Psychiatric providers […]
Mental Health Liaison Group Supports Behavioral Health Coverage Transparency Act NABH and more than 40 other organizations that comprise the Mental Health Liaison Group this week sent letters to House and Senate lawmakers that expressed strong support for the Behavioral Health Coverage Transparency Act of 2019. “In unity, we advocated tirelessly for the enactment of the Paul Wellstone and Pete Domenici Mental Health and Addiction Equity Act of 2008 and recognize that increased transparency and improved accountability of health insurers is essential to fully realizing both the letter and spirit of this landmark law, and its application to the Affordable Care Act,” the letter said. The legislation would require issuers to disclose the analysis they perform in making parity determinations, as well as their denial rates for mental health versus medical/surgical claims and reasons for those denials. In addition, the bill would require federal regulators to conduct a minimum of 12 random audits of health plans per year, and it would create a central online portal for consumers to access publicly available material, such as information about their parity rights and information insurers submit about how they make parity decisions. NABH will keep members apprised of the legislation’s progress. SAMHSA Releases Report on Older Adults Living with Serious Mental Illness The needs and growth of America’s older population with serious mental illness (SMI) exceeds the number of behavioral health providers who are trained in geriatric care, according to a new report from the Substance Abuse and Mental Health Services Administration (SAMHSA). The analysis, Older Adults Living with Serious Mental Illness: The State of the Behavioral Health Workforce, notes that of the 49.2 million adults over the age of 65 years old in the United States, 1.4 to 4.8 percent suffer from SMI. Meanwhile, the U.S. Census Bureau’s National Population Projections show that by 2030, all Baby Boomers— those born between the years 1946-1965—will be older than age 65. At that point, the number of older adults will exceed the number of children. SAMHSA’s report also includes information about workforce barriers, ideas for strengthening the geriatric workforce to address SMI, programs and resources that address the needs of older Americans, and recommendations. Sen. Tina Smith Shares Experience with Depression During Mental Health Month In conjunction with Mental Health Month, Sen. Tina Smith (D-Minn.) shared her personal experience with depression in remarks she gave last week on the U.S. Senate floor. Smith, a member of the Senate Health, Education, Labors and Pensions (HELP) Committee, noted that de-stigmatizing and de-mystifying mental illness is just the beginning, and that everyone can help those in need by urging them to take advantage of available resources. “But the 100 of us here in the Senate have a responsibility to make sure those resources are available to everyone,” Smith said. “We can’t afford to leave holes in the net we build to catch people when they fall.” Click here to read Sen. Smith’s remarks as prepared for delivery and to download the video of her remarks. U.S. News Analysis Shows Link Between Racial Bullying and Risky Health Behavior in Kids Students in California’s public high schools who […]
America’s Health Rankings’ Senior Report Shows Rise in Excessive Drinking and Depression Excessive drinking increased 12 percent from 2016 to 2019 among the nation’s seniors, while the percentage of seniors who reported a health professional has told them they have depression has risen 19 percent in the last year alone, according to America’s Health Rankings’ Senior Report  for 2019. Produced by the United Health Foundation, UnitedHealth Group’s not-for-profit arm, America’s Health Rankings has provided an analysis of national health for 30 years and relies on health, environmental, and socioeconomic data to determine national health benchmarks and state rankings. This year’s Senior Report included a special comparison of data from 2002 and 2017 to show how the health of younger seniors aged 65 to 74 has changed in the last 15 years. Younger seniors now represent 9.1 percent of the U.S. population compared with 6.4 percent of the U.S. population in 2002. Comparing 2017 with 2002, the report showed that excessive drinking is 42 percent higher, obesity is 36 percent higher, and death by suicide is 16 percent higher. All of the results were not negative, however. The findings also showed that among younger seniors today, the death rate is 22 percent lower, smoking is 16 percent lower, and reporting of “very good or excellent health” is 11 percent higher. HRSA Awards $24 million to 120 Rural Organizations for Opioid Response HHS’ Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy this week awarded $24 million for the second round of Rural Communities Opioid Response Program (RCORP) planning grants. Award recipients across 40 states will receive $200,000 for one year to formalize partnerships with local stakeholders, conduct needs assessments, and develop plans to implement and sustain substance use disorder (SUD), including opioid use disorder (OUD) prevention, treatment, and recovery interventions. The goal, according to a statement from HRSA Administrator George Sigounas, M.S., Ph.D., is to reduce the morbidity and mortality of the diseases in high-risk, rural communities. A complete list of all grant recipients is available here. For more information about the RCORP initiative, please contact the Federal Office of Rural Health Policy. Separately, the American Farm Bureau Federation this month sponsored a Morning Consult poll that surveyed rural adults and farmers/farmworkers to better understand factors that affect the mental health of farmers, availability of resources, perceptions of stigma, personal experiences with mental health challenges, and other relevant topics. According to the poll, farmers and farmworkers said financial issues (91 percent), farm or business problems (88 percent), and fear of losing the farm (87 percent) affect farmers’ mental health. Other factors included stress, weather, the economy, isolation, and social stigma. DEA Online Form Available for Physicians Reporting Phone Scams Physicians should be aware of a reported uptick in phone scams from people posing as U.S. Drug Enforcement Administration (DEA) or other federal agents, and report these practices in the DEA’s online form. Earlier this year, the DEA—an agency under the U.S. Justice Department—warned DEA-registered practitioners and members of the public to be cautious of telephone calls from criminals posting as DEA or other law enforcement personnel threatening arrest and […]
New Report Shows Prescription Opioid Volume Declined 17 percent in 2018 Prescription opioid dosage volume—defined by morphine milligram equivalents, or MMEs—declined 17-percent in 2018, according to a new report from IQVIA, a research firm that specializes in advanced analytics and technology solutions. The study, Medicine Use and Spending in the U.S.: A Review of 2018 and Outlook to 2023, notes this was the single-largest annual drop ever recorded within the U.S. market. The findings also showed that prescription opioid volume had increased annually since 1992 and reached its highest level in 2011. Then a series of regulatory and legislative restrictions, combined with stricter clinical prescribing guidelines and greater reimbursement controls, led to a 4-percent-per-year drop on average from 2012 to 2016; followed by a 12-percent drop in 2017; and the 17-percent decrease last year. Murray Aitken, IQVIA senior vice president and executive director of the IQVIA Institute for Human Data Science, noted in a news release that while prescription opioid usage continues to decline, researchers saw many more people receiving medication assisted treatment (MAT) for opioid addiction. “Our research shows new therapy starts for MAT increased to 1.2 million people in 2018, nearly a 300-percent increase compared with those seeking addiction help in 2014,” Aitken said. “This is an important indicator of the effects of increased funding and support for treatment programs to address addiction.” CMS Extends Enhanced FMAP Period for Certain Medicaid Health Homes for Persons with SUD The Centers for Medicare and Medicaid Services (CMS) has announced the availability of an extension of the enhanced Federal Medical Assistance Percentage (FMAP) period for certain Medicaid health homes for individuals with substance use disorder (SUD). According to CMS, last year’s Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act permits CMS to extend, at a state’s request, the period of 90-percent FMAP for certain Medicaid health homes if certain conditions are met. This is available only for expenditures for SUD-eligible individuals under an SUD-focused state plan amendment. “States whose health homes meet those criteria may request that the Secretary extend the enhanced FMAP period beyond the first 8 fiscal year quarters, for the subsequent 2 fiscal year quarters, for a total of 10 fiscal year quarters from the effective date of the state plan amendment,” the guidance noted. See CMS’ information bulletin for more information. Tennessee to Adopt Block Grant Funding for Medicaid Tennessee Gov. Bill Lee (R) is expected to sign a bill soon that seeks approval from the Trump administration to turn federal funding for the state’s Medicaid program into a block grant. The Wall Street Journal reported this week that other GOP-controlled states have adopted or are asking for federal approval for work requirements as a way to control costs, as growth in Medicaid means the federal healthcare program is making up a larger portion of state budgets. “The waiver would seek the CMS’ approval to transform TennCare, the state’s $12 billion Medicaid program covering 1.3 million Tennesseans, from an open-ended entitlement program to one where the federal government makes fixed payments,” Modern Healthcare reported. Needle Exchanges Endorsed and Legalized […]
SUPPORT Act Expands Access to Medication Assisted Treatment The Substance Abuse and Mental Health Services Administration (SAMHSA) announced this week that several sections of last year’s SUPPORT Act made changes to the Controlled Substance Act that affords practitioners with greater flexibility in providing medication assisted treatment, or MAT, to patients. Signed into law in October 2018, the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act  allows qualified physicians who are board-certified in addiction medicine or addiction psychiatry, or practitioners who provide MAT in a qualified practice setting,  start treating up to 100 patients in the first year of MAT practice with a waiver. According to SAMHSA, current practitioners with an approved waiver from the agency that authorizes them to treat a maximum of 30 patients at one time are permitted to increase that number to 100 patients if they provide SAMHSA with a notification of their intention to treat 100 patients. Rep. Tonko Expected to Introduce Bill to Deregulate Addiction Treatment Rep. Paul Tonko (D-N.Y.) is expected to introduce legislation next week that would allow physicians to prescribe the addiction-treatment drug buprenorphine without restrictions. Life sciences and medical news outlet STAT reports that about 5 percent of U.S. physicians have undergone the eight-hour training required to prescribe buprenorphine (commonly marked as Suboxone). The bill from Tonko follows a recent announcement that the U.S. Justice Department filed suit again buprenorphine’s best-known manufacturer, Indivior, the British firm that has been accused of marketing Suboxone fraudulently as being safer than generic alternatives. Health Systems Commit to Transforming Behavioral Health in 100 Communities Nationwide Twenty-eight health systems met this week to kick off a new effort to transform the country’s behavioral healthcare resources especially in underserved communities. The collective effort is part of the Medicaid Transformation Project, a national initiative announced last year that is intended to transform healthcare and related social needs for the nearly 75 million Americans who are Medicaid beneficiaries. The announcement came from AVIA, a network of health systems. Citing statistics from SAMHSA, the National Institute of Mental Health, and the Kaiser Family Foundation, Avia noted in its announcement that 44.7 million American adults—including 10 million adults covered by Medicaid—experienced a mental health illness as of 2016, a number that is likely underestimated due to stigma issues. Meanwhile, about 35 percent of adults with a serious mental illness are not receiving mental health treatment. “As jarring as the national behavioral health statistics are, they only serve as the tip of the iceberg for the long-term consequences that we risk if we don’t take wide-reaching, decisive action to address this crisis today,” Andy Slavitt, chair for the Medicaid Transformation Project and former acting administrator at the Centers for Medicare & Medicaid Services, said in a news release. “Twenty-eight healthcare organizations have stepped up to proclaim with a singular, unmistakable voice that enough is enough,” Slavitt continued. “Within the next year, I expect dozens of new positive initiatives to launch. Within five to seven years, we could spark the transformation the country needs.” Last month, Molly Joel Coye, MD, MPH, physician leader in Medicaid […]
CMS Proposes 1.7 Percent Increase for Inpatient Psychiatric Facilities in 2020 The Centers for Medicare & Medicaid Services (CMS) on Thursday proposed a 1.7-percent payment increase for inpatient psychiatric facilities (IPF) in 2020, which the agency estimates will increase total IPF payments by about $75 million. In addition, CMS proposed adopting one new claims-based measured starting with the fiscal year 2021 payment determination and continuing in subsequent years. The measure—Medication Continuing Following Inpatient Psychiatric Discharge (National Quality Forum #3205)—assesses whether patients admitted to IPFs with diagnoses of Major Depressive Disorder, schizophrenia, or bipolar disorder filled at least one evidence-based medication within two days before discharge or during the 30-day, post-discharge period. Also in 2020, CMS has proposed to rebase and revise the IPF market basket to reflect a 2016 base year from a 2012 base year. Payments have been rebased and revised since the IPF prospective payment system was established, CMS noted. NABH is reviewing the proposed rule and will provide more details the week of April 22. The deadline for public comments is June 17. Federal Government Lost $26 Billion in Tax Revenue from Opioid Crisis Between 2000-2016 The federal government lost $26 billion in income tax revenue due to opioid misuse between 2000 and 2016, according to a new study in the journal Medical Care. Meanwhile, researchers found that opioid misuse cost state governments $11.8 billion, including $1.7 billion in lost sales tax revenue and $10.1 billion in lost income tax revenue. “By omitting lost tax revenue due to labor force exits, prior studies have missed an important component of opioid-related costs borne by state and federal governments,” the study’s authors wrote. The authors concluded that as more states and the federal government consider litigation for opioid-related damages, lost tax revenue reflects an important cost that could be recouped and allocated to opioid prevention and treatment programs. Joint Commission Releases Advisory on Drug Diversion and Impaired Healthcare Workers In an advisory released this week, the Joint Commission identified more than 20 patterns and trends that indicate drug diversion, the transfer of a legally prescribed controlled substance from the individual for whom it was prescribed to another person for illicit use. The advisory cited statistics from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the American Nurses Association (ANA) that estimate about 10 percent of U.S. healthcare workers are abusing drugs. Patterns and trends in this area include when: controlled substances are removed with no doctor’s orders, for patients not assigned to the nurse, or for recently discharged or transferred patients; product containers are compromised; and a verbal order for controlled substances is created but not verified by a prescriber. “Experts believe that only a fraction of those who are diverting drugs are ever caught, despite clear signals — such as abnormal behaviors, altered physical appearance, and poor job performance,” the advisory noted. “Direct observation is vital to detecting diversion and may be the only way to identify an impaired colleague.” Report Shows Psychiatrists Have a High Willingness and High Usage Rate for Telehealth Psychiatry is the only physician specialty that has both a high willingness and […]
OTPs to Follow Standard Care Recommendations for People with Suicide Risk The nation’s opioid treatment programs will be begin following the National Action Alliance (Action Alliance) for Suicide Prevention’s recommended guidelines to care for people with suicide risk in June, the news outlet Stateline reported this week. The story cited statistics from the Centers for Disease Control and Prevention (CDC) that found people with an opioid addiction are at much higher risk for suicide than the rest of the population, and that opioid use was a contributing factor in more than 40 percent of all suicide and overdose deaths in 2017. Guidelines from the Action Alliance will become facilities’ minimum standard of care for patients in both inpatient and outpatient addiction-treatment settings, Michael Johnson, managing director for the Commission on Accreditation of Rehabilitation Facilities, which oversees opioid treatment programs, said in the story. “Right now, there’s no real standards for suicide prevention in addiction treatment programs,” Johnson told Stateline. “We want to change that.” The Action Alliance is a public-private partnership that works to advance the National Strategy for Suicide Prevention and reduce the nation’s suicide rate 20 percent by 2025. Report Finds Older Americans Turning to Suicide in Long-Term Care Settings A six-month investigation from Kaiser Health News (KHN) and the PBS NewsHour has found older Americans are dying by suicide in the nation’s nursing homes, assisted living centers, and adult care homes. KHN analysis of new data from the University of Michigan data suggests that hundreds of suicides by older adults each year, or nearly one per day, are related to long-term care. Meanwhile, thousands more people may be at risk in those settings, where up to a third of residents report suicidal reports, the research found. “Each suicide results from a unique blend of factors, of course,” the study noted. “But the fact that frail older Americans are managing to kill themselves in what are supposed to be safe, supervised havens raises questions about whether these facilities pay enough attention to risk factors like mental health, physical decline, and disconnectedness—and events such as losing a spouse or leaving one’s home,” it continued. “More controversial is whether older adults in those settings should be able to take their lives through what some fiercely defend as ‘rational suicide.’” CDC Finds Kratom Has Caused Nearly 100 Overdose Deaths in the United States The CDC has reported the herbal supplement kratom has caused 91 overdose deaths in 27 states from July 2016-December 2017. Kratom, a plant native to Southeast Asia, contains the alkaloid mitragynine, which the CDC reports can produce stimulant effects in low doses and some opioid-like effects at higher doses when consumed. “As of April 2019, kratom was not scheduled as a controlled substance,” the CDC report noted. “However, since 2012, the Food and Drug Administration has taken a number of actions related to kratom, and in November 2017 issued a public health advisory; in addition, the Drug Enforcement Administration has identified kratom as a drug of concern,” it added. “During 2011–2017, the national poison center reporting database documented 1,807 calls concerning reported exposure to kratom.” FDA Announces Reports […]
China Bans All Types of Fentanyl, Cutting U.S. Supply China this week announced it would ban all types of the opioid fentanyl, a decision that could slow the supply of the deadly drug to the United States. The decision fulfills a pledge that Chinese leader Xi Jinping made to President Trump in December. House Energy and Commerce Republicans hailed the move in a blog post, noting that fentanyl analogues—synthetic opioids that are 50 times more potent than heroin and 100 times more potent than morphine—are the leading cause of opioid overdose deaths in the United States. ONC Issues Proposed Rule to Revise Conditions of Participation HHS’ Office of the National Coordinator for Health Information Technology (ONC) has issued a proposed rule that would revise the conditions of participation for psychiatric hospitals and require facilities that have electronic health record (EHR) systems “to send electronic patient event notifications of a patient’s admission, discharge, and/or transfer to another health care facility or to another community provider.” The proposal would limit this requirement to only those Medicare- and Medicaid-participating hospitals that possess EHRs systems with the technical capacity to generate information for electronic patient event notifications. NABH is drafting comments on the proposed rule. House and Senate Introduce Bipartisan Bills to Align 42 CFR Part 2 With HIPAA Identical, bipartisan bills were introduced in the House and Senate this week to align 42 CFR Part 2, commonly referred to as Part 2, with the Health Insurance Portability and Accountability Act (HIPAA) for treatment, payment, and healthcare operations, while also strengthening protections against the use of addiction records in criminal, civil, or administrative proceedings. Reps. Earl Blumenauer (D-Ore.) and Markwayne Mullin (R-Okla.) introduced the Overdose Prevention and Patient Safety Act, or OPPS Act, while Senators Shelley Moore Caputo (R-W.V.) and Joe Manchin (D-W.V.) introduced Protecting Jessica Grubb’s Legacy Act, or the Legacy Act. NABH, a member of the Partnership to Amend 42 CFR Part 2, supports both pieces of legislation. GAO Finds Nearly 40 Million American Adults Have Untreated Substance Use Disorders or Mental Health Conditions A recent Government Accountability Office (GAO) report found that nearly 40 million American adults have untreated substance use disorders or mental health conditions, such as depression. According to the national survey, many of these Americans don’t think they need treatment, while others say it’s hard to get care. Left untreated, these behavioral health conditions can cause other health complications—such as drug overdoses—which, in turn, can raise healthcare costs. The GAO noted that the studies it reviewed were limited to specific conditions or locations, and most found higher healthcare costs for adults who didn’t receive behavioral healthcare treatment. There is no generally accepted estimate of the overall costs, the report said. Emergency Medicine News Releases Special Report on Psychiatric Patient Boarding The decline in the number of inpatient psychiatric beds available nationwide could be the most significant factor to help explain the increase in Emergency Department (ED) wait times for psychiatric patients, according to a special report published in Emergency Medicine News. “Those dropped 35 percent between 1998 and 2013,” the report noted, citing JAMA, “And the drop wasn’t […]
Centene Will Acquire WellCare for $17.3 billion Centene Corp. will acquire WellCare Health Plans, Inc. for $17.3 billion in a deal the two companies announced this week will create a new venture focused on government-sponsored healthcare programs that will have about 22 million members across all 50 states and combined revenue of about $100 billion. News outlet Politico reported that while Centene’s major focus is Medicaid managed care—where it had about 14 million members at the end of 2018—the health insurer has also emerged as a significant player in the Obamacare markets, with about 2 million members across 21 states, or nearly one in five exchange enrollees nationwide, at the start of this year. In 2016, Centene acquired Health Net, another Medicaid managed care plan, for $6.3 billion. Centene and WellCare said in a joint news release the board of the combined company will consist of 11 members, including nine members from Centene’s board and two from WellCare’s board. Centene’s Michael Neidorff will lead the combined company as chairman and chief executive officer, while Ken Burdick and Drew Asher from WellCare are expected to join Centene’s senior management team in new positions as a result of the acquisition. The National Academies Says Medications to Treat OUD Are Effective, but Barriers Prevent Access and Use Three U.S. Food and Drug Administration (FDA)-approved medications to treat opioid use disorder (OUD) are both safe and effective, but most people who would benefit from these treatments do not receive them and access is inequitable, according to a new report from the National Academies of Sciences, Engineering, and Medicine. According to Medications for Opioid Use Disorder Saves Lives, withholding or failing to have available these medications to treat OUD in any care or criminal justice setting is denying appropriate medical treatment. The report identified misunderstanding and stigma, inadequate education and training, current regulations, and the fragmented system of care for people with OUD as the barriers to treatment. “The United States is experiencing a public health crisis of almost unprecedented scale — an epidemic of opioid use disorder and related overdose deaths,” Alan Leshner, chief executive officer emeritus of the American Association for the Advancement of Science, and chair of the committee that conducted the study, said in a news release. “The factors impeding full use of FDA-approved medications to treat OUD must be addressed, including stigma surrounding both addiction and the medications used to treat it as well as counterproductive ideologies that consider addiction simply a failure of will or a moral weakness, as opposed to understanding that opioid use disorder is a chronic disease of the brain that requires medical treatment,” he continued. “Curbing the epidemic will require an ‘all hands on deck’ strategy across every sector — healthcare, criminal justice, people with OUD and their family members, and beyond — in order to make meaningful progress in resolving this crisis.” ASTHO Recommends Approaches to SUD Prevention and Treatment The Association of State and Territorial Health Officials (ASTHO) and the National Academy for State Health Policy (NASHP) have released four recommendations on how public health and Medicaid agencies can engage in cross-agency work […]
NABH Launches Access to Care Initiative at 2019 Annual Meeting NABH this week kicked off Access to Care, the association’s new initiative that will provide information and resources to help inform policymakers, regulators, payers, and patient advocates that only true access can lead to recovery. Access to Care focuses on two major challenges: unjust managed care contracts and countless regulations, both of which often prevent behavioral healthcare providers from offering patients a full range of services. As part of this initiative, the NABH Board of Trustees on March 18 adopted the Access to Care resolution, which addresses unfair managed-care practices and recommends guiding principles for providers and payers to incorporate in contracts with managed care organizations (MCOs). NABH’s provider systems are committed to ensuring patient access to behavioral healthcare treatment across the entire behavioral healthcare continuum, which includes inpatient, residential, partial hospitalization, intensive outpatient, outpatient, and recovery and support services. Too often, MCOs limit coverage to crisis stabilization or short-term, acute-care services for all levels of care because they use internally developed and/or proprietary and non-transparent, medical-necessity criteria. “As our Access to Care resolution states, ‘Fair and appropriate coverage for behavioral healthcare services must ensure—not solely offer—access to the entire behavioral healthcare continuum,” NABH Board Chair Pat Hammer, president and CEO of Oconomowoc, Wis.-based Rogers Behavioral Health, said in a news release about the resolution. “For this to happen, fair and reasonable managed care contracts must include and apply generally accepted standards of professional practice.” NABH created a Managed Care Committee last fall to identify problems and propose solutions in managed care contracts. The association shared copies of the resolution with attendees at the meeting and NABH Board Chair Pat Hammer introduced NABH’s Access to Care video—which personalizes behavioral healthcare services—at the Annual Meeting’s opening session. On March 19, NABH released The High Cost of Compliance: Assessing the Regulatory Burden on Inpatient Psychiatric Facilities, a comprehensive report that examines the burdens that certain regulations impose on the nation’s inpatient psychiatric facilities. commissioned Manatt Health to conduct this first-of-its-kind study that focuses on three federal regulatory domains attached to participation in the Medicare program: the so-called “B-tag” requirements, a detailed set of standards for patient evaluations, medical records, and staffing in inpatient psychiatric facilities; “ligature risk points,” or those aspects of the physical environment that a patient could use to attempt self-strangulation; and the Emergency Medical Treatment and Labor Act (EMTALA), which obligates a hospital to screen all patients for emergency medical conditions, and, if an emergency condition is identified, to stabilize the patient before the patient may be discharged or transferred. The findings estimate that, taken together, these three regulatory areas impose $1.7 billion in compliance costs nationwide each year. Put another way, these regulatory burdens represent about 4.8 percent of an average facility’s annual revenue for all inpatient services from all sources. NABH President and CEO Mark Covall presented a copy of the report to HHS Deputy Secretary Eric Hargan on Tuesday before the deputy secretary addressed Annual Meeting attendees. In his presentation, Deputy Secy. Hargan called the report “timely” and later tweeted about how he had the opportunity […]
President’s Budget Maintains Opioid Funding Levels and Cuts Behavioral Healthcare Funding In his Fiscal Year 2020 budget released this week, President Donald Trump proposed $4.8 billion—which maintains congressional funding levels—to combat the nation’s opioid crisis and proposed hundreds of millions in funding cuts to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) budget and to behavioral healthcare research. According to the president’s proposal, SAMHSA would see a $65 million cut to its total budget, while the behavioral healthcare-related institutes within the National Institutes of Health would see even more severe funding decreases with $436 million in cuts to behavioral healthcare research. For the third year in a row, the president has proposed cutting the Office of National Drug Control Policy’s by more than 95 percent and repealing the Patient Protection and Affordable Care Act’s Medicaid expansion. The budget proposal would also require states to choose between a per-capita cap or a block grant for their Medicaid programs. Each year, the president’s budget is important because it provides a blueprint for the president’s priorities and policy recommendations to Congress. The president’s budget is also significant because it marks the start of the legislative appropriations process. Watch HHS Secretary Alex Azar’s testimony about the Trump administration’s Fiscal Year 2020 budget here. National Survey Shows More Teens and Young Adults Experiencing Mental Health Issues A new nationwide survey found a 50-percent increase in depressive episodes for individuals between the ages of 12 and 17 between 2005 and 2017. Published in the Journal of Abnormal Psychology, the study examined 200,000 people aged 12–17 and 400,000 people aged 18 and older at various points between 2005 and 2017 about any psychological distress and depressive episodes they had experienced. The findings showed a slightly bigger increase—63 percent—in young adults aged 18–25 than in the younger age group. “Cultural trends contributing to an increase in mood disorders and suicidal thoughts and behaviors since the mid-2000s, including the rise of electronic communication and digital media and declines in sleep duration, may have had a larger impact on younger people, creating a cohort effect,” the study said. In its general scientific summary, the study noted that more “U.S. adolescents and young adults in the late 2010s (versus the mid-2000s) experienced psychological distress, major depression, and suicidal thoughts, and more (people) attempted suicide, and took their own lives.” SAMHSA Releases Guidance on Strategies to Promote Best Practice in Antipsychotic Prescribing for Children and Adolescents SAMHSA has released its Guidance On Strategies to Promote Best Practice in Antipsychotic Prescribing for Children and Adolescents. The new resource offers six key principles for system-level strategies, including youth and family engagement, a multi-modal approach, prescribing clinician engagement, consideration for the unique needs of special populations, coordination with other youth-serving systems, and sustainable financing mechanisms. SAMHSA Releases Principles of Community-Based Behavioral Health Services for Criminal Justice Involved Individuals SAMHSA recently released Principles of Community-Based Behavioral Health Services for Criminal Justice Involved Individuals to provide a framework for a quality, community-based behavioral health treatment system that responds to individuals with mental and substance use disorders. The guide is meant to help community-based behavioral healthcare providers […]
NABH Applauds Landmark Behavioral Healthcare Coverage Ruling in California NABH applauded the decision filed in California’s Northern District earlier this week that will open access to behavioral healthcare services for those who need it. “It has been 10 years since President George W. Bush signed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, and we have yet to achieve full parity,” NABH President and CEO Mark Covall said in a statement on March 5. “Today’s decision in California’s Northern District is a turning point. The federal court’s ruling made it clear that insurance companies must use generally accepted standards in the full behavioral healthcare continuum to help patients gain access to the care they need for recovery.” In a nationwide class action lawsuit, the U.S. District Court for the Northern District of California on Tuesday held that United Behavioral Health (UBH) — the country’s largest managed behavioral healthcare organization — developed restrictive medical-necessity criteria that it used to deny coverage for outpatient, intensive outpatient, and residential treatment services. According to the decision, the Court found that UBH’s internal guidelines limited coverage to acute care services, disregarding highly prevalent, chronic, and co-occurring disorders that required greater intensity and/or duration. The Court also found that UBH failed to meet a requirement related to children and adolescents, asserting that although generally accepted standards of care do not require UBH to “create an entirely separate set of guidelines to address the needs of children and adolescents… they do, however, require that UBH’s guidelines instruct decision-makers to apply different standards when making coverage decisions involving children and adolescents, where applicable, including relaxing the criteria for admission and continued stay to take into account their stage of development and the slower pace at which children and adolescents generally respond to treatment.” NABH is especially pleased to see the Court acknowledge that mental health and substance use disorders are chronic illnesses, and that managed care organizations must cover care that not only stabilizes the acute aspects of a patient’s illness, but also addresses a patient’s underlying condition. President Trump Creates Task Force to Develop Blueprint for Suicide Prevention Among Veterans President Trump this week signed an executive order creating a Cabinet-level task force to draft a blueprint for suicide prevention among veterans within one year. The new President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide (PRESENTS) initiative will work to develop a grant system that extends funding to state and local programs and coordinate suicide-prevention research across agencies in the Veterans Affairs, Defense, and Homeland Security departments. Bipartisan Group of Senators Ask HHS to Update Part 2 Thirteen U.S. senators this week sent a letter to HHS Secretary Alex Azar asking his department to initiate a rulemaking process to update the Confidentiality of Alcohol and Drug Abuse Patient Records 42 Code of Regulations 2, known as Part 2. “Part 2 provisions are not compatible with the way health care is delivered currently,” said the letter from 7 Republicans and 6 Democrats. “In order to bring them in line with 21st Century medicine, it is imperative to modernize the […]
HHS Assesses Impact of Parity in Large Group Employer-Sponsored Insurance Market The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 had a “significant positive impact” on the frequency of outpatient services for both mental health and substance use disorder (SUD), HHS reported this week in Assessing the Impact of Parity in the Large Group Employer-Sponsored Insurance Market. The 111-page report from the department’s assistant secretary for planning and evaluation office of disability, aging, and long-term care policy defined frequency as the average number of outpatient services used per service user. HHS concluded the magnitude of the law’s impact on SUD outpatient services was about 10 times larger than the magnitude for mental health outpatient services. Meanwhile, the analysis found that while the 2008 law had a positive and significant impact on average spending by the insurer (for both mental health and SUD outpatient services) and the enrollee (for SUD outpatient services), there was little impact on enrollee cost sharing and no impact on reimbursement rates to providers. The report also evaluated the findings in the context of the nation’s ongoing opioid crisis “The impact of MHPAEA on utilization of SUD outpatient services was not due to the OUD (opioid use disorder) epidemic,” the study said. “MHPAEA affected both OUD and other non-OUD SUD diagnosis groups in a similar way, increasing confidence that the changes observed at the point of parity implementation were due to parity and not to the OUD crisis,” it continued. “However, we did observe a greater magnitude of impact of MHPAEA for OUD outpatient services, suggesting that the influx of individuals with OUD diagnoses during the same timeframe as parity implementation interacted to some extent.” CMS Updates Data for the Inpatient Psychiatric Facility Quality Reporting Program The Centers for Medicare & Medicaid Services’ Hospital Compare website this week added six new measures to the Inpatient Psychiatric Facility Quality Reporting Program (IPFQRP). Hospital Compare reports information on about 100 quality measures for more than 4,000 hospitals nationwide, including Veterans Administration (VA) medical centers and Department of Defense (DoD) military hospitals. For questions about the IPFQRP, please e-mail the Hospital Inpatient Value, Incentives, and Quality Reporting Outreach and Education Support contract team through the Questions and Answers tool or call either of these toll-free numbers on weekdays between 8 a.m. and 8 p.m. ET: 844-472-4477, or 866-800-8765. VA Helps Veterans Manage Chronic Pain Without Opioids The Veterans Affairs (VA) Department’s new virtual reality program is helping the nation’s veterans manage chronic pain without opioids. The program provides veterans with different medical issues—including traumatic brain injury, spinal cord injury, stroke, amputations, or Amyotrophic Lateral Sclerosis (ALS)—with an alternative to using drugs such as opioids. Instead, veterans use a virtual reality headset or a large monitor screen to experience virtual scenic settings with music and narration. “Virtual reality is able to take the user someplace else they’d rather be,” Jamie Kaplan, a recreational therapist at the VA, said in a blog post. “For example, virtual games and activities can allow the wheelchair use to experience freedom from the limitations they face in everyday life.” […]
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 […]
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 […]
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 […]
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 […]
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 […]
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, […]
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. […]
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 […]
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 […]
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 […]
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 […]
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. […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
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.
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 […]
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.
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.
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.
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.
NABH this week sent comments and a series of recommendations to HHS’ Administration for Children and Families (ACF) on how to implement the Family First Prevention Services Act (FFPSA) effectively.
The Justice Department this week made final a rule it proposed in April to improve the Drug Enforcement Administration’s (DEA) ability to control diverting dangerous drugs during the nation’s opioid crisis.
NABH Launches Redesigned Website. We are pleased to announce NABH has launched a redesigned website at www.nabh.org!
U.S. House Passes First Stand-Alone IMD Exclusion Repeal Bill
Illinois House of Representatives Passes Comprehensive Mental Health Parity Bill
The Senate passed sweeping legislation this week to overhaul medical care options for the nation’s veterans.
House Energy and Commerce Committee Approves 25 Opioid Bills
NABH Focuses on IMD Repeal Exclusion During May’s Mental Health Month