CEO Updates

CEO Update 221

Written by Meghan Barrett on March 14, 2025. Posted in CEO Updates.

House and Senate Consider Stopgap Funding Bill to Avert Government Shutdown

The House of Representatives on Tuesday passed a seven-month funding patch aimed at averting a government shutdown by Friday night, March 14.

The stopgap Continuing Resolution (CR) would fund government operations through the remainder of this fiscal year while slashing non-defense funding by roughly $13 billion and increasing defense spending by about $6 billion more than current budgets.

The CR keeps federal agencies operating under last year’s budget constraints and maintains a 2% across-the-board sequestration cut to Medicare provider payments.

In addition, the bill extends $2.4 billion in funding for Community Health Centers (CHCs), the National Health Service Corps (NHSC) and Teaching Health Centers through Sept. 30 while also delaying $1.3 billion in Medicaid Disproportionate Share Hospital (DSH) cuts. Medicare telehealth flexibilities would remain in place through the end of the fiscal year at an estimated cost of $557 million, while hospital-at-home waivers would also be extended. The bill also extends $191 million in increased Medicare payments for low-volume hospitals, $63 million for Medicare-dependent hospitals, and $27 million in add-on payments for ambulance services.

Ultimately the House-passed CR didn’t include language to reverse the Centers for Medicare & Medicaid Services’ 2.83% Medicare physician pay cut, despite intense lobbying for its inclusion. However, the Republican congressional “Doc Caucus” received assurances from Republican congressional leaders that a Medicare “doc fix” would be in the upcoming reconciliation bill. According to the American Medical Association, medical practice costs are 3.5% higher this year alone and Medicare reimbursements are 33% lower than in 2001, adjusted for inflation.

The Senate now must accept or reject the House legislation to avert a government shutdown Friday night. The Republican Majority will need at least eight Democrats to cross the aisle to reach the 60-vote threshold. Initial actions by Senate Democrats indicate united opposition to the bill; however, it’s expected that enough Democrats will cross the aisle to pass the bill.

Reps. Norcross, Fitzpatrick and Courtney Reintroduce Parity Enforcement Act

House Reps. Donald Norcross (D-N.J.) Brian Fitzpatrick (R-Pa.) and Joe Courtney (D-Conn.) have reintroduced H.R. 957, The Parity Enforcement Act, legislation that would expand the U.S. Labor Department’s (DOL) authority to enforce the Mental Health Parity and Addiction Equity Act.

The much-needed legislation holds insurance companies accountable and provides DOL with the tools necessary to impose civil monetary penalties for violating mental health parity requirements.

The legislation was introduced with six cosponsors on Feb. 4 and referred to the House Education and Workforce Committee. NABH expects Sens. Chris Murphy (D-Conn.), Tina Smith (D-Minn.) and Ben Ray Lujan (D-N.M.) to introduce companion legislation. NABH is contacting congressional offices to ask lawmakers to co-sponsor the legislation and push for committee hearings.

NABH president and CEO Shawn Coughlin sent the sponsors a letter thanking the lawmakers for their efforts and highlighting the continued inequities of care. The letter cites the Wit v. United Behavioral Health case as an example of a major health plan using substandard mental health and substance use disorder treatment criteria to deny medically necessary care.

NABH Sends AI Action Plan Recommendations to National Science Foundation

NABH on Thursday sent the National Science Foundation (NSF) a letter with recommendations to help develop an artificial intelligence (AI) action plan as a response to the NSF’s request for information in late January. Specifically, we call for the NSF to consider the limited capacity of behavioral healthcare information technology and AI when developing the national plan.

Our letter highlighted NABH member responses to NABH’s AI surveys, including that our members are focused presently on using AI to improve care quality by augmenting the role of diagnostic and other decision-making by clinical practitioners; raising the efficiency of business operations such as medical record documentation-related functions; and improving workforce retention through related reduction in administrative burden.

‘With regard to the scope of AI rollout, our AI survey results indicate that one-third or fewer of our members are using AI,” the letter continued. “In addition, we note the growing use of telephone apps and online services being used, in part with AI functions, to provide behavioral healthcare services that appear, at least in part, to fall outside of evidence-based care. These platforms can be purchased by individuals who want support related to actual and perceived depression, anxiety, PTSD, psychosis and ADHD. We note that some of these prescription digital therapeutics are subject to FDA review.”

ICYMI: NABH Releases Quality Resources on Patient and Staff Health & Safety

NABH recently developed two quality-related resources to help members learn from their peers and inform policymakers, regulators, and the media about the innovative ways our members are working to protect their patients and staff.

Inpatient Psychiatric Hospitals and Units Implement Effective Violence-Prevention Measures highlights in bullet-list form how inpatient psychiatric hospital providers apply significant prevention protocols beyond existing workplace safety measures that state and federal laws require. Often inpatient psychiatric hospitals employ additional methods that protect staff who treat a range of patients treated in their hospitals, especially those who are admitted because of their violent behaviors.

Meanwhile, in The Right Place at the Right Time: Behavioral Healthcare Solutions to ED Boarding, NABH shares the methods and best practices that association members Avera Behavioral Health Services in South Dakota, Mass General Brigham (an integrated health system that includes NABH member McLean Hospital) in Massachusetts, Rutgers University Behavioral Health Care in New Jersey, and Sharp Mesa Vista in California have developed and implemented successful solutions to the persistent problem of “boarding,” the practice of holding patients with behavioral health conditions in a hospital’s Emergency Department (ED) after admission because no inpatient beds are available.

NABH has posted these factsheets in the Resources section of our homepage and will promote both on LinkedIn at the National Association for Behavioral Healthcare and @NABHBehavioral. Please share these tools with your teams and others who would find the information useful!

The association thanks members of the NABH Quality Committee for their ideas and their help developing these resources.

ICYMI: Please Read and Share NABH’s 2025 Advocacy Priorities!

NABH urges you to share our 2025 Advocacy Priorities with your Government Relations teams and others who want to learn more about the behavioral healthcare field’s most pressing issues..

Leading NABH’s 2025 Advocacy Priorities are parity, workforce, behavioral healthcare information technology, America’s ongoing addiction crisis, and the Institutions for Mental Diseases (IMD) exclusion.

NABH will continue to promote the 2025 Advocacy Priorities @NABHBehavioral and at the National Association for Behavioral Healthcare on LinkedIn. Please follow us on these platforms and help us promote your priorities!

Register for the 2025 Annual Meeting and View Our Program At-a-Glance!

Please take a moment to view our 2025 Annual Meeting At-a-Glance, which highlights a few program changes this year, such as hosting Hill Day on the Annual Meeting’s last day: Wednesday, May 14. NABH will share information about Hill Day and our Annual Meeting speakers, exhibitors, sponsors, and events in weekly Annual Meeting Alerts until the meeting kicks off on Monday, May 12.

Please be sure to register for the meeting and reserve your hotel room at the Salamander Washington, DC, before the hotel cut-off date on Friday, April 18!

Fact of the Week

Nearly one in 10 people in the United States will experience an eating disorder in their lifetime, according to the Substance Abuse and Mental Health Services Administration. Click here to read about some common eating disorder myths and related facts.

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

CEO Update 220

Written by Meghan Barrett on March 7, 2025. Posted in CEO Updates.

NABH Recommends a Distinct Cybersecurity Proposal for Behavioral Healthcare

NABH submitted comments to the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) on a proposed rule to strengthen cybersecurity for protected health information. Our comments express strong caution that the proposed rule does not account for the limited health information technology (HIT) capacity in the behavioral healthcare field.

Despite the ongoing urgency of the behavioral healthcare crisis, too many behavioral healthcare providers continue to lag a generation behind the HIT capacity of our physical healthcare peers – largely due to the exclusion of many behavioral healthcare providers from the Health Information Technology for Economic and Clinical Health Act.

With these concerns in mind, NABH recommended that OCR conduct a review of behavioral healthcare providers’ HIT assets and capacity, relative to the specific technical components of the proposed rule.

NABH Welcomes VA Secretary Collins in Letter Emphasizing Attention to Veterans’ Behavioral Healthcare Needs

On Tuesday, NABH sent a letter to Doug Collins congratulating him on being confirmed as the Secretary of Veterans Affairs. The letter highlights the significant behavioral health conditions experienced by veterans, ranging from post-traumatic stress disorder to alcohol use disorder, as well as the high rate of suicide.

The letter also describes the importance of access to behavioral healthcare services offered by third-party providers to augment services delivered within the U.S. Department of Veterans Affairs (VA) system: “The VA’s Community Care Program offers critical flexibility, ensuring there is always capacity available when and where a veteran needs it – even when a wait list at a local VA is long.”

The letter continues by describing challenges that NABH members have encountered with VA gatekeepers for the Community Care Program, resulting in barriers for veterans to access third-party providers despite them facing lengthy wait times for care at VA facilities.

CMS Rescinds Guidance on Health-Related Social Needs

This week, the Centers for Medicare & Medicaid Services (CMS) rescinded guidance on coverage of services for health-related social needs (HRSN) – including housing and nutrition interventions – in Medicaid and the Children’s Health Insurance Program.

These guidance documents described the various pathways for states to offer coverage for HRSN services for populations in need, such as beneficiaries who have behavioral health conditions or are transitioning out of institutional care settings. As of November 2024, ten states had received approval from CMS to cover HRSN services through a Section 1115 demonstration, one of several pathways.

Going forward, CMS will assess states’ applications to cover HRSN services on a case-by-case basis.

Register Today for the 2025 NABH Annual Meeting!

Registration is now open for the 2025 NABH Annual Meeting, Behavioral Health is Everyone’s Concern: Constant Care, Changing Times, from May 12-14, 2025 at the Salamander Washington, DC!

2025 marks 60 years since President Lyndon Johnson passed The Social Security Amendments of 1965 that created the Medicare and Medicaid programs. Although much has changed in the U.S. behavioral healthcare system in six decades, one thing remains constant: our members’ devotion to delivering quality care and treatment.

Please join us to network with your peers; learn from experts about critical topics such as parity, workforce, and information technology; visit your congressional leaders on Capitol Hill; and explore new products and resources from our exhibitors.

Click here to register and reserve your hotel room today.

We look forward to seeing you in Washington!

ICYMI: NABH Releases Quality Resources on Patient and Staff Health & Safety

ICYMI: Please Read and Share NABH’s 2025 Advocacy Priorities!

NABH recently released its 2025 Advocacy Priorities, which we urge you to read and share with your Government Relations teams and others.

Leading NABH’s 2025 Advocacy Priorities are parity, workforce, behavioral healthcare information technology, America’s ongoing addiction crisis, and the Institutions for Mental Diseases (IMD) exclusion.

NABH will continue to promote the 2025 Advocacy Priorities @NABHBehavioral and at the National Association for Behavioral Healthcare on LinkedIn. Please follow us on these platforms and help us promote your priorities!

Fact of the Week

According to a recent study published in Health Affairs, Medicare enrollment at age 65 led to a 14% increase in visits to primary care providers and a 31% increase in visits to other providers, with the former more prominent among Medicare Advantage enrollees. However, visits to mental healthcare providers did not change.

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

CEO Update 219

Written by Meghan Barrett on March 6, 2025. Posted in CEO Updates.

House Passes Multitrillion-Dollar Budget Bill

The House on Tuesday narrowly passed its multitrillion-dollar budget resolution in a near party-line vote of 217-215, a key step toward advancing President Trump’s sweeping domestic policy agenda.

The Senate passed a competing plan last week, and the Republicans in the two chambers must now reconcile the significant differences between the two fiscal blueprints. Congressional leaders also must deal with a more immediate issue: the March 14 government shutdown deadline before moving to the next steps of reconciliation.

For its part, the Senate is looking to avert deep cuts to Medicaid, while the House is relying on those cuts for significant cost-shifting. Senate Republicans have insisted they will not support a final measure that extends Trump’s 2017 tax cuts only temporarily, which would require making significant changes to the House blueprint.

The House budget tasks the Energy & Commerce Committee, which has jurisdiction over Medicaid, to find $880 billion in funding cuts during the next decade. Advocates including NABH, hospitals, and patient groups have expressed concern to Congress that this will lead to deep cuts to the Medicaid program. A faction of the GOP conference – moderate Republicans, many of whom represent swing districts – also have qualms about the scale of the Medicaid cut the budget plan suggests. House leaders have indicated Medicaid savings would come from cutting “waste, fraud, and abuse;” however, many lawmakers remain skeptical that such large savings can be reached without affecting their constituents.

The most difficult part of the reconciliation process now begins. House and Senate leaders want to send a reconciliation package to President Trump by early May, although many expect the timeline to extend until Fall. It remains uncertain whether the House and Senate will hold a formal conference committee, or if the two chambers will engage in informal negotiations with Trump administration officials to reach a compromise.

NABH is contacting congressional offices to emphasize that behavioral health conditions such as major depressive disorder, schizophrenia, and opioid use disorder are highly prevalent among Medicaid beneficiaries. Decreasing provider payments, restricting benefits, and limiting eligibility – including new work requirements – could affect millions of Americans living with severe mental illness, putting vital mental health services and care at risk and leading to devastating consequences for individuals and families already struggling to access the support they need.

FDA Discontinues the Clozapine REMS Program

The Food and Drug Administration (FDA) on Monday announced it will discontinue the risk evaluation and mitigation strategies (REMS) program for clozapine, an antipsychotic medication indicated for treatment-resistant schizophrenia and recurrent suicidal behavior among people with schizophrenia or schizoaffective disorder.

This REMS program was intended to reduce the risk of severe neutropenia, which clozapine can induce by lowering the number of neutrophils— a type of white blood cell involved in the immune response to infections. The REMS program required clinicians to conduct blood tests before initiating patients on clozapine and then every week, other week, or month, depending on how long the patient had been treated with clozapine and their neutrophil count. Clinicians then reported neutrophil counts to a centralized database that pharmacists checked before dispensing.

Given the significant undertreatment of schizophrenia, effectiveness of clozapine, and feedback FDA received on the burdens of the REMS program, the agency determined that “although the risk of severe neutropenia with clozapine still exists… the REMS program for clozapine is no longer necessary to ensure the benefits of the medicine outweigh that risk.”

White House Executive Order on Pricing Transparency

President Trump signed an executive order on Tuesday intended to make healthcare pricing more transparent by directing federal agencies to enforce an order he signed during his first term as president.

The order instructs the Health and Human Services, Labor, and Treasury Departments to develop a framework within 90 days to enforce Trump’s June 2019 executive order forcing health insurers and hospitals to disclose healthcare cost details.

ICYMI: NABH Releases Quality Resources on Patient and Staff Health & Safety

ICYMI: Please Read and Share NABH’s 2025 Advocacy Priorities!

2025 NABH Annual Meeting Registration Opening Soon!

Please plan to join your peers and the NABH team at the Salamander Washington, DC from May 12-14 for this year’s NABH Annual Meeting: Behavioral Health is Everyone’s Concern: Constant Care, Changing Times.

Our thanks to this year’s Annual Meeting Program Committee, which approved this year’s theme. NABH Board Member Patricia Toole, M.A.S. from Hackensack Meridian Health Carrier Clinic chairs the Program Committee, which also includes NABH members Mary-Catherine Bohan, M.S.W. from Rutgers University Behavioral Health Care and Rhonda Ashley-Dixon, M.A. from Vanderbilt Psychiatric Hospital and Clinics.

Annual Meeting registration and a link to hotel reservations at the Salamander will open soon. We look forward to seeing you in Washington!

Fact of the Week

In a recent study of young adults, lifetime history of heavy cannabis use was associated with lower brain activation during a working memory task, according to a recent article in JAMA Network Open.

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

CEO Update 218

Written by Meghan Barrett on February 21, 2025. Posted in CEO Updates.

NABH Releases Quality Resources on Patient and Staff Health & Safety

NABH has developed two quality-related resources to help members learn from their peers and inform policymakers, regulators, and the media about the innovative ways our members are working to protect their patients and staff.

Inpatient Psychiatric Hospitals and Units Implement Effective Violence-Prevention Measures highlights in bullet-list form how inpatient psychiatric hospital providers apply significant prevention protocols beyond existing workplace safety measures that state and federal laws require. Often inpatient psychiatric hospitals employ additional methods that protect staff who treat a range of patients treated in their hospitals, especially those who are admitted because of their violent behaviors.

Meanwhile, in The Right Place at the Right Time: Behavioral Healthcare Solutions to ED Boarding, NABH shares the methods and best practices that association members Avera Behavioral Health Services in South Dakota, Mass General Brigham (an integrated health system that includes NABH member McLean Hospital) in Massachusetts, Rutgers University Behavioral Health Care in New Jersey, and Sharp Mesa Vista in California have developed and implemented successful solutions to the persistent problem of “boarding,” the practice of holding patients with behavioral health conditions in a hospital’s Emergency Department (ED) after admission because no inpatient beds are available.

NABH has posted these factsheets in the Resources section of our homepage and will promote both on LinkedIn at the National Association for Behavioral Healthcare and @NABHBehavioral. Please share these tools with your teams and others who would find the information useful!

The association thanks members of the NABH Quality Committee for their ideas and their help developing these resources.

ERIC Requests Stay of Enforcement of September 2024 Final Parity Rule

In an announcement on its website Thursday, the ERISA Industry Committee (ERIC) said it has requested a stay of enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA) final parity rule released last September while the organization’s lawsuit against HHS, the U.S. Labor Department (DOL) and the U.S. Treasury Department challenging the rule’s validity is ongoing.

The announcement said former DOL Secretary Eugene Scalia, a partner with the firm Gibson, Dunn & Crutcher that represents ERIC, sent a letter to the three cabinet departments on Feb. 14 asking the agencies to postpone the final rule’s effective date while litigation is pending, which would effectively stay the rule’s enforcement.

“ERIC and stakeholders across the employer and behavioral health community long cautioned that the Biden administration’s mental health parity rule could create unintended and adverse consequences,” ERIC’s statement said. “Now that portions of the final rule have gone into effect, those consequences threaten to raise costs and jeopardize patients’ access to safe, effective, and medically necessary mental health support. Taking action to stay the mental health parity rule provides needed certainty to all parties as the suit works its way through the judicial process.”

NABH posted a statement about ERIC’s lawsuit in January.

ICYMI: NABH 2025 Advocacy Priorities Now Available!

NABH last week released its 2025 Advocacy Priorities, which we urge you to read and share with your Government Relations teams and others.

Leading NABH’s 2025 Advocacy Priorities are parity, workforce, behavioral healthcare information technology, America’s ongoing addiction crisis, and the Institutions for Mental Diseases (IMD) exclusion.

NABH will continue to promote the 2025 Advocacy Priorities @NABHBehavioral and at the National Association for Behavioral Healthcare on LinkedIn. Please follow us on these platforms and help us promote your priorities!

ICYMI: NABH’s Safe Connections Campaign Highlights Cyber-aggression

NABH recently released and promoted two new resources about cyber-aggression as part of its Safe Connections campaign about healthy minds and social media habits for America’s youth.

Please visit our Youth Services page to access all of the Safe Connections resources and share our social media posts on LinkedIn and X.

NABH thanks Donald Grant, Ph.D., with Newport Healthcare, and the NABH Youth Services Committee for its work on this campaign.

Join Us in May for the 2025 NABH Annual Meeting!

Please plan to join your peers and the NABH team at the Salamander Washington, DC from May 12-14 for this year’s NABH Annual Meeting: Behavioral Health is Everyone’s Concern: Constant Care, Changing Times.

Our thanks to this year’s Annual Meeting Program Committee, which approved this year’s theme. NABH Board Member Patricia Toole, M.A.S. from Hackensack Meridian Health Carrier Clinic chairs the Program Committee, which also includes NABH members Mary-Catherine Bohan, M.S.W. from Rutgers University Behavioral Health Care and Rhonda Ashley-Dixon, M.A. from Vanderbilt Psychiatric Hospital and Clinics.

Annual Meeting registration will open in late February. We look forward to seeing you in Washington!

Fact of the Week

More than 40% of physicians, medical school students, and residents cite the fear of disclosure requirements on licensure forms as a main reason they seek mental healthcare, according to the American Medical Association, which is advocating for legislative and regulatory changes.

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

CEO Update 217

Written by Meghan Barrett on February 18, 2025. Posted in CEO Updates.

NABH Releases 2025 Advocacy Priorities!

NABH is pleased to share its 2025 Advocacy Priorities, which we urge you to read and share with your Government Relations teams and others.

Leading NABH’s 2025 Advocacy Priorities are parity, workforce, behavioral healthcare information technology, America’s ongoing addiction crisis, and the Institutions for Mental Diseases (IMD) exclusion.

“Demand for our services across all age groups nationwide has never been higher, as the country continues to face intense access challenges for both MH and SUD patients,” NABH notes in the resource. “Looking ahead, behavioral healthcare providers are armed with new telehealth tools that were expanded during the national response to the COVID-19 pandemic, which optimize access to care and the reach of the often limited behavioral healthcare workforce that continued to decrease during the crisis. Securing continued telehealth services is an important NABH goal.”

NABH will promote the 2025 Advocacy Priorities @NABHBehavioral on X and at the National Association for Behavioral Healthcare on LinkedIn. Please follow us on these platforms and help us promote your priorities!

House and Senate Budgets Take Shape as Medicaid Remains Vulnerable

House and Senate Republican leaders this week diverged on a path forward to enact a budget and President Trump’s domestic agenda.

House Speaker Mike Johnson (R-La.), responsible for uniting all factions within his slim majority, has pushed for a one-budget resolution. Meanwhile Senate Majority Leader John Thune (R-S.D.) wants two separate bills that would allow lawmakers to pass easier aspects of government funding – such as energy and border security – while the second bill would tackle more complicated issues, such as healthcare and taxes. Both chambers of Congress made progress on their respective bills this week.

In party-line vote of 11-10, the Senate Budget Committee on Wednesday evening passed a budget resolution to approve the fiscal framework for a package of energy, border security, and defense policy through the partisan budget reconciliation process. Senate Budget Chair Lindsey Graham (R-S.C.) framed the two-track Senate strategy as a backup plan if House Republicans fail to move swiftly on their own one-bill proposal. The Senate is expected to take up the budget resolution in several weeks.

Meanwhile, House Republicans passed their one-bill budget resolution in the House Budget Committee on Thursday. The House GOP budget resolution includes a floor of $1.5 trillion in spending cuts, a $4.5 trillion cap on tax cuts, and a $4 trillion extension of the debt limit. House GOP leadership expects to move the resolution to the House floor in late February. The resolution itself is nonbinding; however, it would unlock Republicans’ ability to bypass the Senate filibuster to move a massive domestic policy bill with President Trump’s legislative priorities.

As a result of the House GOP’s budget blueprint – which relies on spending cuts to offset a reconciliation bill – House Energy and Commerce Chair Brett Guthrie (R-Ky.) needs to find at least $880 billion in savings, including from the Medicaid program, which currently insures more than 70 million Americans. Per-capita allotments for Medicaid, which would produce the most savings, likely do not have enough support to pass in the House; however, Medicaid work requirements remain a focus for savings and are considered among the most politically feasible choices for Republicans. The nonpartisan Congressional Budget Office has estimated work requirements could save more than $100 billion over a decade.

NABH is communicating with Congress that work requirements must incorporate sufficient exceptions to ensure that individuals whose mental or substance use disorders prevent them from satisfying the requirements remain eligible for Medicaid enrollment and are not terminated from the program. These exceptions should reflect the enormous challenges that people with behavioral health conditions face, many of whom need treatment and cannot access it. Medicaid cuts remain a concern for moderate Republicans who have been working to avert significant cuts to that program.

Republicans in both chambers will eventually need to unite around one budget blueprint to be able to vote on a bill that isn’t subject to the Senate filibuster and can pass with 51 votes.

DEA and HHS Delay Buprenorphine Telehealth Rule Implementation

In line with President Trump’s regulatory freeze, the U.S. Drug Enforcement Administration (DEA) and HHS are delaying the implementation of a final rule issued last month that would allow providers to prescribe buprenorphine for opioid use disorder via telehealth (including audio-only) for up to six months before conducting an in-person medical evaluation.

The rule was originally scheduled to take effect on Feb.18, 2025 and is now planned for March 21, 2025.

DEA and HHS are also accepting comments on whether the effective date should be further delayed, as well as any other concerns about the rule.

This rule will partially make permanent the COVID-19 pandemic-era flexibilities for prescribing buprenorphine via telehealth without ever having conducted an in-person medical evaluation.

Trump Signs Executive Order to Establish ‘Make America Healthy Again Commission’

President Donald Trump this week signed an executive order establishing a “Make America Healthy Again Commission” chaired by newly confirmed HHS Secretary Robert F. Kennedy Jr.

The commission is responsible for assessing and providing a strategy on a host of health issues, including a directive to “identify and describe childhood chronic disease in America compared to other countries; assess the threat that potential over-utilization of medication, certain food ingredients, certain chemicals, and certain other exposures pose to children with respect to chronic inflammation or other established mechanisms of disease, using rigorous and transparent data, including international comparisons; assess the prevalence of and threat posed by the prescription of selective serotonin reuptake inhibitors, antipsychotics, mood stabilizers, stimulants, and weight-loss drugs; and more.

ICYMI: NABH’s Safe Connections Campaign Highlights Cyberaggression

NABH recently released and promoted two new resources about cyber-aggression as part of its Safe Connections campaign about healthy minds and social media habits for America’s youth.

Please visit our Youth Services page to access all of the Safe Connections resources and share our social media posts on LinkedIn and X.

NABH thanks Donald Grant, Ph.D., with Newport Healthcare, and the NABH Youth Services Committee for its work on this campaign.

ICYMI: NABH Analysis on How Medicaid Could Disrupt Behavioral Healthcare Access

Recently NABH sent all members an analysis explaining how several proposals could lower federal financial participation (FFP) in Medicaid.

These proposals include changing the current formula for Federal Medical Assistance Percentages, instituting caps to FFP at the state- or enrollee-levels (such as by transitioning Medicaid to a block grant), or limiting the existing safe harbor preventing a portion of state taxes on providers’ net patient revenue from being considered when calculating FFP.

Other recommendations have been made to institute work requirements for Medicaid beneficiaries. Click here to read the NABH Analysis from Dan Schwarz, NABH’s director of quality and addiction services.

Join Us in May for the 2025 Annual Meeting!

Please plan to join your peers and the NABH team at the Salamander Washington, DC from May 12-14 for this year’s NABH Annual Meeting: Behavioral Health is Everyone’s Concern: Constant Care, Changing Times.

Our thanks to this year’s Annual Meeting Program Committee, which approved this year’s theme. NABH Board Member Patricia Toole, M.A.S. from Hackensack Meridian Health Carrier Clinic chairs the Program Committee, which also includes NABH members Mary-Catherine Bohan, M.S.W. from Rutgers University Behavioral Health Care and Rhonda Ashley-Dixon, M.A. from Vanderbilt Psychiatric Hospital and Clinics.

Annual Meeting registration will open in late February. We look forward to seeing you in Washington!

Fact of the Week

A recent study published in JAMA Network Open found that every $100 invested in an employer-sponsored behavioral health program with fast access to psychotherapy and medication management was associated with a reduction in medical claims costs by $190. These findings suggest that expanding access to behavioral health care may be a financially viable cost-reduction strategy for health care buyers.

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

CEO Update 216

Written by Meghan Barrett on February 11, 2025. Posted in CEO Updates.

Senate Finance Committee Advances RFK, Jr.’s Nomination for HHS Secretary

The Senate Finance Committee on Feb. 4 advanced Robert F. Kennedy Jr.’s nomination to serve as secretary of the U.S. Health and Human Services Department (HHS).

President Donald Trump named Kennedy to lead HHS after Kennedy dropped his own presidential bid and endorsed Trump. Since then, Kennedy has overcome opposition from both Democrats and Republicans concerned about his views on vaccines, abortion, environmental regulation, food production and drug legalization.

The Senate panel voted 14-13 along party lines to advance Kennedy to a full Senate vote. During his confirmation hearing, Kennedy promised to work with senators to repeal the federal ban on Medicaid funding for Institutions for Mental Diseases following a question from Sen. Marsha Blackburn (R-Tenn.).

“This is a discriminatory exclusion, and it denies payment for medically necessary care based on the illness that is being treated, and it has perpetuated unequal coverage in mental healthcare,” Blackburn noted. “So, if you’re confirmed, when you’re confirmed, will you commit to working with me on repealing this discriminatory exclusion and ensuring equal access to mental health care for Medicaid beneficiaries?”

Kennedy answered yes. Congress has previously considered repealing or altering the IMD exclusion, but progress has stalled due to a historically high price tag. Advocates have said they hope this will change because the Congressional Budget Office’s latest estimate found eliminating the IMD exclusion for some or all behavioral healthcare treatments would cost between $7.7 billion and $38.4 billion — far lower than the 2016 proposal’s estimate of $40 billion to $60 billion.

Now the full Senate will decide whether Kennedy will lead HHS. A Senate floor vote has not been scheduled, although it is expected to occur soon.

Meanwhile, the physician and TV personality Mehmet Oz, M.D., M.B.A. has started meeting with senators to garner support for his nomination to lead the Centers for Medicare & Medicaid Services (CMS). The Senate Finance Committee will also decide whether Oz will lead CMS.

Concurrently, the Department of Government Efficiency, or DOGE, has been on-site at CMS to mine key systems for examples of what DOGE considers fraud or waste. The DOGE representatives have gained access to payment and contracting systems. It remains unclear how the DOGE personnel will use any data from the agency to combat any fraud.

In a 77-23 vote, the Senate confirmed former Rep. Doug Collins, a Georgia Republican, to lead the U.S. Veterans Affairs Department (VA). Only Democrats opposed the nominee, who will now inherit an agency that has historically struggled to provide quality healthcare to the millions of veterans it serves. During his confirmation hearing, Collins pledged to expand access to care outside the VA.

NASHP Releases Report on Behavioral Healthcare Workforce Strategies

The National Academy for State Health Policy (NASHP) this week released Key Strategies for Strengthening the Behavioral Health Workforce after the organization convened a multi-sector roundtable composed of policymakers, payors, providers, employers, and others who examined the issue.

The extensive report focused on six themes: 1) understanding the workforce you are building, 2) scaling effective treatment teams for greater impact, 3) better patient matching to need, 4) technological workforce extenders, 5) optimizing the unlicensed skilled workforce, and 6) payment and financing strategies.

Click here to read the full report.

MHA Report Examines Social Media and Youth Well-being

Mental Health America recently released Breaking the Algorithm: Redesigning Social Media for Youth Well-being, a report that explores how social media is affecting young people’s mental health, relationships, and daily lives.

The report gathers insights from more than 900 survey respondents, focus groups with young people, and conversations with youth co-researcher to analyze the dual nature of social media as both a connector and a source of harm, how algorithms shape youth experiences – often without their full understanding or consent –, and why it’s critical to empower young people with tools, education, and a voice in the systems that share their digital worlds.

Click here to read the full report.

ICYMI: NABH’s Safe Connections Campaign Highlights Cyber-aggression

ICYMI: NABH Analysis on How Medicaid Proposals Could Disrupt Behavioral Healthcare Access

Recently NABH sent all members an analysis explaining how several proposals could lower federal financial participation (FFP) in Medicaid.

These proposals include changing the current formula for Federal Medical Assistance Percentages, instituting caps to FFP at the state- or enrollee-levels (such as by transitioning Medicaid to a block grant), or limiting the existing safe harbor preventing a portion of state taxes on providers’ net patient revenue from being considered when calculating FFP.

Other recommendations have been made to institute work requirements for Medicaid beneficiaries. Click here to read the NABH Analysis from Dan Schwarz, NABH’s director of quality and addiction services.

Save the Date: Join Us in May for the 2025 NABH Annual Meeting!

Please plan to join your peers and the NABH team at the Salamander Washington, DC from May 12-14 for this year’s NABH Annual Meeting.

NABH will provide more details soon in future editions of CEO Update and in NABH Annual Meeting Alerts. We look forward to seeing you in Washington!

Fact of the Week

The Centers for Disease Control and Prevention reports the percentage of adults who used electronic cigarettes increased to 6.5% in 2023 from 4.5% in 2019.

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

CEO Update 215

Written by Meghan Barrett on January 31, 2025. Posted in CEO Updates.

Senate Committees Hold Hearings for HHS Secretary Nominee

The Senate Finance Committee and Senate Health, Education, Labor, and Pensions Committee held hearings on Wednesday and Thursday, respectively, to consider the nomination of Robert F. Kennedy Jr. for Secretary of Health and Human Services.

On issues related to behavioral health, Kennedy indicated a willingness to work with Congress on repealing Medicaid’s Institution for Mental Diseases exclusion, proposed to incorporate more training on substance use disorder treatment into graduate medical education for primary care providers, said that medications for substance use disorders should be available but are not the gold standard of treatment, and suggested that additional studies be conducted on the safety of antidepressants.

Prior to the hearings, Patrick Kennedy – former congressman and founder of The Kennedy Forum – expressed support for his cousin’s nomination with respect to substance use disorder treatment, saying that Robert F. Kennedy Jr. is open to multiple pathways to recovery, including medication.

The Senate Finance Committee is expected to vote on Kennedy’s nomination next week.

States’ Access to Medicaid Portals is Restored, but Uncertainty Remains with Federal Funding Pause

On Monday, the White House issued a memo directing federal agencies to temporarily pause spending on a broad swath of programs while their compliance with recent executive orders is reviewed. This coincided with an outage of portals for states to access Medicaid payments, prompting concern that the pause applied to federal Medicaid funding. The White House subsequently issued guidance clarifying that the pause did not apply to Medicaid, and access to portals was restored.

Nonetheless, uncertainty remains about the status of the funding pause; a judge temporarily blocked its implementation, after which the White House rescinded the memo that directed the pause but then later stated that the pause is still in effect.

NABH continues to monitor this situation as it evolves.

President Trump Issues Executive Order on Transgender Youth Services

President Trump issued an executive order on Tuesday aimed at limiting the use of gender-affirming care (i.e., hormones, hormone blockers, surgery) for youth under age 19 who are transgender or experience gender dysphoria.

This order directs federal agencies to ensure that medical institutions receiving research or education grants do not provide such services to youth, as well as consider other actions to prevent the availability of these services, which may involve conditions of participation for Medicare and Medicaid, essential health benefits requirements, and other policies. Among other things, the order also directs TRICARE and federal employees’ health plans to exclude coverage of these services for youth and requires the publication of best practices for youth experiencing gender dysphoria.

NABH is Preparing a Response to the Proposed Rule on Telehealth for Controlled Substances

The Drug Enforcement Administration (DEA) recently proposed a rule regarding the prescribing of controlled substances via telehealth without an in-person evaluation (a final rule specific to prescribing buprenorphine for opioid use disorder via telehealth was also released). The proposed rule includes a variety of concerning items, such as substantial limitations on prescribing schedule II medications, an expansive prescription drug monitoring program review requirement, and the need to obtain multiple registrations. For a summary of the proposed rule, please check out NABH’s issue brief.

NABH plans to submit a comment letter outlining concerns with the proposed rule. To inform its development, we would like to meet with interested members to discuss major concerns. If you would like to be involved, please reach out to Dan Schwartz.

The Joint Commission Updates Requirements for Behavioral Healthcare Providers

The Joint Commission made updates to emergency management and infection control requirements in the behavioral healthcare and human services accreditation program, which will take effect on July 1, 2025. For infection control, a fully revised chapter will replace the current requirements, in alignment with updates for other hospitals; see this reference guide on changes to standards. For emergency management, the updates seek to provide more clarity on hazard vulnerability analyses, leadership involvement, and staff education and training.

While the NABH Quality Committee will review these updates, all members are encouraged to email any questions or concerns to Rochelle Archuleta.

House Schedules Hearing on Illicit Drug Threats

The House Energy and Commerce Committee’s Health Subcommittee scheduled a hearing on existing and emerging illicit drug threats for February 6. The announcement highlights xylazine and nitazenes as concerning issues and mentions that the hearing will help advance the subcommittee’s previous work to “crack down on drug traffickers; provide support to those suffering from substance use disorder; and restore hope to families, law enforcement, and emergency medical personnel.”

Up to now, the federal government has formally designated two emerging drug threats: (1) methamphetamine, and (2) fentanyl adulterated or associated with xylazine.

FDA Approves New Non-Opioid Pain Medication

On Thursday, the Food and Drug Administration (FDA) approved Journavx (suzetrigine), a first-in-class non-opioid oral pain medication indicated for adults with moderate to severe pain. Journavax works by inhibiting the transmission of pain signals in the peripheral nervous system before reaching the brain, which could be associated with a lower risk of dependence relative to opioids.

Researchers Find a Decline in Availability of Some Crisis Services Since 988 Launch

In July 2022, the 988 Suicide and Crisis Lifeline was created to make it easier for people experiencing behavioral health crises to access support than the previous ten-digit dialing code. However, a study found that after 988 launched, several crisis services had less availability nationally: emergency psychiatric walk-in services, mobile crisis response, and suicide prevention services. The greatest decrease was for emergency psychiatric services, a trend that began prior to 988’s launch. Meanwhile, there was an increase in the availability of peer support services.

Across states, there were significant differences in changes to crisis service availability, which may be attributable to different funding levels or varying degrees of preparedness for 988. There were also a variety of facility-level factors associated with greater crisis service availability, such as accepting Medicaid or private insurance.

Ultimately, the authors indicated that “the lack of meaningful growth in most crisis services may limit the long-term success of 988, in particular if callers feel that reaching out to 988 fails to result in access to appropriate sources of care.”

Study Shows Promising Results from Emergency Department Methadone Bridge Clinic

Findings from a new study indicate that emergency departments have the potential to facilitate uptake of methadone for patients with opioid use disorder. Among a small sample of patients initiating methadone at an emergency department-based bridge clinic, 56% completed linkage to a partner Opioid Treatment Program, and 100% of linked patients were retained in treatment at 30 days.

This clinic leveraged a federal rule that allows non-Opioid Treatment Program clinicians to initiate patients with opioid use disorder on methadone by dispensing up to a three-day supply of medication.

Save the Date: Join Us in May for the 2025 NABH Annual Meeting!

Please plan to join your peers and the NABH team at the Salamander Washington, DC from May 12-14 for the 2025 NABH Annual Meeting.

NABH will provide more details soon in future editions of CEO Update and in NABH Annual Meeting Alerts. We look forward to seeing you in Washington!

Fact of the Week

A new JAMA study suggests that mindfulness groups may be useful during opioid use disorder treatment, especially for patients with residual opioid craving while they are prescribed buprenorphine.

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

CEO Update 214

Written by Meghan Barrett on January 24, 2025. Posted in CEO Updates.

Second Trump Administration Health Policy Priorities Start to Take Shape

The newly installed Trump administration’s health policy priorities and the senior officials designated with implementing them are coming into focus.

Attorney Robert F. Kennedy, Jr. is making the rounds with senators before his confirmation process to lead HHS. Kennedy’s first nomination hearing is scheduled for Wednesday, Jan. 29 before the Senate Finance Committee, with the Senate Health, Education, Labor and Pensions (HELP) Committee scheduled to meet with him the next day. Sen. Mike Crapo (R-Idaho) chairs the Senate Finance Committee, which ultimately will vote whether to advance Kennedy’s nomination to the Senate floor.

Meanwhile, the administration has announced candidates for senior staff positions at HHS. These include: John Brooks, a first-term Trump health official who is running the transition’s HHS landing team, will return as chief operating officer at the Centers for Medicare & Medicaid Services (CMS); Drew Snyder is expected to run the CMS’ Medicaid program; Abe Sutton is in line to lead the CMS Innovation Center; Chris Klomp will helm the Medicare program; and Heather Flick, a former senior HHS official during the first Trump term, will return as chief of staff to Kennedy if his appointment is confirmed.

At the Office of Management and Budget (OMB), Don Dempsey is expected to return to the agency as associate director overseeing healthcare programs. Dempsey is currently vice president of policy and research at the Better Medicare Alliance.

Policy decisions and pronouncements are also moving swiftly. At HHS, a recent agency-wide memo directs officials to refrain from issuing any guidance, regulation, notice or grant announcement until it’s been approved by a presidential appointee. The freeze also applies to press releases, social media posts, website posts, communications via listservs and any speaking engagements.

President Trump’s first moves on Medicaid and the Affordable Care Act signal his administration’s willingness to make major changes to the government programs. Trump’s first administration approved several waivers to install Medicaid work requirements, which critics said would only lead to coverage losses. Executive orders for healthcare typically instruct agencies; to date, Trump’s orders only rescind the earlier Biden administration orders and don’t explain how policies should be addressed.

On Inauguration Day, Trump issued an Executive Order asking all agencies to refrain from issuing a rule until it has been reviewed and approved by a Trump administration department head, and to immediately withdraw rules that have been sent to the Office of the Federal Register (OFR) but have not been published. Department heads were also directed to postpone the effective data for any rules published in the Federal Register or that have been issued but have not taken effect so that they can be reviewed. Agencies might also consider reopening comment periods and potentially delaying the rules beyond 60 days.

That Executive Order presumably includes the 2026 Medicare Advantage and Part D rate notice and 2026 draft Part D redesign guidance released Jan. 10, and the 2026 Notice of Benefit and Payment Parameters finalized on Jan. 13 that became effective two days later.

Also unknown is if the Trump administration will choose to fund and implement the Biden Administration’s September 2024 updated parity rule, which established more stringent protocols, amended existing provisions, and added new ones to implement the Mental Health Parity and Addiction Equity Act (MHPAEA).

NABH is contacting new administration officials to support the rule and working with partners to continue supporting the landmark 2008 law’s implementation.

HHS, DOL, and Treasury Send 2024 MHPAEA Report to Congress

HHS, the U.S. Labor Department, and U.S. Treasury Department have released the 2024 MHPAEA Report to Congress, which highlights both progress and continued problems implementing the 2008 parity law.

A fact sheet from the three agencies noted that in fiscal year (FY) 2023, CMS received 43 MHPAEA-related complaints through the “No Surprises” Help Desk and investigated and closed 599 health plan investigations in FY 2023. Of those investigations, 457 involved issuers offering fully insured group or individual health insurance coverage and 142 involved self-funded non-federal governmental plans.

According to a report from Thomson Reuters’ Westlaw Today, a key announcement from the 2024 report is the three agencies’ indication they will release a comparative analysis (CA) with written explanations and supporting documents to show how a plan applied factors and standards in designing non-qualified treatment limitations (NQTLs) consistent with the 2024 final regulations.

“The sample CAs will assess various aspects of how NQTLs are designed and applied,” the Westlaw summary said. “In turn, this will help determine whether any processes, strategies, evidentiary standards, or other factors used in designing and applying the NQTL for MH/SUD benefits are comparable to—and not applied more stringently than—those for M/S benefits.”

ICYMI: NABH Analysis on How Medicaid Proposals Could Disrupt Behavioral Healthcare Access

Earlier this week NABH sent all members an analysis explaining how several proposals could lower federal financial participation (FFP) in Medicaid.

These proposals include changing the current formula for Federal Medical Assistance Percentages, instituting caps to FFP at the state- or enrollee-levels (such as by transitioning Medicaid to a block grant), or limiting the existing safe harbor preventing a portion of state taxes on providers’ net patient revenue from being considered when calculating FFP.

Other recommendations have been made to institute work requirements for Medicaid beneficiaries. Click here to read the NABH Analysis from Dan Schwartz, NABH’s director of quality and addiction services.

Safe Connections: Cyber-aggression Resources

NABH this week released and promoted two new resources about cyber-aggression as part of its Safe Connections campaign about healthy minds and social media habits for America’s youth.

Please visit our Youth Services page to access all of the Safe Connections resources and share our social media posts on LinkedIn and X.

NABH thanks Donald Grant, Ph.D., with Newport Healthcare, and the NABH Youth Services Committee for its work on this campaign.

Deadline is Today: CMS and Abt Seek Nominations for TEP to Design a Patient Assessment Instrument

CMS and its contractor Abt, a research and consulting firm, are assembling a TEP that will provide guidance on clinical and operational issues to design and implement a patient assessment instrument (PAI).

Abt seeks a mix of clinical and operational leaders, including participants with direct knowledge of the patient assessment process. Please refer to the TEP Charter for more information. The TEP will meet periodically for up to four years. All meetings will be held virtually, including the first meeting in February or March 2025.

Nomination packets must include a signed TEP nomination form, letter of interest, and CV, all of which must be e-mailed to IPF-PAI_testing@abtglobal.com with “Nomination” in the subject line. The deadline for applications is today, Jan. 24, 2025 at 5 p.m. ET.

Save the Date: Join Us in May for the 2025 NABH Annual Meeting!

Fact of the Week

A new study published in JAMA Network found that interventions in young people (aged 10 to 24 years old) had a significant short-term association with improvements in stigma-related knowledge, attitudes, and behaviors and help-seeking attitudes and intentions.

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

CEO Update 213

Written by Meghan Barrett on January 17, 2025. Posted in CEO Updates.

HHS and DEA Partially Extend COVID-19-Era Telehealth Flexibilities

HHS and the U.S. Drug Enforcement Administration (DEA) on Wednesday proceeded with rulemaking to partially extend COVID-19 pandemic-era flexibilities for prescribing controlled substances via telehealth without ever having conducted an in-person medical evaluation.

The federal agencies introduced a final rule focused on buprenorphine for opioid use disorder (OUD), and a notice of proposed rulemaking (NPRM) for special registrations focused on all Schedule II-V controlled substances.

The final rule will allow practitioners to prescribe buprenorphine for OUD for up to six months via audiovisual or audio-only telehealth before conducting an in-person medical evaluation, subject to certain requirements. This rule is likely to become effective on Feb. 16, 2025.

The NPRM would create multiple special registrations for practitioners to prescribe controlled substances via telehealth indefinitely, including a Telemedicine Prescribing Registration covering Schedules III-V; and an Advanced Telemedicine Prescribing Registration covering Schedules II-V, which would be limited to practitioners with specific specialties (e.g., psychiatry, pediatrics) or who work in long-term care facilities. In addition, practitioners would generally be required to obtain a State Telemedicine Registration for each state in which their patients are located.

The NPRM includes various requirements for practitioners, such as noting the special registration number on prescriptions, expansive PDMP checks, reporting certain prescribing information to DEA annually, being physically located in the same state as a patient when issuing a Schedule II prescription, limiting the number of special registration Schedule II prescriptions to less than 50% of the total number Schedule II prescriptions issued each month, and using audiovisual technology (there is an exception for buprenorphine for OUD, whereby audio-only visits are permitted after a telehealth evaluation with audiovisual technology).

NABH staff will coordinate with relevant NABH committees to develop a response to the NPRM. We expect that comments will be due by March 18, 2025.

Please read NABH’s Issue Brief for more details.

MedPAC Supports Eliminating Medicare’s 190-day Lifetime Limit

The Medicare Payment and Advisory Commission (MedPAC) this week unanimously supported a draft recommendation to Congress to eliminate both Medicare’s 190-day lifetime limit on covered days in freestanding inpatient psychiatric hospitals, as well as the policy that reduces the cap on covered days for patients who received similar care during the 150 days preceding Medicare eligibility.

MedPAC reported that while only 50,000 Medicare beneficiaries were at or near the 190-day limit in 2023, this group of patients is “highly vulnerable” relative to the general Medicare population. The Commission projects that changing these 60-year-old policies would increase access to care and cost approximately $50 million in additional federal spending per year.

NABH expects the Commission to vote on the measure this month and include the recommendation in the Commission’s annual March report to Congress. The Commission will report its related research on the quality of care and readmissions within 30 days of discharge for these hospitals this spring.

HHS Releases Report on Private Equity in Healthcare

HHS this week released a report highlighting the effects of increasing consolidation in America’s healthcare markets and recent influx of private equity (PE) and other private investors active in the healthcare space.

The U.S. Justice Department and the Federal Trade Commission contributed to the nearly 40-page report after the three federal agencies announced a tri-agency collaboration in December 2023 to promote competition in healthcare markets. As part of that effort, the three agencies released a request for information in March 2024 to understand how certain healthcare market transactions among health systems, private insurers, PE funds, and other private investors may increase consolidation and compromise patients’ health, quality of care, and affordability—and may also threaten workers’ safety, satisfaction, and wages while creating taxpayer burden.

One of the key findings of the report showed through case studies how PE firms loaded hospitals with debt, sold the hospitals’ underlying assets, and paid investors through dividends and financially engineered sales, resulting in negative consequences such as bankruptcy, closure of facilities and service lines, staffing shortages, and patient safety and quality concerns.

The report also included policy recommendations, such as enhancing ownership transparency; increasing disclosures of mergers & acquisitions in healthcare by lowering reporting thresholds, requiring review and approval, and empowering relevant authorities with data and resources needed to conduct review of health care transactions; pursuing further enforcement actions to halt hospital mergers and industry rollup; and continuing to improve data sharing and other collaboration across agencies, Congress, and state and local authorities in an all-government approach to promote competition.

SAMHSA Releases Updated National Behavioral Health Crisis Care Guidance

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week released updated National Behavioral Health Crisis Care Guidance that includes three documents: the 2025 National Guidelines for a Behavioral Health Coordinated System of Crisis Care, Model Definitions for Behavioral Health Emergency, Crisis, and Crisis-Related Services, and Mobile Crisis Team Services: An Implementation Toolkit Draft.

The updated National Guidance reflects the nation’s transition to the 988 Suicide & Crisis Lifeline in 2022 and other progress and emerging needs related to behavioral health crisis care. It also provides a framework for transforming behavioral health crisis care systems in communities throughout the United States, at a time when the country continues to face record high rates of suicide and overdose.

Reminder: CMS and Abt Seek Nominations for TEP to Design a Patient Assessment Instrument

Update: CMS Launches Innovation in Behavioral Health Model in Four States

At the start of January, the Centers for Medicare & Medicaid Services (CMS) launched an eight-year Innovation in Behavioral Health (IBH) model with the Medicaid agencies in Michigan, New York, Oklahoma, and South Carolina to develop managed care payments for integrated physical and mental healthcare services.

These states will partner with managed care organizations and outpatient providers, including physician practices, opioid treatment programs, hospital- or university-affiliated outpatient behavioral healthcare providers, safety net providers and others. Behavioral healthcare provider participants will conduct patient screenings. assessments of behavioral and physical health needs, and other care management functions. Participants will be eligible to receive infrastructure funding and risk-adjusted per-person-per-month integration payments in years two through five, followed by integration payments, performance-based payments and possible bonuses in years four through eight.

The infrastructure funding will range from $100,000 to $200,000 per participant and can be used on staffing, information technology (IT,) and workflow changes needed to implement the model, including the adoption and upgrading of electronic health record systems and telehealth tools.

To learn more, please refer to the Notice of Funding Opportunity, FAQs, and fact sheet. Those who are interested may register for CMS’ listserv to receive ongoing updates and/or issue questions to CMS’ healthcare strategy team.

Congratulations to 2023 NABH Board Chair Harsh Trivedi on Joint Commission Appointment

NABH congratulates 2023 NABH Board Chair Harsh Trivedi, M.D., M.B.A on his recent appointment to The Joint Commission’s Board of Commissioners on Jan. 1.

Trivedi, president and CEO of Sheppard Pratt, was one of six new members named to the Commission’s governing body, which advises on strategies to drive organizational success.

Congratulations, Harsh!

Coming Soon: NABH Developing Advocacy Document on Potential Medicaid Changes

NABH is developing an advocacy document to educate policymakers about the risks of proposed changes to Medicaid financing and eligibility.

The analysis will describe how state efforts to offset reduced revenue could exacerbate existing challenges with low reimbursement and narrow networks, and it will outline potential issues with applying work requirements to people with behavioral health conditions.

NABH’s resource will emphasize the critical need for Medicaid as a funding source for behavioral healthcare organizations, particularly Opioid Treatment Programs.

Save the Date: Join Us in May for the 2025 NABH Annual Meeting!

Fact of the Week

A National Institutes of Health-funded study of nearly 10,000 adolescents has identified distinct differences in the brain structures of those who used substances before age 15 compared with those who did not. Many of these structural brain differences appeared to exist in childhood before any substance use, suggesting they may play a role in the risk of substance use initiation later in life, in tandem with genetic, environmental, and other neurological factors.

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

CEO Update 212

Written by Meghan Barrett on January 10, 2025. Posted in CEO Updates.

NABH Welcomes Jim Shaheen as 2025 Board Chair

NABH is pleased to welcome New Season CEO Jim Shaheen as chair of the NABH Board of Trustees for 2025.

A longtime NABH member, Jim has served NABH in many capacities, including currently as vice president of the NABH Education and Research Foundation and member of the Addiction Treatment Committee, and previously as treasurer of the NABH Board of Trustees.

Jim leads New Season, a medication-assisted treatment company that serves more than 32,000 patients in 88 clinics located in 20 different states. Prior to his current role, Jim founded Shaheen Strategic Investments (SSI) to provide a vehicle for the Shaheen family to grow and expand its holdings in a variety of businesses. Before that, Shaheen founded the national healthcare company Strategic Behavioral Health, a chain of private psychiatric and substance use hospitals nationwide. Headquartered in Memphis, Tenn., the company expanded to 13 hospitals in 8 states.

With more than 33 years of behavioral healthcare experience, Shaheen has helped a variety of small and large companies grow and expand services to meet the demands of behavioral healthcare services in many communities. Currently he serves as chairman of the UT Health Science Center College of Medicine Board of Visitors.

Jim holds a master’s degree in organizational communications from Murray State University and an undergraduate degree in Therapeutic Recreation, also from Murray State University.

The association’s Washington-based team is eager to work with Jim this year and appreciates his passion and leadership for both the behavioral healthcare segment and the association.
In addition, the NABH team is very grateful to Rutgers University Behavioral Health Care CEO Frank Ghinassi, Ph.D., A.B.P.P., for his service as NABH’s 2024 board chair and all he does to promote NABH’s priorities and the association’s vision and mission. Thank you, Frank!

SAMHSA Updates Contingency Management Incentive Limit in New Advisory

In a new advisory, the Substance Abuse and Mental Health Services Administration (SAMHSA) has raised the annual contingency management (CM) incentive limit to $750 per patient from $75 per patient for entities that implement CM using funds from the State Opioid Response and Tribal Opioid Response grant programs.

The advisory also outlines safeguards for grantees implementing CM that align with recommendations HHS outlined in a November 2023 report.

This policy change is a big win for the addiction-treatment community and NABH, which has led advocacy efforts for several years to revise policies that previously limited the uptake of this evidence-based treatment, especially given the rise in stimulant-involved overdose deaths.

Please Share Your Feedback on CMS’ New Cybersecurity Rule

The Centers for Medicare & Services (CMS) recently proposed a rule that seeks to strengthen cybersecurity protections for electronic health information.

The proposed rule would modify the Health Insurance Portability and Accountability Act’s (HIPAA) security rule, which establishes national standards to protect individuals’ electronic health information by entities such as health plans, health care clearinghouses, and healthcare providers.

Last February’s cyberattack on UnitedHealth’s medical claims processor – the largest attack ever reported, which affected the private health information of approximately 100 million people – prompted CMS to propose this regulation.

Both lengthy and complex, the proposed rule includes mandatory and voluntary cybersecurity measures, including updating the HIPAA security rule, that would affect NABH member operations, including:

Requiring written documentation of all HIPAA security policies, procedures, plans, and analyses;
Updating definitions and revising implementation specifications to reflect changes in technology and terminology;
Adding specific compliance time periods for many existing requirements;
Requiring the development and revision of a technology-asset inventory and a network map that illustrates the movement of patient health information throughout providers’ electronic information system(s), at least once every 12 months;
Requiring more specific risk analysis protocols; and
Multiple additional provisions.

Please read the agency’s fact sheet for more information.

NABH encourages members to e-mail Rochelle Archuleta soon to help identify the provisions that would have the greatest effects on your operations and all other concerns and questions. Your feedback will help NABH prepare the association’s comment letter before CMS’ March 7^th deadline.

CMS and Mathematica Seek Experts for TEP on Quality Reporting and Payment

CMS and its contractor Mathematica, a research and data analytics consultancy, seek nominations for a Technical Expert Panel (TEP) to provide information about new and existing measures for CMS quality reporting and payment programs.

This work falls under Mathematica’s Behavioral Health Measures Development and Inpatient and Outpatient Measure Maintenance (BHIOMM) project. The BHIOMM TEP’s objective is to provide feedback and offer opinions on the identification, development, specification, testing, maintenance, re-evaluation, and implementation of health-related quality measures used in CMS’ quality programs.

Click here for more information. The deadline for nominations is next Wednesday, Jan. 15, 2025. Please contact BHIOMMmeasures@mathematica-mpr.com if you have questions.

CMS and Abt Seek Nominations for TEP to Design a Patient Assessment Instrument

NABH Developing Advocacy Document on Potential Medicaid Changes

ICYMI: NABH Launches ‘Safe Connections’ to Promote Awareness About Youth Mental Health

NABH recently launched Safe Connections, a campaign intended to educate policymakers, parents, and the public about the effects of social media on our nation’s youth and to provide tools and resources to help keep kids safe online.

The NABH Youth Services Committee, under the direction of Committee Chair Jameson Norton, M.B.A., FACHE, chief operating officer at Newport Healthcare, oversaw the campaign’s vision and purpose, and Donald Grant, Ph.D., with Newport Healthcare, helped developed the campaign’s resources.

Please visit our Youth Services landing page to access our first two resources: Youth Social Media Use and Mental Health and Misinformation, Malinformation, Disinformation, and Fake News. The page also includes the American Psychological Association’s recent recommendations about healthy teen video viewing that Don Grant also helped to develop.

NABH will promote the campaign’s resources on X and LinkedIn and will update the Youth Services page to include social media messages for you and your teams to share.

Please be sure to look for new resources in the future, starting with two fact sheets about cyberaggression that NABH will release this month.

Fact of the Week

After declining significantly during the COVID-19 pandemic, substance use among adolescents has continued to hold steady at lowered levels for the fourth year in a row, according to the latest results from the National Institutes for Health-funded Monitoring the Future Survey.

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

CEO Update 211

Written by Meghan Barrett on December 20, 2024. Posted in CEO Updates.

NABH Launches ‘Safe Connections’ to Promote Awareness About Youth Mental Health

NABH on Thursday launched Safe Connections, a campaign intended to educate policymakers, parents, and the public about the effects of social media on our nation’s youth and to provide tools and resources to help keep kids safe online.

The NABH Youth Services Committee, under the direction of Committee Chair Jameson Norton, M.B.A., FACHE, chief operating officer at Newport Healthcare, oversaw the campaign’s vision and purpose, and Donald Grant, Ph.D., with Newport Healthcare, helped developed the campaign’s resources.

Please visit our Youth Services landing page to access our first two resources: Youth Social Media Use and Mental Health and Misinformation, Malinformation, Disinformation, and Fake News. The page also includes the American Psychological Association’s recent recommendations about healthy teen video viewing that Don Grant also helped to develop.

NABH will promote the campaign’s resources on X and LinkedIn and will update the Youth Services page to include social media messages for you and your teams to share.

Please be sure to look for new resources in the future, starting with two fact sheets about cyberaggression that NABH will release in January.

NABH 2025 Board Election Ballots Due Tuesday, Dec. 31!

On Dec. 16, NABH e-mailed system members an attachment with NABH Board of Trustees candidate profiles and a ballot to elect new members to the 2025 Board.

If you haven’t yet, please vote for the open NABH Board Chair-Elect position and two available Board seats; sign the ballot; scan it; and send it to nabh@nabh.org or maria@nabh.org no later than Tuesday, Dec. 31, 2024.

Please note your ballot is not valid without a signature. New Board members and the Board Chair-elect will take office in January 2025.

Government Shutdown Likely as Lawmakers Fail to Reach Agreement

The fate of a Continuing Resolution (CR) to fund the government remains uncertain as House and Senate leaders continue to fall short on reaching a spending bill agreement while the deadline looms.

The original CR would have funded the government through March 14, 2025 and included a one-year farm bill extension, $100 billion in disaster relief, $30 billion in disaster and economic assistance for farmers, and, most critical for NABH members, the renewal of expiring healthcare programs and a robust package of healthcare policies.

Both the House and Senate must pass a bill to fund the federal government past the deadline of 12:01 a.m. on Saturday before it heads to the White House for President Biden’s signature. As of this writing, lawmakers haven’t charted a path forward; however, it appears likely they will vote on a “straight CR,” dropping most, if not all, of the additional funding measures, including healthcare extenders.

Lawmakers had agreed to extend through 2026 pandemic-era telehealth rules, a 2.5% payment boost for physicians in Medicare, a one-year delay of cuts to disproportionate-share hospitals, and an extension for five years of the opioid-fighting SUPPORT Act, which expired more than a year ago. Policymakers did not include the Modernizing Opioid Treatment Access Act (MOTAA) in this package.

It is unclear what healthcare provisions will be included in another CR, and remaining provisions would have to be addressed in the 119^th Congress.

NABH has urged Members of Congress to pass the current CR, fully reauthorize the SUPPORT Act, and extend critical telehealth flexibilities that are set to expire.

In other year-end congressional developments, the House Veterans Affairs Subcommittee on Health held a legislative hearing to review numerous bills, most of which dealt with the shortfall in veterans’ access to care and specifically the Veterans’ Affairs Department’s (VA) efforts to limit access to care, including behavioral healthcare through the Community Care Program, established with passage of the Mission Act of 2018.

VA Committee Chairman Mike Bost (R-Ill.) spoke in favor of his recently introduced legislation,
H.R. 10267 Complete the Mission Act of 2024, which would safeguard (VA) community-based healthcare access by codifying current access standards and would require VA to publish their wait times for all VA medical centers, setting a baseline expectation for timeliness of care. The bill would also establish a defined access standard for the provision of residential substance use treatment, recognizing that time is of the essence when a veteran in an addiction crisis decides help is needed.

NABH president & CEO Shawn Coughlin submitted a statement for the record as part of the committee’s proceedings. “We share our members’ growing concern that Veterans Affairs (VA) gatekeepers have presented barriers to veterans receiving the appropriate level of behavioral healthcare services within the amount of time the Mission Act of 2018 promises them,” Coughlin said. “As we understand, veterans who need residential treatment services have faced wait times for services that far exceed the 28-day limit for specialty care, making them eligible to seek community care services. Even then, however, veterans face wait times for behavioral healthcare services that average about two weeks, according to the Government Accountability Office. America’s veterans did not wait to serve our country. We should not make them wait for the behavioral healthcare services they need.”

Chairman Bost intends to reintroduce the Complete the Mission Act in the 119^th Congress, where both the House and Senate VA Committees will renew scrutiny over the VA’s Community Care System.

Meanwhile in the Senate, S. 1351, the Stop Institutional Child Abuse Act, led by Sens. Jeff Merkley (D-Ore.) and John Cornyn (R-Texas) passed in both the Senate HELP Committee and in the full Senate by Unanimous Consent on Dec, 11. The House passed the bill by a vote of 373 – 33 and it now heads to the President Biden’s desk.

Introduced in April 2023, the legislation is also known as the “The Paris Hilton Bill” because of the activist’s advocacy on the legislation that will purportedly increase transparency in youth residential treatment facilities. The original bill would have established a federal work group on Youth Residential Programs to improve the dissemination and implementation of best practices regarding health and safety, but it was amended to direct the National Academy of Sciences (NAS) to issue a report no later than three years after the bill’s enactment and every two years after for a period of 10 years to support the development and implementation of education and training resources for professional and paraprofessional personnel in the fields of healthcare, law enforcement, judiciary, social work, child protection, education, child care, and other relevant fields.

Finally, the Kids Online Safety Act (KOSA) made it close to the finish line but will not pass before this Congress adjourns after being derailed by big tech companies. KOSA would have required social media companies to remove product features doctors believe harm kids’ health.

The Senate passed the bill after several redrafts by sponsors to accommodate First Amendment concerns raised by opponents. In September, the House Energy and Commerce Committee advanced a weak version of the bill; however, it was never scheduled for consideration on the House floor. The U.S. Surgeon General and attorneys general in 35 states, as well as physician groups, including the American Academy of Pediatrics and the American Psychological Association, have all called on Congress to pass KOSA. House Speaker Mike Johnson (R-La.) has promised to address kids’ online safety in the new term.

Call for Behavioral Healthcare Clinicians to Help Develop IPF Patient Assessment Instrument

CMS and its contractor Abt Global are recruiting psychiatrists, psychologists, nurses and other behavioral healthcare clinicians to help develop and test a draft patient assessment tool known as the Inpatient Psychiatric Facility Patient Assessment Instrument (IPF-PAI).

CMS’ primary objectives for this significant policymaking process are to improve both quality of care and payment accuracy. Eventually, the agency plans to require that a common PAI be used during admission and discharge of every IPF patient.

NABH has confirmed with CMS that our members will have multiple opportunities to weigh in on this project. We strongly urge your participation in the alpha stage, during which Abt will identify the PAI data elements to field-test – a critical stage that requires real-world input from our field.

To join the alpha stage of IPF PAI development, please apply here by Dec. 30, 2024.

SAMHSA Releases Toolkit Before First SUD Treatment Month

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released a toolkit for the first Substance Use Disorder Treatment Month to be observed in January 2025.

Substance Use Disorder Treatment Month raises awareness of the benefits and availability of evidence-based treatments for people with a substance use disorder; addresses barriers to treatment, including stigma; and normalizes seeking help.

The toolkit includes information about weekly themes, social media graphics and messaging, a webinar background, and resources that public health organizations, treatment providers, professional associations, and others can use to spread awareness of Substance Use Treatment Month.

Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Policymakers have expressed particular interest in our aggregate estimate on days of uncompensated charity care, as well as the length of delayed health plan responses to prior-authorization requests.

To support this advocacy push, we strongly encourage all NABH members to submit data to the portal. Please contact Emily Wilkins with questions about the data metrics that we are collecting and/or the data-submission process.

Fact of the Week

At the population level, pregnant and parenting adolescents of all genders are at a greater risk than adults for mental health problems during and after the perinatal period, according to a recent study in the journal Health Affairs. The American Academy of Pediatrics recommends that pediatricians screen adolescent mothers and fathers for depression and high stress levels as part of routine well-child care.

Happy Holidays from NABH!

NABH will not publish CEO Update on the next two Fridays and will resume on Friday, Jan 10. The entire NABH staff wishes you, your families, and your teams a very happy, healthy, and safe holiday season!

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

CEO Update 210

Written by Meghan Barrett on December 20, 2024. Posted in CEO Updates.

NABH Welcomes Dan Schwartz as New Director of Quality and Addiction Services

NABH is pleased to welcome Dan Schwartz as the association’s new director of quality and addiction services, effective this past Monday, Dec 9.

Dan brings to NABH a range of experiences in federal agencies related to addiction services, including most recently in his role as a senior behavioral health policy analyst in the Office of the Assistant Secretary for Planning and Evaluation (ASPE) at the U.S. Department of Health and Human Services (HHS).

In that role, Dan engaged in federal policymaking efforts by providing subject matter expertise about the delivery, financing, and regulation of behavioral health services, with an emphasis on the substance use disorder care continuum, controlled substances, and various mental health topics.

Dan also served as the staff lead for the HHS Workgroup on Implementation Strategies for Contingency Management; co-led a workgroup that supported developing legislative proposals related to behavioral health; and was a lead analyst for developing and implementing the HHS Overdose Prevention Strategy.

“We are excited to have Dan join our team,” said NABH President and CEO Shawn Coughlin. “He brings energy, experience, and enthusiasm to a critical role in our association.”

Prior to working at ASPE, Dan worked at the White House Office of National Drug Control Policy and the Substance Abuse and Mental Health Services Administration.

Dan earned a master’s degree in public health from Johns Hopkins University, where he was a Bloomberg Fellow in Addiction & Overdose, and a bachelor’s degree in public health from George Washington University.

ADAW Includes NABH Statement About OTPs in Article Responding to Recent NYT Story

The upcoming edition of the publication Alcohol and Drug Abuse Weekly (ADAW) includes a statement NABH posted to its website last weekend in response to a story in The New York Times (NYT) on Dec. 7 that did not provide a full and fair description of opioid treatment programs (OTPs).

“OTP facilities play a vital role in addressing the nation’s opioid and addiction crises, and it is imperative that we continue to support providers who do this important work so people in need can immediately access the personalized care, treatment options, and ongoing support services they need to achieve long-term recovery,” NABH said in its statement, which the association sent to members in an NABH Alert on Monday, Dec. 9.

ADAW also included responses and statements from The New York Times, NABH member Acadia Healthcare, and the National Association of Addiction Treatment Providers in its latest issue.

NABH and Other Groups Urge CMS to Strengthen MHPAEA Requirements in Medicaid & CHIP

NABH is one of 67 organizations that sent a recent letter to the Centers for Medicare & Medicaid Services (CMS) recommending ways the agency can strengthen the Mental Health Parity and Addiction Equity Act’s (MHPAEA) Medicaid and Children’s Health Insurance Program’s (CHIP) requirements.

The seven-page letter urges CMS to implement a host of measures, such as aligning the Medicaid MHPAEA regulations with those in private insurance and adopting the six-step comparative analysis framework for these templates (codified in the Consolidated Appropriations Act of 2021); strengthening enforcement provisions of MHPAEA in Medicaid and CHIP; amending the templates to require separate analysis and reporting of mental health and substance use disorder; and requiring the collection and evaluation of relevant outcome data to assess MHPAEA compliance in operation.

“We would encourage CMS to, at a minimum, post summary documents of these analyses in plain language so Medicaid enrollees and their authorized representatives can get meaningful information about whether and how their plan is in compliance with MHPAEA,” the letter concluded. “These summaries should be accompanied by additional instructions for consumers on how they can get claims processed or reprocessed when a violation has been identified, and how they can enforce their rights if they believe they have been subject to discrimination.”

Call for Behavioral Healthcare Clinicians to Help Develop IPF Patient Assessment Instrument

NIMH to Host Webinar on Youth Suicidal Behaviors on Monday, Dec. 16

The National Institute of Mental Health (NIMH) will host an hourlong webinar about youth suicidal behaviors this Monday, Dec. 16 starting at 2 p.m. ET.

NIMH Acting Director Shelli Avenevoli, Ph.D., and researcher Arielle H. Sheftall, Ph.D. will examine current trends, risk factors, and protective strategies in youth mental health. The two presenters will also highlight research advancements that can shape future efforts to reduce suicide rates among young people in the United States.

Click here to register.

Pew Article Highlights How to Reduce Methadone Access Roadblocks in Pharmacies

The Pew Research Center published an article last week outlining federal and state policy changes that could facilitate access to methadone for opioid use disorder in pharmacies by streamlining legal and regulatory requirements to operate Opioid Treatment Program (OTP) medication units.

The recommended policy changes focus on approval processes; methadone ordering and storage; and inventory, recordkeeping, and reporting systems.

The article was based on a report by the Legislative Analysis and Public Policy Association that analyzes current state and federal laws and regulations that affect access to methadone in pharmacies, with specific consideration of three models for pharmacy-based methadone access: (1) a medication unit in a pharmacy, (2) a mobile medication unit near a pharmacy, and (3) methadone being prescribed by a clinician and dispensed at a pharmacy.

HHS Publishes Report on Wait Time Standards for Behavioral Health Network Adequacy

HHS released a report last week that examined how regulators implemented behavioral healthcare appointment wait time (WT) standards as part of insurance network oversight.

The report identified existing wait time standards used in federal and various state programs, including how they are defined, measured, reported, and enforced. Experts interviewed for the project emphasized the importance of using wait time standards to help ensure network adequacy of behavioral health services and acknowledged that further work is needed to refine and interpret standards and properly factor in telehealth and patient preferences.

“Regulators interviewed at times have imposed penalties on health plans found to be non-compliant with WT standards,” the report concluded. “However, they prefer to work with health plans to develop corrective action plans and find other strategies to address access gaps, viewing collaborative approaches as more productive than imposing penalties, which could exacerbate access problems for consumers,” it continued. “Regulators also recognize that provider shortages make it harder for health plans to recruit providers to their networks.”

Call for Presenters: NABH to Kick Off AI Webinar Series in 2025

NABH is seeking presenters who have integrated AI in their business operations to share their experiences in the association’s new webinar series about AI in behavioral healthcare scheduled for Spring 2025.

The first webinar will focus on using AI to reduce administrative burden and create efficiencies, and the second webinar will highlight using AI for clinical-decision support.

Please contact NABH Associate Manager for Congressional Affairs Emily Wilkins at Emily@nabh.org by close of business this coming Monday, Dec. 16 if you want to participate.

ICYMI: NABH’s Webinar on Using Publicly Available Data in Health Plan Negotiations

NABH recently hosted a webinar about using hospital data effectively in your negotiations with health plans.

The webinar featured Erica K. Fox, M.B.A., vice president of business development and managed care contracting at Perimeter Healthcare. Please click here for the webinar’s recording and here for the presentation slides.

Please Submit Data to NABH’s Denial-of-Care Portal

Fact of the Week

Deaths involving carfentanil increased sharply to an average of 34.4 a month between July 2023 and June 2024 from an average of 3.3 a month between January 2021 and June 2023, according to a recent report from the Centers for Disease Control and Prevention.

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

CEO Update 209

Written by Meghan Barrett on December 6, 2024. Posted in CEO Updates.

NABH Expresses Serious Concerns About MOTAA in Letter to House and Senate Leaders

NABH this week sent a letter to House and Senate leaders that reinforced the association’s concerns that the Modernizing Opioid Treatment Access Act (MOTAA) [S. 644/ H.R. 1359] is a misguided attempt to deregulate opioid treatment programs (OTPs), the effective standard of treatment for opioid use disorders (OUDs).

In our letter, NABH highlighted three areas of potential, unintended consequences and harms that may result from legislation proposing such abrupt and expansive regulatory changes: the risk of diversion and increases in overdose deaths, the risk of relying on community pharmacies to fill the gap in patient access to care, and the potential for significant harm to populations that already suffer from health inequities.

“In addition to the noted dangers, the wholesale regulatory change that would result from this legislation would be difficult to implement,” the letter said. “Other organizations share this practical concern, including law enforcement leaders who note that the proposed changes in MOTAA would lead to more overdose deaths and diversion of methadone…”

NABH suggested a more cautious approach to addressing concerns about access to methadone, such as pausing to study carefully the effects of the significant recent efforts to expand access, with a specific focus on understanding the root causes behind incremental of OUD-related overdoses as well as the disproportionate harm suffered by marginalized populations; and encouraging new models of care whereby OTPs can collaborate with local pharmacies to allow stable patients and patients living in rural settings to pick up their OTP-prescribed methadone outside of OTPs.

SAMHSA Releases OTP Guidelines that Align with Regulations Released This Year

The Substance Abuse and Mental Health Services Administration (SAMHSA) on Wednesday released Federal Guidelines for Opioid Treatment Programs to provide recommendations and best practices for OTPs related to the implementation and compliance of regulatory changes in 42 CFR Part 8 that became effective in April and for which OTPs were required to comply starting on Oct. 2, 2024.

The revised regulations took steps to increase access to evidence-based medications for opioid use disorder, or MOUD, and promote practitioner discretion; support patient-centered care; reduce barriers to treatment; and remove stigmatizing or outdated language from the 2001 regulations.

The newly released guidelines replace guidelines published in 2015.

Call for Behavioral Healthcare Clinicians to Help Develop IPF Patient Assessment Instrument

The Centers for Medicare & Medicaid Services (CMS) and its contractor Abt Global are recruiting psychiatrists, psychologists, nurses and other behavioral healthcare clinicians to help develop and test a draft patient assessment tool known as the Inpatient Psychiatric Facility Patient Assessment Instrument (IPF-PAI).

CMS’ primary objectives for this significant policymaking process to improve both quality of care and payment accuracy. Eventually, the agency plans to require that a common PAI be used during admission and discharge of every IPF patient.

NABH has confirmed with CMS that our members will have multiple opportunities to weigh in on this project. We strongly urge your participation in the alpha stage, during which Abt will identify the PAI data elements to field-test – a critical stage that requires real-world input from our field.

To join the alpha stage of IPF PAI development, please apply here by Dec. 30, 2024.

SAMHSA Issue Brief Offers Information on Co-Occurring Mental Health and Substance Use

SAMHSA has released an issue brief for State Mental Health Authorities (SMHA) about co-occurring mental health and substance use disorders (CODs).

The document highlights the commonality of CODs and negative outcomes in the absence of evidence-based integrated care. It also provides an overview of treatment barriers and potential solutions and the effectiveness of integrated care.

Call for Presenters: NABH to Kick Off AI Webinar Series in 2025

ICYMI: NABH’s Webinar on Using Publicly Available Data in Health Plan Negotiations

Please Submit Data to NABH’s Denial-of-Care Portal

Fact of the Week

A study published in Health Affairs this month found that in 2021, 42.8% of U.S. children ages 5-17 lived with an adult who had at least four adverse childhood experiences (ACEs). The report noted that childhood exposure to adult ACEs was correlated negatively with child mental health, particularly among children living in low-income and publicly insured families.

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

CEO Update 208

Written by Meghan Barrett on November 22, 2024. Posted in CEO Updates.

DEA Extends Authority for Telehealth Prescribing Without an In-person Visit a Third Time

The Drug Enforcement Administration (DEA) and HHS this week again temporarily extended the existing telemedicine flexibilities for the prescribing of controlled medications through Dec. 31, 2025.

This latest extension allows prescribing practitioners to prescribe controlled medications without first conducting an in-person evaluation of the patient. This third extension of this flexibility – which was introduced in January 2020 in response to the COVID-19 pandemic – follows the first extension in May 2023 and the second in August 2023.

Among the agencies’ primary objectives for these extensions is to ensure a smooth transition for patients and practitioners who have relied on telemedicine for controlled-medication prescriptions, as well as to preserve access for those who may need this flexibility before a more permanent policy is established.

NABH and other stakeholders continue to wait for DEA and HHS to finalize two proposed rules issued in March 2023: Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have Not Had a Prior In-Person Medical Evaluation and the Expansion of Induction of Buprenorphine via Telemedicine Encounter.

NABH’s comments on these rules were among the 38,000 comments that stakeholders sent to the federal agencies.

APA Releases Recommendations for Healthy Teen Video Viewing

The American Psychological Association (APA) this week issued its first set of recommendations to help parents, policymakers, and tech companies empower teens to manage their viewing habits.

The APA Recommendations for Healthy Teen Video Viewing summarizes scientific research on adolescents’ viewing habits to offer guidance to parents, youth, and educators, as well as recommendations to policymakers and technical industry professionals for substantial changes.

“Research consistently shows that video content, and the platforms that host it, have the potential to help or harm teens,” APA CEO Arthur C. Evans Jr., Ph.D., said in an announcement about the recommendations. “It is the shared responsibility of video platforms, content creators, parents, caregivers, educators, policymakers and the technology industry to create an environment where youth can learn and express themselves safely online.”

The report calls for tech companies to change the built-in features of their platforms that can affect adolescent well-being because the APA notes platforms that recommend content to youth and switch rapidly between short-form videos and autoplay videos to extend viewing times could magnify the effects of harmful video content and contribute to maladaptive viewing habits in youth.

In addition, the report recommends limiting exposure to content that encourages violent or risky behaviors and/or reinforces negative stereotypes, especially on platforms that allow users to share content or add comments or “likes” that may endorse harmful behaviors; guiding adolescents to choose content based on quality and accuracy, especially when evaluating health related information by creators who are not licensed health professionals; teaching adolescents about false, damaging or biased information and other risks introduced by content generated by artificial intelligence (AI); encouraging access to video content that promotes empathy, learning, emotional well-being and joy; and encouraging video skills that allow adolescents to develop healthy relationship skills.

Your Expertise is Needed to Help Develop IPF Patient Assessment Instrument

The Centers for Medicare & Medicaid Services (CMS) is recruiting participants to help the agency, its contractors RTI International and Abt Global, and other partners develop and test a draft patient assessment instrument, or the Inpatient Psychiatric Facility Patient Assessment Instrument (IPF-PAI).

NABH urges all members to assist CMS and participate in this important project that aims to advance care quality in IPFs. Your feedback will help inform CMS’ efforts in the agency’s rulemaking process.

Please click here to learn more and here to apply.

Call for Presenters: NABH to Kick Off AI Webinar Series in 2025

Please contact NABH Associate Manager for Congressional Affairs Emily Wilkins at Emily@nabh.org by close of business on Monday, Dec. 16 if you are interested in participating.

ICYMI: NABH’s Webinar on Using Publicly Available Data in Health Plan Negotiations

NABH on Nov. 14 hosted a webinar about using hospital data effectively in your negotiations with health plans.

The webinar featured Erica K. Fox, M.B.A., vice president of business development and managed care contracting at Perimeter Healthcare. Please click here for the webinar’s recording and here for the presentation slides.

Please Visit Our New Website!

We have also updated our member password, which is required for member-only resources, such as our letters to congressional offices and regulatory agencies, as well as previous editions of CEO Update (all of which can be found by clicking on the “News” tab. NABH members should refer to the NABH Alert they received on Thursday, Oct. 31 for the new member password.

Please e-mail nabh@nabh.org with any questions or feedback you may have about the new site.

Please Submit Data to NABH’s Denial-of-Care Portal

Fact of the Week

The University of South Florida will track young people through 2050 to learn more about the long-term effects of smartphones, social media, and other digital media on individual wellbeing.

Happy Thanksgiving!

The NABH staff wishes its members and their families a very happy, healthy, and safe Thanksgiving! NABH will not publish CEO Update next week and will resume on Friday, Dec. 6, 2024.

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

CEO Update 207

Written by Meghan Barrett on November 15, 2024. Posted in CEO Updates.

SAMHSA Announces Behavioral Health Workforce Career Navigator

The Substance Abuse and Mental Health Services Administration this week launched the
Behavioral Health Workforce Career Navigator to help current and aspiring behavioral health professionals identify state requirements for a range of behavioral health careers.

“We need a behavioral health workforce that can meet our country’s needs. That includes helping current and aspiring behavioral health workers pursue their careers and thrive in their work,” HHS Secretary Xavier Becerra said in an announcement. “The new Behavioral Health Workforce Career Navigator is an important tool towards improving the process of finding and comparing education, training, and licensure and certification requirements across the country. President Biden and Vice President Harris’ Unity Agenda continues to take on the biggest challenges facing Americans, including addressing our nation’s behavioral health needs.”

HHS will host a webinar about the new resource today, Friday, Nov. 15 at 3 p.m. ET. Click here to register.

If you haven’t yet, please be sure to check out the NABH Education and Research Foundation’s Workforce Startup Guide and share it with members of your human resources and operations teams.

Trump Chooses RFK, Jr. to Lead HHS While Senate GOP Leadership Takes Shape

President-elect Donald Trump on Thursday named environmental lawyer and activist Robert F. Kennedy, Jr., son of the late Sen. Robert F. Kennedy, as the nation’s next HHS secretary.

Kennedy, a widely known vaccine skeptic, will require Senate confirmation to lead the department that oversees agencies including the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, the Food and Drug Administration, and the National Institutes of Health.

“The safety and health of all Americans is the most important role of any administration, and HHS will play a big role in helping ensure that everybody will be protected from harmful chemicals, pollutants, pesticides, pharmaceutical products, and food additives that have contributed to the overwhelming health crisis in this country,” Trump wrote Thursday in a post on the social media platform X.

Meanwhile, in the Senate, Sen. John Thune (R-S.D.) was elected by his peers to serve as majority leader to lead the Republican Caucus and control the Senate’s legislative agenda. Thune succeeds Sen. Mitch McConnell (R-Ky.) after McConnell decided to step down from the position while remaining in the Senate until the end of his term. Thune was elected to the Senate in 2005, ousting then-Majority Leader Tom Daschle (D-S.D.). A leader in the Senate Finance Committee, Thune has been a strong proponent for repealing the IMD exclusion.

Sen. Bill Cassidy, M.D. (R-La.) and Sen. Mike Crapo (R-Idaho) are positioned to chair the Senate HELP and Finance Committees, respectively, following the Republican victory on Nov. 5 that flipped Senate control to the GOP from Democrats. Cassidy is a policy-focused gastroenterologist. As ranking member of the Senate HELP Committee, Cassidy focused on pharmacy benefit manager reform and on site-neutral payment policy, among other issues. He has been a proponent of increasing access to behavioral healthcare services and voted in favor of S. 644, the Modernizing Opioid Treatment Access Act (MOTAA) in committee last December. Cassidy has heard the concerns over MOTAA from NABH and NABH member companies and allied groups and has appeared interested in working towards a mutually agreeable outcome. It is unknown currently to what extent he will prioritize the issue.

Both chairmen are expected to advocate for limited government and market-driven strategies to cut healthcare costs and work closely with President-elect Trump to implement his administration’s priorities, which could include allowing enhanced Affordable Care Act (ACA) subsidies to expire and promoting policies that chip away at the ACA and Medicaid. The chairmen will also have to advance a slew of Trump administration health nominees.

With the GOP gaining control of both chambers of Congress, lawmakers may use Reconciliation – a complex process allowing bill passage with a simple majority vote — to push through priority legislation.

Sen. Bernie Sanders (I-Vt.) is likely to remain as the HELP Committee’s ranking member. The incoming majority party will have two seats to fill, while the incoming minority party will have one vacancy.

With Crapo’s ascension, Sen. Ron Wyden (D-Ore.) will become the Senate Finance Committee’s ranking member. Democrats will have six seats to fill due to the retirement of Sens. Stabenow (D-Mich.), Carper (D-Del.), and Cardin (D-Md.) and the defeats of Sens. Brown (D-Ohio), and Casey (D-Pa.) and resignation of Menendez (D-N.J.)

The House of Representatives will choose its committee chairmen and ranking members in December.

Future of the Kids Online Safety Act is Uncertain as 118^th Congress Wraps Up

The outlook for the Kids Online Safety Act (KOSA) is uncertain despite the Senate approving the legislation in a 91-3 vote this past July.

Introduced shortly after Surgeon General Vivek Murthy, M.D. released his advisory on social media and youth mental health, the bill aims to protect children from the harm social media causes to youth mental, physical, and emotional health by requiring social media companies to protect children’s privacy, prevent targeted advertising, and block manipulative algorithms to users 17 and younger.

The House Energy and Commerce Committee approved the bill on Sept. 18 and the measure is seen as a priority for outgoing House Energy and Commerce Chair Cathy McMorris Rodgers (R-Wash.); however, leaders including House Speaker Mike Johnson (R-La.) and Majority Leader Steve Scalise (R-La.) find the “platform duty-of-care” requirements and potential for censorship problematic.

Amended to mitigate the concerns about the duty-of-care language and the provision that would require tech companies to remove features that encourage compulsive use, the bill advanced through the committee process and has just a few weeks to become law before the 118^th Congress ends.

Some youth and parent advocacy groups are concerned that the House version lacks the strength of the Senate version. Referring to the House version of the bill, Zamaan Qureshi, co-chair of the youth-led coalition Design It For Us, said “…In essence (it) removed the ability to target some of the design features that have preyed on my generation, preyed on young people,” according to Roll Call. Some parent advocacy groups said they hope Sen. Marsha Blackburn (R-Tenn.) and other Senate leaders will encourage House counterparts to pass the legislation.

If the bill does not pass during this Congress, it will need to be introduced in the 119^th Congress.

Please Visit Our New Website!

NABH’s website is live! NABH has designed our updated site to help members, policymakers, journalists, patient advocates, and the general public learn about our association and the resources we provide in a way that is easier to navigate so you find what you’re looking for quickly and efficiently.

We have also updated our member password, which is required for member-only resources, such as our letters to congressional offices and regulatory agencies, as well as previous editions of CEO Update (all of which can be found by clicking on the “News” tab. NABH members should refer to the NABH Alert they received on Thursday, Oct. 31 for the new member password.

Please e-mail nabh@nabh.org with any questions or feedback you may have about the new site.

ICYMI: NABH’s Webinar on Using Publicly Available Data in Health Plan Negotiations

NABH on Thursday hosted a webinar about using hospital data effectively in your negotiations with health plans.

The webinar featured Erica K. Fox, M.B.A., vice president of business development and managed care contracting at Perimeter Healthcare.

Please click here for the webinar’s recording and here for the presentation slides.

Reminder: Manatt to Host Webinar About State Medicaid Innovations to Address America’s Behavioral Health Crisis

Research firm Manatt will host a webinar with state leaders to address topics such as 1115 demonstrations, strategies to combine Medicaid with other sources of funding, and what policies states are implementing to address the nation’s behavioral health crisis.

The hourlong webinar will start at 3 p.m. ET on Thursday, Nov. 21. Click here to register.

Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Policymakers have expressed particular interest in our aggregate estimate on days of uncompensated charity care, as well as the length of delayed health plan responses to prior-authorization requests.

To support this advocacy push, we strongly encourage all NABH members to submit data to the portal. Please contact NABH Associate Manager for Congressional Affair Emily Wilkins with questions about the data metrics that we are collecting and/or the data-submission process.

Fact of the Week

Rates of hospitalizations and ED visits related to mental health exceeded expected rates in only the second year after the pandemic onset (6% and 5%, respectively), whereas those related to self-harm persistently increased above expected rates after the pandemic onset (28% and 43% in the third year, respectively), according to a recent study in JAMA Network Open.

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

CEO Update 206

Written by Administrator on November 8, 2024. Posted in CEO Updates.

Republican Wins Bring Changes to White House and Congress; Leadership Posts Pending

Former President Donald Trump’s re-election to office on Nov. 5 also led a strong Republican wave in both chambers of Congress, with Republicans winning control of the Senate and likely retaining a small majority in the House of Representatives.

Either party needs 218 seats to win the majority in the House; as of this writing, Republicans can claim 211 seats, Democrats can claim 199 seats, and 25 races are too close to call.

In the Senate, Democrats have 45 seats, Republicans have 53 seats, and two seats are still too close to call. Senate Veterans Affairs Committee Chairman Jon Tester (D-Mont.) lost his bid for reelection. Meanwhile, Senate HELP Committee members Sherrod Brown (D-Ohio) and Bob Casey (D-Pa) lost their bids for a fourth term, while Sen. Tammy Baldwin (D-Wis.) was narrowly reelected to her third term.

Congress will return Nov. 12 to develop a funding package for FY 2025, while the deadline to fund the federal government is Dec. 20. With the change in both the administration and Congress, it is likely that Congress will pass a short-term Continuing Resolution (CR) until the Spring when the 119^th Congress will establish funding priorities.

House Republican leadership elections are scheduled for next Wed., Nov 13. Speaker Mike Johnson (R-La.) and members of the House Republican leadership are seeking reelection to their respective posts. Meanwhile, Senate Republican leadership elections will also likely be held Nov. 13, with Sens. John Thune (S.D.), John Cornyn (Texas) and Rick Scott (Fla.) vying to replace Sen. Mitch McConnell (Ky.) as Majority Leader. Sen. John Barrasso (Wy.) is running unopposed for Majority Whip.

House Democratic leadership elections will likely be the week of Nov. 18, with all Members seeking to maintain their leadership posts, led by House Minority Leader Hakeem Jeffries (NY). Senate Democratic Leadership elections will likely be in early December, based on past practice. The only open job is retiring Sen. Debbie Stabenow’s (MI) position as chair of the Policy and Communications Committee.

NABH government relations staff will introduce NABH and our priority issues to incoming freshman Members of the House and Senate as the 119^th prepares to convene.

2025 Physician Payment Rule Finalizes Slight Increase to Psychiatrist Payments; Provides Some Telehealth Support

In its recently released physician fee schedule 2025 final rule, the Centers for Medicare & Medicaid Services (CMS) increased payments to psychiatrists by 1.0%, contrary to an overall negative update of 2.93% for physician payments relative to 2024 rates. Congressional discussions are expected to determine how to offset this overall drop, perhaps by year’s end or in early 2025.

Telehealth
With regard to telehealth measures in the rule, CMS phased out current flexibilities implemented during the COVID-19 pandemic, as required by federal law. However, NABH is pleased CMS made permanent certain telehealth flexibilities, including allowing some practitioners to provide two-way, real-time, audio-only communications when the patient is not capable of or does not consent to using video technology. In addition, the rule implements three digital therapeutics codes for the first time (G0552, G0553 and G0554) that fall under existing FDA authority, which pertain to initial telehealth care plan education for patients, the first 20-minute of treatment, and subsequent 20-minute treatments. The agency also finalized additions to the Medicare Telehealth Services List, including caregiver training services, patient counseling, and safety planning

Telehealth provisions that only apply to 2025 include continuing to permit distant-site practitioners to use their enrolled practice locations rather than a home address when providing telehealth services from their home. Also, treatment frequency limits will remain suspended in 2025.

Because Congress has not finalized an extension of pandemic-originating telehealth services, the rule rolls back major Medicare telehealth services to pre-pandemic levels. NABH notes there is broad bipartisan support for extending these services, with separate bills passing both House and Senate earlier this year, which could potentially lead to enactment by year’s end, although an extension remains uncertain. Given the broad support of this extension, if Congress passes telehealth legislation before year’s end, the agency could issue an interim final rule to restore this coverage, which could take effect immediately. The longer Congress takes to act, the less time CMS has to prepare and issue such a rule.

Crisis Care and Opioid Use Disorder (OUD) Provisions
The rule introduces new billing codes and telehealth services to improve the quality and access of opioid use disorder treatment. The rule also finalized new coding and payment rules for safety-planning interventions for patients in crisis.

Physician Supervision
The final rule allows supervising physicians to provide guidance virtually through real-time audio and visual telehealth. This new definition of physician supervision for “incident to” services will be submitted by the physician using CPT code 99211. The code also pertains to telehealth supervision for outpatient evaluation and management of established patients who may not require another health care professional in the appointment.

CMS will continue to permit telehealth supervision of all other services furnished that require the direct supervision of the physician or other supervising practitioner through telehealth through 2025, when both the treatment and supervision are furnished virtually through, for example, a three-way telehealth visit.

Please Visit Our New Website!

NABH’s website is live! NABH has designed our updated site to help members, policymakers, journalists, patient advocates, and the general public learn about our association and the resources we provide in a way that is easier to navigate so you find what you’re looking for quickly and efficiently.

We have also updated our member password, which is required for member-only resources, such as our letters to congressional offices and regulatory agencies, as well as previous editions of CEO Update (all of which can be found by clicking on the “News” tab. NABH members should refer to the NABH Alert they received on Thursday, Oct. 31 for the new member password.
Please e-mail nabh@nabh.org with any questions or feedback you may have about the new site

Register Today for NABH’s Webinar on Using Publicly Available Data in Health Plan Negotiations

National Study Highlights MA Plans with High Numbers of Veteran Enrollment and Utilization

A new study published in Health Affairs found that veterans increasingly enrolled in Medicare Advantage (MA) plans between 2016 and 2022, including a growing number of MA plans in which 20% or more of the enrollees were veterans.

According to the findings, about one in five Veterans Health Administration (VHA) enrollees in these high-veteran MA plans did not incur any Medicare services paid by MA within a given year—a rate 2.5 times that of VHA enrollees in other MA plans and 5.7 times that of the general MA population. Meanwhile, VHA enrollees in high-veteran MA plans were significantly more likely to receive VHA-funded care.

The study reported that in 2020, CMS paid more than $1.32 billion to MA plans for VHA enrollees who did not use any Medicare services, with 19.1% going to high-veteran MA plans.

Manatt to Host Webinar About State Medicaid Innovations to Addressing America’s Behavioral Health Crisis

Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Policymakers have expressed particular interest in our aggregate estimate on days of uncompensated charity care, as well as the length of delayed health plan responses to prior-authorization requests.

To support this advocacy push, we strongly encourage all NABH members to submit data to the portal. Please contact NABH Associate Manager for Congressional Affair Emily Wilkins with questions about the data metrics that we are collecting and/or the data-submission process.

Fact of the Week

In Appalachia, the seat of one of the earliest and deadliest waves of the opioid crisis, physicians at West Virginia University’s Rockefeller Neuroscience Institute are using focused ultrasound waves to reset the brain’s reward center, the nucleus accumbens. They hope the procedure can treat addictions ranging from drugs like opioids and methamphetamine to gambling and eating.

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

CEO Update 205

Written by Administrator on November 1, 2024. Posted in CEO Updates.

Please Visit Our New Website!

NABH is pleased to announce our new website is now live!

NABH has designed our updated site to help members, policymakers, journalists, patient advocates, and the general public learn about our association and the resources we provide in a way that is easier to navigate so you find what you’re looking for quickly and efficiently.

We have also updated our member password, which is required for member-only resources, such as our letters to congressional offices and regulatory agencies, as well as previous editions of CEO Update (all of which can be found by clicking on the “News” tab). NABH members should refer to the NABH Alert they received on Thursday, Oct. 31 for the new member password.

Please e-mail nabh@nabh.org with any questions or feedback you may have about the new site.

As always, thank you for all you do each day to support and advance NABH’s mission and vision!

Deadline for Inpatient Psychiatric Hospital All-Inclusive Reporting Survey is Due Today, Nov. 1

As follow-up to its FY 2025 IPF PPS final rule, the Centers for Medicare & Medicaid Services (CMS) on Oct. 17 issued online guidance explaining the temporary flexibilities for hospitals transitioning from all-inclusive cost reporting to traditional reporting that includes ancillary costs and charges, such as those for lab and drug items. This shift requires IPF hospitals to change their charge structure to include ancillary costs and charges, for cost reports beginning on or after Oct. 1, 2024.

The new guidance provides a new and temporary option for IPFs that will require extra time to implement the new billing structure needed to capture and report ancillary costs and charges. Specifically, the CMS guidance applies to providers that are unable to complete the transition to ancillary reporting for the full 12 months of cost reporting periods beginning between Oct. 1, 2024 – May 31, 2025. Such hospitals may ask their Medicare Administrative Contractor (MAC) to use an alternate cost reporting methodology on a temporary basis.

If the MAC approves the request, a provider may report estimated ancillary charges using a six-step process to extrapolate ancillary costs and charges from at least a portion of the cost reporting cycle to the full cycle.

For NABH members who operate inpatient psychiatric hospitals: please review this multi-step process carefully in the online guidance and email any concerns or feedback with this process to NABH at nabh@nabh.org.

NABH continues to communicate with CMS representatives about this complex transition. To help with our advocacy efforts, please complete this survey on your estimated timing of compliance with ancillary reporting by Friday, Nov. 1.

The survey findings will be used only in the aggregate during our advocacy to extend CMS’ announced flexibilities to also address hospitals that will be delayed beyond June 1, 2025, due to fixed variables such as affordability, supply chain and vendor delays, a shortage of available personnel with training on relevant information technology protocols, and other factors.

Your survey response will help NABH tell this story and advocate for additional flexibility following May 2025. As always, thank you for your time and cooperation!

Register Today for NABH’s Webinar on Using Publicly Available Data in Health Plan Negotiations

Please join NABH for a webinar on Thursday, Nov. 14, 2024 to learn about using hospital data effectively in your negotiations with health plans.

The webinar will feature Erica K. Fox, M.B.A., vice president of business development and managed care contracting at Perimeter Healthcare. A member of NABH’s Managed Care Committee, Fox will review the use of publicly available data from hospitals, such as payer-specific negotiated rates and standard charges for all payers and plans, to negotiate contracts with health plans.

Fox has more than 25 years of senior leadership experience in the behavioral health sector. Prior to her current role, she served as the business development director at Peachford Hospital, a Universal Health Services facility. Fox earned her undergraduate degree from Michigan State University, where she received a dual degree in Communications and Spanish. She later earned a master’s degree in healthcare administration from Loyola University Chicago.   

Register here for this hourlong webinar that will begin at 1 p.m. on Nov. 14.

Manatt to Host Webinar About State Medicaid Innovations to Addressing America’s Behavioral Health Crisis

Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Policymakers have expressed particular interest in our aggregate estimate on days of uncompensated charity care, as well as the length of delayed health plan responses to prior-authorization requests.

To support this advocacy push, we strongly encourage all NABH members to submit data to the portal. Please contact NABH Associate Manager for Congressional Affair Emily Wilkins with questions about the data metrics that we are collecting and/or the data-submission process.

Fact of the Week

A Centers for Disease Control and Prevention analysis of a nationally representative sample of U.S. adults found that in 2023, an estimated 15.5 million, or about 6.0%, had a current attention-deficit/hyperactivity disorder (ADHD) diagnosis. The study found that about one half of adults with current ADHD have ever used telehealth for ADHD services. “As policies are currently developed and evaluated related to ADHD clinical care for adults, access to prescription stimulant medications, and flexibilities related to telehealth, these results can guide clinical care and regulatory decision-making,” the study noted.

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

CEO Update 204

Written by Administrator on October 18, 2024. Posted in CEO Updates.

2025 NABH Board Nominations Are Due Monday, Oct. 21!

NABH’s Selection Committee needs your help as it considers possible nominees to serve on the NABH Board of Trustees in 2025.

Please help us identify potential candidates for:

Board Chair-Elect
Two Board Seats

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

Please download a nomination form to share your recommendations of individuals you would like to see included in the single slate for 2025. Please attach a curriculum vitae (CV) for each person you recommend. This will help the Selection Committee in its deliberations. You are welcome to suggest yourself.

Please return this form and candidates’ CVs by Monday, Oct. 21, 2024 to maria@nabh.org.

Thank you for your time.

NABH Thanks Sheppard Pratt for Hosting a Successful Unit Committee Leadership Forum!

NABH member Sheppard Pratt graciously welcomed the NABH Behavioral Health Services within General Healthcare Systems Committee (Unit Committee) to Baltimore last week for the Unit Committee’s annual leadership forum.

The Committee enjoyed two days of hospital tours, presentations, and networking. Attendees toured two Sheppard Pratt facilities—the state-of-the-art Baltimore/Washington campus and the historic Towson campus. While networking with peers was a highlight, seeing the Aurora Borealis over Baltimore’s Inner Harbor during the group’s dinner cruise was a stand-out memory!

The tour of the Baltimore/Washington campus, featuring extra space for future growth, highlighted the staff and CannonDesign’s patient-friendly design, with its focus on natural materials, abundant light, and integration with the wetlands surrounding the hospital.

After a delicious and nutritious lunch catered by the same chef that cooks for patients, attendees learned from the CannonDesign team about the wide array of customized unit spaces the firm has created nationwide, as well as about the facility-design trends of the future, including an aging population, earlier clinical intervention, home-based care, integration with primary care, and the growth of outpatient care.

Sheppard Pratt Solutions Vice President and COO Stephen Merz led a discussion about Crisis Care and psychiatric urgent care, a unique, patient-centered intake model, and his work with local governments for funding and implementation.

Finally, leaders shared keys to effective dyadic relationships based on trust and respect, along with the blending of professional skills and styles.

The group concluded the second day on the Towson campus. Geisinger Health and Main Line Health leaders discussed best practices for managing recovery centers in acute care systems. Michael Abbatiello, operations executive at Sheppard Pratt, led a discussion about major pain points for members of the committee. The meeting closed with the designers of the Yale Patient Experience tool, referred to by CMS as the “PIX,” which will be used in CY 2025 for voluntary reporting, with mandatory reporting to follow. Attendees also had the opportunity to visit Sheppard Pratt’s museum, Institute for Advanced Diagnostics, and Psychiatric Urgent Care department.

NABH thanks the entire Sheppard Pratt team for its planning and gracious hospitality and all who attended this year’s Leadership Forum!

NABH Thanks Director of Quality and Addiction Services Sarah Wattenberg!

NABH and its Washington-based team thanks Sarah Wattenberg, the association’s director of quality and addiction services since 2018, for her excellent work and dedication to improving policies, regulations, and protocols that help open access to quality care for people with substance use disorders.

Sarah is retiring from the behavioral healthcare field and her last day at NABH is today, Friday, Oct. 18. Sarah’s industrious career includes positions at HHS at both the Substance Abuse and Mental Health Services Administration and the Assistant Secretary for Health, where she worked on critical issues of the day, including privacy, electronic health records, performance measures, the Affordable Care Act, opioids, marijuana, college drinking, financing, and workforce.

In a farewell letter to colleagues, Sarah noted that this quote from former HHS Secretary Hubert Humphrey – inscribed in a plaque on a wall at HHS – refreshed her commitment to public service every day: “The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy, and the handicapped.”

We all thank Sarah and wish her many years of continued success and happiness in her retirement!

CMS Provides Temporary Flexibilities to All-Inclusive Cost Reporters

Following ongoing communication with NABH, the Centers for Medicare & Medicaid Services (CMS) posted online official guidance for inpatient psychiatric facilities (IPF) that, based on the agency’s fiscal year 2025 final rule, must phase out “all-inclusive” reporting for cost reports beginning on or after Oct. 1, 2024. This shift requires IPF hospitals to change their charge structure to include ancillary costs and charges, such as those for lab and drug items.

Under a new and temporary option for this subset of IPFs, CMS will provide flexibility for those IPFs that will require extra time to implement reporting of ancillary costs and charges. Specifically, the CMS guidance applies to providers that are unable to complete the transition to ancillary reporting for the full 12 months of cost reporting periods beginning between Oct. 1, 2024 – May 31, 2025. Such hospitals may ask their Medicare Administrative Contractor (MAC) to use an alternate cost reporting methodology on a temporary basis.

If the MAC approves the request, a provider may report estimated ancillary charges using a six-step process to extrapolate ancillary costs and charges from at least a portion of the cost reporting cycle to the full cycle.

Please carefully review this multi-step process in the online guidance, which NABH helped develop, and share with NABH any concerns or feedback with this process to nabh@nabh.org.

NABH continues to communicate with CMS representatives about this complex transition. As part of this advocacy, please complete the related survey that NABH will send to members on Monday, Oct. 21. The survey will ask all of NABH’s all-inclusive members to estimate the timing of their sites’ compliance with ancillary reporting.

This communication will focus on member sites that will not be able to implement the necessary changes to their charges structure by May 31, 2025, the date targeted in CMS’ guidance. NABH will emphasize the fixed variables that will prevent some sites from achieving full reporting capability by this date, including affordability, supply chain and vendor delays, a shortage of available personnel with training on relevant information technology protocols, and other factors.
As always, thank you for your cooperation!

Reps. Tonko and Turner Seek Feedback on Effects of ‘Mainstreaming Addiction Treatment Act’

Hospitals, insurance plans, pharmacies, pharmacists, and providers were the recipients of inquiries from Reps. Paul D. Tonko (D-N.Y.) and Mike Turner (R-Ohio) to help the lawmakers better understand the impact of the Mainstreaming Addiction Treatment Act, (MAT) a 2023 law that removed the DATA Waiver 2000 as a way to increase the number of medical professionals prescribing buprenorphine for individuals with opioid use disorder.

The goal is to expand providers from 130,000 to 1.8 million.

“For the millions of Americans battling substance use disorder, having access to proven, affordable treatment can mean the difference between life and death,” Tonko said in a statement.

“Passing the MAT Act into law last Congress was a crucial step forward in our country’s battle against opioid addiction and substance use disorder,” Turner added.

Tonko also introduced the BUPE for Recovery Act, legislation that would require the Drug Enforcement Administration administrator to temporarily exempt buprenorphine from the Suspicious Orders Report System, or SORS, for the remainder of the opioid public health emergency.

The congressmen sent 38 letters to healthcare providers nationwide, including to UnitedHealth Group, The Cigna Group, Kaiser Permanente, Elevance Health, Centene Corporation, Blue Cross and Blue Shield, CVS Health/Aetna, Molina Healthcare, Health Care Services Corporation, Highmark Health, Humana, and others. See the full list here.

Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Policymakers have expressed particular interest in our aggregate estimate on days of uncompensated charity care, as well as the length of delayed health plan responses to prior-authorization requests.

To support this advocacy push, we strongly encourage all NABH members to submit data to the portal. Please contact NABH Associate Manager for Congressional Affair Emily Wilkins with questions about the data metrics that we are collecting and/or the data-submission process.

Fact of the Week

A large, multicenter cohort study found that prescription of GLP1R in adolescents with obesity was associated with decreased risk for suicidal ideation, according to an article in JAMA Pediatrics.

NABH will host its Fall 2024 Board of Trustees Meeting in Nashville next Friday, Oct. 25 and will not publish CEO Update. CEO will resume on Friday, Nov. 1.

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

CEO Update 203

Written by Administrator on October 4, 2024. Posted in CEO Updates.

Reminder: NABH’s Second AI Survey Deadline is Due Monday!

NABH continues to explore how our members use Artificial Intelligence (AI), and our AI survey earlier this year identified Care Quality, Business Operations, and Workforce Solutions as our members’ priority areas.

As follow-up to our first survey, we ask you to complete this brief follow-up survey to help us delve deeper into members’ AI practices, which will help refine our advocacy efforts on this important issue.

Please complete the survey by this coming Monday, Oct. 7.

HHS and Industry Leaders to Form Joint Task Force on AI & Cybersecurity

HHS, industry leaders, and the Health Sector Coordinating Council Cybersecurity Working Group will soon launch a joint task force to examine the cybersecurity implications of AI, the news publication Inside Health Policy (IHP) reported recently.

According to the story, Micky Tripathi, Ph.D., who leads HHS’ health information technology office, confirmed to IHP that staff from HHS’ Deputy Secretary’s Office and Administration for Strategic Preparedness and Response are engaged in the task force on AI and cybersecurity.
Greg Garcia, executive director of the Health Sector Coordinating Council Cybersecurity Working Group, told IHP that it’s uncertain whether the task force will produce a white paper, list of best practices, or some other resource. The task force is expected to discuss the implications of AI with different healthcare sectors in the next six to 12 months, the story reported.

In related news, Politico reported today, Friday, Oct. 4 that HHS Deputy Secretary Andrea Palm said she expects to release a new AI strategy in January to comply with President Joe Biden’s executive order on AI practices. Palm also discussed how she intends to manage the more than 150 ways AI is used at the agency and what worries her most about the technology.

OIG Report Says Medicare & Medicaid Enrollees in High-Need Areas May Lack Access to Medications for OUD

HHS’ Office of Inspector General (OIG) recently published a report that found while the Centers for Medicaid & Medicaid Services (CMS) has taken several steps in recent years to increase medications for opioid use disorder (MOUD) access, many Medicare and Medicaid enrollees do not receive MOUD.

According to the report, hundreds of counties lack office-based buprenorphine providers and opioid treatment programs; in counties that have appropriate providers, they often do not treat Medicare or Medicaid enrollees.

Meanwhile, the OIG found that the lack of providers might be due to Medicare Advantage prior-authorization requirements, low Medicaid reimbursement rates, and inadequate public information about MOUD provider locations.

The OIG recommends that CMS geographically target efforts to increase providers treating Medicare and Medicaid enrollees in high-need counties; work with states to assess whether Medicaid reimbursement rates are sufficient to recruit and retain enough providers; and work with the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop and maintain a list of active office-based buprenorphine providers.

National Academy of Medicine to Focus on Mental Health and SUD in Upcoming Annual Meeting

The National Academy of Medicine (NAM) will host a symposium titled “Bridging Science, Practice, and Policy to Advance Mental Health” on Monday, Oct. 21.

That session will feature panel discussions on the social drivers that affect mental health and substance use, emerging science and innovative therapies, and equitable access to mental healthcare.

The two-day event – which will be held both virtually and in person at the National Academy of Sciences Building in Washington, D.C. – will include Interest Group sessions on the meeting’s first day, Sunday, Oct. 20. Those sessions will bring together NAM members from a variety of disciplines to engage and convene on the most current topics affecting science, medicine, technology, and health.

Click here to learn about registration and additional meeting details.

Register for Our November Webinar on Using Publicly Available Data in Health Plan Negotiations

Please join NABH for a webinar on Thursday, Nov. 14, 2024 to learn about using hospital data effectively in your negotiations with health plans.

The webinar will feature Erica K. Fox, M.B.A., vice president of business development and managed care contracting at Perimeter Healthcare. A member of NABH’s Managed Care Committee, Fox will review the use of publicly available data from hospitals, such as payer-specific negotiated rates and standard charges for all payers and plans, to negotiate contracts with health plans.

Fox has more than 25 years of senior leadership experience in the behavioral health sector. Prior to her current role, she served as the business development director at Peachford Hospital, a Universal Health Services facility. Fox earned her undergraduate degree from Michigan State University, where she received a dual degree in Communications and Spanish. She later earned a master’s degree in healthcare administration from Loyola University Chicago.

Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Policymakers have expressed particular interest in our aggregate estimate on days of uncompensated charity care, as well as the length of delayed health plan responses to prior-authorization requests.

To support this advocacy push, we strongly encourage all NABH members to submit data to the portal. Please contact NABH Associate Manager for Congressional Affair Emily Wilkins with questions about the data metrics that we are collecting and/or the data-submission process.

Fact of the Week

Fewer than half (43.8%) of 1,028 U.S. jails surveyed nationwide provided any medication for opioid use disorder, and only 12.8% made these available to anyone with the disorder, according to a National Institute on Drug Abuse-supported study published in JAMA Network Open.

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

CEO Update 202

Written by Administrator on September 27, 2024. Posted in CEO Updates.

Please Submit Your Updated Member Information Today, Friday Sept. 27!

NABH is developing its online-only 2024 Membership Directory, an essential member benefit that helps the association in its advocacy efforts.

Last month NABH e-mailed system members a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use that link to our membership-update tool and verify your system’s information.

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

We extended the deadline for members to submit changes to today, Friday, Sept. 27. If you need assistance, please contact Maria Merlie maria@nabh.org or 202-393-6700, ext. 104.

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

FDA Approves First New Schizophrenia Drug in Decades

The U.S. Food and Drug Administration (FDA) on Thursday approved Cobenfy (xanomeline and trospium chloride) capsules for oral use to treat schizophrenia in adults. According to the FDA, it is the first antipsychotic drug approved to treat schizophrenia that targets cholinergic receptors as opposed to dopamine receptors that has long been the standard of care.

“Schizophrenia is a leading cause of disability worldwide. It is a severe, chronic mental illness that is often damaging to a person’s quality of life,” Tiffany Farchione, M.D., director of the Division of Psychiatry, Office of Neuroscience in the FDA’s Center for Drug Evaluation and Research, said in the agency’s announcement. “This drug takes the first new approach to schizophrenia treatment in decades. This approval offers a new alternative to the antipsychotic medications people with schizophrenia have previously been prescribed.”

House and Senate Clear Short-term Spending Bill, Delaying Funding Fights to December

The House and Senate on Wednesday night approved a bill to avert a government shutdown, pushing numerous tough spending fights past the November elections to the end of the year.

The legislation leaves federal agencies with static budgets through Dec. 20 and will now move to the White House for President Biden’s signature before the Sept. 30 shutdown deadline.

The three-month stopgap legislation sets the stage for another shutdown showdown in December, during the congressional “lame-duck” period, when lawmakers will have to piece together a spending bill to keep the government funded past the new deadline.

House Speaker Mike Johnson (R-La.) has vowed that the House will not approve a sprawling omnibus bill to avert a December shutdown, although he acknowledged that will be a difficult goal to achieve as the House has passed only five of 12 spending bills, while the Senate Appropriations Committee reached bipartisan agreements on 11 of the 12 appropriations bills—none of which made it to the Senate floor.

The two chambers are currently nearly $90 billion apart on overall discretionary spending, and that was before the Biden administration identified a $12 billion veterans’ healthcare shortfall. The success of a year-end spending bill and any additional year-end legislative priorities will also hinge on the November elections and which party wins control of the House, Senate, and White House.

Update: FY 2025 IPF PPS Rule’s Provision on All-Inclusive Reporting

After the Centers for Medicare & Medicaid Services (CMS) released its FY 2025 IPF PPS final rule, NABH has communicated with CMS staff to discuss the rule’s provisions related to all-inclusive reporting on cost reports.

Under the rule, inpatient psychiatric hospitals that are not tribally or federally owned must bridge from all-inclusive reporting to include ancillary charges – especially laboratory and pharmacy charges – on cost reports, including for claims from private payers. This shift is to be implemented by the cost reporting period beginning on or after Oct. 1, 2024.

As the final rule lacked full details on the agency’s expectations and protocols for how providers and their Medicare administrative contractors (MAC) should implement this change, NABH has recommended to CMS a bridging methodology that recognizes that every all-inclusive hospital will not be in full compliance with this shift for their entire next cost-reporting period. CMS understands this reality and this week the agency reported it has several forms of guidance in process, including instructions for both providers and MACs.

NABH is waiting for CMS’ final position on the matter; however, it appears the agency will grant some flexibility to hospitals facing challenges implementing a new charges reporting system. NABH will keep members posted as soon as we learn more about such flexibilities.

Sens. Wyden and Warner Introduce Bill to Enforce Minimum Healthcare Cybersecurity Standards

Senate Finance Committee Chairman Ron Wyden (D-Ore.) and Senate Intelligence Committee Chairman Mark Warner (D-Va.) on Thursday unveiled legislation that would require HHS to enforce minimum cybersecurity standards in the healthcare sector.

According to the bill’s sponsors, the legislation is in response to a surge in cybersecurity attacks that threatened patients’ privacy and lives as well as healthcare providers’ bottom lines. In 2023, 725 data breaches that affected more than 120 million Americans were reported. HHS has not conducted a cybersecurity audit since 2017 and has not issued updated regulations under the HIPAA Security Rule since 2013.

If adopted, the legislation would modify HIPAA requirements by mandating HHS adopt minimum cybersecurity standards for HIPAA-covered entities such as providers, insurers, and their business associates within two years. HHS would also be required to update those standards every two years. Meanwhile, covered entities and business associates would have to conduct a security risk analysis, craft plans to resolve cyber incidents, and conduct stress tests.
The legislation would create fines for violators, rising from $500 for violators with no “knowledge” and up to $250,000 for violators with “willful neglect” that don’t make corrections. HHS may consider an entity’s size, history of compliance, and “good faith efforts to comply” with the requirements.

It would also offer $800 million for two years for 2,000 rural and urban safety net hospitals to prepare, as well as $500 million to encourage hospitals to adopt enhanced practices. The bill would also cement HHS’ authority to provide accelerated and advanced Medicare payments in the event of a cyberattack, such as the one that happened in the wake of the Change Healthcare cyberattack.

The outcome of the legislation is unknown at this point. Sens. Wyden and Warner would like to get the legislation into an end-of-year legislative package; however, Republican members have not expressed support for the legislation and the bill’s unknown cost could potentially be a barrier.

Click here for a one-page summary of the bill; here for a section-by-section summary; and here for the full legislative text.

Please Tell Us More About Your AI Use!

NABH continues to explore how our members use Artificial Intelligence (AI). Our AI survey earlier this year identified Care Quality, Business Operations, and Workforce Solutions as our members’ priority areas.

Please complete our survey by Monday, Oct. 7.

Register for Our November Webinar on Using Publicly Available Data in Health Plan Negotiations

Please join NABH for a webinar on Thursday, Nov. 14, 2024 to learn about using hospital data effectively in your negotiations with health plans.

Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Fact of the Week

National surveys from the Centers for Disease Control and Prevention show an unprecedented decline in drug deaths of roughly 10.6%. Nabarun Dasgupta, Ph.D., M.P.H., a researcher at the University of North Carolina and an expert on street drugs, said he expects the data will show an even larger decline in drug deaths when federal surveys are updated to reflect improvements being seen at the state level, especially in the eastern United States. “In the states that have the most rapid data collection systems, we’re seeing declines of twenty percent, thirty percent,” Dasgupta told NPR.

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

CEO Update 201

Written by Administrator on September 20, 2024. Posted in CEO Updates.

Deadline Extended: Please Submit Updated Member Information by Friday, Sept. 27!

NABH is developing its online-only 2024 Membership Directory, an essential member benefit that helps the association in its advocacy efforts.

We have extended the deadline for members to submit changes to Friday, Sept. 27. If you need assistance, please contact Maria Merlie maria@nabh.org at 202-393-6700, ext. 104.

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

House Advances Telehealth and Social Media Reform Bills

On Wednesday, Sept.18, the House Energy & Commerce Committee passed several bills related to telehealth and social media access, as Congress attempts to complete pending business before the November election.

In a unanimous vote, lawmakers advanced an amended version of H.R. 7623, the bipartisan Telehealth Modernization Actby Reps. Buddy Carter (R-Ga.) and Lisa Blunt Rochester (D-Del.) which would extend pandemic era Medicare telehealth rules for two years and applies flexibilities to federally qualified health centers and rural clinics. The existing rules are scheduled to expire at year’s end. The Congressional Budget Office gave the two-year telehealth extension an estimated cost of about $4 billion. The bill is offset using pharmacy benefit manager reforms. The legislation, which offers payment parity between virtual and in-person care, must be reconciled with similar legislation in the House Ways & Means Committee and must pass both legislative chambers.

The Committee also passed several bills concerning children and social media. H.R. 7891, the Kids Online Safety Act – sponsored by Reps. Bilirakis (Fla.), Castor (Fla.), and Schrier (Wash.), tasks social media platforms with removing or mitigating design features that promote suicide, eating disorders, substance use or sexual exploitation. H.R.7890, the Children and Teens’ Online Privacy Protection Act, by Reps. Castor (Fla.) and Rep. Walberg (Mich.), bans targeted advertising aimed at minors. Neither the Kids Online Safety Act nor the Children and Teens Online Privacy Protection Actrequire warning labels but are the first step toward regulating the platforms, which have largely been immune to legal scrutiny. Last week, a bipartisan group of 39 state attorney generals backed that recommendation and called on Speaker Johnson, Senate Majority Leader Schumer and Senate Minority Leader McConnell to pass legislation requiring social media companies to post warnings that their sites endanger kids’ mental health.

The Senate previously passed the Kids Online Safety Act by a 91-3 vote in July, but the measure advanced in Energy & Commerce is significantly different, eliciting some opposition by members on both sides of the aisle. The committee debate suggests Republican leaders might demand further changes to allow for a vote for this bill on the House Floor. If the House were to pass it, representatives and senators will meet to form a compromise version of the bill, then vote again to pass that version.

Also on Wednesday, the House of Representatives passed H.R. 7858, the Telehealth Enhancement for Mental Health (TELEMH) Act of 2025, by Rep. James (Mich.) which amends title XVIII of the Social Security Act to establish a Medicare incident to modifier for mental health services furnished through telehealth. This bill is a positive development as it would allow supervised “non-physician practitioners” (PAs, NPs, etc.) to bill for telehealth services. Supporters say it would ensure virtual care is used efficiently and with integrity. The bill must now pass the Senate.

Updated Date!: Join NABH for November Webinar on Using Publicly Available Data in Health Plan Negotiations

Please join NABH for a webinar to learn about using hospital data effectively in your negotiations with health plans on Thursday, Nov. 14, 2024.

Register here for this hourlong webinar now occurring on Thursday, Nov. 14 starting at 1 p.m. ET. We hope you join us!

SAMHSA Publishes Compendium: Connected and Strong

A newly published SAMHSA Compendium highlights ten papers aimed at enhancing and unifying behavioral health crisis services. This compilation of resources pinpoint recommendations and present strategies to improve connection within behavioral healthcare.

Focus areas discussed within the papers include but are not limited to the integration of peer support, improving access through the utilization of technology, as well as expanding the crisis response workforce. You can find the complete list of the papers included in the compendium here.

Please Submit Data to NABH’s Denial-of-Care Portal

To support this advocacy push, we strongly encourage all NABH members to submit data to the portal. Please contact NABH Associate Manager of Congressional Affairs Emily Wilkins with questions about the data metrics that we are collecting and/or the data-submission process.

Fact of the Week

Despite a 13% decline in adolescents experiencing major depressive episodes between 2021 and 2023, a SAMHSA reportfound that 40% of young people between the ages of 12 and 17 with major depressive episodes did not receive mental health treatment.

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

CEO Update 200

Written by Administrator on September 13, 2024. Posted in CEO Updates.

Deadline Extended: Please Submit Updated Member Information by Friday, Sept. 27!

NABH is developing its online-only 2024 Membership Directory, an essential member benefit that helps the association in its advocacy efforts.

We have extended the deadline for members to submit changes to Friday, Sept. 27. If you need assistance, please contact Maria Merlie maria@nabh.org or 202-393-6700, ext. 104.

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

Mental Health Parity Final Rule Promises Meaningful Implementation of Groundbreaking Law

NABH is very pleased that the U.S. Health and Human Services (HHS), Labor (DOL) and Treasury Departments’ parity final rule released this week takes major steps toward meaningful implementation of true parity between behavioral and physical healthcare coverage.

Additional sub-regulatory guidance on how to execute the complex rule is pending, and the rule’s provisions will be implemented in a staged manner. Consequently, it will take some time before we can achieve actual parity nationwide and among countless health plans. Given this complexity, NABH, our members, and other partners will remain engaged with federal and state policymakers until the final rule provides meaningful parity protection.

The long-awaited rule lays the groundwork for more stringent compliance protocols and related definitions (noted below) to finally bring the Mental Health Parity and Addiction Equity Act to life 16 years after it was signed into law in October 2008. Responding to the 9,500 comments from stakeholders about the proposed parity rule released in July 2023, HHS, DOL and Treasury made some positive changes from their initial proposal in the final rule, which also reflects the concerns of health plans regarding the feasibility of some of the proposed rule’s recommendations.

In addition, many of the changes allow for closer alignment with existing federal statute, seemingly to acknowledge the risk of legal challenges to the final rule to align with the recent U.S. Supreme Court decision in Loper Bright Enterprises v. Raimondo, in which the High Court overturned the 40-year-old Chevron deference doctrine.

The rule affects group health plans and group or individual health insurance coverage that cover both behavioral and physical healthcare services. In general, the main focus of the rule is to require health plans to prepare comparative analyses that assess parity compliance of their non-quantitative treatment limitations (NQTLs), including specifying the mandatory components of these analyses, and a process for publicly sharing these reports. Examples of important NQTLs include:

“Medical management standards (such as prior authorization) limiting or excluding benefits based on medical necessity or medical appropriateness, or based on whether the treatment is experimental or investigative,
Formulary design for prescription drugs,
For plans with multiple network tiers (such as preferred providers and participating providers), network tier design,
Standards related to network composition, including but not limited to, standards for provider and facility admission to participate in a network or for continued network participation, including methods for determining reimbursement rates, credentialing standards, and procedures for ensuring the network includes an adequate number of each category of provider and facility to provide services under the plan or coverage, and
Plan or issuer methods for determining out-of-network rates, such as allowed amounts; usual, customary, and reasonable charges; or application of other external benchmarks for out-of-network rates.”

A Data-driven Approach for Demonstrating NQTL Parity Compliance
The rule requires health plans to implement a data analysis plan to assess how each NQTL impacts access to mental health (MH)/substance use disorder (SUD) care, including whether each NQTL causes “material differences” in access. In the final rule, health plans will be allowed to consider “the terms of the NQTL at issue, the quality or limitations of the data, causal explanations and analyses, evidence as to the recurring or non-recurring nature of the results, and the magnitude of any disparities.” Using such analyses, NQTLs that are found to be parity non-compliant will not be implemented until they are compliant. The final rule also notes that NQTL oversight will be a collaborative process that includes working with health plans to find ways to address potential issues with compliance, rather than taking a strictly punitive approach.

Increased Compliance Transparency
Plans and issuers are required to provide all comparative analysis upon request to the three federal departments, states, and consumers experiencing treatment limitations. For self-insured employers, all beneficiaries are entitled to request the comparative analyses. These analyses must include:

“a description of the NQTL,
the identification and definition of the factors used to design or apply the NQTL,
a description of how factors are used in the design or application of the NQTL,
a demonstration of comparability and stringency, as written,
a demonstration of comparability and stringency, in operation, and
findings and conclusions.”

More Stringent NQTL Compliance Measures
NQTLs include prior authorization requirements and other medical management techniques, standards related to network composition, and methodologies to determine out-of-network reimbursement rates. The rule addresses these NQTL issues by:

Reinforcing that health plans and issuers cannot use NQTLs that are more restrictive than those predominantly applied to physical health benefits in the same classification.
Disallowing implementation of new NQTLs that do not meet parity standards.
Specifying how insurers are to measure and report on their network composition, out-of-network reimbursement rates, and medical management and prior authorization NQTLs.
Concerning the design of NQTLs, prohibiting discriminatory information, evidence, sources, or standards that systematically disfavor access to behavioral healthcare benefits as compared with physical health benefits.

Mitigating the Impact of Bias in NQTL Design
The final rule prohibits the use of “discriminatory factors and evidentiary standards” in designing a NQTL. Specifically, factors are considered discriminatory if, “based on all the relevant facts and circumstances, they systematically disfavor access or are specifically designed to disfavor access to mental health or substance use disorder benefits as compared to medical/surgical benefits.” For example, a seemingly neutral NQTL, but which is based on historical claims data not compliant with parity, would violate this provision of the final rule.

Generally Accepted Standards of Care (GASC)
Another important gain is the rule’s requirement that health plans explain any medical necessity standards that diverge from GASC. While the parity law does not require that medical necessity guidelines align with GASC, this new requirement will bring meaningful transparency and accountability to the process of creating these extremely effective guidelines.

Standardized “Substantially All,” “Treatment Limitations,” and Other Elements
When determining the treatment limits of a MH or SUD benefit, the parity test to compare the coverage with relevant physical health benefits should be applied to substantially all medical/surgical benefits in that classification. HHS, DOL, and Treasury included this approach in the final rule, rather than the proposed mathematical test for “substantially all” to implement a less cumbersome option.

The rule further defines “treatment limitations” as well as “processes, strategies, evidentiary standards, and other factors.” This provides greater clarity for compliance and eliminates potential loopholes. The rule also offers more specific examples of each, including specifying that the list of example non-quantitative treatment limitations (NQTLs) is meant to not be exhaustive. The final rule defines “treatment limitations” as: “Limits on benefits based on the frequency of treatment, number of visits, days of coverage, days in a waiting period, or other similar limits on the scope or duration of treatment. Treatment limitations include both quantitative treatment limitations, which are expressed numerically (such as 50 outpatient visits per year), and nonquantitative treatment limitations (such as standards related to network composition), which otherwise limit the scope or duration of benefits for treatment under a plan or coverage.”

Mandates Use of Standard Clinical Identifiers
In defining MH and SUD, the rule uses the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM), removing any non-clinical considerations from the definition. Importantly, this makes it clear that eating disorders and autism spectrum disorders fall within the definition of MH/SUD for parity compliance.

“Meaningful Benefits” Definition
To meet the mandatory “meaningful benefits” test, MH and SUD benefits will be compared with all benefits provided for physical health coverage in the same classification. This provision accommodates NABH’s request for a final definition that can mitigate future coverage disagreements among stakeholders, including plans, providers, auditors, and the courts. A meaningful benefit includes “a core treatment,” i.e., “a standard treatment or course of treatment, therapy, service, or intervention indicated by generally recognized independent standards of current medical practice.” This provides additional clarity about what is expected for coverage at every level of benefit under parity.

No “Network Adequacy” Guidance
The final rule does not include a special calculation for network adequacy, which the proposed rule suggested. In the discussion of the final rule, HHS, DOL and Treasury noted they responded to comments citing operational and legal concerns. The final rule also does not require a particular approach for analyzing data around network adequacy, such as reimbursement data.

Self-insured Employers
The final rule contains a number of considerations for self-insured employers in working with third-party administrators (TPAs) to help them achieve parity compliance with minimal additional burden. This includes considerations about how to engage TPAs in getting required data, as well as sharing compliance reporting obligations and liability for non-compliance. The federal departments also signaled interest in continuing to work with employers to ease the burden of compliance and improve coordination with TPAs.

Opt-out Option Removed
The rule amends the sunset provision to prevent opting out of compliance with MHPAEA, as required by law, after Dec. 29, 2022, with a June 27, 2023 deadline for certain plans that are subject to collective bargaining.

Effective Dates
The deadline to implement “the meaningful benefits standard, the prohibition on discriminatory factors and evidentiary standards, the relevant data evaluation requirements, and the related requirements in the provisions for comparative analyses” is Jan. 1, 2026.

For more details, please see the federal departments’ joint fact sheet and news release.

Senate Passes CBO Data Sharing Act

On Tuesday the Senate passed by unanimous consent bipartisan legislation that would allow the Congressional Budget Office (CBO) director to gain stronger authority to access sensitive healthcare data from federal agencies with fewer delays.

House Budget Committee Chairman Jodey Arrington (R-Texas) and ranking Democrat Brendan Boyle (Pa.) introduced the CBO Data Sharing Act (H.R.7032) in January. The legislation would give the CBO director the authority to request and receive information, including sensitive data, from federal agencies without lengthy negotiations or formal agreements, provided confidentiality is upheld. The bill also ensures that future laws cannot unintentionally restrict the CBO’s access to such data unless stated explicitly. The bill aims to prevent data-sharing roadblocks and ensure that Congress has more reliable information when considering changes to Medicare, Medicaid, and other public health policies.

The bill does not directly address the CBO’s interactions with federal health agencies; however, it is expected to have healthcare policy implications by helping the CBO overcome bureaucratic hurdles to secure essential health data and deliver faster, more accurate analyses of healthcare proposals.

As an example, the CBO released a 2023 report on proposals to modify or eliminate the Institutions for Mental Diseases (IMD) exclusion that limits Medicaid funding for inpatient care in psychiatric hospitals or other mental health facilities. To fully assess the potential impact of these proposals, the CBO requested detailed data from CMS on facilities meeting the IMD criteria. CMS denied the request, citing legal restrictions under the Public Health Service Act of 2000. Consequently, the CBO had to rely on less detailed public information, which limited the accuracy of its analysis. Had this bill been in place, the CBO could have bypassed that bureaucratic hurdle and provided Congress with more reliable data, according to the House Budget Committee’s bipartisan fact sheet about the legislation.

The House passed H.R. 7032 in April. The legislation now heads to the White House, where it is expected that President Biden will sign the bill into law.

ICYMI: Watch NABH’s World Suicide Prevention Day Webinar

NABH thanks all who joined us on Sept. 10 for our webinar that highlighted the 2024 National Strategy for Suicide Prevention, a 10-year, comprehensive, societal approach to suicide prevention that provides concrete recommendations for addressing gaps in the suicide-prevention field.

NABH welcomed Julie Goldstein Grumet, Ph.D., vice president of suicide prevention strategy at the Education Development Center (EDC) and director of the EDC’s Zero Suicide Institute; and
Colleen Carr, M.P.H., director of the National Action Alliance for Suicide Prevention.

If you missed it, please click here for the webinar’s recording; here for the presentation slides; and on the links below for some useful resources:

Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Fact of the Week

Mental health jobs are expected to grow three times the rate of all U.S. jobs in the next decade, according to a recent analysis of data from the U.S. Labor Department’s Bureau of Labor Statistics.

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

CEO Update 199

Written by Administrator on September 6, 2024. Posted in CEO Updates.

Reminder: Please Submit Updated Member Information by Next Friday, Sept. 13!

NABH is developing its online-only 2024 Membership Directory, an essential member benefit that helps the association in its advocacy efforts.

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

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

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

Former CDC Directors Caution that Paring Down Agency Could Cost Lives and Damage Economy

Eight former Centers for Disease Control and Prevention (CDC) directors penned an op-ed this week in STAT that warns cutting funding to the Atlanta-based public health agency could endanger lives and the U.S. economy.

“One misguided narrative is that the CDC should focus only on a ‘core mission’ of combatting infectious diseases,” wrote former directors William Foege, William Roper, Jeffrey Koplan, Julie Gerberding, Tom Frieden, Brenda Fitzgerald, Robert Redfield, and Rochelle Walensky, all of whom are physicians. “In fact, the core mission of the CDC is to save lives and protect Americans from all health threats — not only infectious diseases but also cancer, environmental risks, injuries, and the conditions that are the leading causes of death among Americans.”

They added that the CDC has helped save millions of lives through reduced tobacco and alcohol use, diabetes prevention and control, injury prevention including reducing traumatic brain injury, healthier pregnancies with lower maternal mortality, and other health-protection programs.

“Limiting our health defense to just some threats would be like allowing our military to protect us from only some types of attack, telling the National Weather Service to warn people about tornadoes but not hurricanes, or allowing doctors to treat only some diseases,” they continued.

The piece is a response to a Republican bill that would cut funding to the CDC by 22% and also to an op-ed earlier this year from Scott Gottlieb, M.D., former director of the U.S. Food and Drug Administration who now serves on the board of Pfizer.

September Issue of JAMA Pediatrics Includes Several Mental Health-Related Articles

NABH calls members’ attention the September edition of JAMA Pediatrics, which includes a number of articles focused on mental health.

Topics include healthcare needs and costs for children exposed to prenatal substance use, hospital admissions for eating disorders, mental health of transgender youth following gender identity milestones, and more.

September is National Recovery Month and Suicide Prevention Month

September is National Recovery Month, and the Substance Abuse and Mental Health Services Administration (SAMHSA) will commemorate the annual observance with a campaign focused on the four dimensions of recovery: health, home, purpose, and community.

Week One will emphasize health and will highlight choices that support well-being – such as eating a nutritious diet, exercising regularly, developing healthy sleeping habits, and managing other health issues –that can help support people with mental health and substance use conditions in their journey to recovery. Click here to access SAMHSA’s Recovery Month social media toolkit.

September is also Suicide Prevention Month, and SAMHSA has created a separate toolkit with hashtags and posts for the month and also World Suicide Prevention Day on Sept. 10 to remember the lives of those lost to suicide.

Reminder: Join NABH for World Suicide Prevention Day Webinar on Sept. 10

Please join NABH this coming Tuesday, Sept. 10, World Suicide Prevention Day, for a webinar that will feature two experts who will highlight HHS’ 2024 National Strategy for Suicide Prevention, a 10-year, comprehensive, societal approach to suicide prevention that provides concrete recommendations for addressing gaps in the suicide-prevention field.

NABH will welcome Julie Goldstein Grumet, Ph.D., vice president of suicide prevention strategy at the Education Development Center (EDC) and director of the EDC’s Zero Suicide Institute; and Colleen Carr, M.P.H., director of the National Action Alliance for Suicide Prevention.

Grumet and Carr will discuss the core strategic directions of the National Strategy; provide context on how these goals fit into current efforts by health systems, providers, and their partners in the field; highlight opportunities to support National Strategy implementation efforts; and what to expect – as well as how to engage – as the new strategy rolls out.

The discussion will also include an overview of key NABH priorities reflected in the new strategy, including workplace violence prevention and current efforts to protect and advance workforce wellbeing, including suicide prevention.

Please click here to register for this hourlong webinar on Tuesday at 2 p.m. ET.

Join NABH for October Webinar on Using Publicly Available Data in Health Plan Negotiations

Please join NABH for a webinar to learn about using hospital data to improve negotiations with health plans on Wednesday, Oct. 16, 2024.

Please register here for this hourlong webinar on Wednesday, Oct. 16 starting at 2 p.m. ET. We hope you join us!

Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Fact of the Week

An analysis of provisional data from the National Institute on Drug Abuse found that between 2015 and 2023, there was a nearly five-fold increase in overdose deaths among non-Hispanic Black men 55 and older.

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

CEO Update 198

Written by Administrator on August 23, 2024. Posted in CEO Updates.

Reminder: Please Update Your Member Information for the 2024 NABH Membership Directory!

NABH is developing its online-only 2024 Membership Directory, an essential member benefit that helps the association in its advocacy efforts.

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

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

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

Legislative Preview: What to Expect from Congress This Fall

Following their annual August recess and respective party conventions, federal lawmakers will return to Capitol Hill on Monday, Sept 9 to determine next steps for funding the federal government and provide stop-gap funding for veterans’ benefits.

The House and Senate will continue to attempt to pass appropriations bills funding various federal agencies before the Sept. 30 deadline. Both chambers have passed respective appropriations bills for Labor and HHS with vastly different funding levels, which likely won’t be reconciled before the deadline.

Numerous other agency funding bills are still pending. Congressional leaders are already having conversations about passing a Continuing Resolution (CR) to fund the government, which Congress will need to approve by Sept. 30 to stave off a government shutdown. The length of the CR will likely extend past the election or potentially after the 119 Congress takes office in January.

In addition, Congress will likely consider a $3 billion emergency aid bill that would cover veterans benefits and services as the Veterans Affairs Department (VA) warns of a nearly $14.9 billion shortfall through fiscal year 2025. A bipartisan group of appropriators and other senators intend to introduce legislation that would provide almost $2.3 billion in additional fiscal 2024 funding for the VA to cover compensation and pensions in the near term, along with almost $597 million for readjustment benefits. Without action from Congress by Sept. 20, the VA has warned it won’t be able to pay out roughly $3 billion in disability compensation, pension, and education benefits as early as Oct. 1. Because this is considered “must pass” legislation, Congress could attempt to add additional bills to this action.

Congress is expected to adjourn Sept. 27 after completing these tasks and return after the Nov. 5 elections. At that time, Congress will return to address unfinished business before the end of the year, commonly known as the “lame duck session.” Typically, most work during this session depends on which political party won majorities in the House and Senate during the November elections and whether there is a pending change in majority in either legislative chamber.

The outcome of the U.S. presidential race can also play a role in the level of activity during a lame duck session. Some congressional members might continue to push for an end-of-year health package, which could include reauthorizing the SUPPORT Act and a telehealth extension, among other priorities.

September is National Recovery Month and Suicide Prevention Month

Next month marks National Recovery Month, and the Substance Abuse and Mental Health Services Administration (SAMHSA) will commemorate the annual observance with a campaign focused on the four dimensions of recovery: health, home, purpose, and community.

Reminder: Join NABH for World Suicide Prevention Day Webinar on Sept. 10

Please join NABH on World Suicide Prevention Day, for a webinar that will feature two experts who will highlight HHS’ 2024 National Strategy for Suicide Prevention, a 10-year, comprehensive, societal approach to suicide prevention that provides concrete recommendations for addressing gaps in the suicide-prevention field.

NABH will welcome Julie Goldstein Grumet, Ph.D., vice president of suicide prevention strategy at the Education Development Center (EDC) and director of the EDC’s Zero Suicide Institute; and Colleen Carr, M.P.H., director of the National Action Alliance for Suicide Prevention.

Please click here to register for this hourlong webinar on Tuesday, Sept. 10 at 2 p.m. ET.

HHS and DOJ to Host Webinar on Incarcerated Youth and Medicaid Next Week

HHS and the U.S. Justice Department (DOJ) will host a webinar next Tuesday, Aug. 27 that will highlight policy approaches designed to connect justice-involved youth with Medicaid and CHIP services.

In late July, the Centers for Medicare & Medicaid Services (CMS) sent a letter to state health officials that addressed the statutory requirements in the Consolidated Appropriations Act, 2023 regarding the availability of certain state plan services for incarcerated youth in Medicaid and the Children’s Health Insurance Program (CHIP) and modification of CHIP eligibility requirements for children who become incarcerated in juvenile or adult corrections systems.

During this webinar, HHS and DOJ leadership and subject matter experts will discuss how this opportunity will help advance health equity and build healthier and safer communities.
Click here to register for the webinar that will start at 2 p.m. ET.

SAMHSA Offers On-Demand Module on Motivational Interviewing Strategies for AUD

SAMHSA is offering an on-demand module to help physicians, physician associates, nurses, social workers, and other healthcare professionals learn how to use Motivational Interviewing strategies as a guided approach to clinical interactions and fostering behavior change in patients with alcohol use disorder.

SAMHSA’s PCSS-MAUD Motivational Interviewing for Alcohol Use Disorder Treatment is a self-paced training program that addresses the Accreditation Council for Graduate Medical Education competencies of patient care, medical-based knowledge, and practice-based learning.

National Academies Examines Strategies to Improve Behavioral Healthcare Access in Medicare and Medicaid

The National Academies has released Expanding Behavioral Healthcare Workforce Participation Through Medicare, Medicaid, and Marketplace Plans, a new resource it developed after SAMHSA and CMS asked the not-for-profit institutions t convene a committee that would examine current challenges in ensuring broad access to evidence-based behavioral healthcare services through Medicare, Medicaid, and Marketplace programs—and propose strategies to address those challenges.

“Barriers to obtaining behavioral health treatment are most evident in populations receiving Medicare, Medicaid, and Marketplace plans,” the National Academies wrote in its description of the new resource. “Behavioral healthcare providers serving individuals enrolled in these plans are more likely to experience challenges around reimbursement and training, which disincentivizes participation.”

Join NABH for October Webinar on Using Publicly Available Data in Health Plan Negotiations

Please join NABH for a webinar to learn about using hospital data effectively in your negotiations with health plans on Wednesday, Oct. 16, 2024.

Please register here for this hourlong webinar on Wednesday, Oct. 16 starting at 2 p.m. ET. We hope you join us!

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Fact of the Week

The National Institutes of Health announced it has launched a program to advance research that will support Native American communities to lead research to address overdose, substance use, and pain, including factors such as mental health and wellness.

NABH will not publish CEO Update next Friday, Aug. 30. The NABH staff wishes you, your teams, and your families a safe and happy Labor Day weekend next week! CEO Update will resume on Friday, Sept. 6.

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

CEO Update 197

Written by Administrator on August 16, 2024. Posted in CEO Updates.

Please Update Your Member Information for the 2024 NABH Membership Directory!

NABH is developing its online-only 2024 Membership Directory, an essential member benefit that helps the association in its advocacy efforts.

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

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

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

HRSA Social Worker Licensure Compact Seeks to Increase Behavioral Healthcare Access and Enhance Telehealth Services

The Health Resources and Services Administration (HRSA) announced recently its first Licensure Portability Grant Program investment in a multi-state social worker licensure compact.

According to HRSA, state licensure compacts allow states to agree on a common approach to licensing health care providers, allowing providers to practice across state lines without having to apply for a license in each state. Streamlining licensure while maintaining quality standards improves access to services both by better facilitating hiring and by easing pathways to utilizing telehealth. HRSA made the announcement at its National Telehealth Conference last month.

“Social workers are essential to expanding access to behavioral health care services, a top priority of the Biden-Harris administration,” HHS Deputy Secretary Andrea Palm said in a statement. “HRSA is leading the way in growing the behavioral health workforce both by training more providers and by breaking down barriers to allow the workforce to make mental health and substance use disorder services more accessible across the country,” she added.

Click here to see the grant program awardees.

Join NABH Sept. 10 for Webinar on the 2024 National Strategy for Suicide Prevention

Please help NABH recognize World Suicide Prevention Day on Tuesday, Sept. 10, 2024 by joining us for a webinar featuring two experts who will highlight HHS’ 2024 National Strategy for Suicide Prevention, a 10-year, comprehensive, societal approach to suicide prevention that provides concrete recommendations for addressing gaps in the suicide-prevention field.

The webinar will feature Julie Goldstein Grumet, Ph.D., vice president of suicide prevention strategy at the Education Development Center (EDC) and director of the EDC’s Zero Suicide Institute; and Colleen Carr, M.P.H., director of the National Action Alliance for Suicide Prevention.

Please register here for this hourlong webinar on Tuesday, Sept. 10 webinar that starts at 2 p.m. ET. I hope you join us!

Reminder: Behavioral Health Business to Examine ‘How AI is Making Healthcare More Human’ in August Webinar

The publication Behavioral Health Business will host a webinar next month to explore how AI could potentially enhance humanity in behavioral health.

The discussion will examine how AI could extend to underserved communities, improve patient outcomes, and increase both clinician and patient satisfaction.

It also promises to highlight new research involving 130,000 patients that shows people are significantly more likely to begin therapy when their experience starts with Limbic, an AI-powered clinical assessment, with the most positive effects observed among minority groups.

The webinar will be held Thursday, Aug. 22 at Noon ET. Click here to register.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Fact of the Week

According to a Pew Charitable Trusts fact sheet released this week, more than 10.2 million people ages 12 and older misused stimulants – which includes cocaine, prescription stimulants for ADHD and methamphetamine – in 2022. This reflects a nearly 9% increase from 2021.

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

CEO Update 196

Written by Administrator on August 9, 2024. Posted in CEO Updates.

Contingency Management Battles Ongoing Headwinds

Earlier this week, a STAT news article reviewed the executive branch’s response to advocacy efforts to expand financing for the only evidence-based treatment for stimulant use disorder, contingency management (CM.) CM provides financial rewards for abstinence from stimulants and has decades of research demonstrating that intervention changes the reward centers of the brain, resulting in behavior change. There are no medications for stimulant use disorders.

Currently, the Substance Abuse and Mental Health Services Administration limits CM rewards to $75, which is too low for effective treatment. In addition, members of Congress have confused CM treatment with harm reduction and made the treatment a highly charged political issue. Speaking on behalf of NABH, Sarah Wattenberg, director of quality and addiction services, stated, “I understand their political concerns, but sometimes you just have to bite the bullet.” She continued, “Too many people are dying, and we need to act now.”

Reminder: Join NABH Sept. 10 for Webinar on the 2024 National Strategy for Suicide Prevention

Please register here for this hourlong webinar on Tuesday, Sept. 10 webinar that starts at 2 p.m. ET. I hope you join us!

NABH Seeks Member Feedback on CMS’ 2025 PFS and OPPS Proposed Rules

NABH seeks member feedback on the Centers for Medicare & Medicaid Services (CMS) proposed 2025 Physician Fee Schedule rule and 2024 Outpatient Prospective Payment System rule.

To weigh in, please begin by reviewing the regulations and NABH’s recent 2025 Physician Fee Schedule and 2025 Outpatient Prospective Payment System alerts to help NABH staff identify the priorities we should address with CMS, such as payment, impact on patients and quality, or operational challenges.

Please email your comments to Rochelle Archuleta by Friday, Aug. 9. Comments for both rules are due to CMS by Monday, Sept. 9.

Reminder: SAMHSA Announces Funding Opportunity to Enhance Capacity of Women’s Behavioral Health Providers

SAMHSA is accepting applications for its Women’s Behavioral Health Technical Assistance Center to enhance capacity of women’s behavioral health providers, general healthcare providers, and others involved in the holistic care of women with or at risk for mental health and substance use conditions—including women who were greatly affected by the COVID-19 pandemic.

The agency said it has a total of $12.5 million for five years and anticipates granting one award. Applications are due by Tuesday, Aug. 20, 2024. Click here to learn more.

Reminder: Behavioral Health Business to Examine ‘How AI is Making Healthcare More Human’ in August Webinar

The publication Behavioral Health Business will host a webinar this month to explore how AI could potentially enhance humanity in behavioral health.

The discussion will examine how AI could extend to underserved communities, improve patient outcomes, and increase both clinician and patient satisfaction.

The webinar will be held Thursday, Aug. 22 at Noon ET. Click here to register.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Fact of the Week

A recent JAMA study found that between Jan. 2010 and Dec. 2021, 60% of youth who lost their lives to suicide lacked mental health diagnoses. This study’s findings highlight the importance of “…equitable access to MH screening, diagnosis, and treatment for all youths. “

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

CEO Update 195

Written by Administrator on August 2, 2024. Posted in CEO Updates.

CMS Finalizes 2.5% IPF Payment Increase and Payment System Reforms

The Centers for Medicare & Medicaid Services’ (CMS) fiscal year (FY) 2025 final rule on the inpatient psychiatric facility prospective payment system (IPF PPS) implements a net increase of 2.5 percentage points. The overall update of $65 million, compared with FY 2024 payment levels, represents a slight decrease from the proposed 2.6 percentage point increase.

This update includes a market basket increase of 3.3 percentage points that is offset by a 0.5 percentage point for productivity. In addition, to maintain the mandated outlier pool of 2.0% of total payments, CMS finalized an outlier payment reduction of 0.3 percentage point to stay within this target, which reduces the number of cases that will qualify for an outlier payment.

CMS also finalized several adjustments to ensure that the PPS design and other changes discussed below are implemented in a budget-neutral manner. Due to these adjustments, the base per diem rate will be reduced to $876.53 from $895.63.

All-Inclusive Reporting
NABH is extremely disappointed that CMS finalized a significant narrowing of its all-inclusive reporting policy, which will take effect for upcoming cost reporting periods. Current policy allows IPFs to use an alternative methodology for reporting ancillary charges on cost reports. The final rule restricts this reporting option for ancillary charges only to Indian Health Service (IHS) hospitals, tribally owned and government-owned psychiatric, and acute care hospitals. CMS overlooked NABH’s strong caution that for many “all-inclusive IPFs,” significant administrative, timing and cost considerations will make impossible a timely transition to this change.

Under the finalized timing framework, CMS contractors will begin assessing compliance with the change through a look-back process that begins following the completion of a provider’s upcoming cost-reporting period that begins on or after Oct. 1, 2024. Specifically, all IPFs will be required to have a charge structure that allows the reporting of ancillary costs and charges on their cost reports for all ancillary services and correlating charges, such as labs and drugs.

With this change, IPFs that are currently in the all-inclusive category now will have their cost reports included in the annual IPF PPS update that CMS calculates. Because CMS calculates the annual update using the sum of routine and ancillary costs, in prior years the agency has removed from the calculation the all-inclusive IPFs, as their cost reports lack data on ancillary services. The final rule notes that in 2018, because of this exclusion, 82,491 (out of 364,080 total stays) were removed from the update calculation. CMS acknowledges that this exclusion has been producing skewed updates that do not represent the costs of the entire IPF field, with approximately 55 percent of stays from freestanding all-inclusive facilities removed in 2018, and 0.3 percent of stays from all-inclusive psychiatric units.

In response to feedback that all-inclusive IPFs are providing full and clinically-appropriate services and that the absence of ancillary charges on cost reports is due to gained cost efficiencies, CMS said it “believe[s that] IPFs are providing these necessary services to patients.” The agency added: “…maintaining an accurate charge structure would be part of a business’s accounting for reordering and restocking pharmaceuticals at a minimum, as well as more accurate payment for the purposes of outlier payments.”

Payment Increase for Electroconvulsive Therapy
For FY 2025, to achieve some alignment with outpatient rates, CMS finalized the proposed 71 percent increase for ECT payment per treatment from the current rate of $385.58 to $661.52.

IPF PPS Modifications
As mandated by Congress, CMS reviewed key IPF PPS elements with a focus on facility and patient-level adjustments, and in this rule finalizes multiple, relatively modest changes. While the agency is maintaining the rural and teaching facility adjustments, as is, the rule finalizes multiple budget-neutral changes to the structure of the PPS. As shown in Tables 4 and 5 in the rule, CMS finalized these changes:

Added DRGs 917 (Poisoning and toxic effects of drugs w MCC) and 918 (Poisoning and toxic effects of drugs w/out MCC).
Replaced DRGs 080 (Nontraumatic stupor & coma w MCC) and 081 (Nontraumatic stupor & coma w/o MCC) with DRGs 947 (Signs and Symptoms w MCC) and 948 (Signs and Symptoms w/out MCC.
Removed 2 DRGs: DRG 887 (Other mental disorder diagnoses) and DRG 896 (Alcohol, Drug Abuse or Dependence w/out rehab therapy w MCC).
Multiple changes to comorbidity payment add-ons were finalized as shown in Table 10.

IPF Quality Reporting Program
As proposed, the final rule implements one new measure: the 30-Day Risk-Standardized All-Cause Emergency Department Visit Following an Inpatient Psychiatric Facility Discharge. In response to concerns raised through public comments that its implementation may not be feasible, CMS did not finalize the proposed requirement for IPFs to submit patient-level quality data every quarter (versus the current annual basis).

Please see CMS’ fact sheet for more information about the rule.

NABH Seeks Member Feedback on CMS’ 2025 PFS and OPPS Proposed Rules

NABH seeks member feedback on the Centers for Medicare & Medicaid Services (CMS) proposed 2025 Physician Fee Schedule rule and 2024 Outpatient Prospective Payment System rule.

Please email your comments to Rochelle Archuleta by Friday, Aug. 9. Comments for both rules are due to CMS by Monday, Sept. 9.

Senate Passes Kids Online Safety and Privacy Act

The Senate on July 30 voted 91-3 to pass the Kids Online Safety and Privacy Act (KOPSA), a combination of the Kids Online Safety Act and the Children and Teens’ Online Privacy Protection Act. The bill would for the first time make social companies such as Facebook and TikTok responsible for the ill effects of design features that recommend content and encourage engagement.

KOPSA prescribes that technology companies must limit the amount of data they collect on children under 17; not target minors with advertising; give children the highest privacy settings by default; offer the ability to opt out of various design features like content recommendations and engagement nudges; and have an independent third party audit their platforms for potential harm to children; among other provisions.

Recent developments have increased pressure on Congress to pass a bill protecting online safety and privacy. Several states have passed social media and privacy laws aimed at mitigating youth harms. And in June, U.S. Surgeon General Vivek Murthy called for social media platforms to come with warning labels.

Technology companies and free speech advocates staunchly oppose the bill, which is expected to face certain legal challenges if it becomes law. Grassroots organizations alarmed by child suicide have pushed for the federal legislation, and have helped to enact laws in California, Colorado, Connecticut, Maryland, and New York meant to regulate social media for minors.

House companion bills are awaiting committee action, with House Energy and Commerce Chair Cathy McMorris Rodgers (R-Wash.) planning a vote this Fall. House Leadership has also signaled interest in the measures and there is bipartisan support for them.

Passing this legislation would be the first major regulation in years to alter how large technology companies interact with children on their platforms.

SAMHSA Releases 2023 National Survey on Drug Use and Health

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week released key findings from the 2023 National Survey on Drug Use and Health (NSDUH).

Conducted by the federal government since 1971, the NSDUH is a primary source of statistical information on self-reported substance use and mental health of the U.S. civilian, noninstitutionalized population 12 or older. Estimates are presented by age group and by race/ethnicity for selected measures.

ASAM Past President Stuart Gitlow Pens Op-Ed on Cannabis Re-Scheduling

Stuart Gitlow, M.D., M.P.H., M.B.A., DFAPA, DFASAM, past president of the American Society of Addiction Medicine, penned an Op-Ed in ASAM Weekly in response to a proposal by the U.S. Justice Department to reschedule marijuana from Schedule I to Schedule III.

Currently, marijuana is illegal at the federal level, while many states have implemented decriminalization and legalization initiatives. This creates a difficult position for physicians (among others, such as dispensaries) who might recommend or fill out state-required forms for medical marijuana.

In his opinion piece, Gitlow argued that this would not change under rescheduling. Additionally, rescheduling would not decriminalize or legalize marijuana use. He also wrote there has not been sufficient research confirming any “true medical utility” of marijuana, whereas there is an understanding that the plant has addictive potential and impacts public health negatively.

Join NABH Sept. 10 for Webinar on the 2024 National Strategy for Suicide Prevention

Please register here for this hourlong webinar on Tuesday, Sept. 10 webinar that starts at 2 p.m. ET. I hope you join us!

Reminder: Behavioral Health Business to Examine ‘How AI is Making Healthcare More Human’ in August Webinar

The publication Behavioral Health Business will host a webinar next month to explore how AI could potentially enhance humanity in behavioral health.

The discussion will examine how AI could extend to underserved communities, improve patient outcomes, and increase both clinician and patient satisfaction.

The webinar will be held Thursday, Aug. 22 at Noon ET. Click here to register.

ICYMI: CMS Shares Discusses EMTALA and Behavioral Health in ACEP Podcast

CMS participated in the American College of Emergency Physicians’ ACEP Frontline podcast to discuss the Emergency Medical Treatment & Labor Act (EMTALA) and behavioral health.

The podcast describes how behavioral health conditions and physical health conditions are considered similarly from the standpoint of EMTALA.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Fact of the Week

NBC News reported recently that athletes prioritized their mental health ahead of the Summer 2024 Olympic Games that opened in Paris a week ago.

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

CEO Update 194

Written by Administrator on July 26, 2024. Posted in CEO Updates.

House Passes Bill to Reauthorize Child Welfare Programs Included RTF Provision

The House Ways and Means Committee on Thursday passed unanimously H.R. 9076, the Bipartisan Protecting America’s Children by Strengthening Families Act, to reauthorize and reform the nation’s child welfare programs under Title IV-B of the Social Security Act. Authorization for these programs expired in fiscal year 2021, and there have been no serious reforms since 2008.

Introduced by Reps. Darin LaHood (R-Ill.) and Danny Davis (D-Ill.), H.R. 9076 focuses mainly on America’s child foster care system and also includes a provision titled Improving Data Collection and Reporting for Youth in Residential Treatment Programs.

The language directs HHS and other agencies to update guidance to state agencies in administering state plans approved under parts B and E of title IV of the Social Security Act on a) best practices for federal and state agencies to collect data and share information related to the well-being of youth residing in residential treatment facilities, including those facilities operating in multiple states or serving out-of-state youth; b) best practices on improving state collection and sharing of data related to incidences of maltreatment of youth residing in residential treatment facilities, including with respect to meeting the requirement of section 471(a)(9)(A) of such Act for such youth in foster care; and c) best practices on improving oversight of youth residential programs receiving federal funding and research-based strategies for risk assessment related to the health, safety, and well-being of youth in the facilities.

The House Ways and Means Committee’s passage of this legislation follows the influential panel’s hearing last month about child welfare programs, which included testimony from Paris Hilton, who supported H.R. 2955, The Stop Institutional Child Abuse Act, aspects of which were incorporated into the data collection and reporting Section of H.R. 9076.

The next step would be for H.R. 9076 to move to the House floor for a vote; however, it’s unclear whether the House will consider the legislation. It’ also unknown if the Senate will consider the bill or consider similar legislation.

NABH will continue to monitor any congressional action related to H.R. 9076

HHS Streamlines Technology, Cybersecurity, and AI Functions Under ONC

HHS on Thursday announced a reorganization to streamline and strengthen its technology, cybersecurity, data, and AI strategy and policy functions.

Under the restructured format, the Office of the National Coordinator for Health Information Technology, or ONC, will be renamed the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology, or ASTP/ONC. All oversight of technology, data, and AI policy and strategy will move from its current structure under the Assistant Secretary for Administration to ASTP/ONC, including the HHS-wide roles of chief technology officer, chief data officer, and chief AI officer.

In addition, the public-private effort between the health sector and the federal government on cybersecurity (“405(d) Program”) will move from ASA to the Assistant Secretary for Strategic Preparedness and Response, or ASPR, joining the other health sector cybersecurity activities already located in ASPR’s Office of Critical Infrastructure Protection.

Biden Administration Awards $45.1 Million to Expand Mental Health and Substance Use Services

The Biden administration this week announced grant awards totaling $45.1 million – including $15.3 million specifically for children and youth– to expand mental health and substance use services.

The youth funding will go toward supporting their mental health in school settings; serving children and families who have experienced traumatic events and grief; and providing services specific to young people of transitional ages who are at risk for or have serious mental health conditions.

“Be it fostering wellness in young people, caring for the unhoused, facilitating treatment and more, this funding directly supports the needs of our neighbors,” HHS Secretary Xavier Becerra said in an announcement about the funding. “These investments will empower communities to implement effective solutions that promote long-term healing and resilience.”

Click here to read about the various grant awards and access links to apply.

NABH Seeks Member Feedback on CMS’ 2025 PFS and OPPS Proposed Rules

NABH seeks member feedback on the Centers for Medicare & Medicaid Services’ (CMS) proposed 2025 Physician Fee Schedule rule and 2024 Outpatient Prospective Payment System rule.

Please email your comments to Rochelle Archuleta by Friday, Aug. 9. Comments for both rules are due to CMS by Monday, Sept. 9.

Reminder: SAMHSA Announces Funding Opportunity to Enhance Capacity of Women’s Behavioral Health Providers

The agency said it has a total of $12.5 million for five years and anticipates granting one award. Applications are due by Tuesday, Aug. 20, 2024. Click here to learn more.

Reminder: Behavioral Health Business to Examine ‘How AI is Making Healthcare More Human’ in August Webinar

The publication Behavioral Health Business will host a webinar next month to explore how AI could potentially enhance humanity in behavioral health.

The discussion will examine how AI could extend to underserved communities, improve patient outcomes, and increase both clinician and patient satisfaction.

The webinar will be held Thursday, Aug. 22 at Noon ET. Click here to register.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Fact of the Week

A new poll from the National Alliance on Mental Illness found 82% of Americans are still not familiar with 988, the lifeline that helps people in mental health, substance use, and suicide crises get connected to support services.

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

CEO Update 193

Written by Administrator on July 25, 2024. Posted in CEO Updates.

FDA & FTC Issue Warnings to Crack Down on Illegal Sales of Food Products with Delta-8 THC

The Food and Drug Administration (FDA) and the Federal Trade Commission this week issued warnings to five companies to crack down on illegal sales of food products containing delta-8 THC.

The products’ packaging resemble familiar snacks and candies, potentially leading to accidental ingestion or overconsumption. The agencies are especially concerned about the appeal to children and potential impurities or unpredictable effects from processes used to synthesize delta-8 THC, the psychoactive cannabinoid from the Cannabis sativa plant.

The companies have 15 working days to submit written responses detailing how they will address these violations and prevent future ones. If the violations are not addressed promptly, the agency may take legal action.

From Jan. 1, 2021, to Dec. 31, 2023, the FDA received more than 300 adverse event reports involving children and adults who consumed delta-8 THC products. In response, the agency issued a warning to customers in June 2022. Meanwhile, between Jan. 1, 2021, and May 31, 2022, national poison control centers handled 10,448 single substance exposure cases involving edible products containing THC, 77% of them for people 19 or younger.

Adverse effects can include hallucinations, vomiting, tremor, anxiety, dizziness, confusion and loss of consciousness, the agency said.

Joint Commission’s Revised Guidelines for Restraint and Seclusion to Begin Next Year

The Joint Commission has announced new and revised requirements will apply to behavioral healthcare and human services organizations that use restraint and/or seclusion starting on Jan 1, 2025.

The changes include revising the definition of restraint; reducing redundancies; streamlining processes; and removing requirements for physical holding of a child or youth and incorporating this concept into the requirements for restraint and seclusion because physical holding that restricts freedom of movement is a type of restraint.

Click here to learn more.

DEA Rule on Telehealth Slated for September

The Drug Enforcement Administration is expected to issue its highly anticipated telehealth prescribing rule in September, according to an article in Inside Telehealth, an Inside Health Policy publication.

“A last-minute title change of the proposed rule may indicate that the registration could allow for prescribing controlled substances across state lines, sources say,” the article noted.

The article also said the rule’s title was updated to “Special Registrations for Telemedicine and Limited State Telemedicine Registration,” according to DEA’s spring regulatory agenda published July 5.

NIH Study: Doctors Reluctant to Treat Addiction Report Lack of Support as Barrier

A new National Institutes of Health study found “instiutional environment” as the most frequently reported reason why physicians are reluctant to intervene in addiction treatment.

“Institutional environment” refers to factors such as lack of support from a physician’s institution or employer; insufficient resources, such as staff and training; challenges in organizational culture; and competing demands. This reason for reluctance was cited in 81% of the studies reviewed, followed by insufficient skill (74%), lack of cognitive capacity to manage a certain level of care (74%), and inadequate knowledge (72%).

Meanwhile, about 66% of studies cited negative social influences – or beliefs about public and community acceptance of addiction care – while 56% of studies cited fear of harming the patient-physician relationship as deterrents for physicians to intervene in addiction.

The study’s findings highlighted the need for institution-wide changes to improve the adoption of evidence-based substance use disorder treatment practices among physicians, such as increasing organizational support, leadership and staff buy-in, and education and training.

Kaiser Family Foundation to Host ‘Beyond Chevron: How the SCOTUS Decision will Affect Healthcare Policy Decisionmaking’ Webinar Next Week

The Kaiser Family Foundation (KFF) will host a webinar next week to discuss the potential challenges stemming from the U.S. Supreme Court’s decision on June 28 to overturn the Chevron precedent that required federal courts to defer to reasonable agency decisions when federal law is unclear.

Moderated by KFF Executive Vice President for Health Policy Larry Levitt, the discussion will address questions such as: How will the decision change how regulators approach drafting new regulations? What type of health policy regulations are likely to be most vulnerable to future court challenges? How will it alter the legislative process and the ability to pass new laws? And to what extent will Congress be able to provide greater specificity in delegating authority to federal agencies in future legislation?

The 45-minute webinar will be held on Thursday, July 25 at Noon ET. Click here to register.

Behavioral Health Business to Examine ‘How AI is Making Healthcare More Human’ in August Webinar

The publication Behavioral Health Business will host a webinar next month to explore how AI could potentially enhance humanity in behavioral health.

The discussion will examine how AI could extend to underserved communities, improve patient outcomes, and increase both clinician and patient satisfaction.

The webinar will be held Thursday, Aug. 22 at Noon ET. Click here to register.

Reminder: SAMHSA Announces Funding Opportunity to Enhance Capacity of Women’s Behavioral Health Providers

The agency said it has a total of $12.5 million for five years and anticipates granting one award. Applications are due by Tuesday, Aug. 20, 2024. Click here to learn more.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Fact of the Week

Early population estimates from the Centers for Disease Control and Prevention (CDC) show that around 7% of the entire U.S. adult population reported having Long COVID in 2022. “Some of the most common mental health conditions associated with Long COVID include fatigue, sleep disturbances, depression, anxiety, psychosis, cognitive impairment, obsessive-compulsive disorder, and posttraumatic stress disorder,” the Substance Abuse and Mental Health Services Administration (SAMHSA) reported recently. “Both COVID-19 and Long COVID can result in new onset of behavioral health conditions in those who have not previously reported these conditions, and aggravate complications for those with pre-existing mental health conditions and substance use disorders.”

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

CEO Update 192

Written by Administrator on July 12, 2024. Posted in CEO Updates.

FDA Releases Guidance on Constructing Effective Clinical Trials for Devices

The FDA on Thursday issued guidance about constructing effective clinical trials to develop medical devices that treat patients who misuse opioids.

The new guidance is intended to improve both the design and development of clinical studies to provide a reasonable assurance of safety and effectiveness for a device intended to treat OUD. Challenges in developing OUD device studies include inaccurate patients report of drug use, high rates of missing data, and confounding effects of concomitant drug treatments.

The guidance is not legally enforceable.

CMS Updates IOP and PHP Payment Rates for 2025

The Centers for Medicare & Medicaid Services (CMS) this week issued its calendar year (CY) 2025 Medicare hospital outpatient prospective payment system (OPPS) proposed rule, which proposes a net increase of 2.3 percentage points, relative to current year rates. The net update reflects a market basket increase of 3.0 percentage points and the statutorily required 0.4 percentage point cut, along with several budget neutrality adjustments and a minor increase in outlier payments.

The proposed update would apply to services paid under the OPPS, intensive outpatient programs (IOP), partial hospitalization programs (PHP), community mental health centers (CMHCs), opioid use disorder (OUD) treatments in an IOP, and other settings.

In addition to other items, the proposed rule addresses the behavioral healthcare provisions summarized below and lists in Table 68 the eight proposed ambulatory payment classification (APC) per diems for IOPs and PHPs that are set according to the number of services provided per day.

IOPs
For the IOP benefit established last year, the current dual-rate, per-diem structure would be maintained: one rate for days with three services and another rate for days with four or more services. In general, the structure of the IOP mirrors the design of the PHP, including provisions on coding, billing, and payment policies.

The rule defines IOPs as distinct and organized outpatient programs of psychiatric services provided for individuals who have an acute mental illness or substance use disorder, consisting of a specified group of behavioral health services paid on a per-diem basis for a minimum of nine hours of IOP services per week, or other payment system.

Opioid Treatment Program (OTP) Payment Add-On
For the new OPPS coverage of OUD treatments that OTPs provide, CMS would maintain the payment add-on of three times the payment rate for APC 5861 (intensive outpatient of three services per day) for hospital-based IOPs.

FQHCs and RHCs
The annual payment update for IOP services provided by federally qualified health centers and rural health clinics will be addressed in the pending physician fee schedule proposed rule for CY 2025.

PHPs
For PHPs, services provided in hospital outpatient departments and CMHCs, CMS proposes to maintain the current payment structure, which sets reimbursements based on whether a patient receives three services versus four or more services per day. PHPs are intensive, structured outpatient programs that are alternatives to psychiatric hospitalization, consisting of a specified group of mental health services paid on a per-diem basis for a minimum of 20 hours of PHP services per week, based on per diem costs.

Access to Non-Opioid Treatments for Pain Relief
As mandated by Congress, CMS is proposing temporary add-on payments for certain non-opioid treatments for pain relief. This complex provision would take effect from Jan. 1, 2025 through Dec. 31, 2027, and would require certain clinical evidence for medical devices and FDA-approved indications for pain management. The payment add-on would be capped at the estimated average of 18% of the full OPPS payment, calculated using the top five procedures by volume for each drug or device. Table 84 in the rule lists the proposed seven injections and other items that would qualify for a payment add-on under this provision.

CMS will accept comments on this rule through Sept 9. See the agency’s related fact sheet for more information.

CMS’ Proposed 2025 PFS Rule Would Cut Overall Payments by 2.8%

In its proposed rule for the calendar year (CY) 2025 physician fee schedule, the Centers for Medicare & Medicaid Services on Wednesday recommended reducing the conversion factor by 2.8% to $32.36 in CY 2025, compared with $33.29 in CY 2024. This change reflects the expired 2.93% statutory payment increase for CY 2024; a 0.00% conversion factor update under the Medicare Access and Children’s Health Insurance Program Reauthorization Act; and a .05% budget-neutrality adjustment.

Proposed New Behavioral Healthcare Services
The lengthy rule includes these proposals to improve payment for and access to behavioral healthcare services:

For people determined to have elevated suicide or overdose risk, a new payment for safety planning interventions and post-discharge follow-up contacts;
New digital tools payment for:
- Post-discharge telephonic follow-up;
- Software devices that treat a mental health condition in conjunction with ongoing treatment; and
Extending evaluation and management services payment to allow clinical psychologists, clinical social workers, marriage and family therapists, and mental health counselors to conduct interprofessional consultations among themselves, as well with psychiatrists and other physicians.

Proposed Payment Updates by Specialty
Table 128 in the proposed rule lists these and other proposed updates by specialty:

+3.0% for clinical psychologists;
+1.0% for psychiatrists;
+4.0% for clinical social workers;
+1.0% for family practice physicians;
+1.0% for internal medicine physicians; and
No change for nurse practitioners.

Opioid Treatment Programs (OTPs)

Telehealth Extended for Methadone Treatment
Regarding methadone treatments, CMS proposes extending current telehealth flexibilities permanently for periodic assessments and initiation of treatment. For beneficiaries lacking permanent access to two-way audio-video communications technology, CMS would allow periodic assessments to be furnished via audio-only communications when applicable requirements are met. To support this proposal, CMS cites evidence that audio-only visits produce many of the same benefits as video-based visits. The rule also notes that this provision would advance the agency’s health equity goals.

For initiation of treatment with methadone for any new patient, audio-visual telehealth may be used if an OTP can conduct an adequate evaluation of the patient. Audio-only telehealth is not permitted. Such telehealth evaluations would use OTP intake add-on code (HCPCS code G2076) and must comply with the Drug Enforcement Administration, the Substance Abuse and Mental Health Services Administration (SAMHSA), and other requirements. These OTP provisions also are intended to align with SAMHSA’s goals for reducing barriers to access.

Payment for Patient Intakes
The rule proposes payment updates for intake activities (HCPCS code G2076) by OTPs, which align with recent SAMHSA reforms to advance patient-centered and evidence-based paradigms of care for Opioid Use Disorder (OUD) treatments such as harm-reduction interventions and recovery support services. Specifically, the rule would implement payment for social determinants of health risk assessments (HCPCS code G0136) to identify unmet health-related social needs or the need for OUD-related harm-reduction interventions and recovery support services. In addition, CMS seeks feedback on how OTPs currently coordinate care and make referrals to community-based organizations that address unmet Health Related Social Needs (HRSNs), provide harm-reduction services, and/or offer recovery support services.

Opioid Agonist and Antagonist Medications
CMS proposes to establish payment for new opioid agonist and antagonist medications that the U.S. Food and Drug Administration approved recently. Specifically, the rule would create a new add-on code to the bundled payment to reflect take-home supplies for nalmefene hydrochloride (nalmefene) nasal spray (Opvee®). The agency also proposes paying for a new extended-release injectable buprenorphine product (Brixadi®), indicated to treat moderate to severe OUD using a new weekly bundled payment code to reflect the weekly formulation of Brixadi®. In addition, the rule would update payment for the existing bundled payment for monthly injectable buprenorphine (HCPCS G2069) in order to reflect payment for the monthly formulation of Brixadi®. CMS’ goals for these changes are to help prevent additional opioid overdose deaths, reduce illicit opioid use, and retain more individuals with an OUD in treatment.

Billing Clarification
The rule also clarifies that for billing, an OUD diagnosis code is required on claims submitted under the Medicare OTP benefit, which helps ensure that payments for Part B OTP services are for the treatment of OUD.

Additional Telehealth Proposals
Permanent Expansion of Audio-only Telehealth
CMS proposes to permanently expand the allowable forms of telehealth “interactive telecommunications systems” to include audio-only communication technology if the patient is not capable of, or does not consent to, the use of video technology.

Temporary Telehealth Expansions
In addition, CMS is proposing temporary changes for the use of audio-visual (not audio-only) telehealth for the purpose of physician/practitioner supervision. Specifically, the rule would expand through CY 2025 the allowance for supervising practitioners to be “immediately available” through audio-visual telehealth. In addition, for CY 2025 only, teaching physicians could continue to supervise audio-visual telehealth services furnished by residents in all teaching settings, such as through a 3-way telehealth visit. Also for CY 2025, the agency will continue to permit physicians to use their currently enrolled practice location instead of their home address when providing telehealth services from home.

The rule also extends through CY 2025 the pandemic-originating coverage of telehealth services provided by federally qualified health centers and rural health clinics. This extension also includes the waiver allowing for reporting of enrolled practice addresses, rather than home addresses, when providers perform services from their home, and the waiver for virtual supervision for residents in all teaching settings when the services are provided virtually.

NABH is displeased that beginning Jan. 1, 2025 – in compliance with federal law – the rule repeals crucial telehealth flexibilities that would subject most digital care to pre-pandemic regulations.

Permanent Audio-visual Telehealth for Low-Risk Services
For services furnished after December 2025, CMS proposes that physician/practitioner oversight via audio-visual telehealth shall be limited to services that are “low risk by their nature, do not often demand in-person supervision, and are typically furnished entirely by the supervised personnel.” CMS’ stated goal for approving remote supervision for these particular low-risk services is that they already are known to balance patient safety concerns with the need to expand access and optimize workforce capacity:

Services with the underlying HCPCS code that has been assigned a PC/TC indicator of ‘5’; and
Services described by CPT code 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional).

In addition to CMS’ proposed telehealth expansions, Congress is also considering extending telehealth flexibilities beyond this year, most likely through a two-year extension. NABH strongly endorses these flexibilities.

Quality
For reporting in 2025, CMS proposes six new, optional metrics for the quality payment program.
Please see the agency’s news release to read a high-level summary of the rule.

CMS will accept comments on the proposed rule through Sept. 9.

Reminder: SAMHSA Accepting Nominations for First SAMHSA Trailblazers in Advancing Recovery Awards

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced this week it has started accepting nominations for the inaugural SAMHSA Trailblazers in Advancing Recovery (STAR) awards, which honor leaders with lived experience of mental health and/or substance use condition, including family members whose lives have been affected.

The new STAR awards will also recognize organizations that have demonstrated a commitment to promoting equitable and inclusive access to wellness and recovery supports for individuals with mental health and/or substance use conditions.

Last year SAMHSA published Recovery from Substance Use and Mental Health Problems Among Adults in the United States, which reports that more than 70% of people, or about 50 million people, identified as ever having a mental health and/or substance use problem were in recovery.

Nominations opened June 26 and will remain open through July 18. SAMHSA is planning an awards ceremony that it will livestream in September as part of National Recovery Month. Click here to learn about the award categories, eligibility requirements, and nominating process.

Reminder: SAMHSA Announces Funding Opportunity to Enhance Capacity of Women’s Behavioral Health Providers

The agency said it has a total of $12.5 million for five years and anticipates granting one award. Applications are due by Tuesday, Aug. 20, 2024. Click here to learn more.

Reminder: ONC Funding Opportunity Seeks to Accelerate BHIT

HHS’ Office of the National Coordinator for Health Information Technology (ONC) last month announced a funding opportunity totaling $2 million for fiscal year 2024 under the Leading Edge Acceleration Projects (LEAP) in Health Information Technology (Health IT).

ONC is seeking applications that address two areas of interest. The first area seeks to develop innovative ways to evaluate and improve the quality of healthcare data used in artificial intelligence (AI) tools in healthcare to improve electronic health record technologies.

The second area is focused on designing, developing, and piloting lightweight health IT solutions that can enhance health IT capabilities in behavioral healthcare settings and improve care coordination between behavioral healthcare and clinical healthcare settings.

“These two areas of interest are a natural extension of ONC’s work,” Steve Posnack, deputy national coordinator for health information technology and an NABH 2024 Annual Meeting speaker, said in a statement. “We look forward to receiving innovative applications and seeing the impacts generated by selected awardees.”

Click here to learn more about the grant opportunity; ONC will accept applications through today, July 12, 2024.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Fact of the Week

Results from a recent national survey showed 61% of Americans are unaware that primary care physicians can prescribe medication for opioid use disorder and 13% incorrectly believed that they could not, according to study published in JAMA.

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

CEO Update 191

Written by Administrator on June 28, 2024. Posted in CEO Updates.

House Ways and Means Committee Hearing Examines U.S. Child Welfare System
and RTFs

The House Ways and Means Committee on Wednesday held a hearing about strengthening America’s child welfare system and protecting America’s children through reauthorizing Title IV-B, a child and youth foster-care program.

Although committee members focused primarily on improving the nation’s child foster care system, they also asked several questions of witness Paris Hilton, who testified about Residential Treatment Facilities (RTFs) and offered support for S.1351/H.R.2955, The Stop Institutional Child Abuse Act. Members and witnesses acknowledged the need for RTFs and also called for greater state and federal oversight, an expanded workforce, additional mental healthcare for children in the youth foster-care system outside RTFs, and more community-based care.

The hearing was one of several this Congress held to explore reauthorizing the Social Security Act’s Title IV-B program, which provides flexible funding for states to support family preservation, reunification, adoption, and permanency for children in foster care. Congress has not reauthorized the program since 2008.

In addition to potentially reauthorizing Title IV-B, several committee members discussed legislation they have drafted related to RTFs, which the committee could examine in a future mark-up session. These bills include:

H.R. 8817, the Promoting Accountability, Reporting, Information Sharing, and Health Act, by Reps. Steube (R-Fla.) and Jimmy Panetta (D-Calif.), which directs the U.S. Health and Human Services Department, the U.S. Education Department, the Administration for Children and Families, the Center for Medicare & Medicaid Services, and the U.S. Justice Department, to develop guidance on best practices for federal agencies and states. The guidance would focus on collecting data collection and sharing information related to youth well-being in RTFs, improving data on maltreatment, and enhancing oversight of youth residential programs receiving federal funding.

H.R. 8643, the Foster Youth Mental Health Support Act, by Rep. Michelle Steel (R-Calif.), which amends subpart 1 of Title IV part B of the Social Security Act to strengthen state plan requirements to include comprehensive mental health and well-being for children and youth in foster care.

Both bills were recently introduced, and NABH will share the bill language with members as soon as it is available. NABH sent the Ways and Means Committee comments about RTFs and our new youth RTF fact sheet, which highlights 10 essential facts about youth RTFs.

NABH Congratulates Board Chair Frank Ghinassi for AHRQ Technical Expert Panel Position

NABH is pleased to announce NABH Board Chair Frank Ghinassi, Ph.D., A.B.P.P., president and CEO of Rutgers University Behavioral Health Care and vice president of the behavioral health and addictions service line at RWJBarnabas Health, is serving on a behavioral health technical expert panel (TEP) that the Office of the Assistant Secretary, or ASPE, convened in partnership with the Agency for Healthcare Research and Quality (AHRQ).

ASPE and AHRQ engaged research firm Mathematica to identify and recommend behavioral health integration measure concepts for further development. In Phase 1 – completed in March 2024 – the team conducted an environmental scan and gathered feedback from key stakeholders about priorities for measures related to the integration of behavioral and physical healthcare.

In Phase 2, the current phase, the team will develop draft measure specifications based on further review of the literature and interviews with key stakeholders. The TEP will provide feedback on the draft measure specifications as well as the face validity of the measures, according to a memo from Mathematica, which said it will use the TEP feedback to refine the measure specifications.

ICYMI: Surgeon General’s Op-Ed on Why Social Media Platforms Should Carry Warning Labels

U.S. Surgeon General Vivek Murthy, M.D., M.B.A., last week penned an op-ed in The New York Times urging social media platforms to carry warning labels.

“The mental health crisis among young people is an emergency— and social media has emerged as an important contributor,” Murthy wrote. “Adolescents who spend more than three hours a day on social media face double the risk of anxiety and depression symptoms, and the average daily use in this age group, as of the summer of 2023, was 4.8 hours. Additionally, nearly half of adolescents say social media makes them feel worse about their bodies,” he continued. “It is time to require a surgeon general’s warning label on social media platforms, stating that social media is associated with significant mental health harms for adolescents.

Murthy added that a surgeon general’s warning label – which requires congressional action – would regularly remind parents and adolescents that social media has not been proved safe. He recognized that a warning label alone will not keep kids safe and added that the advisory he issued last year includes specific recommendations for policymakers, platforms, and the public to make social media safer for kids.

SAMHSA Accepting Nominations for First ‘SAMHSA Trailblazers in Advancing Recovery’ Awards

Nominations opened June 26 and will remain open through July 18. SAMHSA is planning an awards ceremony that it will livestream in September as part of National Recovery Month.

Click here to learn about the award categories, eligibility requirements, and nominating process.

SAMHSA Announces Funding Opportunity to Enhance Capacity of Women’s Behavioral Health Providers

The agency said it has a total of $12.5 million for five years and anticipates granting one award. Applications are due by Tuesday, Aug. 20, 2024. Click here to learn more.

Reminder: ONC Funding Opportunity Seeks to Accelerate BHIT

Click here to learn more about the grant opportunity; ONC will accept applications through July 12, 2024.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Fact of the Week

A study published in JAMA last week found that, despite their known association with reduced risk of a fatal drug overdose, only a small percentage of Medicare beneficiaries (4.1%) received medications for opioid use disorder (MOUD) or filled a naloxone prescription (6.2%) in the 12 months after a nonfatal drug overdose. “Efforts to improve access to behavioral health services; MOUD; and overdose-prevention strategies, such as prescribing naloxone and linking individuals to community-based health care settings for ongoing care, are needed,” the study noted.

Happy Independence Day from NABH!

NABH will not publish CEO Update on Friday, July 5 and will resume on Friday, July 12. The NABH team wishes you, your families, and your teams a happy and safe Independence Day weekend!

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

CEO Update 190

Written by Administrator on June 21, 2024. Posted in CEO Updates.

House Ways & Means Committee to Host Hearing Next Week on Strengthening
Child Welfare

The House Ways and Means Committee is scheduled to conduct a hearing next Wednesday, June 26 focused on strengthening child welfare by reauthorizing Title IV-B, a program serving children and youth in foster care. Policymakers are expected to review youth Residential Treatment Facilities (RTFs) during the hearing.

Among witnesses invited to testify is Paris Hilton, who has spoken about her turbulent experience at a youth treatment center and is an advocate for S.1351/H.R.2955, The Stop Institutional Child Abuse Act. The bill establishes an interagency Federal Work Group on Youth Residential Programs to support and implement best practices regarding the health and safety, care, treatment, and appropriate placement of youth in youth residential programs.

The hearing is part of the Committee’s ongoing focus to reauthorize the Social Security Act’s Title IV-B programs. The Committee has previously held several hearings to examine various programs included in Title IV-B. The Title IV-B program provides flexible funding for states to support family preservation, reunification, adoption, and permanency for children in foster care; however, many consider the program outdated, and Congress has not reauthorized it since 2008.

NABH will submit comments to the Ways & Means Committee and will also share our new youth RTF fact sheet, which highlights 10 essential facts about youth RTFs.

The hearing comes on the heels of last week’s Senate Finance Committee hearing about RTFs, “Youth Residential Treatment Facilities: Examining Failures and Evaluating Solutions” and a partisan report, Warehouse of Neglect: How Taxpayers Are Funding Systemic Abuse in Youth Residential Treatment Facilities, which cites limitations and problems at youth RTFs and fails to recognize the critical care, treatment, and educational support these programs provide to America’s youth. NABH sent this letter to the Senate Finance Committee last week in conjunction with the hearing.

CMS Announces Funding Opportunity Application Period for the Innovation in Behavioral Health Model

The Centers for Medicare & Medicaid Services (CMS) this week released its notice of funding opportunity application for the Innovation in Behavioral Health (IBH) model that focuses on improving the behavioral and physical health outcomes and quality of care for Medicare and Medicaid enrollees who experience moderate to severe behavioral health conditions.

The IBH Model is a state-based model that state Medicaid agencies (SMAs) lead with a goal of aligning payment between Medicaid and Medicare for integrated care.

CMS will select up to eight SMAs to participate in the IBH Model, and these agencies will use cooperative agreement funding to develop necessary infrastructure and capacity to implement the IBH Model. The SMAs will recruit “Practice Participants” to deliver care, and they will receive funding to support necessary upgrades to health information technology, electronic health records, practice transformation activities, and staffing to implement the model.

CMS will issue award notices to selected SMAs in mid-December. Learn more from this CMS IBH model overview fact sheet. For additional questions, you can reach the IBH Model team at IBHModel@cms.hhs.gov.

SAMHSA Announces New Way to Order 988 Print Materials

The Substance Abuse and Mental Health Services Administration has announced a new website to order 988 awareness printed materials.

“Over the past two years, we’ve heard your requests to simplify and improve the ordering process for 988 Suicide & Crisis Lifeline print materials,” SAMHSA said in an announcement. “We know that print materials are a critical need for all who are working to raise awareness about 988 across the country, and we have been working behind the scenes to improve this process.”

Providers and other partners will still be able to use the “order print materials” link from SAMHSA’s 988 Partner Toolkit.

CDC Reports 26% Drop in Uninsured Americans Since 2019

New data from the Centers for Disease Control and Prevention’s National Health Interview Survey (NHIS) show 7.6% of Americans did not have health insurance in 2023, compared with 10.3% of Americans without health insurance in 2019, reflecting a 26% decrease in the number of uninsured Americans.

Meanwhile, the NHIS reported that among adults ages 18–64 living in Medicaid expansion states, the percentage with public coverage increased to 25.2% in 2023 from 23.4% in 2019. A similar increase in public coverage was observed among adults living in non-Medicaid expansion states 18.1% in 2023 from 15.1% in 2019.

In a story this week, Behavioral Health Business highlighted how more Americans with health insurance could affect the behavioral healthcare segment.

Reminder: ONC Funding Opportunity Seeks to Accelerate BHIT

Click here to learn more about the grant opportunity; ONC will accept applications through July 12, 2024.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Fact of the Week

Hospitals that report using AI to detect patterns of drug diversion – when drugs are stolen from hospitals – nearly doubled to 56% in 2023 from 29% in 2019, according to a Wolters Kluwer survey.

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

CEO Update 189

Written by Administrator on June 14, 2024. Posted in CEO Updates.

Senate Finance Committee Holds Hearing and Releases Report on Youth RTFs

In conjunction with a hearing Wednesday, the Senate Finance Committee released Warehouse of Neglect: How Taxpayers Are Funding Systemic Abuse in Youth Residential Treatment Facilities, a partisan report that cites limitations and problems at youth RTFs and fails to recognize the critical care, treatment, and educational support these programs provide to America’s youth.

Only members of the Committee’s minority staff developed the report, a two-year effort that focused on four operators of youth residential treatment facilities (RTFs), including three NABH system members.

“NABH is eager to work with federal leaders to develop policies that advance access to quality care in the appropriate settings for U.S. youth who struggle with mental health and substance use disorders,” NABH President and CEO Shawn Coughlin said in a statement Wednesday. “We also want to remind congressional leaders that if public discourse about youth RTFs is to benefit the common good, we need to ensure that policymakers, members of the media, worried parents, concerned teachers, and the general public share the same, clear understanding of the role that regulated, licensed RTFs play in the behavioral healthcare continuum.”

The report recommended three main points: 1) children placed in RTFs must be afforded safety, dignity, and homelike conditions and provided with the treatment and support that they need, 2) government funding should prioritize community-based services and placements to address children’s behavioral health needs, and 3) effective oversight mechanisms of RTFs require substantial investment at all levels of government.

At the hearing, several Democratic members joined Senate Finance Committee Chairman Ron Wyden (D-Ore.) and Ranking Member Mike Crapo (R-Idaho). Several witnesses, including a disabilities-rights advocate and a Government Accountability Office representative, painted an incomplete picture of the care and treatment that RTFs provide. While most acknowledged youth RTFs play a role in the behavioral healthcare continuum, senators and witnesses called for more home and community-based services and better state and federal oversight, among other recommendations.

Meanwhile, there were no statements that reflected the successful treatment in RTF programs and the increasing need for them in the United States today. Since 2010, the number of youth residential treatment programs has declined by 60.9%; the number of youth served has declined by 77%; and the number of beds has declined by 66.2%; according to a May 2024 study from the Manhattan Institute.

Also Wednesday, NABH sent a letter to the Senate Finance Committee and released a new youth RTF fact sheet, which highlights 10 essential facts about youth RTFs. Please share the fact sheet with your teams and engage with NABH’s X and LinkedIn posts to spread the message about these facilities and the critical – and often life-saving – care that NABH members provide in RTFs every day.

Legal Action Center to Host Webinar Next Week on How SUD Providers Can Leverage Medicaid Reentry for People Leaving Prisons and Jails

Medicaid reentry is a new federal policy meant to strengthen access to health coverage and transitional services for people preparing to come home from prison or jail, with a primary goal to prevent overdose among reentering individuals.

The Legal Action Center, an Opioid Response Network training partner, will host Medicaid Reentry: How Substance Use Disorder Service Providers/Stakeholders Can Leverage This New Opportunity to Strengthen Equitable Health Outcomes for People Leaving Prison/Jail, a 75-minute webinar next Thursday, June 20 starting at noon ET.

Click here to add the event to your calendar.

National Academies Releases Publication on Adult ADHD

The National Academies has released Adult Attention-Deficit/Hyperactivity Disorder: Drug Development, Diagnosis, and Treatment, which is based on proceedings from a December 2023 workshop about the topic.

According to the National Academies, evidence suggests adults with ADHD may be more likely to develop an SUD, and there are concerns that non-medical use of prescription stimulants could lead to misuse, overdose, or toxicity.

Reminder: ONC Funding Opportunity Seeks to Accelerate BHIT

Click here to learn more about the grant opportunity; ONC will accept applications through July 12, 2024.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

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

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

Time-based data on the number of days between a request for coverage and a plan’s denial, which improves our ability to assess and compare health plan responsiveness.
The gap between days of provided care versus days of covered care to quantify and compare uncompensated days per health plan.

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

Fact of the Week

The number of individual pills containing fentanyl that law enforcement officer seized was 2,300 times greater in 2023 compared with 2017, with 115,562,603 pills seized in 2023 versus 49,657 in 2017, according to a recent announcementfrom the National Institute on Drug Abuse.

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

CEO Update 188

Written by Administrator on June 7, 2024. Posted in CEO Updates.

Senate Democrats Pressure Biden Administration to Complete Final Parity Rule

A group of Senate Democrats is pressuring the Biden administration to complete and release its final rule on the Mental Health Parity and Addiction Equity Act’s requirements.

In a letter to the leaders of HHS, the Internal Revenue Service, and the U.S. Labor Department’s Employee Benefits and Security Administration, Sens. Chris Murphy (Conn.), Peter Welch (Vt.), Alex Padilla (Calif.), Ed Markey (Mass.), Amy Klobuchar (Minn.), and Ben Ray Luján (N.M.) urged the Biden administration to stay the course on completing its work to finalize the 2023 proposed rule.

The letter noted: “…these rules will close existing loopholes in the law, expand narrow networks, and prohibit restrictive practices that prevent families from accessing care.”

Particularly important are the rules that combat the nonquantitative treatment limitations that are being used to deny mental health services to patients. These common-sense parity rules will help Americans suffering from mental health conditions or substance use disorder, reduce costs for taxpayers, and save lives.

NABH and leaders of mental health advocacy groups are also strongly urging these agency leaders to oppose efforts from insurance and employer groups to weaken the proposed rule’s strong protections.

Meanwhile, these communications come as a powerful group of employer organizations – the ERISA Industry Committee, the Partnership for Employer-Sponsored Coverage, and the U.S. Chamber of Commerce – have pushed back on the administration and the proposed rule, arguing that the regulations would be “unworkable” and undermine access to care.

Insurers have also slammed the proposed rule, saying it wouldn’t address underlying workforce shortages, which they say limit access to care. The Treasury Department has targeted June to finalize the rules, although it remains uncertain if that will happen.

HRSA Accepting STAR Loan Repayment Program Applications Through June 27

The Health Resources and Services Administration (HRSA) will accept applications from eligible
SUD treatment clinicians and community health workers for its Substance Use Disorder Treatment and Recovery (STAR) Loan Repayment Program through Thursday, June 27.

Click here for guidance about the STAR Loan Repayment program and here for information about the application process.

HRSA Adds Occupations to Guide for Licensure Portability

HRSA has announced that counseling and school psychologists have been added as new disciplines to the Multi-Discipline Licensure Resource Project that HRSA supports with the Association of State and Provincial Psychology Boards.

Previously the site provided guidance for psychology, social work, physical therapy, and occupational therapy. The new disciplines include counseling, dentistry, dieticians, emergency medical services, physician assistants, nursing, advanced practice nursing, and school psychologists.

SAMHSA Releases Issue Brief on Peer Support in Mental Health

The Substance Use and Mental Health Services Administration has released an issue brief for state mental health authorities about the benefits of peer support and inclusion of the peer workforce throughout the behavioral healthcare continuum.

The new resource highlights current standards and best practices for including peer support workers as an essential component of services delivery for mental and co-occurring disorders such as SUD.

Reminder: ONC Funding Opportunity Seeks to Accelerate BHIT

ONC is seeking applications that address two areas of interest. The first area seeks to develop innovative ways to evaluate and improve the quality of healthcare data used in artificial intelligence tools in healthcare to improve electronic health record technologies.

Click here to learn more about the grant opportunity; ONC will accept applications through July 12, 2024.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

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

Time-based data on the number of days between a request for coverage and a plan’s denial, which improves our ability to assess and compare health plan responsiveness.
The gap between days of provided care versus days of covered care to quantify and compare uncompensated days per health plan.

Fact of the Week

Starting people with opioid use disorder on extended-release, injectable naltrexone (XR-naltrexone) within five to seven days of seeking treatment is more effective than the standard treatment method of starting within 10-15 days, but requires closer medical supervision, according to results from a National Institute on Drug Abuse-supported clinical trial.

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

CEO Update 187

Written by Administrator on May 31, 2024. Posted in CEO Updates.

NABH Comments on Fiscal Year 2025 IPF PPS Final Rule

This week NABH sent its public comment letter to the Centers for Medicare & Medicaid Services (CMS) about the agency’s fiscal year 2025 inpatient psychiatric facility prospective payment system (IPF PPS) rule.

In the letter, NABH emphasized that the proposed net update for FY 2025 – an increase of 2.6% percent relative to FY 2024 rates – does not adequately account for the nationwide cost pressures that IPFs continue to face.

“The update does not reflect the remaining healthcare cost inflation that was sparked by the COVID-19 pandemic and still persists in the form of workforce pressures and shortages and other elevated costs,” NABH wrote. “These include continued head-to-head wage competitions with other employers within and outside of local healthcare marketplaces, which are exacerbated by burnout among clinical and non-clinical personnel, and other factors that continually pressure IPFs to raise compensation levels.”

NABH offered its perspective and suggestions on a range of other topics, including the need for modern behavioral health information technology, a request to delay the requirement for ancillary-services reporting by two years, and proposed quality reporting changes.

“NABH urges CMS to delay implementing its proposed policy restriction on all-inclusive reporting. Given the complexity of transitioning from all-inclusive to traditional reporting of ancillary charges, the proposed effective date of Oct. 1, 2024 is impossible and should be changed to Oct. 1, 2026.”

The association thanks all its members who gave their time and recommendations in the last few months to help NABH prepare the letter to CMS.

FDA Launches ‘Prescribe with Confidence’ Campaign to Help Providers Treat OUD

The U.S. Food and Drug Administration (FDA) has launched Prescribe with Confidence, a campaign to help healthcare providers recognize and treat opioid use disorder (OUD), which the agency says affects 6 million people over the age of 12 in the United States.

“Research shows that OUD treatment is most effective when medications are used,” FDA Commissioner Robert Carliff, M.D. said in a brief video about the campaign.

In its announcement, the FDA noted that many primary care providers have found prescribing medications to treat OUD is easier than they thought it would be. The agency has provided firsthand testimonials, free training, and other resources to help providers. Click here to learn more.

ICYMI: 2024 NABH Annual Meeting Highlights

NABH thanks all who traveled to Washington earlier this month for the association’s 2024 Annual Meeting!

Photos from the meeting are now available. If you choose to use any of these pictures, please credit photographer Chris Ferenzi.

NABH has shared the Annual Meeting slide presentations and learned some attendees had trouble downloading them. We have re-posted the presentations as PDF documents on our 2024 Annual Meeting Speakers & Presentations page. David Wasserman’s presentation will be available until today, Friday, May 31.

We’ve received positive feedback about the NABH Education and Research Foundation’s workforce panel, and we urge you to share NABH’s Workforce Startup Guide with your teams. You can download the guide on NABH’s website homepage.

Reminder: ONC Funding Opportunity Seeks to Accelerate BHIT

HHS’ Office of the National Coordinator for Health Information Technology (ONC) on May 13 announced a funding opportunity totaling $2 million for fiscal year 2024 under the Leading Edge Acceleration Projects (LEAP) in Health Information Technology (Health IT).

Click here to learn more about the grant opportunity.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

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

Time-based data on the number of days between a request for coverage and a plan’s denial, which improves our ability to assess and compare health plan responsiveness.
The gap between days of provided care versus days of covered care to quantify and compare uncompensated days per health plan.

Fact of the Week

A new analysis in JAMA highlights how a hospital cyberattack can affect neighboring facilities and an entire community’s care: researchers examined emergency department (ED) discharge data from the California Department of Health Care Access and Information between 2014-2020 and found a temporary decrease in ED visits and inpatient admissions at hospitals targeted by ransomware attacks and a temporary increase in ED visits at nearby, unaffected hospitals.

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

CEO Update 186

Written by Administrator on May 24, 2024. Posted in CEO Updates.

2024 NABH Annual Meeting & Hill Day Highlights

NABH thanks all who traveled to Washington last week for the 2024 Annual Meeting!

Photos from the meeting are now available. If you choose to use any of these pictures, please credit photographer Chris Ferenzi.

Last week NABH shared the Annual Meeting slide presentations and learned some attendees had trouble downloading them. We have re-posted the presentations as PDF documents on our 2024 Annual Meeting Speakers & Presentations page. David Wasserman’s presentation will be available until May 31.

NABH also thanks all members who participated in Hill Day in conjunction with #NABH2024! Our members met with policymakers and their staff and highlighted the crucial need to secure the promise of parity between behavioral and physical healthcare, increase the behavioral healthcare workforce, and invest in behavioral health information technology to adopt electronic health records.

NABH members conducted more than 60 congressional meetings and prioritized key offices for policymakers who serve on committees of jurisdiction overseeing behavioral healthcare policy, including the Senate Finance Committee, Senate Health, Education, Labor and Pension Committee, House Energy and Commerce Committee, and House Ways and Means Committee.

Please save the date for next year’s Annual Meeting: May 12-14, 2025 at the Salamander Washington, DC!

House Committees Advance Telehealth Extension Bills

The House Energy & Commerce Health Subcommittee on May 16 unanimously advanced telehealth legislation to the full House Energy & Commerce Committee that would extend for two years key COVID-19 pandemic telehealth waivers scheduled to expire at the end of this year.

The bill that the Subcommittee advanced – similar to the bill the House Ways & Means Committee passed in the previous week – would delay the in-person requirement and originating site restrictions for mental health services and extend the provision for audio-only telehealth services for the next two years. Both bills also include a five-year extension of waivers for the Acute Hospital Care at Home program, allowing patients to receive hospital-level care in their homes until 2029.

The House Energy & Commerce’s bill includes payment parity for federally qualified health centers and rural health clinics, so they can bill the same amount for telehealth and in-person outpatient services. Under the House Ways & Means Committee’s bill, the centers would be reimbursed at lower rates for most virtual services.

Meanwhile, the Energy & Commerce panel also advanced a second telehealth bill that would establish a Medicare incident to modifier for mental health services furnished through telehealth. Both committees’ bills include offsets that impose new transparency requirements on pharmacy benefit managers and delay the upcoming changes to Medicare payment rates for clinical lab tests by one year.

The Senate has yet to take up a telehealth extension bill, although Senate Finance Committee Chair Ron Wyden (D-Ore.) is pushing to extend permanently some of the COVID-19-era telehealth flexibilities set to expire at the end of this calendar year. If Congress passes a short-term telehealth extension, lawmakers will have to restart the process after it expires.

Final Medicaid Rule Reduces Allowed Wait Times for Behavioral Healthcare Outpatient Appointments

The Centers for Medicare & Medicaid Services (CMS) recently published a Medicaid final rule that includes positive changes on several NABH priority issues.

NABH is pleased that beginning in June 2027, wait times for adult and pediatric outpatient mental health and substance use disorder (SUD) services will be subject to a 10-day maximum. Also, starting in 2028, states will be required to conduct annual “secret shopper” surveys to investigate whether managed care plans are meeting wait time requirements and the validity of provider directories.

In July 2027, states must survey Medicaid enrollees to assess their managed care experience. Finally, to help CMS understand and improve payment adequacy, beginning in July 2026, states must annually submit payment data that compare state Medicaid managed care plan rates with Medicare or Medicaid state plan rates, including specific data for mental health and SUD services.

This CMS fact sheet provides additional details about the final rule.

ONC Funding Opportunity Seeks to Accelerate BHIT

Click here to learn more about the grant opportunity.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

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

Time-based data on the number of days between a request for coverage and a plan’s denial, which improves our ability to assess and compare health plan responsiveness.
The gap between days of provided care versus days of covered care to quantify and compare uncompensated days per health plan.

Fact of the Week

A new study of more than 1.2 million people has identified 95 regions of the genome linked to PTSD, and 80 of those have not been identified previously. Researchers also identified 43 genes that seem to play a role in causing PTSD.

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

CEO Update 185

Written by Administrator on May 10, 2024. Posted in CEO Updates.

2024 NABH Annual Meeting Starts Monday!

We’re pleased to devote this week’s edition of CEO Update to details about the 2024 Annual Meeting that starts Monday, May 13 in Washington, D.C.

This year’s Annual Meeting focuses on The Future of Behavioral Healthcare, and our presenters will explore this theme as it relates to behavioral health information technology, parity, workforce issues, and more.

To prepare for the meeting, please view our preliminary program, learn more about this year’s speakers, and see our list of exhibitors and sponsors attending the meeting.

Be Sure to Access the 2024 NABH Annual Meeting Mobile App!

Again this year, attendees will have access to all Annual Meeting programming and materials through NABH’s web-based app.

Early Monday, NABH will send all attendees an Annual Meeting alert with this link to the app that displays details about sessions, speakers, meeting room locations, NABH’s advocacy priorities, and more. Attendees can also access the link through a QR code near the Registration Desk at the Annual Meeting.

Deputy National Coordinator for Health IT Steven Posnack to Open Monday Sessions

NABH is pleased to welcome Deputy National Coordinator for Health Information Technology Steven Posnack, M.S., M.H.S. as our first 2024 Annual Meeting presenter on Monday, May 13 t 2:45 p.m. ET in the Salamander hotel’s Grand Ballroom.

Posnack advises the national coordinator, leads the execution of the Office of the National Coordinator for Health Information Technology’s (ONC) mission, and represents ONC’s interests at a national and international level.

Together with the national coordinator, Posnack also oversees ONC’s federal coordination, regulatory policy, public-private initiatives, and the overall implementation of statutory authorities and requirements, including those from the 21st Century Cures Act and HITECH Act. He will discuss behavioral health information technology at our Annual Meeting.

NABH Education and Research Foundation to Workforce Panel on Monday at 4 p.m. ET

Building on last year’s success, the NABH Education and Research Foundation will host a panel discussion featuring NABH members and workforce consultants on Monday from 4 p.m. – 5 p.m. ET.

This year’s panel will focus on NABH member best workforce practices, internships, apprenticeships, and other “grow your own” programs.

NABH Education and Research Foundation Vice President Jim Shaheen of New Season, who also serves on the NABH Board of Trustees, will moderate the panel that will feature Jason Brooks, Ph.D., senior vice president of Human Resources at New Season; Rhonda Ashley-Dixon, vice president of Strategic Partnerships & Engagement at Vanderbilt Behavioral Health; Beth Kuhn, principal at Stonegate Strategies and former commissioner, Kentucky Department of Workforce Investment; and John Pallasch, founder and CEO of One Workforce Solutions and former U.S. assistant secretary for employment and training at the U.S. Labor Department (DOL).

This year’s panel discussion will include poll questions for the audience, and we urge NABH members to attend and engage with panelists during the question-and-answer period!

DOL Official Timothy Hauser to Discuss Parity on Tuesday, May 14 at 10 a.m.

Timothy D. Hauser, deputy assistant secretary for program operations of DOL’s Employee Benefits Security Administration (EBSA) will discuss parity when he kicks off Day 2 of the NABH 2024 Annual Meeting on Tuesday, May 14 at 10 a.m.

Hauser, who serves as EBSA’s chief operating officer, joined DOL in 1991 as a trial attorney for the Plan Benefits Security Division (PBSD), where he represented the department in federal district court and appellate litigation. From November 2000 until November 2013, Mr. Hauser was the associate solicitor of the division. As the head of PBSD, he was responsible for all of DOL’s legal work under ERISA.

Before joining DOL, Mr. Hauser worked as a trial attorney for six years at Legal Aid of Western Missouri. Hauser graduated from Harvard Law School in 1985 and earned his undergraduate degree at the University of Illinois.

Election Analyst David Wasserman to Examine 2024 Elections at 11 a.m.

Following Hauser’s presentation Tuesday morning, election analyst David Wasserman will provide Annual Meeting attendees with an in-depth look at this year’s upcoming presidential and congressional elections.

Wasserman is the senior editor for the non-partisan newsletter The Cook Political Report with Amy Walter, which has analyzed U.S. presidential, Senate, House, and gubernatorial races since 1984. Referred to as “pretty much the only person you need to follow on Election Night” according to Meet the Press host Chuck Todd, Wasserman is also a contributor to NBC News.

Prior to joining the The Cook Political Report with Amy Walter in 2007, Wasserman served for three years as House editor of Sabato’s Crystal Ball, a widely respected political analysis newsletter and website founded by renowned University of Virginia professor Larry Sabato (a former NABH Annual Meeting presenter). Wasserman graduated from the University of Virginia.

NABH President and CEO Shawn Coughlin to Address Attendees at Annual Meeting Luncheon

Please join us for this year’s Annual Meeting Luncheon on Tuesday at Noon to hear brief remarks from NABH President and CEO Shawn Coughlin.

Coughlin will provide updates on NABH’s work and help prepare attendees who will head to Capitol Hill for congressional visits following the luncheon.

Help Us Advocate Your Issue Priorities at Hill Day 2024!

NABH is eager to welcome its members and guests to Hill Day 2024 on Tuesday, May 14 from 1:30 – 5 p.m. ET!

As always, Hill Day is an excellent opportunity for NABH members to meet personally with Members of Congress and their staff to share our association’s advocacy priorities. It’s not too late to register if you’re interested!

If you registered for the Annual Meeting, are interested in Hill Day, and have not yet signed up, please contact e-mail NABH Associate Manager for Congressional Affairs Emily Wilkins.

How it Works:

After you register for the NABH Annual Meeting, the NABH Congressional Affairs team will match you with legislators who represent your facility’s footprint.

On Hill Day, NABH will have our Advocacy Room open from 12:30 p.m. – 1:50 p.m. in the Renwick Room of the Salamander. Here NABH will help prepare you with materials and talking points to guide your conversations with Members of Congress and their staff. The Advocacy Room will reopen from 4:15 p.m. – 5:00 p.m. for you to debrief your meetings.

What We Need From You:

Please indicate in your Annual Meeting registration form that you are interested in Hill Day, and be sure to include all the states where your system has a footprint. If you have an existing relationship with a legislator, please let us know! This is very helpful when scheduling meetings.

Also, Hill Day participants—and all Annual Meeting attendees—can review the association’s 2024 Advocacy Priorities and Hill Day fact sheets before or during the Annual Meeting through our web-based meeting app.

Wednesday Policy Breakfast to Feature Remarks from Rep. Doris Matsui & NABH Consultant Meiram Bendat, J.D., Ph.D.

Join us for the Annual Meeting Policy Breakfast on Wednesday at 8 a.m. to watch a brief video from NABH Champion Rep. Doris Matsui (D-Calif.) and to learn about the ongoing Wit v. United Behavioral Health case from NABH consultant Meiram Bendat, J.D., Ph.D.

Matsui will highlight her legislation, the Behavioral Health Information Technology Coordination Act, and discuss why adopting BHIT is critical.

An attorney with a background in mental health, Bendat represented children and families in the Los Angeles child welfare system and treated patients before he founded Psych-Appeal, the country’s first private mental health insurance law firm, in 2011.

Since then, Bendat has helped patients and providers successfully challenge denials of mental health treatment through administrative appeals and impact litigation, recovering millions of dollars in wrongly withheld benefits.

The NABH team wishes everyone a safe trip to Washington, and we look forward to seeing you soon!

Please note: NABH will not publish CEO Update next week and will publish the next issue on May 24. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update: 184

Written by Meghan Barrett on May 3, 2024. Posted in CEO Updates.

DOL Official Timothy Hauser to Headline NABH Annual Meeting Day #2

NABH is pleased to announce Timothy D. Hauser, deputy assistant secretary for program operations at the U.S. Labor Department’s (DOL) Employee Benefits Security Administration (EBSA), will kick off our Annual Meeting’s second day on Tuesday, May 14 at 10 a.m. Hauser, who serves as EBSA’s chief operating officer, will discuss parity and be prepared to answer questions from attendees. Hauser joined DOL in 1991 as a trial attorney for the Plan Benefits Security Division (PBSD), where he represented the department in federal district court and appellate litigation. From November 2000 until November 2013, Hauser was the associate solicitor of the division. As the head of PBSD, Hauser was responsible for all of DOL’s legal work under ERISA. Before joining DOL, Hauser worked as a trial attorney for six years at Legal Aid of Western Missouri. He graduated from Harvard Law School in 1985 and earned his undergraduate degree at the University of Illinois. You can learn more about this year’s speakers and view our preliminary program on NABH’s Annual Meeting homepage. And please be sure to register for the Annual Meeting if you haven’t yet. We look forward to seeing you in Washington!

Remember to Register for Hill Day 2024!

Please register for Hill Day 2024 on Tuesday, May 14 and urge members of your team to join you! Hill Day is an excellent opportunity to meet one-on-one with legislators to discuss the issues that matter most to behavioral healthcare providers. After you register for the NABH Annual Meeting, the NABH Congressional Affairs team will match you with legislators who represent you or your facility footprint. Closer to the day of the meeting, we will send you a meeting schedule, materials, and talking points to guide your conversations with Members of Congress and their staff. Please indicate in your Annual Meeting registration form that you are interested in Hill Day and be sure to include all the states where your system has a footprint. If you have an existing relationship with a legislator, please let us know!

SAMHSA’s Recent Grant Funding Opportunities Limit Financial Incentives for Contingency Management

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week released funding opportunity notices for State Opioid Response and Tribal Opioid Response grants that limit financial incentives for contingency management to $75 per budget period. While the grants require implementing evidence-based practices, the funding limitation is contrary to what is known to be an evidence-based incentive amount that produces behavior change. This amount is inconsistent with what the Contingency Management Policy and Practice Group (CMPG) – known formerly as the Motivational Incentive Policy Group and of which NABH is a member – has advised the federal government. “This is a squandered opportunity to implement a highly effective treatment for stimulant use disorder, which is fueling almost half of our nation’s overdoses,” said NABH Director of Quality and Addiction Services Sarah Wattenberg, who serves as NABH’s CMPG representative. “If we can’t get a handle on stimulant use, we won’t see the overdose rate go down,” Wattenberg said before she cautioned providers against using $75 for incentives because they haven’t proven effective. The grant applications are due July 1, 2024.

Reminder: Please Complete Federal BHIT Data Standards Survey by May 12

Advocating for parity in behavioral health information technology (BHIT) is one of NABH’s top advocacy priorities. That’s why we strongly urge our members’ information technology, medical record documentation, and coding leaders to complete a federal survey by May 12 that will help create standardized behavioral health data elements. NABH alerted members about the survey from SAMHSA and the Office of the National Coordinator for Health Information Technology (ONC) in CEO Update earlier this year. Part of SAMHSA and ONC’s joint BHIT initiative, the survey presents more than 150 potential data elements for consideration, including many clinical elements, as well as provides a platform for survey respondents to submit alternative elements for evaluation. Ultimately, HHS expects to incorporate the final data metrics into the Center for Medicare and Medicaid Innovation’s eight-year project with eight states to develop alternative payment models and quality measures to advance integrated BH and physical healthcare services, including a Medicare per-member-per-month risk-adjusted payment, and a complementary Medicaid payment model and statewide IT approach. To participate in the survey, respondents must first create a user account using the log in feature in the top right of the USCDI+ Platform page. See the USCDI+ User Guides for help creating an account, navigating datasets, and submitting new data elements or comments. Learn more from this federal resource page, or e-mail USCDI.Plus@hhs.gov for further assistance.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

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

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

Fact of the Week

The American Psychological Association recently released a report that calls on social media companies to take responsibility to help protect youth mental health. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 183

Written by Meghan Barrett on April 26, 2024. Posted in CEO Updates.

Please Help Us Welcome Deputy National Coordinator for Health IT Steven Posnack on May 13!

NABH is pleased to welcome Deputy National Coordinator for Health Information Technology Steven Posnack, M.S., M.H.S., as our first 2024 Annual Meeting presenter on Monday, May 13 at 2:45 p.m. ET in the Salamander hotel’s Grand Ballroom. Posnack advises the national coordinator, executes the Office of the National Coordinator for Health Information Technology’s (ONC) mission, and represents ONC’s interests at a national and international level. Together with the national coordinator, Posnack also oversees ONC’s federal coordination, regulatory policy, public-private initiatives, and the overall implementation of statutory authorities and requirements, including those from the 21st Century Cures Act and HITECH Act. He will discuss behavioral health information technology at our Annual Meeting. Also, please join us for Monday’s workforce panel on Monday, May 13 at 4 p.m. This year’s panel of NABH members and workforce consultants will highlight NABH member best practices to recruit and retain talent as well as how to establish partnerships and “grow your own” programs to address your workforce needs. Please click here to learn about our panelists and other Annual Meeting speakers. And be sure to register for the meeting, reserve your hotel room, and view our preliminary program if you haven’t yet. We look forward to seeing you in Washington!

Biden Administration Releases First National Strategy for Suicide Prevention

The Biden administration this week released the 2024 National Strategy for Suicide Prevention and accompanying federal action plan to combat America’s deadly mental health and overdose crises. The National Strategy was the result of a combined effort among the Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and Prevention, the National Action Alliance for Suicide Prevention, and more than 20 agencies across 10 federal departments. The National Strategy maps out recommendations for addressing gaps and meeting the needs of at-risk populations, while the federal action plan identifies 200 discrete actions to be initiated and evaluated over the next three years. Actions include identifying ways to address substance use and suicide risk together in the clinical setting; funding a mobile crisis locator for use by 988 crisis centers; increasing support for survivors of suicide loss and others whose lives have been affected by suicide; and evaluating promising community-based suicide prevention strategies. The Biden administration said it will monitor and evaluate these strategies regularly to determine progress and success, and to further identify barriers to successful suicide prevention.

CMS Releases Final Rule on Medicare Managed Care Transparency and Accountability

NABH is pleased with the Centers for Medicare & Medicaid Services’ (CMS) final rule on transparency and accountability for Medicaid managed care plans that the agency released this week. Nearly a year after issuing its proposed rule – and facing firm opposition from healthcare insurance stakeholders – CMS released a rule with provisions that NABH strongly supports, including maximum appointment wait time standards aligned with commercial insurance, including a 10-day wait time standard for outpatient mental health and substance use disorder services. The rule also requires independent annual secret shopper surveys that assess appointment timeliness standards and provider director accuracy. And in an important move toward price transparency, health plans will be required to share their actual expenditures and revenues for state-directed payments and to report any identified or recovered overpayments to states within 30 days. Given the rule’s complex rollout schedule, CMS issued a detailed chart showing the staggered implementation plan for the rule, with effective dates ranging from immediate implementation to four years after its release. Additional information is available in the agency’s fact sheet.

NABH Comments to CMS About Agency’s Accrediting Organization Oversight Rule

NABH recently sent a comment letter to CMS about a proposed rule intended to improve and make more consistent the agency’s oversight of accrediting organizations (AO). NABH supports the rule’s overall direction, which is to improve the accountability and transparency of AO survey and accreditation activities. Of the nine AOs this rule would affect, The Joint Commission is the one of most interest to NABH members. “NABH appreciates that the proposed rule recognizes the current disparity of survey findings among The Joint Commission (and other AOs) and state survey agencies,” NABH wrote in our letter. “Such disparities raise red flags about the misaligned criteria, as well as the reliability of relevant surveyor training programs and preparedness of individual surveyors,” the letter continued. “Current inadequacies have resulted in inconsistent, and therefore at least partially inaccurate, survey findings. This entire process warrants closer examination by CMS of the overall scope and details of these inconsistencies – and the public sharing of related findings with stakeholders.”

NABH Opposes FTC’s Final Rule Banning Non-Compete Agreements

NABH staunchly opposes this week’s final rule banning noncompetes from the Federal Trade Commission (FTC) that the agency said it expects will generate new businesses, raise worker wages, and boost innovation. The FTC estimates that the final rule will lead to new business formation growing by 2.7% per year, resulting in more than 8,500 additional new businesses created each year. The FTC also expects the final will result in higher earnings for workers, with estimated earnings increasing for the average worker by an additional $524 per year; as well as lower healthcare costs by up to $194 billion over the next decade. The U.S. Chamber of Commerce and other business groups filed suit to stop the FTC from banning noncompetes, arguing the FTC doesn’t have the authority to prohibit companies from limiting their employees’ ability to work for competitors. NABH weighed in on the proposed rule a year ago and acknowledged the FTC’s other efforts to address issues of genuine, unequal bargaining power between certain employers and certain types of workers. However, we opposed the proposed rule for several reasons. “First, the rule proposes an overly simplified, one-size-fits-all approach for all employees across all industries,” NABH said in our March 2023 comment letter. “From a behavioral healthcare perspective, the proposed rule would profoundly alter the healthcare labor market – particularly for physicians and senior hospital executives – by instantly invalidating millions of dollars of existing contracts,” the letter continued. “The rule would affect the full array of NABH members’ employees, including those who are highly trained and lower skilled; as well as both highly compensated and lower-wage employees.”

The Joint Commission Announces New Telehealth Accreditation Program

The Joint Commission this week announced its new Telehealth Accreditation Program for eligible hospitals, ambulatory, and behavioral healthcare organizations. Effective July 1, 2024, the program’s requirements contain many of the standards similar to other Joint Commission accreditation programs, such as requirements for information management, leadership, medication management, patient identification, documentation, and credentialing and privileging. Some requirements specific to the new telehealth program include:

Streamlined emergency management requirements to address providing care and clinical support remotely rather than in a physical building.
New standards for telehealth provider education and patient education about the use of telehealth platforms and devices.
New standards chapter focused on equipment, devices, and connectivity.

The Joint Commission’s announcement noted telehealth use increased by 154% during the COVID-19 pandemic’s early years before stabilizing and presently remaining at levels 38 times higher than they were in 2019.

NABH Telehealth Survey is Due Tuesday, April 30

NABH is eager to learn how your system uses telehealth services in its operations. Please remember to complete this brief survey by Tuesday, April 30, 2024. Your responses will help guide our advocacy efforts. We also urge you to share this survey with IT colleagues who have insight into how your facilities use telehealth to support your patients. Please email NABH Executive Vice President for Government Relations and Public Policy Rochelle Archuleta if you have questions.

Reminder: The National Academies to Explore Mental Health Services for Anxiety & Mood Disorders in Women

The National Academies Forum on Mental Health and Substance Use Disorder will host a hybrid public workshop in Washington, D.C. and via webcast to explore mental health care services related to anxiety and mood disorders in women on April 29 and 30. Sponsored by the Health Resources and Services Administration, the workshop will examine currently available evidence to identify, define, and prepare strategies for the provision of essential healthcare services related to anxiety and mood disorders in women across the life course. Presentations will also describe health disparities, healthcare finances, and policies related to the quality and access of mental healthcare services available for women.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

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

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

Fact of the Week

Researchers have created an AI model that can identify accurately women at risk of child-birth related PTSD, Science Daily reports. The study notes early intervention is critical to prevent progression of a disorder that could carry serious health consequences for as many as 8 million women a year globally. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 182

Written by Meghan Barrett on April 19, 2024. Posted in CEO Updates.

RTI Study Shows Pervasive Disparities in Access to In-Network Behavioral Healthcare

A report this week from not-for-profit research institute RTI International adds to mounting research showing a lack of access to affordable mental health and substance use disorder treatment in the United States continues. NABH helped sponsor the study, Behavioral Health Parity—Pervasive Disparities in Access to In-Network Care Continue, which found that patients went out-of-network 3.5 times more often to see a behavioral health clinician than a medical/surgical clinician, 8.9 times more often to see a psychiatrist, 10.6 times more often to see a psychologist, 6.2 times more often for acute behavioral inpatient care, and 19.9 times more often for sub-acute behavioral inpatient care. “It’s upsetting, though not surprising, that RTI researchers found what we’ve seen for too long: patients who need critical behavioral healthcare services are forced to seek that care out-of-network much more than they do for medical-surgical services because of inadequate insurer networks. This comes at higher personal costs to these patients,” NABH President and CEO Shawn Coughlin said in a statement. “Worsening the problem, behavioral healthcare providers are reimbursed at much lower rates than their peers in medical/surgical facilities. The Mental Health Parity and Addiction Equity Act passed more than 15 years ago,” he continued. “It’s time lawmakers and regulators ensure this critical law is implemented fairly and fully nationwide.” The study also found that in-network office visit reimbursement, which health plans use to encourage provider in-network participation, was higher for medical/surgical clinicians than office visits with behavioral clinicians: 22% higher on average; 48% higher at the 75th percentile; and 70% higher at the 95th percentile. Notably, physician assistants were reimbursed for office visits at an average amount 19% higher than psychiatrists and 23% higher than psychologists.

In Case You Missed It: Watch Our Foundation’s Talent-Recruitment, Part II Webinar

The NABH Education and Research Foundation hosted the second in its two-part webinar series about talent recruitment and retention on Thursday, April 18. NABH Board Chair Frank Ghinassi, Ph.D., A.B.P.P., president and CEO of Rutgers University Behavioral Health Care, and senior vice president of the Behavioral Health and Addictions Service Line at RWJBarnabas Health, co-led the webinar with workforce consultants Beth Kuhn of Stonegate Strategies and John Pallasch of One Workforce Solutions. The presenters discussed long-term solutions to recruiting and retaining talent through partnerships; how skills-based hiring is a more effective approach to talent management; and what funding sources are available to help NABH members in their workforce-related efforts. If you missed it, please click here for the webinar’s recording, here for the presentation slides, and here for the poll question results. And be sure to join us for our Annual Meeting Workforce Panel on Monday, May 13 from 4 – 5 p.m. ET in the Salamander Washington DC’s Grand Ballroom. NABH Education and Research Foundation Vice President Jim Shaheen, CEO of New Season, will moderate the panel, which will include this week’s webinar presenters Kuhn and Pallasch, as well Jason Brooks, senior vice president of Human Resources at New Season, and Rhonda Ashley-Dixon, vice president of strategic partnership and engagement at Vanderbilt Behavioral Health.

Please Meet Our Exhibitors and Sponsors at the 2024 NABH Annual Meeting Next Month!

NABH appreciates the generous support of our exhibitors and sponsors, whose valuable products and services help NABH members deliver quality behavioral healthcare every day to those who need it. Please make time to visit our exhibitors and sponsors at the Annual Meeting from May 13-15 at the Salamander Washington, DC. Before then, you can view a list of our exhibitors and sponsors on our Annual Meeting homepage. Also, please register for the Annual Meeting, reserve your hotel room, and view our preliminary program, if you haven’t done so yet. We look forward to seeing you in Washington!

FTC Brings Case Against Monument to Enforce Health Data Privacy Protections

The Federal Trade Commission for the first time took enforcement action through the Opioid Addiction Recovery Fraud Prevention Act (OARFPA) to stop telehealth company Monument from disclosing health data to advertising platforms by bringing a case against the company, which treats patients with alcohol addiction virtually, Inside Health Policy reports. The story also noted that Monument’s data-sharing practices also violated section 5 of the FTC Act, resulting in a proposed ban on data sharing with third parties and a $2.5 million civil penalty, FTC says. Enacted in 2018, OARFPA authorizes FTC to seek civil penalties for unfair or deceptive acts or practices related to substance use disorder treatment services or products.

Center for Health Strategies Examines Medicaid Options to Cover Incarcerated Youth

The Center for Health Care Strategies, together with the Annie E. Casey Foundation, has developed a policy cheat sheet outlining requirements that will expand Medicaid options to cover services for incarcerated youth starting in 2025. Several provisions under the Consolidated Appropriations Act of 2023 will expand Medicaid services to youth who are incarcerated, of which nearly two-thirds have a diagnosable mental health or substance use disorder, according to the Medicaid Payment and CHIP Access Commission, or MACPAC. The fact sheet outlines the new requirements, opportunities for Medicaid to collaborate with the corrections sector, and next step for Medicaid agencies before the provisions take effect.

Reminder: The National Academies to Explore Mental Health Services for Anxiety & Mood Disorders in Women

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

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

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

Fact of the Week

Among U.S. college athletes, suicide is now the second leading cause of death after accidents—and rates have doubled to 15.3% from 7.6% in the past 20 years, according to a study published in the British Journal of Sports Medicine. CNN analyzed the report’s findings in a recent article. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update: 181

Written by Meghan Barrett on April 12, 2024. Posted in CEO Updates.

NABH Remembers Unit Committee Member Anthony Santucci, M.S.

NABH remembers with grateful appreciation Anthony Santucci, M.S., 50, of BayCare Behavioral Health, who died unexpectedly on March 25. Anthony served as BayCare’s director of nursing for 13 years and was an active and energetic member of NABH’s Behavioral Health Services within General Healthcare Systems Committee – known as the Unit Committee – for many years. Born and raised in South Jersey, Anthony earned his nursing degree at Wesley College in Delaware and continued his education at Jacksonville and Walden Universities, ultimately earning a Master of Science degree in nursing in 2016. Anthony was also a 2020 graduate of the Tampa Bay Chamber’s Leadership Tampa, an intensive executive leadership program, and was a devoted member of the Tampa Bay behavioral health community for more than 25 years. Anthony is survived by Jaclyn Santucci, his wife of 20 years, and their daughter Josephine Cecilia. Anthony will be missed by all who knew him. In lieu of flowers, donations can be made in Anthony’s memory to Feeding Tampa Bay or to the Pinellas County Hunter Association, a horseback riding association, via Zelle at 123pcha@gmail.com.

Register Today for Part II of Our Foundation’s Talent-Recruitment Webinar Series on April 18

Please join us and register today for the NABH Education and Research Foundation’s second webinar about recruiting and retaining talent next Thursday, April 18 from 2 p.m. – 3 p.m. ET. NABH Board Chair Frank Ghinassi, Ph.D., A.B.P.P. president and CEO, Rutgers University Behavioral Health Care and senior vice president, Behavioral Health and Addictions Service Line, RWJBarnabas Health, will co-lead this free, interactive webinar with workforce consultants Beth Kuhn of Stonegate Strategies and John Pallasch of One Workforce Solutions. Kuhn has more than 30 years of workforce experience and served previously as commissioner of the Kentucky Department of Workforce Investment and as Vermont’s director of workforce development. Pallasch has spent more than 20 years influencing organizational personnel, efficiency, and productivity in the public and private sectors and served previously as the assistant secretary for employment and training at the U.S. Labor Department. Together they will discuss establishing and developing partnerships to “grow your own” within your systems; explore funding opportunities to help support your workforce efforts; and urge you to focus more on skill sets and less on job responsibilities among your staff. Please share the registration link with your Human Resources, Operations, and Workforce Engagement teams!

The 2024 NABH Annual Meeting Hotel Cutoff Date is Now Sunday, April 28

The Salamander Washington, DC has extended its cutoff date for NABH 2024 Annual Meeting room reservations through Sunday, April 28. Please reserve your hotel room today and be sure to register for our Annual Meeting (May 13-15), if you have not done so yet. We look forward to seeing you in Washington!

House and Senate Committees Examine Behavioral Healthcare Policies in Hearings

House and Senate Committees returned from the Easter recess and reviewed several pending behavioral healthcare policies this week. In a hearing on Wednesday, April 10, the House Energy & Commerce Committee Health Subcommittee explored ways to support patients’ access to telehealth as lawmakers determine how best to extend digital health flexibilities in effect through Dec. 31. Lawmakers will need to decide whether to pursue a temporary or permanent extension of pandemic-era telehealth policies. Extending telehealth coverage beyond 2024 is expected to be costly, and if implemented in a budget neutral manner, would reduce funds available for other Medicare programs. Committee members said best practices on digital billing codes, policies that prevent overuse of telehealth services and limit fraud, and CMS’ ability to capture and report telehealth data are integral pieces for them to determine whether telehealth provisions will be extended permanently by year’s end. Lawmakers also expressed concerns that changes to virtual care policy will not hinder access to in-person care. Wednesday’s hearing announcement included a list of 15 telehealth bills that would extend or make permanent telehealth provisions. Two bills specific to behavioral healthcare include H.R. 3432, Rep. Doris Matsui’s (D-Calif.) Telemental Health Care Access Act, which eliminates certain restrictions relating to Medicare coverage of mental health services that are provided through telehealth; and H.R. 7858, the Telehealth Enhancement for Mental Health Act of 2024 from Reps. John James (R-Mich.), Don Davis (D-N.C), and David Schweikert (R-Ariz.), which would establish a Medicare “incident to” modifier for tele-mental health services. Lawmakers remain divided over whether to extend audio-only telehealth. Representatives who serve rural and underserved communities say audio-only telehealth may be the only way their constituents can experience virtual care. The ultimate collection of provisions – either temporary or permanent – will likely be included in a larger healthcare package expected to be taken up in a lame-duck session. The Senate Finance Health Subcommittee convened a roundtable to discuss opportunities to improve substance use disorder (SUD) treatments within federal health programs. Witnesses described how measures such as treatment prior authorization, low physician reimbursement rates, and inadequate funding perpetuate treatment barriers for individuals living with SUD. Both Democrats and Republican lawmakers expressed support for increasing access to care through peer support specialists, increased reimbursement rates, comprehensive care, and certified community behavioral health clinics (CCBHCs). Additional discussion items included the importance of a continuum of care and opportunities to reduce SUD stigma. One panelist highlighted increasing the availability of methadone treatment options, and several senators reiterated support for S. 644, the Modernization Opioid Treatment Access Act. Committee leaders indicated they will hold an official hearing about increasing access to SUD treatment in the future.

The National Academies to Explore Mental Health Services for Anxiety & Mood Disorders in Women

The National Academies Forum on Mental Health and Substance Use Disorder will host a hybrid public workshop in Washington, D.C. and via webcast to explore mental health care services related to anxiety and mood disorders in women on April 29 and 30. Sponsored by the Health Resources and Services Administration, the workshop will examine currently available evidence to identify, define, and prepare strategies for essential healthcare services related to anxiety and mood disorders in women across the life course. Presentations will also describe health disparities, healthcare finances, and policies related to the quality and access of mental healthcare services available for women.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

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

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

Fact of the Week

A new JAMA study shows probabilities of parents having anxiety-related visits (10.6% versus 7.0%), depression-related visits (8.4% versus 6.1%), and any mental health-related visits (18.1% versus 13.3%) were higher in families of children with cancer versus children without cancer. The authors said the findings underline the importance of multi-level interventions – such as providing MH screening, counseling, and timely support and ensuring comprehensive insurance coverage and paid medical leave – to better meet the mental-health needs of these parents. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 180

Written by Meghan Barrett on April 10, 2024. Posted in CEO Updates.

Please Join Us for Our Annual Meeting Workforce Panel on Tuesday, May 14!

Building on last year’s success, the NABH Education and Research Foundation will host a panel discussion featuring NABH members and workforce consultants during the 2024 Annual Meeting on Monday, May 13 from 4 p.m. – 5 p.m. ET. This year’s panel will focus on NABH member best workforce practices, workforce development boards, apprenticeships, fellowships, and other “grow your own” programs. It will feature the following panelists: Jason Brooks, Senior Vice President of Human Resources, New Season Rhonda Ashley-Dixon, Vice President, Strategic Partnerships & Engagement, Vanderbilt Behavioral Health Beth Kuhn, Principal, Stonegate Strategies and former Commissioner, Kentucky Department of Workforce Investment John Pallasch, Founder and CEO, One Workforce Solutions and former U.S. Assistant Secretary for Employment and Training, U.S. Labor Department The Foundation urges NABH members to attend the session and engage with panelists during the question-and-answer period. Also, please remember to register for the Annual Meeting and reserve your hotel room if you haven’t done so yet. We look forward to seeing you in Washington!

Learn About Long-term Solutions in the Fight for Talent!

Please join us for the NABH Education and Research Foundation’s second in its two-part webinar series about recruiting and retaining talent on Thursday, April 18 from 2 p.m. – 3 p.m. NABH Board Chair Frank Ghinassi, Ph.D., A.B.P.P., who serves as president and CEO of Rutgers University Behavioral Health Care and senior vice president of the Behavioral Health and Addictions Service Line at RWJBarnabas Health, will co-lead this interactive webinar with workforce consultants Beth Kuhn of Stonegate Strategies and John Pallasch of One Workforce Solutions. Kuhn has more than 30 years of workforce experience and served previously as commissioner of the Kentucky Department of Workforce Investment and as Vermont’s director of workforce development. Pallasch has spent more than 20 years influencing organizational personnel, efficiency, and productivity in the public and private sectors and served previously as the assistant secretary for employment and training at the U.S. Labor Department. Together they will present practical approaches to attracting and keeping top talent, such as developing partnerships and offering apprenticeship programs. Participants will come away with some applicable next steps to employ in their own systems to set the foundation for long-term solutions. Please click here to register and be sure to alert your members of your Human Resources, Operations, and Workforce Engagement teams to attend!

NABH Comments to Federal Agencies About Proposed BHIT Data Standards

NABH on March 29 submitted comments to the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of the National Coordinator for Health Information Technology (ONC) on their joint effort to create official data standards for behavioral health information technology (IT). In addition to the association sending a comment letter, NABH members concurrently responded to the related online survey about potential behavioral health data items. As we know, behavioral healthcare providers were not eligible recipients of the HITECH Act of 2009 funding, and, as such, most IT vendors did not develop viable BHIT systems or tools at that time or since. More than 15 years after HITECH became law, our country needs a federal investment in BHIT to help our field align with the IT capacity of the rest of the continuum of healthcare providers. Our comments emphasized that a significant portion of our membership lacks an IT system compliant with the ONC standards set in 2015. As a result, many in our field face reduced efficiency and more administrative burden. We also noted that on the policy front, the ongoing use of outdated IT reduces the field’s ability to engage in recent policy initiatives that require modern interoperability. NABH recommended that the new behavioral health language include data metrics for behavioral health populations that tend to be overlooked by behavioral health IT system modules, such as for patients experiencing suicidality or the potential of harm to self or others; substance use disorder patients; patients in intensive outpatient programs or partial hospitalization programs; and adolescent and youth populations. Our letter also recommended social determinants of health to include in the new standards. In addition, we urged the initiative to consider data terms related to the emerging use of artificial intelligence within behavioral healthcare settings. Because this is a top priority of NABH, we urged SAMHSA and ONC to work closely with providers and other stakeholders on this long-awaited investment. This collaboration is of highest importance because it is expected that the data standards that emerge from this project will be used in future standards for BH electronic medical records.

NABH Weighs in On Physical Holds for Children and Youth in Joint Commission Letter

In a letter to The Joint Commission (TJC) this week, NABH noted that The Joint Commission’s proposal to modify standards on the use of physical holds for children and youth would affect NABH-member group homes, foster care, non-hospital residential treatment programs, and perhaps others – many of which are accredited by the Council on Accreditation. The Joint Commission’s proposed change would combine the current physical holding standards for children and youth with existing standards for restraints and seclusions for all individuals served. Because the brief proposal lacks a clear rationale, NABH’s letter outlined several key elements that stakeholders need before responding to the proposal. Specifically, we asked for a comprehensive policy justification and evidence, impact estimate, and explanation of any link between this proposal and efforts to combat workplace violence. NABH also requested a meeting with The Joint Commission to learn more about the proposal.

Reminder: U.S. Labor Department Seeks Information in Parity Enforcement Survey

The U.S. Labor Department is conducting an 11-question survey to better understand stakeholder views about the department’s federal parity law oversight and enforcement efforts. In particular, the survey focuses on compliance enforcement for non-quantitative treatment limitations, which include prior authorization protocols, network adequacy standards, and timeliness requirements. Click here to complete the survey, which opened on Wednesday, March 27 and closes on Wednesday, April 10.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

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

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

Fact of the Week

A new telehealth study focused on patients with Alcohol Use Disorder showed some groups were less likely to receive any video telehealth than telephone visits, suggesting that multiple treatment modalities should remain available to ensure treatment access. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 179

Written by Meghan Barrett on March 29, 2024. Posted in CEO Updates.

CMS Proposes IPF PPS Reforms and FY 2025 Increase of 2.6%

The Centers for Medicare & Medicaid Services (CMS) on Thursday proposed a net update of 2.6 percentage points for fiscal year (FY) 2025 payment levels relative to FY 2024 levels for hospitals and units reimbursed under the inpatient psychiatric facility prospective payment system (IPF PPS). The update moderately varies by provider types, with a 2.2% increase for urban, freestanding for-profit providers, and a 2.4% increase for urban, freestanding not-for-profit hospitals, as well as for urban, for-profit and not-for-profit units. The IPF PPS rule also proposed budget-neutral adjustments to the Medicare severity diagnosis related groupd (DRG), which are payment categories that reflect a patient’s principal diagnosis, selected comorbidities, patient age, and the variable per diem adjustments. The proposed changes also include:

Maintaining the current 17 DRGs.
In response to the growing volume of these cases, CMS proposes to make these two current DRGs eligible for payment add-ons: DRGs 917 (Poisoning and toxic effects of drugs w MCC) and 918 (Poisoning and toxic effects of drugs w/out MCC). See Table 4 in the rule for more details.
Replacing DRGs 080 (Nontraumatic stupor & coma w MCC) and 081 (Nontraumatic stupor & coma w/o MCC) with DRGs 947 (Signs and Symptoms w MCC) and 948 (Signs and Symptoms w/out MCC), because volume in these current DRGs have decreased significantly and CMS said the proposed replacement DRGs are a more appropriate fit. See Table 3 in the rule for more details.

Regarding comorbidity payment add-ons, in an overall budget-neutral manner, CMS proposes multiple changes to these payment adjustment rates, as outlined in Table 8 in the rule. To maintain this payment system’s 2.0% outlier pool, CMS proposed to increase the fixed dollar loss threshold to $35,590 from $33,470, which will result in fewer cases qualifying for outlier payments. The rule also proposes to increase payments for electroconvulsive therapy to $660.30 in FY 2025 from the current rate of $385.58. Due to these adjustments, the base per diem was reduced to $874.93 from $895.63 (a 2.3% reduction) to ensure that overall payments remained budget neutral. And our analysis will further explain this reduction and its overall financial impact to the industry. In addition, under the congressional mandate from the Consolidated Appropriations Act, 2023, the rule includes two requests for information (RFI) on potential future IPF PPS reforms. For the first RFI, CMS revisits and builds upon its 2022 technical report by flagging several potential future reforms to the current adjustments for rural IPFs, teaching IPFs, and “safety-net” IPFs. The second RFI in the rule proposes to develop a standardized IPF patient assessment instrument, which will be designed to implement in 2028. Please see the agency’s fact sheet for additional information about the proposed rule. Public comments are due by Tuesday, May 28. Also, please join NABH via Zoom on Tuesday, April 16 from 2 p.m. – 3 p.m. ET, when we’ll discuss the rule in greater detail, as well as priority issues that NABH will address in the association’s official comment letter.

View the NABH 2024 Annual Meeting Preliminary Program!

Earlier this week NABH shared its 2024 Annual Meeting preliminary program with members and meeting registrants. Unless noted otherwise, meeting sessions are open to all Annual Meeting attendees. Please remember to register for the Annual Meeting and reserve your hotel room today if you haven’t done so yet. We look forward to seeing you in Washington!

Deadline to Advertise in the 2024 NABH Exhibitor and Sponsor Guide is Today, March 29!

NABH will distribute the 2024 NABH Exhibitor and Sponsor Guide to all registrants at the 2024 NABH Annual Meeting from May 13-15 at the Salamander Washington, DC. Be sure your organization is included in it! All ads are due today, Friday, March 29, 2024. Please click here for details about advertising options, requirements, payment, and more. The association also will send the guide to all NABH members after the meeting and post it on the NABH Annual Meeting webpage.

Register for Part II of Our Foundation’s Talent-Recruitment Webinar Series!

Please join us on Thursday, April 18 at 2 p.m. ET for Part II of the NABH Education and Research Foundation’s talent-recruitment webinar series, which will explore long-term solutions. NABH Board Chair Frank Ghinassi, Ph.D., A.B.P.P. president and CEO, Rutgers University Behavioral Health Care and senior vice president, Behavioral Health and Addictions Service Line, RWJBarnabas Health, will lead the April webinar along with Kuhn and workforce consultant John Pallasch of One Workforce Solutions. Pallasch served previously as the assistant secretary for employment and training at the U.S. Labor Department. This interactive webinar will explore how to develop partnerships for apprenticeships and other “grow your own” programs. Please click here to register.

ICYMI: Watch Part I of Our Foundation’s Talent-Recruitment Webinar Series!

On March 26, our foundation hosted Part I of its two-part, talent-recruitment webinar series, which focused on short-term solutions. If you missed it, please click here for the webinar’s recording, here for the presentation slides, and here for the poll question results.

U.S. Labor Department Seeks Information in Parity Enforcement Survey

Reminder: Please Submit Data to NABH’ Denial-of-Care Portal

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

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

Fact of the Week

Perinatal mood and anxiety disorder (PMAD) diagnoses among privately insured people nationwide increased by 93.3% from 2008 to 2020, growing faster in 2015–20 than in 2008–14, according to a new study published in Health Affairs. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 178

Written by Meghan Barrett on March 22, 2024. Posted in CEO Updates.

Congress Moves to Approve Final Spending Bill Before Government Shutdown Deadline

Congressional appropriators on Thursday unveiled legislative text for the final spending package for fiscal year 2024. The House will vote first on this six-bill “minibus,” which contains the appropriations bills for Labor-HHS-Education, Defense, Financial Services and General Government, Homeland Security, State-Foreign Operations, and Legislative Branch during a Friday session. The Senate is moving quickly to review the package before the federal funding deadline expires at midnight. Absent this “time agreement,” a brief weekend shutdown could be possible while the bill works its way to the president’s desk. Negotiations between House and Senate leadership broke down on another skinny health package. This deal would have included additional funding for community health centers, PBM reforms and price transparency provisions, as well as extensions for the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPA) and the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment Act (SUPPORT). Lawmakers may consider these provisions during the congressional lame duck session after the elections. In the bill, HHS is set to receive an increase of $955 million above the current funding level to more than $117 billion. Behavioral healthcare funding includes more than $4.6 billion to support substance use prevention and treatment efforts to address the rising toll of opioid overdoses; $2 billion for the Substance Use Prevention, Treatment, and Recovery Services Block Grant; $1.575 billion for State Opioid Response grants; $145 million for the Rural Communities Opioid Response Program; and $1 billion for the Mental Health Block Grant. The bill also provides $153 million for the Behavioral Health Workforce Education and Training Program to support community-based clinical training and strengthen the mental health workforce through repayment of education loans for individuals working in either a Mental Health Professional Shortage Area or where the overdose death rate exceeds the national average. The package allocates $42 million to the Health Resources and Services Administration (HRSA) for the Office of the Advancement of Telehealth (OAT) for expenses, grants, contracts and “cooperative agreements for the advancement of telehealth activities; $1 million to connect rural veterans to health care facilities; and $20.9 million for rural hospitals to adopt health information technology. The bill also provides an $18 million increase for the 988 Suicide Prevention Lifeline, building on the nearly $400 million increase in fiscal year 2023. The proposed boost comes after GOP leaders on the House Energy and Commerce Committee requested that the Government Accountability Office audit the Substance Abuse and Mental Health Services Administration’s (SAMHSA) oversight of funds to the lifeline, saying more than half of designated funding has gone unused.

Register Today for Next Week’s NABH Education and Research Foundation Workforce Webinar

There’s still time to register for the NABH Education and Research Foundation’s workforce webinar on Tuesday, March 26 from 2 p.m. – 3 p.m. ET. Next week’s webinar is the first in a two-part series that explores talent recruitment and retention. Foundation Vice President Jim Shaheen, CEO of New Season/Colonial Management Group, LP, Foundation Secretary Mary Pawlikowski, president at Vanderbilt Psychiatric Hospital and Clinics, and workforce consultant Beth Kuhn of Stonegate Strategies will lead participants in an interactive discussion to share their talent-recruitment and retention challenges, as well as their best, short-term strategies to address those problems. These practices include re-organizing recruitment teams to align with operations, developing alumni outreach initiatives, streamlining an organization’s onboarding process, conducting stay interviews, and more. Please join us and click here to register for Part I on March 26 at 2 p.m. ET! The second webinar in this series will examine longer-term solutions to recruiting talent – such as Registered Apprenticeship Programs, education and certification opportunities, fellowships, and more – on Thursday, April 18 at 2 p.m. ET. NABH Board Chair Frank Ghinassi, Ph.D., A.B.P.P. president and CEO, Rutgers University Behavioral Health Care and senior vice president, Behavioral Health and Addictions Service Line, RWJBarnabas Health, will lead the April webinar along with Kuhn and workforce consultant John Pallasch of One Workforce Solutions. Pallasch served previously as the assistant secretary for employment and training at the U.S. Labor Department. Please join us and click here to register for Part II on April 18!

HHS Needs Your Feedback to Help Develop a Behavioral Healthcare Data Set

Through next Friday, March 29, HHS’ Office of the National Coordinator (ONC) – the federal agency that standardizes information technology requirements for healthcare providers – is collecting information about specific data elements to include in a new behavioral healthcare data set. NABH encourages you to help with this important project. The task is a joint effort between ONC and the Substance Abuse and Mental Health Services Administration (SAMHSA) to create the draft United States Core Data for Interoperability (USCDI) + BH to address core data and interoperability for behavioral health needs beyond the scope of the USCDI. In December 2023, ONC launched a new USCDI+ platform to support the organization, linking of domains, and functionality to solicit and receive feedback for all USCDI+ domains. HHS’ goal with this activity is to confirm the data points needed to improve and advance care continuity for patients who see behavioral healthcare providers and other healthcare providers. Survey respondents will identify the specific data metrics from among 187 options – such as the patient’s address, insurance information, clinical data points, and more – that HHS should collect, as well as items that HHS should not collect. Your expertise will help develop an eventual government-endorsed data set for the behavioral healthcare field and also influence a separate HHS effort to develop a future behavioral health information technology system. Behavioral Health Information Technology, or BHIT, is one of NABH’s top advocacy priorities, so we strongly urge you and your teams’ health IT experts to complete ONC’s survey by no later than Friday, March 29. Meanwhile, NABH is working with its committees to prepare an association comment letter to ONC. Please contact Sarah Wattenberg with any questions.

White House Announces Challenge to Save Lives from Overdose

The Biden administration has announced The White House Challenge to Save Lives from Overdose, a nationwide call to action to stakeholders from all sectors to save lives by increasing training about and access to life-saving opioid overdose reversal medications. The White House urges organizations, philanthropists, local governments, and businesses large and small to participate in a variety of ways, such as training 100% of an organization’s employees on how and when to use an opioid reversal medication; ensure an opioid overdose reversal medication is in every first aid kit in worksites and schools; and purchase and distribute opioid overdose reversal medications to a certain number of employees. Click here to learn more about the challenge.

2024 Annual Meeting Hotel Reservation Cutoff Date is Approaching!

Please reserve your hotel room today at the Salamander Washington, DC for the 2024 NABH Annual Meeting from May 13-15, 2024! The Salamander, Washington DC’s reservation cutoff date is Sunday, April 14. And please remember to register for this year’s Annual Meeting, The Future of Behavioral Healthcare, if you haven’t done so yet. The Annual Meeting’s preliminary program will be available soon. We look forward to seeing you in Washington!

Advertise in the 2024 NABH Exhibitor and Sponsor Guide!

NABH will distribute the 2024 NABH Exhibitor and Sponsor Guide to all registrants at the 2024 NABH Annual Meeting from May 13-15 at the Salamander Washington, DC. Be sure your organization is included in it! All ads are due by next Friday, March 29, 2024. Please click here for details about advertising options, requirements, payment, and more. The association also will send the guide to all NABH members after the meeting and post it on the NABH Annual Meeting webpage.

Reminder: Please Submit Data to NABH’ Denial-of-Care Portal

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

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

In Case You Missed It: NABH’s 2024 Advocacy Priorities

NABH has released its 2024 Advocacy Priorities, which we urge you to read and share with your Government Relations teams. Topping NABH’s priorities this year are parity, workforce, behavioral healthcare information technology, America’s ongoing addiction crisis, and the Institutions for Mental Diseases (IMD) exclusion.

Fact of the Week

A recent JAMA study reported Delta 8-THC use prevalence is appreciable among U.S. adolescents and is higher in states without marijuana legalization or existing Delta 8-THC regulations. The study noted that prioritizing surveillance, policy, and public health efforts addressing adolescent Delta 8-THC use may be warranted. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 177

Written by Meghan Barrett on March 15, 2024. Posted in CEO Updates.

HHS Needs Your Feedback to Help Develop a Behavioral Healthcare Data Set

Through March 29, HHS’ Office of the National Coordinator (ONC) – the federal agency that standardizes information technology requirements for healthcare providers – is collecting information about specific data elements to include in a new behavioral healthcare data set. NABH encourages you to help with this important project. The task is a joint effort between ONC and the Substance Abuse and Mental Health Services Administration (SAMHSA) to create the draft United States Core Data for Interoperability (USCDI) + BH to address core data and interoperability for behavioral health needs beyond the scope of the USCDI. In December 2023, ONC launched a new USCDI+ platform to support the organization, linking of domains, and functionality to solicit and receive feedback for all USCDI+ domains. HHS’ goal with this activity is to confirm the data points needed to improve and advance care continuity for patients who see behavioral healthcare providers and other healthcare providers. Survey respondents will identify the specific data metrics from among 187 options – such as the patient’s address, insurance information, clinical data points, and more – that HHS should collect, as well as items that HHS should not collect. Your expertise will help develop an eventual government-endorsed data set for the behavioral healthcare field and also influence a separate HHS effort to develop a future behavioral health information technology system. Behavioral Health Information Technology, or BHIT, is one of NABH’s top advocacy priorities, so we strongly urge you and your teams’ health IT experts to complete ONC’s survey by no later than Friday, March 29. Meanwhile, NABH is working with its committees to prepare an association comment letter to ONC. Please contact Rochelle Archuleta with any questions.

Register Today for the NABH Education and Research Foundation’s Talent-Recruitment Webinars

The NABH Education and Research Foundation will host a two-part webinar series about talent recruitment featuring NABH members and workforce experts in March and April. Part I –Talent Recruitment: Exploring Short-Term Solutions – on Tuesday, March 26 will feature Foundation Vice President Jim Shaheen, CEO of New Season/Colonial Management Group, LP; Foundation Secretary Mary Pawlikowski, president at Vanderbilt Psychiatric Hospital and Clinics; and workforce consultant Beth Kuhn of Stonegate Strategies. In this hourlong webinar, presenters will lead participants in an interactive discussion to share and discuss their talent-recruitment and retention challenges, as well as their best, short-term strategies to address those problems. These practices include re-organizing recruitment teams to align with operations, developing alumni outreach initiatives, streamlining an organization’s onboarding process, conducting stay interviews, and more. Please join us and click here to register for Part I on March 26 at 2 p.m. ET! The second webinar in this series will examine longer-term solutions to recruiting talent – such as Registered Apprenticeship Programs, education and certification opportunities, fellowships, and more – on Thursday, April 18 at 2 p.m. ET. NABH Board Chair Frank Ghinassi, Ph.D., A.B.P.P. president and CEO, Rutgers University Behavioral Health Care and senior vice president, Behavioral Health and Addictions Service Line, RWJBarnabas Health, will lead the April webinar along with Kuhn and workforce consultant John Pallasch of One Workforce Solutions. Pallasch served previously as the assistant secretary for employment and training at the U.S. Labor Department. Please join us and click here to register for Part II on April 18!

President Biden’s Fiscal 2025 Budget Proposal Aims to Transform Behavioral Healthcare

President Biden this week unveiled his fiscal year (FY) 2025 budget proposal, which would provide considerable funding to achieve the Biden administration’s goal of transforming behavioral healthcare in America. Each year, the president’s budget proposal is most significant for sending a message about the administration’s priorities. President Biden’s FY 2025 proposal provides $1 billion to advance BHIT adoption and interoperability among providers. It also provides a combined total of $216 million for mental health programs, including $200 million from the Bipartisan Safer Communities Act, a 900% increase in program funding since 2021. The funds will help to increase the number of school-based counselors, psychologists, social workers, and other mental health professionals in K-12 schools. NABH is also pleased to see the president’s budget proposal seeks to strengthen parity by requiring all commercial market health plans to cover mental health and substance use disorder benefits; ensuring that plans have an adequate network of behavioral health providers; and improving the U.S. Labor Department’s (DOL) ability to enforce the law. The budget includes $275 million over 10 years to increase the DOL’s capacity to ensure that large group market health plans and issuers comply with mental health and substance use disorder requirements, and to act against plans and issuers that do not comply. The budget’s other behavioral healthcare provisions include: investing in strengthening the behavioral healthcare workforce, including integration into primary care settings; increasing funding for the Children’s Mental Health Initiative by $50 million; increasing funding for the State Opioid Response grant program, investing in a new technical assistance center to strengthen health providers’ understanding and treatment of substance use and women’s mental health; expanding the 988 Suicide and Crisis Lifeline, and more.

SAMHSA to Host Webinar Next Week on Assisted Outpatient Treatment Program for Individuals with Serious Mental Illness

SAMHSA will host a virtual webinar for prospective applicants interested in applying for the fiscal year 2024 Assisted Outpatient Treatment Program for Individuals with Serious Mental Illness (AOT). The webinar will provide an overview of SAMHSA’s late-February AOT funding opportunity and application requirements. Registration is not required for the webinar on Wednesday, March 20 from 2:30 – 4 p.m. ET.

Register Today for the 2024 NABH Annual Meeting

Please remember to register for the 2024 NABH Annual Meeting, The Future of Behavioral Healthcare and reserve your hotel room at the Salamander Washington, DC from May 13-15, 2024. This year’s meeting will examine and discuss critical issues that behavioral healthcare providers manage today and will continue to address tomorrow, including access to care, parity, technology, workforce, the political environment, and more. We look forward to seeing you in Washington!

Join Us for Hill Day 2024

Please remember to sign up for Hill Day 2024 on Tuesday, May 14, the second day of this year’s Annual Meeting. Hill Day is an excellent opportunity to meet one-on-one with legislators to discuss the issues that matter most to behavioral healthcare providers. After you register for the NABH Annual Meeting, the NABH Congressional Affairs team will match you with legislators who represent you or your facility footprint. Closer to the day of the meeting, we will send you a meeting schedule, materials, and talking points to guide your conversations with Members of Congress and their staff. Please indicate in your Annual Meeting registration form that you are interested in Hill Day, and be sure to include all the states where your system has a footprint. If you have an existing relationship with a legislator, please let us know!

Reminder: Please Submit Data to NABH’ Denial-of-Care Portal

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

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

In Case You Missed It: NABH’s 2024 Advocacy Priorities

NABH released its 2024 Advocacy Priorities, which we urge you to read and share with your Government Relations teams. Topping NABH’s priorities this year are parity, workforce, behavioral healthcare information technology, America’s ongoing addiction crisis, and the Institutions for Mental Diseases (IMD) exclusion.

Fact of the Week

In 2021 and 2022, people ages 75 and older had the highest suicide rate among all age groups, largely driven by males, according to the Centers for Disease Control and Prevention and noted in a recent Health Affairs article. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 176

Written by Meghan Barrett on March 12, 2024. Posted in CEO Updates.

NABH Supported Behavioral Healthcare Riders in Funding Package Passes House and Awaits Senate Passage

House and Senate Leadership agreed to a six-bill spending package with a March 9 deadline that contains a narrow list of health measures, including several important NABH priorities. The agreement set up a Wednesday vote in the House, which passed the legislation 339-85 and sent the package to the Senate. The Senate is expected to consider and pass the legislation today or early tomorrow morning to avoid a partial government shutdown. Following passage of the initial package, lawmakers will have roughly three additional weeks to fund HHS as part of the second funding package which has a March 22 deadline. The limited health care riders include NABH priority provisions to permanently require state Medicaid plans to cover medication-assisted treatment and to create a permanent state Medicaid option allowing treatment of substance use disorder at institutions. Other behavioral health provisions include establishing Certified Community Behavioral Health Clinic services as an optional Medicaid benefit, requiring HHS to issue guidance on how states can improve integrating behavioral health with primary care, and a provision to make treatments more streamlined for justice-involved Medicaid beneficiaries — states must suspend rather than terminate coverage for incarcerated enrollees. The skinny health care package also includes funding to eliminate the statutorily required payment reductions intended to offset hospitals’ uncompensated care costs through Dec. 31, 2024. Notably excluded from the healthcare package is the Modernizing Opioid Treatment Access Act (MOTAA), which NABH and coalition partners advocated extensively to stop. Other healthcare provisions excluded include an extension of now-expired pandemic provisions allowing employers to offer telehealth as a separate benefit, highly-debated items related to prescription drugs and hospitals, such as pharmacy benefit manager (PBM) reforms, hospital price transparency measures, or any site neutral payment policies for hospitals. There is the potential that some healthcare provisions could move with the March 22 funding package or in a year-end health package following the November elections. Should another healthcare package emerge, NABH will continue to advocate for remaining SUPPORT Act provision priorities and to prevent any effort to include MOTAA.

HHS Announces Steps to Assist Providers After Change Healthcare Cyberattack

HHS on Thursday announced what the Centers for Medicare & Medicaid Services (CMS) is doing to help healthcare providers continue to serve patients following the late-February cyberattack on Change Healthcare, a unit of UnitedHealth Group (UHG). The HHS announcement also said the department is in regular contact with UHG leadership, state partners, and with numerous external stakeholders to better understand the nature of the impacts and to ensure the effectiveness of UHG’s response. “HHS has made clear its expectation that UHG does everything in its power to ensure continuity of operations for all health care providers impacted and HHS appreciates UHG’s continuous efforts to do so,” said in its statement. “HHS is also leading interagency coordination of the Federal government’s related activities, including working closely with the Federal Bureau of Investigations (FBI), the Cybersecurity and Infrastructure Security Agency (CISA), the White House, and other agencies to provide credible, actionable threat intelligence to industry wherever possible.” Click here to read about the steps CMS is taking to assist providers. And please contact NABH if your system has been affected by the cyberattack and/or if you have questions for NABH.

SAMHSA Announces $36.9 Million in Behavioral Healthcare Grant Funding

The Substance Abuse and Mental Health Services (SAMHSA) recently announced $36.9 million in grant program funding to support behavioral healthcare services nationwide. The funding covers a variety of areas, including $10 million for screening, brief intervention, and referral to treatment; more than $6 million to support first responders and others with training, administering, and distributing naloxone and other Food and Drug Administration (FDA)-approved opioid overdose reversal medications or devices; and more than $5 million to help expand and ensure that students in health professional receive SUD education early in their academic careers and have a basic knowledge of strategies to identify and treat addiction and support recovery after they graduate. Click here to read about the other funding opportunities.

Register for the NABH Education and Research Foundation’s Talent Recruitment Webinars

The NABH Education and Research Foundation will host a two-part webinar series about talent recruitment featuring NABH members and workforce experts in March and April. Part I –Talent Recruitment: Exploring Short-Term Solutions – will be held Tuesday, March 26, 2024 at 2 p.m. ET. Foundation Vice President Jim Shaheen, CEO of New Season/Colonial Management Group, LP, and Foundation Secretary Mary Pawlikowski, president at Vanderbilt Psychiatric Hospital and Clinics, will join workforce consultant Beth Kuhn of Stonegate Strategies for this interactive webinar to help NABH members learn about and share their best, short-term solutions to recruiting talent. Kuhn has more than 30 years of workforce experience and has served in both Democratic and Republican administrations, including in her roles as commissioner of the Kentucky Department of Workforce Investment and as Vermont’s director of workforce development. She has also served as chief engagement officer at the Kentucky Cabinet of Health and Family Services. The second webinar in this series will examine longer-term solutions to recruiting talent – such as Registered Apprenticeship Programs, education and certification opportunities, fellowships, and more – on Thursday, April 18 at 2 p.m. ET. NABH Board Chair Frank Ghinassi, Ph.D., A.B.P.P. president and CEO, Rutgers University Behavioral Health Care and senior vice president, Behavioral Health and Addictions Service Line, RWJBarnabas Health, will lead the April webinar with Kuhn and workforce consultant John Pallasch of One Workforce Solutions. Pallasch served previously as the assistant secretary for employment and training at the U.S. Labor Department. Please join us and click here to register for Part 1 on March 26 and here to register for Part 2 on April 18!

Alcohol Deaths Jump During Pandemic

A new CDC study found that more than 178,300 people died from excessive alcohol use during 2020 and 2021 in the U.S., a 29% increase from 2016 and 2017, and that the number of people who died per year increased by more than 40,000 within six years. Female deaths had a 35% spike compared to 27% for males. The report suggests that increases may have been caused by changes in alcohol policies during the COVID-19 pandemic in which many states permitted alcohol carryout and delivery to homes for off-premises consumption.

SAMHSA to Hold Briefing on CFR Amendments

Join a virtual stakeholder briefing on Thursday, March 14, 3-4 pm ET, unveiling recent amendments to 42 CFR part 8 of the Code of Federal Regulations (CFR) governing opioid treatment program (OTP) certification and treatment standards. Published on Feb. 2, 2024, these revisions aim to enhance care access through reduced barriers, flexible treatment, and telehealth integration. This event will include a presentation from Dr. Yngvild Olsen, director of SAMHSA’s Center for Substance Abuse Treatment (CSAT), others, and followed by a Q&A and discussion. Register for this breifing here.

Register Today for the 2024 NABH Annual Meeting!

Reminder: Please Submit Data to NABH’ Denial-of-Care Portal

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

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

In Case You Missed It: NABH’s 2024 Advocacy Priorities

Last week NABH released its 2024 Advocacy Priorities, which we urge you to read and share with your Government Relations teams. Topping NABH’s priorities this year are parity, workforce, behavioral healthcare information technology, America’s ongoing addiction crisis, and the Institutions for Mental Diseases (IMD) exclusion.

Fact of the Week

Research from the Treatment Advocacy Center (TAC) reports that bed availability within state psychiatric hospitals reached a low of 10.8 beds per population of 100,000 in 2023. TAC’s report attributed this trend to a variety of circumstances, including the COVID-19 pandemic and the increasing, disproportionate number of beds filled by individuals from the criminal legal system. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 175

Written by Meghan Barrett on March 1, 2024. Posted in CEO Updates.

Now Available: NABH 2024 Advocacy Priorities!

NABH is pleased to share its 2024 Advocacy Priorities, which we urge you to read and share with your Government Relations teams. Topping NABH’s priorities this year are parity, workforce, behavioral healthcare information technology, America’s ongoing addiction crisis, and the Institutions for Mental Diseases (IMD) exclusion. “NABH’s 2024 advocacy priorities reflect the organization’s mission to advance responsive, accountable, and clinically effective prevention, treatment, and care for children, adolescents, adults, and older adults with mental health (MH) and substance use disorders (SUD),” the advocacy priorities document notes. “2024 is a critically important year as the country continues to face intense access challenges for both MH and SUD patients. Demand for our services across all age groups nationwide has never been higher.

NABH Education and Research Foundation to Host Webinar Series on Talent Recruitment

The NABH Education and Research Foundation will host a two-part webinar series about talent recruitment featuring NABH members and workforce experts in March and April. Part I –Talent Recruitment: Exploring Short-Term Solutions – will be held Tuesday, March 26, 2024 at 2 p.m. ET. Foundation Vice President Jim Shaheen, CEO of New Season/Colonial Management Group, LP, and Foundation Secretary Mary Pawlikowski, president at Vanderbilt Psychiatric Hospital and Clinics, will join workforce consultant Beth Kuhn of Stonegate Strategies for this interactive webinar to help NABH members learn about and share their best, short-term solutions to recruiting talent. Kuhn has more than 30 years of workforce experience and has served in both Democratic and Republican administrations, including in her roles as commissioner of the Kentucky Department of Workforce Investment and as Vermont’s director of workforce development. She has also served as chief engagement officer at the Kentucky Cabinet of Health and Family Services. The second webinar in this series will examine longer-term solutions to recruiting talent – such as Registered Apprenticeship Programs, education and certification opportunities, fellowships, and more – on Thursday, April 18 at 2 p.m. ET. NABH Board Chair Frank Ghinassi, Ph.D., A.B.P.P. president and CEO, Rutgers University Behavioral Health Care and senior vice president, Behavioral Health and Addictions Service Line, RWJBarnabas Health, will lead the April webinar with Kuhn and workforce consultant John Pallasch of One Workforce Solutions. Pallasch served previously as the assistant secretary for employment and training at the U.S. Labor Department. Please join us and click here to register for Part 1 on March 26 and here to register for Part 2 on April 18!

Lawmakers Avert Government Shutdown; Healthcare Funding Package Slated for Late March

Federal lawmakers this week averted a partial government shutdown after the Senate on Thursday approved a two-step Continuing Resolution that clears the path for policymakers to conclude appropriations work and prepare for a healthcare funding package scheduled for March 22. The House and Senate moved quickly to pass a stopgap funding bill ready for President Biden’s signature this weekend, buying more time to finalize half a dozen spending bills that congressional leaders must pass by the new March 8 deadline. The vote will set up a first tranche of full-year spending bills, which include the Agriculture, Commerce-Justice-Science, Energy-Water, Interior-Environment, Military Construction-VA and Transportation-Housing and Urban Development measures. Enacting these bills would fund those agencies through Sept. 30. Congress will consider a second batch of bills as they face a new deadline of March 22 to avoid a partial government shutdown. That package includes the Defense, Financial Services, Legislative Branch, Homeland Security, Labor-HHS-Education and State-Foreign Operations measures. A final deal on the Labor-HHS bill could include a stripped-down healthcare package with a handful of priorities, including a NABH priority: an IMD provision that would make the state plan amendment option permanent. Other healthcare priorities expected in the bill include a partial fix to Medicare physician pay cuts, extended funding for community health centers, and delayed disproportionate share hospital cuts. Other long-debated health policy measures – including pharmacy benefit manger reforms, site-neutral hospital policies, transparency reforms, and some SUPPORT Act provision reauthorizations – are likely to be set aside until the lame-duck session after November’s elections. MOTAA proponents will likely continue to advocate for including this measure – which NABH will continue to oppose – in a November funding package.

SAMHSA to Host Webinar on Models to Reduce Frequent Service Utilization for Individuals with MH and SUD

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) GAINS Center will host the webinar Implementing Complex Care Models to Reduce Frequent Service Utilization Among Individuals Experiencing Mental and Substance Use Disorders later this month. As SAMHSA noted in its announcement, people with complex healthcare needs, including mental and substance use disorders, can sometimes fall through service gaps and cycle among emergency, criminal justice, and hospital systems. Their complex needs require a person-centered approach to care and linkages to support treatment retention and recovery. Learn more in this webinar on Thursday, March 21 starting at 1:30 p.m. ET. Click here to register.

Now Open: 2024 NABH Annual Meeting Registration

Registration is now open for the 2024 NABH Annual Meeting, The Future of Behavioral Healthcare. Please join us at the Salamander Washington, DC from May 13-15, 2024 for this year’s Annual Meeting to examine and discuss critical issues that behavioral healthcare providers manage today and will continue to address tomorrow, including access to care, parity, technology, workforce, the political environment, and more. Click here to register for the meeting and reserve your hotel room. We look forward to seeing you in Washington!

Join Us for Hill Day 2024!

Reminder: Please Submit Data to NABH’ Denial-of-Care Portal

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

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

Fact of the Week

In areas with some racial or ethnic diversity, there is a large decline in the geographic availability of buprenorphine prescribers and prescription fills, according to a new study from the University of Pittsburgh. “In areas that are less than 95% white, for example, there’s a 45 to 50% drop (in access),” said Coleman Drake in a U.S. News and World Report article. Drake is an assistant professor of health policy and management at Pitt Public Health in Pittsburgh and the study’s lead author. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 174

Written by Meghan Barrett on February 28, 2024. Posted in CEO Updates.

DOL Includes Mental Health in $200 Million Grant Announcement for Registered Apprenticeships

The U.S. Labor Department this week announced nearly $200 million in grants to support public-private partnerships that expand, diversify, and strengthen Registered Apprenticeships and included mental health occupations under the “care economy” sector that is eligible to apply. The funding opportunity includes $95 million of competitive grants through the second round of the Apprenticeship Building America Grant Program and $100 million in the second round of State Apprenticeship Expansion Formula Grants. The Apprenticeship Building America Grant Program aims to leverage Registered Apprenticeships as a workforce solution while assuring that people from underrepresented and underserved communities can access high-quality training and pre-apprenticeships that lead directly to enrolling in a Registered Apprenticeship program. In addition to the care economy, sectors include information technology/cybersecurity, K-12 teacher occupations, clean energy, hospitality, public sector, and supply chain sector (logistics, warehousing, transportation, manufacturing). Click here to learn about the second round of the Apprenticeship Building America Grant Program and here to learn about the State Apprenticeship Expansion Formula grants. The NABH Education and Research Foundation will host a webinar this spring to help members learn more about Registered Apprenticeships and will provide details soon.

U.S. Supreme Court Rejects UBH Request to Hear Claim Denial Case

In a win for behavioral healthcare providers, the U.S. Supreme Court this week rejected a request for appeal from United Behavioral Health (UBH) to hear a behavioral health claim denial case. The initial case centered on how health plans under the Employee Retirement Income Security Act (ERISA) handle clinician insights in the denial-appeal process and how those decisions should be communicated to members. UBH sought to challenge a prior court’s rule pertaining to whether the health plan gave the plaintiff – a patient who ultimately died by suicide – a full and fair review during the denial-appeals process. The Supreme Court’s rejection this week upholds the 10^th U.S. Circuit Court of Appeals’ May 2023 ruling, which noted: “United argues its actions were not arbitrary and capricious because it met certain ERISA regulatory requirements. It points to regulations which discuss requirements for engagement with medical opinions in ERISA disability plans,” and continued: “We recognize the textual difference in the ERISA disability and ERISA medical regulations pointed out by United but disagree that the dialogue absolves United from its duty to engage in meaningful dialogue that includes a full and fair review of the insured’s claim.”

National Academies Report Urges Developing Standards to Limit Potential Social Media Harms on Adolescent Mental Health

A recent report from the National Academies of Sciences, Engineering, and Medicine (NASEM) recommends developing new industry standards to limit the potential harms of social media on adolescent mental health while bolstering its possible benefits. The report notes that during the past 15 years, an increase in young people’s smartphone usage has coincided with a decline in mental health, a damaging association that U.S. Surgeon General Vivek Murthy, M.D., M.B.A, warned against in a May 2023 advisory. Click here to read the JAMA article about the NASEM report.

HHS & DOJ to Host Webinar on Tech-facilitated Abuse in Teen Relationships Next Week

In conjunction with February’s Teen Dating Violence Awareness Month, HHS and the U.S. Justice Department (DOJ) will host a webinar on Feb. 28 to help participants learn about the use of technology in teen dating and its related impacts on behavioral health. HHS’ Office of Family Violence Prevention and Services and Substance Abuse and Mental Health Services Administration, along with DOJ’s Office on Violence Against Women, will lead the 75-minute event, which will also examine non-consensual image-sharing and practices to address these challenges at the community level. Click here to register for the webinar, which will begin at 3 p.m. ET next Wednesday.

Now Open: 2024 NABH Annual Meeting Registration

Reminder: Please Submit Data to NABH’ Denial-of-Care Portal

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

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

Fact of the Week

A recent report from union group National Nurses United showed 81.6% of nurses polled said they had experienced workplace violence in at least one form. Respondents reported the three most common types of violence were being verbally threatened (67.8%), physically threatened (38.7%), and being pinched or scratched (37.3%). For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update: 173

Written by Meghan Barrett on February 27, 2024. Posted in CEO Updates.

NABH Remembers Youth Services Committee Member Mike Lyons, M.S.

NABH remembers with grateful appreciation Mike Lyons, M.S., 54, who died unexpectedly of a brain aneurysm on Sunday, Feb. 11. Mike served as vice president of specialty education for Universal Health Services’ (UHS) Behavioral Health Division, where he was responsible for implementing UHS’ Best in Class Academic Accountability System throughout the organization’s network of academic programs in acute, partial hospitalization, residential, and day-school settings. Mike also championed education legislation at the state and federal levels to make certain that children and adolescents with mental illness receive an equitable and quality educational experience. At the association, Mike was an influential and supportive member of the Youth Services Committee, where his fellow members and NABH team respected him highly for his insights, thoughtful comments, and devotion to helping kids learn. As an example, last year Mike sent his regrets for missing the 2023 Annual Meeting and Youth Services Committee meeting so he could attend the high school graduation ceremony at one of UHS’ facilities. Mike will be missed by all who knew him. There will be a celebration of Mike’s life at The Casa Bella Club House, 6005 Anello Drive, Melbourne, Florida 32940 from 2 – 5 p.m. on Saturday, Feb. 17. In lieu of flowers, donations can be made to Camp Marist, 22 Abel Boulevard, Effingham, New Hampshire, 03882. Under the leadership of the Marist Brothers for more than 70 years, Camp Marist is based in New Hampshire’s White Mountain Lakes region and is a place where children learn about character, leadership, and community.

NABH Sends MOTAA Opposition Letter to Congressional Leaders

This week NABH sent a letter to House and Senate leaders outlining the association’s strong opposition to the Modernizing Opioid Treatment Access Act (MOTAA). “The Modernizing Opioid Treatment Access Act (MOTAA) [H.R. 1359 / S. 644] would permit addiction physicians outside OTPs to prescribe methadone that would be dispensed through pharmacies,” NABH wrote in its letter. “This legislation has not been vetted appropriately with stakeholders, the House has not held a hearing to examine it, and the Senate has given it only a cursory review,” the letter continued. “The bill’s goal is to provide greater access to methadone; however, patient safety concerns with such an untested approach warrants further review and attention before further congressional consideration.” NABH cautioned that MOTAA would significantly introduce more danger of overdose given the safety profile of methadone (versus buprenorphine, for example). Instead, NABH wrote that implementing the Substance Abuse and Mental Health Services Administration’s (SAMHSA) regulations released on Feb. 2 would be a more effective approach to providing greater access. “They will allow greater access to individuals of all ages, provide greater convenience for patients, bolster the workforce, ease expansion to broader settings of care (medication units and mobile units), and more,” NABH wrote. “The regulations also recognize that methadone has a more dangerous pharmacological profile than other medications for OUD.”

CMS Clarifies Parameters on Using AI in Coverage Decisions for MA Plans

In a recent memo, the Centers for Medicare & Medicaid Services (CMS) clarified that Medicare Advantage (MA) plans cannot use artificial intelligence (AI) and algorithms to deny prior authorization requests but may use the technology to assist in coverage decisions. This clarification – published in the memo as frequently asked questions (FAQ) – is based on the agency’s April 2023 rule, which took effect on Jan. 1, 2024. In the FAQ, the agency responds to concerns about inappropriate coverage denials based on algorithms. “An algorithm or software tool can be used to assist MA plans in making coverage determinations, but it is the responsibility of the MA organization to ensure that the algorithm or artificial intelligence complies with all applicable rules for how coverage determinations by MA organizations are made,” the agency noted in its FAQ. This scrutiny aligns with recent lawsuits against UnitedHealth Group, Humana, and Cigna’s MA plans, as well as a 2022 HHS Office of the Inspector General report about the erroneous algorithm coverage decisions.

Kaiser Family Foundation to Examine Prior Authorization in Webinar Next Week

The Kaiser Family Foundation (KFF) will host a webinar on Feb. 22 featuring a panel of four experts who will explore why insurers use prior authorization, its effect on patients and providers, and how new regulations may change current practices. Larry Levitt, KFF’s executive vice president for health policy, will moderate the 45-minute discussion that will include Troyen Brennan, M.D., adjunct professor of health policy and management at the Harvard T.H. Chan School of Public Health and former CVS Care executive; Fumiko Chino, M.D., radiation oncologist at Memorial Sloan Kettering Cancer Center; Anna Schwamlein Howard, principal, policy development at the American Cancer Society Action Network; and Kaye Pestaina, KFF’s vice president and director of the Program on Patient and Consumer Protection. Click here to register for the webinar, which is scheduled for Thursday, Feb. 22 at noon ET.

SAMHSA Releases Resource on Medicaid Coverage of Medications for Alcohol and Opioid Use Disorders

SAMHSA has released a report that provides an update on the present state of coverage, availability of, and access to medications within state Medicaid plans for treating ongoing alcohol use disorder (AUD) and opioid use disorder (OUD) and reversing an opioid overdose. The new resource also includes examples of efforts to increase access to medications for treating SUD. SAMHSA also developed an hourlong webinar and slides in conjunction with the report.

SAMHSA Announces New SUD-Related Funding Opportunities

SAMHSA this week released two separate notices of funding opportunities focused on SUD. In the first funding notice, SAMHSA will distribute up to 10 awards totaling $9.95 million to implement the screening, brief intervention, and referral to treatment public health model for children, adolescents, and/or adults in primary care and community health settings, HMOs, PPOs, health plans, federally qualified health centers, children’s hospitals, and more with a focus on screening for underage drinking, opioid use, and other substance use. The other funding notice will distribute up to 18 awards totaling $5.4 million to expand and assure that graduate-level healthcare students receive SUD education early in their academic careers and prepare them to identify and treat UD in mainstream healthcare after they graduate.

Now Open: 2024 NABH Annual Meeting Registration

Join Us for Hill Day 2024!

Reminder: Please Submit Data to NABH’ Denial-of-Care Portal

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

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

Fact of the Week

Behavioral healthcare jobs made three of the top seven and five of the top 20 jobs in Indeed’s Best Jobs of 2024, which focused on jobs w/ a minimum salary of $75,000 and w/ at least 10% of postings that included remote or hybrid work. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 172

Written by Meghan Barrett on February 9, 2024. Posted in CEO Updates.

Now Open: 2024 NABH Annual Meeting Registration!

SAMHSA and ONC Launch Behavioral Health Information Technology Initiative

HHS’ Substance Abuse and Mental Health Services Administration (SAMHSA) and Office of the National Coordinator for Health Information Technology (ONC) this week announced they will invest more than $20 million of SAMHSA funds in the next three years to advance health information technology (IT) in behavioral healthcare and practice settings. The announcement acknowledged that behavioral healthcare providers lag behind other providers in health IT adoption in part because they are ineligible to participate in health IT incentive programs that the Centers for Medicare & Medicaid Services (CMS) provide. An ONC analysis of American Hospital Association survey data from 2019 and 2021 found that 86% of non-federal, general acute care hospitals had adopted a 2015-edition certified electronic health record (EHR), while only 67% of psychiatric hospitals had adopted the same certified EHR. Meanwhile, ONC analysis of SAMHSA survey data from 2020 show psychiatric hospitals lag even further behind in adoption of interoperability and patient engagement functions. To address these challenges, the Behavioral Health Information Technology (BHIT) Initiative will identify and pilot a set of behavioral health-specific data elements with SAMHSA’s Substance Use Prevention, Treatment, and Recovery Services Block Grant and Community Mental Health Services Block Grant grantees and Community Mental Health Services Block Grant grantees. The data elements will be coordinated via a new USCDI+ domain for behavioral health to improve the effectiveness and reduce the costs of data capture, use, and exchange for behavioral health providers. This year ONC, SAMHSA, and other federal partners will begin to identify data elements for the USCDI+ project as part of the broader BHIT Initiative. This collaborative approach will incorporate input on behavioral health priorities from a variety of individuals and entities including clinicians, grantees, states, and advocates. Then SAMHSA and ONC will coordinate with technology developers and participating providers on how to best include USCDI+ behavioral health data elements in health IT and pilot their use.

HHS Finalizes ‘42 CFR Part 2’ Rule to Better Align with HIPAA Standards

HHS on Thursday released its final Confidentiality of Substance Use Disorder (SUD) Patient Records rule to implement the Coronavirus Aid, Relief, and Economic Security Act (CARES) amendments to the federal substance use confidentiality rule – commonly known as 42 CFR part 2, or Part 2. Consistent with NABH recommendations, the new rules further align Part 2’s requirements with the Health Insurance Portability and Accountability Act’s (HIPAA) rules and the Health Information Technology for Economic and Clinical Health Act (HITECH). Although opponents to these changes argued they were unnecessary, HHS nonetheless adopted these modifications to align with HIPAA, a rule that has historically had fewer privacy protections than part 2. The new rule permits patients to provide one-time consent for the disclosure of treatment records; permits an accounting of disclosures; strengthens prohibitions against disclosure of records in civil, criminal, or legislative proceedings, and provides HHS with enforcement authority, including financial penalties. Importantly, the rule creates a new definition for SUD clinicians’ notes that is analogous to the protections HIPAA provides for psychotherapy notes. The rule will become effective 60 days after publication and compliance is not required until 2026. Meanwhile, HHS’ Office for Civil Rights plans to finalize changes to the HIPAA Notice of Privacy Practices (NPP) to address uses and disclosures of protected health information that is also protected by Part 2 along with other changes to the NPP requirements, in an upcoming final rule modifying the HIPAA privacy. In addition, HHS plans to implement in separate rulemaking the CARES Act antidiscrimination provisions that prohibit the use of patients’ Part 2 records against them.

CMS Releases Updated State Medicaid & CHIP Telehealth Toolkit

CMS this week released an updated State Medicaid & Children’s Health Insurance Program (CHIP) Telehealth Toolkit, a series of resources that include telehealth policies and information about telehealth platforms, billing best practices, strategies to deliver accessible and culturally competent care via telehealth, and more. The resources provide states with statutory and regulatory infrastructure issues to consider as they evaluate the need to expand their telehealth capabilities and coverage policies, including coverage and reimbursement policies, providers, and practitioners eligible to provider telehealth, technology requirements, considerations for specific populations, and state examples and strategies.

Prevent Suicide New Jersey to Host Safety Planning Intervention Workshop on Feb. 28

Prevent Suicide New Jersey, a partnership among state departments, professional and community organizations, schools, and families, will host a free workshop on Feb. 28 about the Stanley Brown Safety Planning Intervention (SPI), a collaborative, clinical intervention that results in a prioritized written list of warning signs, coping strategies, and resources for suicidal individuals. The virtual workshop will teach participants the six steps to create a safety plan: 1) recognizing warning signs; 2) identifying internal coping strategies; 3) identifying other people or social settings for distraction; 4) identifying individuals to ask for help; 5) identifying professionals and agencies for help; and 6) making the environment safe. The New Jersey Chapter, American Academy of Pediatrics (NJAAP), ABFT International Training Institute, LLC, and the U.S. Journal of Training are co-sponsoring the training, and the webinar is open to certified licensed community behavioral health clinicians, school-based behavioral health providers, and interested community members. Click here to register.

Reminder: Please Submit Data to NABH’ Denial-of-Care Portal

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

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

Fact of the Week

Researchers at the University of Texas at Austin, the University of Texas at Dallas, and the University of Miami have identified a molecule that reduces hypersensitivity in trials in mice by binding to a protein they have shown is involved in neuropathic pain, according to a study published in Science Daily. The new compound, dubbed FEM-1689, does not engage opioid receptors in the body, making it a possible alternative to existing pain medications linked to addiction. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 171

Written by Meghan Barrett on February 2, 2024. Posted in CEO Updates.

NABH Alert: SAMHSA Updates OTP Regulations

The Substance Abuse and Mental Health Services Administration published Medications for the Treatment of Opioid Use Disorder late yesterday for public inspection. The final rule was published earlier today and becomes effective on April 2, 2024, with compliance by October 2, 2024. [Please note that this is a correction of the compliance date of October 2, 2026 that was published yesterday in the public notice.] NABH provided comments on the Notice of Proposed Rule Making that was issued in December 2022 calling for greater regulatory flexibility for opioid treatment programs (OTPs). The final regulations align closely to NABH recommendations and herald greater deference to clinical decision-making in the nation’s (OTPs). Among the provisions, the regulations:

Make permanent the Covid-era take-home schedule;
Permit methadone for new patients via audio-visual telemedicine with the dispensing of medication at the OTP (not audio-only).
Permit audio-only telemedicine when the patient is in the presence of a practitioner who is registered to prescribe SII, including dispensing.
Clarify (in response to NABH off-line discussion and official comments) that the prescription of methadone to community pharmacies is NOT permitted;
Change the requirement for a one-year history of OUD for eligibility so that now either the patient must a) meet diagnostic criteria for moderate-severe OUD, or b) be in OUD remission, or c) at high risk for overdose;
Remove the requirement for two treatment failures for people under 18 to be eligible for services;
Remove requirement for a one-year history of OUD for people recently released from a correctional facility, pregnant patients, or previously enrolled individuals;
Allow medication units to provide all OTP services;
Decouple medication and attendance at counseling services;
Permit interim treatment for 180 days, including at for-profit OTPs;
Permit mid-levels (“…those appropriate licensed by the state”) to prescribe without exemption;
Clarified accreditation standards to reduce potential for a burdensome increase in less-than 3-year accreditations;
Permit buprenorphine prescribing in an OTP via audio-only and audio-visual without an in-person evaluation; and
Update terminology to reflect contemporary, non-stigmatizing language.

The final rule additionally codifies the Consolidated Appropriations Act, 2023 elimination of the Drug Addiction and Treatment Act (DATA) Waiver by removing all relevant language.

CMS Proposes MA Rates for 2025

The Centers for Medicare & Medicaid Services (CMS), on Wednesday, released a calendar year (CY) 2025 advance notice which includes measures related to Medicare Advantage (MA) and other issues. The advance notice proposes an annual increase to MA payments of, on average, 3.7 percent ($16 billion), relative to 2024. This advance notice complements another CY 2025 proposed rule issued last November. It also builds upon technical updates in 2023 to the MA risk adjustment model that are designed to yield more accurate payments. CMS will accept comments on the advance notice through April 1. For additional background, see this CMS fact sheet. NABH appreciates CMS’s meaningful efforts in recent years to improve the MA program, including increasing the accountability and transparency of MA health plans as well as substantive proposals to enforce parity and improve the prior authorization program.

CMS Requests Information on MA In Push For Data Transparency

The Centers for Medicare & Medicaid Services (CMS), on Thursday, Jan. 24, requested information on Medicare Advantage (MA) data capabilities to increase data transparency. The RFI asked for recommendations for improving data capabilities to increase accuracy on coverage, enhance quality of care, and better inform healthcare professionals. This RFI builds upon CMS’ extensive regulatory activity to increase transparency and accountability of Medicare Advantage plans. CMS is aiming to have comprehensive data on the MA program made publicly available and thus allowing for further comparative analyses between other health programs. Click here to read the full press release.

SAMSHA Releases Guide for Overdose Prevention and Response

The SAMHSA Overdose Prevention Toolkit provides guidance on preventing and responding to an overdose and the role of opioid overdose reversal medications. The toolkit emphasizes that harm reduction and access to treatment are essential aspects of overdose prevention. Appendices are directed to specific audiences, such as people who use drugs (PWUD), people taking prescribed opioids, first responders, healthcare practitioners, and others. Click here to access the toolkit.

GAO Evaluates the Potential Expansion of FHA Loans to Behavioral Health Hospitals

The Government Accountability Office last week issued recommendations to Congress on the pros and cons on the possible expansion of the Federal Housing Authority (FHA) Hospital Mortgage Insurance Program. Any expansion in the future would expand access to higher-acuity behavioral health services. Today, this FHA program funds loans to general acute-care hospitals for capital improvements, not including hospitals focused on treating behavioral health patients due to their, on average, smaller size, revenue, and margins. The report, commissioned by Congress, suggests that any expansion of this program be coupled with parameters to mitigate potential risks, such as initially limiting the volume loans to newly eligible hospitals through a pilot program, and requiring regular loan performance updates from FHA to Congress

SAMHSA Offers Consumer Guide for Peer Support in Substance Use Recovery

The newly released peer support recovery guide from The Substance Abuse and Mental Health Services Administration (SAMHSA) provides an in-depth look into the role of peer specialists. SAMHSA states that readers can utilize visual aids and consumer forms to better understand the range of services provided by peer specialists and how they can be a resource to those in recovery from substance use. Click here to access the guide.

HHS’ Office of Long Covid Welcomes Ian Simon as Director

The Department of Human and Health Services (HHS) appointed Ian Simon as the director of the Office of Long Covid Research and Practice. In this position, Simon will lead HHS towards a coordinated government response to better understand the long-term impacts of COVID-19. Simon was the assistant director for health strategy and bio preparedness at the White House’s Office of Science and Technology Policy. He also brings additional experience from his time at the National Institute of Allergy and Infectious Diseases (NIAID).

Reminder: SAMHSA Releases Updated 988 Partner Toolkit

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released an updated 988 Partner Toolkit that the agency says is designed to help users better navigate the bank of materials available to promote the lifeline in communities. The toolkit has the same video PSAs, social media promotions, FAQs, and print materials, and is now available to search by target audience, population, language, and resource type. Click here to access the toolkit.

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

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

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

Save the Date for the NABH 2024 Annual Meeting!

Please plan to join us at the Salamander Washington, DC from May 13-15, 2024 for this year’s Annual Meeting, The Future of Behavioral Healthcare. Registration will open in February.

Fact of the Week

A study from JAMA Internal Medicine found that pregnant patients treated with buprenorphine within the first trimester had an 18% lower risk of congenital malformations than those treated with methadone. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 170

Written by Meghan Barrett on January 26, 2024. Posted in CEO Updates.

CMS $50 Million in Grants for School-Based Health Services, Particularly for Mental Health

The Centers for Medicare & Medicaid Services (CMS) this week announced $50 million in state grant funding to connect millions more children to critical healthcare services, especially mental health, in schools. The funding comes through the Bipartisan Safer Communities Act and will provide 20 states up to $2.5 million each in funding that can help states implement, enhance, and expand school-based health services through Medicaid and the Children’s Health Insurance Program, or CHIP. “This funding will be transformational for states at any stage in developing school-based health services programs, which represent one of CMS’ most powerful tools for expanding access to care for our children,” CMS Administrator Chiquita Brooks-LaSure said in an announcement about the funding. “Medicaid and CHIP cover over 39 million children. This targeted support is one way CMS can help kids get the health care they need by meeting them where they are — in school.” CMS said it anticipates a total of 20 grant awards, with a minimum of 10 awards to states that have yet to cover school-based health services for all children covered under Medicaid or CHIP. In addition, the agency said up to 10 grants are intended for states that have taken initial steps to expand school-based health services, with the hope that these grants will enhance or refine their existing programs. Applications for grant funding are due by March 25 and funding is expected by this summer. Click here for more information.

National Academy for State Health Policy Updates State Opioid Settlement Tracker

The National Academy for State Health Policy (NASHP) this month updated its tracker to show how states are implementing administrative structures to disburse an expected $50 billion awarded to states and localities from opioid-related lawsuits, which includes $26 billion awarded to 46 states as part of the National Opioid Settlement. These structures include strategies for engaging a wide variety of stakeholders on priorities for reducing opioid-related deaths and investing in SUD prevention, treatment, and recovery infrastructure. NASHP released an issue brief about its tracker in December 2022 to show funding allocated to each state through the National Opioid Settlement, as well as laws, agreements, and processes that states have established for allocating the funds.

Now Available: NABH Education and Research Foundation Webinar Resources and Interview

Thank you to all who joined or watched our foundation’s webinar, Redesigning the Present and Future Behavioral Healthcare Workforce, on Tuesday, Jan. 23. NABH regrets that we were unable to hear from NABH Education and Research Foundation President and co-presenter Don Parker soon after the webinar began due to a power outage in Parker’s service area. Below is an exchange between Parker and co-presenter Beth Kuhn, principal at workforce consultancy Stonegate Strategies, in a post-webinar interview. BK: Don, what can you tell us about the top workforce challenges you experienced at Hackensack Meridian Health System? DP: At the start of the COVID-19 pandemic, the Hackensack Merdian Health System asked the system’s Behavioral Health Care Transformation Services to develop a post-pandemic strategy recognizing that we would have two major problems to deal with: a rapidly increasing demand for behavioral healthcare, given all of the fear, loss, isolation and uncertainty our citizens were experiencing, and an unpredictable reaction from our staff who had the same fears but just multiplied given the nature of their jobs in health care. Although we slowed our feared staff exodus, similar to every other hospital in America, it increased and has led to shortages across the professions. As we now face both supply (under staffing of all levels of professionals) and demand (unprecedented demand for behavioral health from every age cohort) our HMH team has turned its focus to improving retention and attracting new recruits to bolster our veterans. BK: Your system has been especially focused on building partnerships to support your talent supply efforts. What can you tell us about your approach? DP: Knowing we would face a shortage of psychiatrists, HMH initiated 64 psychiatry resident slots and 16 fellowships (heavily weighted to children). Our first class graduated last year and began to fill our ranks. For the many residents and fellows we recruited to stay at HMH, we engaged them in an “Earn While You Learn” program for their final year. They received what would be equal to a signing bonus in monthly increments for the year. It provided great recruitment and retention. Our health system created two new nursing school partnerships with all the nurses rotating through the HMH psychiatry locations. The exposure has proven to be highly beneficial to our nursing recruitment. On the Mental Health Technician front, we have initiated several programs in partnership with the Local Workforce Investment Boards and the Community Colleges. I have had more than a 30-year history of working closely with WIBs. I also served as chairman of the WIB in my county in New Jersey for several years. I have been a Board Member of the Community College in my County for 17 years and personally started my education in a Junior College. BK: One webinar participant asked for information on what “resiliency investments” look like. It seems to me that you have some answers within your overall retention strategy. DP: Our administrative staff were deeply concerned that we would experience an exodus of our staff due to the sheer everyday extreme stress they were experiencing. During the pandemic HMH engaged in multiple staff support strategies, from shortened schedules, on the spot individual and group counseling, integrative medicine delivered remotely or on the spot, as well every morale booster we could engage in. In addition, as a retention strategy, HMH has shifted to a Strength-based motivational system (our version of Strength-based therapy). We expect that the focus on creating a mindset as a Survivor as opposed to being a victim of the pandemic will have a major impact on improving retention. BK: Apprenticeship seems to hold a lot of potential, both in bringing more professionals into your system and in prompting workforce redesign. Tell us about HMH apprenticeship efforts. DP: Our post-pandemic initiatives have featured two collaborations with Middlesex Community College in New Jersey and the WIB Board. In Fall 2023, we worked with Middlesex to develop and deliver a certification as a Mental Health Technician. While not specifically designated as an apprenticeship, it served the purpose, as the academics, designed in collaboration with the HMH staff, were delivered to the college, with the on-the-job at HMH Psychiatric Hospitals. HMH has engaged in designing a second MHT Certification with a specialization in Integrative medicine. Each of our four psychiatric inpatient hospitals at HMH provide a daily curriculum filled with options for patients to engage in relaxation exercises, music therapy, yoga, Qigong, exercise programs, and a substantial exposure to art therapy. We expect this initiative will expand our recruitment pool to all the integrative medicine providers who practice in the community and can blend their practices with a job that offers steady income and benefits.

Reminder: SAMHSA Releases Updated 988 Partner Toolkit

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

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

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

Save the Date for the NABH 2024 Annual Meeting!

Please plan to join us at the Salamander Washington, DC from May 13-15, 2024 for this year’s Annual Meeting, The Future of Behavioral Healthcare. Registration will open in February.

Fact of the Week

Semaglutide, a highly popular medication that the U.S. Food and Drug Administration has approved to treat obesity and manage type 2 diabetes, was associated with a 49% to 73% lower risk of first-time or recurring suicidal ideations compared with other medications for controlling obesity and type 2 diabetes that work via different mechanisms, according to a recent NIH-funded study. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 169

Written by Meghan Barrett on January 19, 2024. Posted in CEO Updates.

NABH Education and Research Foundation to Kick Off Webinar Series Next Week

The NABH Education and Research Foundation is pleased to host its first webinar, Redesigning the Present and Future of Behavioral Healthcare, on Tuesday, Jan. 23, 2024 from 2 p.m. – 3 p.m. ET. Foundation President Donald Parker, who serves as president of Behavioral Health Care Transformation Services for Hackensack Meridian Health, will co-lead the webinar with workforce consultant Beth Kuhn of Stonegate Strategies. Kuhn has more than 30 years of workforce experience – with special interest and expertise in behavioral healthcare workforce development – and has served in both Democratic and Republican administrations, including in her roles as commissioner of the Kentucky Department of Workforce Investment and as director of workforce development at the Vermont Department of Labor. Kuhn’s accomplishments include creating the Strategic Initiative for Transformation Employment, or SITE, a statewide model designed to bridge the gap between recovery and workforce participation for individuals active in their recovery from substance use issues. During this interactive webinar, participants are encouraged to ask questions of Kuhn and Parker, who will provide an overview of existing behavioral healthcare workforce challenges; explain why America’s current workforce structure doesn’t meet present or future workforce needs; suggest redesign strategies, present examples of current successes; and offer ideas about how to leverage current options to help providers develop a more robust workforce system. Please join us and click here to register for this free webinar!

Congress Clears Stop Gap Funding Extension, Delaying Potential Healthcare Package

Staving off a government shutdown, House and Senate lawmakers passed legislation this week to extend the federal government’s current funding deadlines into March. The House passed the bill in 314-108 vote hours after the Senate passed the measure 77-18. The legislation extends funding for agencies under four appropriations bills that were scheduled to expire today, Jan. 19 – Agriculture, Rural Development, Food and Drug Administration, and related agencies; Energy and Water Development; Military Construction, Veterans Affairs, and related agencies; and Transportation, Housing and Urban Development, and related agencies – until March 1. Funding covered under the remaining eight bills that were scheduled to expire Feb. 2 have been extended through March 8. Lawmakers have indicated they expect this is the final stopgap spending measure needed for fiscal year 2024. Several non-controversial healthcare provisions were included in the March 8 stopgap measure, such as providing continued funding for community health centers, teaching health centers and the National Health Service Corps; funding special diabetes programs; averting steep cuts to hospitals that have a high volume of uninsured and Medicaid patients; and providing continued funding for the Sexual Risk Avoidance Education Program, which aims to limit teen pregnancy and domestic violence. The bill did not address several expired health programs, including the SUPPORT Act reauthorization; the global HIV/AIDS program, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR); the Pandemic and All-Hazards Preparedness Act; and heath price transparency legislation. Lawmakers are expected to include those programs in a potential March deal, if Congress doesn’t have to punt again with another spending patch. NABH continues to advocate for SUPPORT Act reauthorization and to stop the Modernizing Opioid Treatment Access Act (MOTAA) as part of a broader healthcare package. Health policy leaders in the House and Senate remain in negotiations on a final package.

CMS Increases Prior Authorization Timeliness and Transparency in Final Rule

The Centers for Medicare & Medicaid Services (CMS) this week finalized a rule that takes concrete steps to shorten the prior authorization process, which physicians and providers use to request health plan coverage for medical treatments and services that a physician has prescribed for a patient. In part, this rule responds to recent government audits that found that many government-contracted health plans were denying coverage inappropriately for services that actually were covered. The rule mostly takes effect for managed contracts in 2026 and beyond for insurers who contract with Medicare, Medicaid, and the Children’s Health Insurance Program, but not private insurance. Specifically, health plans will be required to make prior authorization coverage decisions within seven days and 72 hours for urgent requests. The rule also requires health plans to provide a specific reason for denying a prior-authorization request, which will help facilitate the correction of fixable claims as well as denial appeals. These payers also will be required to report their clinical and/or policy basis publicly for prior-authorization denials. Finally, to further reduce administrative burden, payers will now be required to conduct prior authorizations using a common electronic interface for transactions and data exchange, using Health Level 7 and other applications. Overall, CMS estimates that the final rule will reduce federal healthcare expenditures by approximately $15 billion over 10 years. Click here to learn more in the agency’s fact sheet.

CMS Announces Model to Test Approaches for Advancing Integration in Behavioral Health

CMS on Thursday introduced its Innovation in Behavioral Health (IBH) model to improve the care quality and outcomes for adults with Medicare and Medicaid who have mental health conditions and/or substance use disorder (SUD) by connecting them with the physical, behavioral, and social supports they need. The CMS Innovation Center will test the new IBH model, under which community-based behavioral healthcare practices will form interprofessional care teams composed of behavioral and physical health providers, as well as community-based supports. This new model supports President Biden’s mental health strategy and implements an action item in the HHS Roadmap for Behavioral Health Integration. “The Biden-Harris administration will continue to explore innovative ways to help people with mental health conditions and/or substance use disorder,” HHS Secretary Xavier Becerra said in an announcement. “Put simply, mental health is health—and by expanding access to the high-quality care that people need, we are changing lives.” CMS’ announcement said through the interprofessional care teams, people will experience an integration of services that will bridge the gaps between physical and behavioral health. The model enables a “no wrong door” approach, meaning that regardless of how patients enter care, they will have access to all available services. Through this practice, IBH also aims to reduce overall program expenditures. The model will launch in Fall 2024, and CMS said it expects it to operate for eight years in up to eight states. CMS will release a notice of funding opportunity for the model in Spring 2024. Click here to learn more.

SAMHSA Releases Updated 988 Partner Toolkit

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

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

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

Save the Date for the NABH 2024 Annual Meeting!

Please plan to join us at the Salamander Washington, DC from May 13-15, 2024 for this year’s Annual Meeting, The Future of Behavioral Healthcare. Registration will open in February. Fact of the Week SAMHSA’s Food and Mood Project aims to promote emotional wellness and reduce the impact of mental health and substance use conditions among the nation’s K-12 population by implementing strategies that address the intersection among behavioral health, food/nutrition security, and cultural food diversity. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 168

Written by Meghan Barrett on January 12, 2024. Posted in CEO Updates.

Congress Returns to Urgent Funding Deadlines and Full 2024 Agenda

Congress returned to Washington this week facing two deadlines to fund all federal government operations as it works to clear some policy priorities – including a healthcare package with the SUPPORT Act’s reauthorization – ahead of the 2024 campaign season. In early January, House Speaker Mike Johnson (R-La.) and Senate Majority Leader Chuck Schumer (D-N.Y.) agreed to topline funding figures, allowing congressional appropriations leaders to begin the process of negotiating each of the spending allocations for all 12 spending bills. Congress has until Jan. 19 before the first government funding deadline for the U.S. Agriculture, Energy, Housing and Urban Development, Transportation, and Veterans Affairs Departments. All other departments, including HHS, are funded through Feb. 2. There is a growing likelihood that Congress will have to pass a short-term continuing resolution (CR) to allow lawmakers to agree on funding, although conservative House members are strongly opposed to that action and threaten to derail progress. Congressional leaders have indicated a healthcare package will likely be included in the first funding bill, due to the urgency in addressing several expired health programs and funding provisions for physician payments. This package will include several healthcare bills the House and Senate have passed. NABH continues to advocate strongly for the SUPPORT Act’s reauthorization with new provisions and opposes the Modernizing Opioid Treatment Access Act (MOTAA), which only the Senate HELP Committee has passed and the House has not considered. MOTAA proponents are strongly advocating for this bill to be included in the final package, and NABH and coalition partners are working with both congressional chambers to prevent this effort. This advocacy includes working with members of the Senate HELP Committee who oppose MOTAA to continue raising concerns with their Senate leadership; contacting members who serve on the Senate Judiciary Committee; contacting other senators who share concerns with law enforcement officials about implementing this legislation; as well as contacting members of the House Energy and Commerce Committee and House Judiciary Committee. House Energy & Commerce Republicans remain strongly opposed to including MOTAA in any legislative package. NABH continues to emphasize to Members of Congress that there is no consensus on MOTAA and these policies need more vetting. Other health policies that lawmakers might fold into a larger legislative package include addressing expired telehealth regulations, Medicare’s physician pay cut, transparency measures, reporting requirements for insurers, hospitals and pharmacy benefit managers, and site-neutral payment provisions. In addition, funds for graduate medical education, community health centers, and special diabetes programs sunset on Jan. 19, and certain Medicaid disproportionate share hospital cuts are delayed until that date. NABH will continue to support provisions important to our members and fight to prevent bad policies from becoming law. Please see next week’s edition of CEO Update for the latest information.

NABH Education and Research Foundation to Host Workforce Webinar on Jan. 23

Please join us for the NABH Research and Education Foundation’s first webinar, Redesigning the Present and Future of Behavioral Healthcare, on Tuesday, Jan. 23, 2024 from 2 p.m. – 3 p.m. ET. Foundation President Donald Parker, who serves as president of Behavioral Health Care Transformation Services for Hackensack Meridian Health, will co-lead the webinar with workforce consultant Beth Kuhn of Stonegate Strategies. Kuhn has more than 30 years of workforce experience – with special interest and expertise in behavioral healthcare workforce development – and has served in both Democratic and Republican administrations, including in her roles as commissioner of the Kentucky Department of Workforce Investment and as Vermont’s director of workforce development. Kuhn’s accomplishments include creating the Strategic Initiative for Transformation Employment, or SITE, a statewide model designed to bridge the gap between recovery and workforce participation for individuals active in their recovery from substance use issues. During this interactive webinar, participants are encouraged to ask questions of Parker and Kuhn, who will provide an overview of existing behavioral healthcare workforce challenges; explain why America’s current workforce structure doesn’t meet present or future workforce needs; suggest redesign strategies, present examples of current successes; and offer ideas about how to leverage current options to help providers develop a more robust workforce system. Please click here to register for this free webinar and share the link with members of your teams!

CMS Administrator Brooks-LaSure to Outline Agency’s 2024 Priorities in Stakeholder Call

The Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure will host a stakeholder call to discuss the agency’s 2023 accomplishments, 2024 priorities, and CMS Strategic Plan on Tuesday, Jan. 23. CMS Principal Administrator and Chief Operating Officer Jon Blum and other members of the CMS leadership team will also serve as presenters during the hourlong call, which will begin at 1 p.m. ET. Click here to register.

CMS Releases State Plan Summaries for American Rescue Plan of 2021

CMS has released state spending plan summaries for a section of the American Rescue Plan of 2021 (ARP) that provides information about the amount of money spent on activities to enhance, expand, or strengthen community-based services. NABH members might find the report useful because it includes information about state spending on efforts related to workforce, technology, education, behavioral healthcare support for youth, housing and homelessness, and more. Click here for the full report and to read your state’s summary.

Save the Date for the NABH 2024 Annual Meeting!

Registration will open soon for the NABH 2024 Annual Meeting, The Future of Behavioral Healthcare, at the Salamander Washington, DC from May 13-15, 2024. Please plan to join us!

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

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

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

Fact of the Week

About 52,000 Medicare enrollees experienced an opioid overdose in 2022; however, only 18% of Medicare patients with opioid use disorder received medication-assisted treatment, according to a report from the HHS Office of the Inspector General. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 167

Written by Meghan Barrett on January 5, 2024. Posted in CEO Updates.

NABH Welcomes Frank Ghinassi, Ph.D. as 2024 Board Chair

NABH is pleased to welcome Rutgers University Behavioral Health Care (UBHC) President and CEO Frank Ghinassi, Ph.D. as chair of the NABH Board of Trustees for 2024. A longstanding NABH member, Frank has served the association in many capacities, including as board treasurer, Quality Committee chair, and Annual Meeting program chair. As UBHC’s CEO, Frank is responsible for a statewide system of academically based mental health and addiction services across New Jersey; managing an annual operating budget of $320 million and 2,200 staff and faculty. UBHC, one of the largest providers of behavioral and addictions healthcare in the country, offers a wide range of clinical services across all diagnosis, and across the lifespan, including inpatient units, partial hospitalization programs, intensive outpatient programming, case management, traditional outpatient treatment, correctional health care, a Certified Community Behavioral Health Center, peer operated helplines for service members, veterans, mothers of children with special needs, law enforcement officers and child protection workers, a statewide suicide prevention hotline and a clinical research and training institute, as well as an array of specialty and peer support services. Frank also serves as professor at Rutgers Graduate School of Applied and Professional Psychology; an adjunct professor of psychiatry at Rutgers Robert Wood Johnson Medical School; an adjunct associate professor of psychiatry at the University of Pittsburgh School of Medicine; and a core faculty member at Rutgers Global Health Institute. The association’s Washington-based team is eager to work with Frank this year and appreciates his vision and leadership. NABH is also grateful to Sheppard Pratt President and CEO Harsh Trivedi, M.D., M.B.A. for his service as the association’s 2023 board chair and all he has done to promote NABH, its priorities, and its mission. Thank you, Harsh!

NABH Letter to CMS Cites Concerns about Medicare Advantage Plans that Block Access to Care

NABH this week sent a letter to the Centers for Medicare & Medicaid Services (CMS) expressing concerns about Medicare Advantage (MA) plans that either block or delay access to behavioral healthcare services. The association’s letter endorsed and also made recommendations related to the rule’s positive provisions, such as incentivizing MA coverage for additional behavioral healthcare practitioners and inclusion in a health plans’ provider networks; annually analyzing the health equity level of MA plans relative to underserved populations; and laying the groundwork for increased data collection on MA coverage decisions, appeals and decision rationales. NABH’s letter also urged CMS to modify its existing proposal to improve the appeals process for MA enrollees in certain settings to include behavioral healthcare settings, which the letter describes in detail.

Sen. John Fetterman Discusses His Battle with Depression on NBC’s ‘Meet the Press’

In an exclusive interview with NBC News’ “Meet the Press” on Dec. 31, Sen. John Fetterman (D-Pa.) spoke candidly about his experience with clinical depression and how he is grateful for receiving treatment. The first-term senator was discharged March 31 from Walter Reed National Medical Center, where he had received treatment for clinical depression. Fetterman checked himself in for treatment on Feb. 15 last year following a battle with depression that worsened during his recovery from a stroke he suffered in May 2022. “The line [is] ‘I’m living my best life,’ and I really am, because I just am so grateful,” Fetterman told journalist Kristen Welker. “And I’m always talking about mental health because I want everybody that can hear that is that help works, and you should get help. And please, don’t suffer any longer, because you deserve to be better. And I’m so grateful to do that, and I’m paying it forward by talking about it.” Click here to watch Fetterman’s interview.

NABH Education and Research Foundation to Host Workforce Webinar on Jan. 23

The NABH Education and Research Foundation is pleased to host its first webinar, Redesigning the Present and Future of Behavioral Healthcare, on Tuesday, Jan. 23, 2024 from 2 p.m. – 3 p.m. ET. NABH Education and Research Foundation President Donald Parker, who serves as president of Behavioral Health Care Transformation Services for Hackensack Meridian Health, will co-lead the webinar with workforce consultant Beth Kuhn of Stonegate Strategies. Kuhn has more than 30 years of workforce experience – with special interest and expertise in behavioral healthcare workforce development – and has served in both Democratic and Republican administrations, including in her roles as commissioner of the Kentucky Department of Workforce Investment and as Vermont’s director of workforce development. Kuhn’s accomplishments include creating the Strategic Initiative for Transformation Employment, or SITE, a statewide model designed to bridge the gap between recovery and workforce participation for individuals active in their recovery from substance use issues. Throughout this interactive webinar, participants are encouraged to ask questions of Parker and Kuhn, who will provide an overview of existing behavioral healthcare workforce challenges; explain why America’s current workforce structure doesn’t meet present or future workforce needs; suggest redesign strategies, present examples of current successes; and offer ideas about how to leverage current options to help providers develop a more robust workforce system. The Foundation will also ask attendees poll questions during the hourlong webinar to gauge member interest in future workforce events and resources. Please join us and click here to register for this free webinar!

National Academies to Host Webinar on Behavioral Healthcare Provider Experience with Public Insurance Programs Next Week

The National Academies’ Committee on Strategies to Improve Access to Behavioral Health Care Services through Medicare and Medicaid will host a virtual webinar that discusses behavioral healthcare provider experiences with public insurance programs on Wednesday, Jan. 10. This webinar will examine the experiences of behavioral healthcare providers who accept Medicare, Medicaid, and Marketplace insurance and discuss what can be done to increase access to behavioral healthcare services for this patient population. Click here to register for the two-hour webinar, which starts at 2 p.m. ET next Wednesday.

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

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

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

Save the Date for the NABH 2024 Annual Meeting!

Please mark your calendars and plan to join us at the Salamander Washington, DC from May 13-15, 2024 for this year’s NABH Annual Meeting!

Fact of the Week

A new study in Psychiatry Research suggests ethnoracial inequities in patient assignment to buildings that differed in clinical and physical conditions. Examining data from more than 18,000 unique patients during a period of six years, researchers said the findings serve as a call to action for hospital systems to examine the ways in which structural racism impact clinical care. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 166

Written by Meghan Barrett on December 22, 2023. Posted in CEO Updates.

NABH Education and Research Foundation to Host Workforce Webinar in January

The NABH Education and Research Foundation is pleased to host its first webinar, Redesigning the Present and Future of Behavioral Healthcare, on Tuesday, Jan. 23, 2024 from 2 p.m. – 3 p.m. ET. Foundation President Donald Parker, who serves as president of Behavioral Health Care Transformation Services for Hackensack Meridian Health, will co-lead the webinar with workforce consultant Beth Kuhn of Stonegate Strategies. Kuhn has more than 30 years of workforce experience – with special interest and expertise in behavioral healthcare workforce development – and has served in both Democratic and Republican administrations, including in her roles as commissioner of the Kentucky Department of Workforce Investment and as Vermont’s director of workforce development. Kuhn’s accomplishments include creating the Strategic Initiative for Transformation Employment, or SITE, a statewide model designed to bridge the gap between recovery and workforce participation for individuals active in their recovery from substance use issues. During this interactive webinar, participants are encouraged to ask questions of Parker and Kuhn, who will provide an overview of existing behavioral healthcare workforce challenges; explain why America’s current workforce structure doesn’t meet present or future workforce needs; suggest redesign strategies, present examples of current successes; and offer ideas about how to leverage current options to help providers develop a more robust workforce system. Please join us and click here to register for this free webinar!

NABH 2024 Board Election Ballots Due Friday, Dec. 29!

NABH has e-mailed system members NABH Board of Trustees candidate profiles and a ballot to elect new members to the 2024 Board. If you have not done so, please vote for the open Board Chair-Elect position and four available Board seats; sign the ballot (it is not valid without a signature); and return it to NABH. You can do this by scanning your completed ballot and e-mailing it nabh@nabh.org or maria@nabh.org. NABH must receive all ballots no later than Friday, Dec. 29, 2023. New Board members and the Board Chair-elect will take office in January 2024.

SAMHSA Releases Advisory on Implementing Low-Barrier Care to Expand Access and Improve Outcomes for Individuals with SUD

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released an advisory that outlines recommendations to implement low barrier models of care to significantly expand access to lifesaving treatment for individuals with substance use disorders (SUD). Despite evidence showing the effectiveness of SUD treatment, fewer than 10% of individuals who need care receive it. Barriers such as lack of treatment availability, strict program requirements, stigma, and discrimination. The advisory emphasizes the importance of low barrier care in overcoming substantial gaps in access to SUD treatment and engaging more people in care.

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

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

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

Save the Date for the NABH 2024 Annual Meeting!

Please mark your calendars and plan to join us at the Salamander Washington, DC from May 13-15, 2024 for next year’s NABH Annual Meeting!

Fact of the Week

The Centers for Disease Control and Prevention reports that while the provisional number of suicides in 2022 (49,449) was 3% higher than in 2021 (48,183), suicide rates for people in age groups 10–14, 15–24, and 25–34 declined 18%, 9%, and 2%, respectively, from 2021 to 2022.

Happy Holidays from NABH!

NABH will not publish CEO Update next week and will resume on Friday, Jan. 5, 2024. The entire NABH team wishes you, your families, and your teams a very happy, healthy, and safe holiday season! For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 165

Written by Emily Wilkins (NABH) on December 15, 2023. Posted in CEO Updates.

House & Senate Advance Key Behavioral Healthcare Legislation to Consider in the New Year

The House and Senate advanced several behavioral healthcare-related bills this week that NABH either supports and opposes and Congress is expected to consider early in the New Year. The Senate Health, Education, Labor and Pensions (HELP) Committee marked up several pieces of legislation, including reauthorization of the SUPPORT Act and S. 644, the Modernizing Opioid Treatment Access Act (MOTAA). The Committee approved its version of the SUPPORT Act reauthorization bill 19-1. This bill would reauthorize programs to improve the prevention, treatment, and recovery of substance use disorders (SUD), including supporting training for first responders and programs that support youth and mental health. The legislation also directs the U.S. Health and Human Services Department (HHS) and the Drug Enforcement Agency (DEA) to establish a special registration program permitting physicians to prescribe controlled substances through telemedicine, among other provisions. The Modernizing Opioid Treatment Access Act, S. 644 was reported favorably as amended by a roll call vote of 16-5 with Ranking Member Sen. Bill Cassidy, M.D. (R-La.) supporting the legislation. Sens. Susan Collins (R-Maine), Rob Marshall (R-Kan.), Tommy Tuberville (R-Ala.), Markwayne Mullin (R-Okla.), and Ted Budd (R-NC) voted against the bill. NABH opposed the bill, which would expand access to methadone by permitting take-home prescribing of the drug through pharmacies. On Wednesday the House passed both the Lower Costs, More Transparency Act (H.R. 5378), and the H.R.4531, the Support for Patients and Communities Reauthorization (SUPPORT) Act of 2023. H.R. 5378 contains provisions to promote more transparency within various sectors of the healthcare industry; delay certain disproportionate share payment cuts; and extend funding for community health centers, the National Health Service Corp, and teaching health centers that operate graduate medical education (GME) programs. The bill also increases reporting requirements for insurers, hospitals and pharmacy benefit managers, and changes Medicare payment policy so that drugs administered in a hospital outpatient department are reimbursed at the same rate as they are in a physician’s office, a policy known as site-neutral payments. Meanwhile, House Energy and Commerce Subcommittee on Health Chair Brett Guthrie (R-Ky.) and Rep. Anne Kuster (D-N.H.) led H.R.4531, the Support for Patients and Communities Reauthorization (SUPPORT) Act of 2023, which the House passed in a 386-37 vote. The bill includes several important NABH priorities, including permanently lifting Medicaid’s IMD Exclusion, which restricts access to care for rehab and institutional care services; ensuring Medicaid beneficiaries have access to Medication Assisted Treatment; reauthorizing resources for residential SUD treatment for pregnant and postpartum women; and monitoring prescribing of antipsychotic medications. The House Energy and Commerce Committee passed H.R. 4531 in a 49-0 vote this past July. These healthcare bills, in addition to the Senate Finance Committee’s previously passed Better Mental Health Care, Lower-Cost Drugs and Extenders Act, which included language from S. 3098, the Securing Advances and a Variety of Evidence-Based (SAVE) Institutions for Mental Diseases (IMD) Options Act which would make the state plan amendment option permanent, will be rolled into one healthcare package for Congress to consider in the New Year. Other healthcare issues include addressing scheduled cuts to the Medicare Physician Fee Schedule (MPFS), reform and transparency for pharmacy benefit managers (PBM) and Medicare Advantage (MA) plans, and other bipartisan policies to address drug shortages, antimicrobial resistance, and workforce needs. Congress has two early deadlines in 2024 to move the healthcare package across the finish line — Jan. 19 and Feb. 2, the latter of which includes the deadline for Labor-HHS-Education funding bill. NABH and allied partners will be working to stop MOTAA and include our policy priorities in this final package.

HHS Takes Step to Regulate AI in Health Data, Technology, and Interoperability Final Rule

HHS this week unveiled the department’s data-related priorities for the next two years in a rule that includes information about data sharing across the government and the private sector and using artificial intelligence (AI) to boost medical innovation and improve health outcomes. HHS’ Office of the National Coordinator (ONC) for Health Information Technology finalized its Health Data, Technology, and Interoperability rule, which establishes the first transparency requirements for AI and other predictive algorithms that are part of certified health information technology. ONC reports that it certifies health IT that supports care delivered by more than 96% of hospitals and 78% of office-based physicians nationwide. The final rule also implements the 21^st Century Cures Act’s requirement to adopt a Condition of Certification (the “Insights Condition”) for developers of certified health IT to report certain metrics as part of their participation in the Certification Program. These metrics will give more insight into how certified health IT is used in support of care delivery. Click here to learn when ONC will host information sessions about the rule in January and February.

CMS Releases Guidance on Dually Eligible Beneficiaries Receiving Medicare Part B Marriage and Family Therapist, Mental Health Counselor, and Intensive Outpatient Services

The Centers for Medicare & Medicaid Services (CMS) on Thursday released Guidance to State Medicaid Agencies on Dually Eligible Beneficiaries Receiving Medicare Part B Marriage and Family Therapist Services, Mental Health Counselor Services, and Intensive Outpatient Services, an informational bulletin with changes that take effect on Jan. 1, 2024. Beginning in the New Year, Medicare will become the primary payer for dually eligible beneficiaries receiving these services from Medicare-enrolled practitioners or providers. According to CMS, typically state Medicaid agencies may not pay claims if it is likely that a third party (such as Medicare) is liable for the claim, as Medicaid is generally the payer of last resort. For dually eligible beneficiaries, Medicare is generally liable for claims for Medicare-covered services, including MFT services, MHC services, and IOP services furnished on or after Jan. 1, 2024, and therefore state Medicaid agencies are required to cost-avoid claims for such services, or seek reimbursement from the practitioner or provider. Currently, MFTs and MHCs provide services that can be covered as an optional state plan benefit such as services of other licensed practitioners under the Medicaid state plan. IOP services are generally covered through the optional rehabilitative services benefit under the Medicaid state plan.

AMCHP and ASTHO Release Guidance on Public Health Approaches to Perinatal Substance Use

The Association of Maternal & Child Health Programs (AMCHP) and the Association of State and Territorial Health Officials (ASTHO) have released a special issue of the Maternal and Child Health Journal focused on public health approaches to perinatal substance use. This December 2023 special issue features 21 open-access articles with the latest research, programs, and policy initiatives related to perinatal substance use that highlight approaches to preventing and mitigating the harmful effects of perinatal substance use and improving maternal and child health. AMCHP and ASTHO will host a virtual forum about the special issue on Tuesday, Dec. 19 at 12:30 p.m. ET. Click here to learn more and register.

NABH 2024 Board Election Ballots Due Friday, Dec. 29!

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

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

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

Save the Date for the NABH 2024 Annual Meeting!

Please mark your calendars and plan to join us at the Salamander Washington, DC from May 13-15, 2024 for next year’s NABH Annual Meeting!

Fact of the Week

Overdoses in the United States involving methadone were 48% higher in 2020 than in 2019, according to a study of overdose deaths during the COVID-19 pandemic published in Forensic Science International. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 164

Written by Emily Wilkins (NABH) on December 8, 2023. Posted in CEO Updates.

Senate HELP Committee to Mark Up SUPPORT Act Reauthorization Bill Next Week

The Senate Health, Education, Labor, and Pensions (HELP) Committee is slated to mark up the Substance-Use Disorder Prevention that Promotes Opioid Recovery and Treatment Act’s (SUPPORT Act) reauthorization bill along with other legislation – including the Modernizing Opioid Treatment Access Act (MOTAA) – on Tuesday, Dec. 12. The SUPPORT Act expired on Sept. 30, and Congress has long been expected to reauthorize the opioid treatment and prevention programs that the 2018 law created. NABH sent a Government Relations Network alert asking members to contact Senate HELP Committee members and urge them to apply an all-hands-on-deck approach to America’s mental health and addiction crises by reauthorizing the SUPPORT Act’s expired provisions. The association also asked NABH members to encourage HELP Committee members to oppose the MOTAA bill, which would threaten patient safety if methadone prescriptions were allowed outside opioid treatment programs. While the MOTAA bill was not incorporated into the underlying SUPPORT Act, lawmakers will consider it as stand-alone legislation and the committee may pass it. If this happens, NABH will work with partners to oppose the bill if it moves to the full Senate for a vote and also urge House lawmakers not to consider it. Also next week, the House is expected to pass its version of the SUPPORT Act, which includes several NABH priorities. The House Energy and Commerce Committee passed this bill with bipartisan support and did not consider the MOTAA bill in this legislation. Meanwhile, House and Senate conferees are negotiating a broader healthcare package for Congress to consider in early 2024. NABH will provide the latest information about these and other congressional actions next week and future editions of CEO Update.

ONDCP to Host Webinar on Medicaid 1115 Re-Entry Demonstration Opportunity on Dec. 12

The White House Office of National Drug Control Policy (ONDCP) will host a webinar on Tuesday, Dec. 12 to highlight the state of Washington’s work on the Medicaid Re-Entry Demonstration Opportunity that the Centers for Medicare and Medicaid Services (CMS) announced in April 2023. The opportunity allows states to cover a package of pre-release services, including medications for opioid use disorder and connection to substance use disorder care, for up to 90 days before an incarcerated individual’s release date. To date, 16 states have applied for the waiver and two states have been approved. Click here to register for the 90-minute webinar, which will begin at 2:30 p.m. ET on Tuesday.

National Academies to Host Webinar About Social Media and Adolescent Health on Dec. 13

The National Academies of Sciences, Engineering, and Medicine will host a webinar next week highlighting the conclusions and recommendations from the Academies’ ad hoc committee that drafted a report about social media’s effect on adolescents’ mental and physical health. Click here to learn more and register for the hourlong webinar, which will start at noon ET on Wednesday, Dec. 13.

CMS Provides Guidance to States on Mandatory Medicaid and CHIP Core Set Reporting Requirements

CMS sent a letter to state health officials that offered guidance about implementing the reporting requirements outlined in the Mandatory Medicaid and Children’s Health Insurance Program (CHIP) Core Set Reporting final rule that the agency released in August. The letter includes guidance about mandatory reporting regulations and adherence to reporting guidance; Core Set measures for which reporting is mandatory in 2024; the populations who must be included in reporting and the population exemption process; categories of stratified data that must be reported in or before 2025; measures subject to stratification in 2025; attribution rules; and the Child and Adult Core Set State Plan Amendment.

Reminder: Please Contribute Data to NABH’s Enhanced Denial-of-Care Portal

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

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

Save the Date for the NABH 2024 Annual Meeting!

Please mark your calendars and plan to join us at the Salamander Washington, DC from May 13-15, 2024 for next year’s NABH Annual Meeting!

Fact of the Week

The first government-sanctioned overdose prevention centers (OPCs) opened in New York City in November 2021, drawing concerns that they might increase crime and disorder. A new study in JAMA that examined two OPCs and 17 syringe service programs found no significant increases in crimes recorded by the police or calls for emergency service. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 163

Written by Emily Wilkins (NABH) on December 1, 2023. Posted in CEO Updates.

Please Urge Your Senators to Reauthorize the SUPPORT Act and Oppose MOTAA

As Congress returned this week for its year-end push, NABH continues to advocate for federal lawmakers to reauthorize the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT) and oppose the Modernizing Opioid Treatment Access Act (MOTAA). The Senate Health, Education, Labor and Pensions (HELP) Committee has not announced a markup for these bills; however, lawmakers may act on them during the first or second week of December. As NABH outlined in a letter to Sen. Bill Cassidy, M.D. (R-La.) on Nov. 22, the association supports efforts to reauthorize the expired provisions of the SUPPORT Act. NABH wrote in the letter that the nation’s mental health crisis requires an all-hands-on-deck approach, and that it makes no sense to limit grantees based on a facility’s tax status when many individuals who need mental health and substance use disorder services are not able to access those services. Meanwhile, in a letter to the Senate HELP Committee this week, NABH expressed our firm opposition to the MOTAA bill, which would threaten patient safety if methadone prescription would be allowed outside Opioid Treatment Programs (OTPs). Our concern reflects the complexity of this patient population, which requires comprehensive and ongoing clinical oversight that would be difficult for busy pharmacies to provide. To assure patient safety, NABH supports additional research and data collection prior to altering current methadone prescribing protections provided by OTPs. Please help NABH’s advocacy efforts by contacting Senate HELP Committee members in your region and urge their support to reauthorize the SUPPORT Act and oppose MOTAA. Thank you for your support! Please contact NABH Director for Congressional Affairs Andy Dodson if you have questions.

HHS OIG Reports Low Misuse of Medicare Part D Buprenorphine

A new report from HHS’ Office of the Inspector General (OIG) found most Medicare Part D beneficiaries prescribed buprenorphine for opioid use disorder received recommended amounts in 2022, meaning there was likely little misuse of the drug. The findings are similar to a 2021 report’s results, which led the OIG to conclude in the new review that there continues to be little risk of buprenorphine misuse among Part D enrollees. Click here to read the full report.

Bipartisan Policy Center to Host Medicare Reform Webinar on Dec. 11

The Bipartisan Policy Center (BPC) will explore potential solutions to improve the beneficiary experience and ensure a fiscally responsible Medicare program, which nearly 20% of Americans rely on for healthcare coverage and is estimated to become insolvent by 2031. During the discussion, BPC will release federal policy recommendations meant to enhance Medicare benefits, increase competition, establish better program management, and improve financing. The hourlong event starts at 11:30 a.m. ET. Click here to register.

NIDA to Host ‘Monitoring the Future’ Survey Data Release Webinar on Dec. 13

The National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH) will host a webinar to discuss results from its annual Monitoring the Future (MTF) survey on Wednesday, Dec. 13. The MTF survey has measured drug and alcohol use and related attitudes among adolescent students nationwide since 1975. In it, a nationally representative sample of survey participants report their drug use behaviors across three time periods: lifetime, past year, and past month. NIDA funds the survey, which is conducted by the University of Michigan. This year, the hourlong briefing will feature Marsha Lopez, Ph.D., M.H.S., who serves as chief of the epidemiology research branch in NIDA’s Division of Epidemiology, Services and Prevention Research. The webinar will begin at 10 a.m. ET. Click here to register.

National Academies to Host Workshop that Examines Adult ADHD Diagnosis & Treatment

The National Academies’ Forum on Drug Discovery, Development and Translation and Forum on Neuroscience and Nervous System Disorders will host a workshop to explore the diagnosis and treatment of adults with Adult Attention-Deficit/Hyperactivity (ADHD) Disorder and the challenges and opportunities for drug development on Dec. 12 and 13. The workshop is intended to offer professionals who typically diagnose ADHD—such as physicians, psychologists, social workers, nurse practitioners, and other licensed counselors or therapists—as well as drug developers, researchers, and regulators, to discuss and support the public health goal of treating adults with ADHD safely and effectively. Supported partly through a grant from the Food and Drug Administration’s Center for Drug Evaluation and Research, the workshop will be presented on Tuesday, Dec. 12 from 8:30 a.m. – 5 p.m. ET and on Wednesday, Dec. 13 from 8:30 a.m. – 2 p.m. ET. Click here to register.

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

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

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

Save the Date for the NABH 2024 Annual Meeting!

Please mark your calendars and plan to join us at the Salamander Washington, DC from May 13-15, 2024 for next year’s NABH Annual Meeting! Fact of the Week Drug overdose deaths rose noticeably between January to June 2018 and July to December 2021 among 10- to 44-year-old girls and women who were pregnant or pregnant within the previous 12 months, according to a new study by NIDA researchers at the NIH. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 162

Written by Emily Wilkins (NABH) on November 17, 2023. Posted in CEO Updates.

SAMHSA Releases 2022 National Survey on Drug Use and Health

Among U.S. adults aged 18 or older in 2022, 23.1%, or 59.3 million people, had any mental illness in the past year while 48.7 million people aged 12 or older, or 17.3%, had a substance use disorder (SUD) in the past year, according to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2022 National Survey on Drug Use and Health (NSDUH). The annual report provides nationally representative data on the use of tobacco, alcohol, and drugs; SUDs; mental health issues; and receipt of substance use and mental health treatment among the civilian, noninstitutionalized population aged 12 or older in the United States. In addition, the 2022 Methodological Summary and Definitions report summarizes the information users need to properly interpret NSDUH estimates related to substance use and mental health. This report accompanies the annual detailed tables and provides information on overall methodology, key definitions for measures and terms used in 2022 NSDUH reports and tables, along with some analysis of these measures and of the survey as a whole.

NIH Study Examines How to Reduce Suicide Risk Among Young People in Hospital EDs

The National Institutes of Health (NIH) has released Emergency Department Safety Assessment and Follow-Up Evaluation 2 (ED-SAFE 2), a study that shows it’s possible to significantly reduce suicidal behaviors among young people at risk for suicide in emergency departments. ED-SAFE is a randomized clinical trial designed to improve suicide risk screening and detection in emergency department settings. The trial differs from similar studies because routine clinical staff—rather than researchers—deliver the suicide risk intervention, according to the NIH. This approach increases the likelihood that the suicide prevention strategies can be reliably implemented and sustained in the real world. ED-SAFE is also the largest practical clinical trial of suicide-related best practices in emergency departments.

National Academies Examines How to Support and Sustain the Current and Future Workforce to Care for People with Serious Illness

The National Academies Roundtable on Quality Care for People with Serious Illness has released a resource from its April 2023 public workshop that explored strategies and approaches to address major workforce challenges for those who care for people with serious illness. The workshop built on a 2019 Roundtable workshop, Building the Workforce We Need to Care for People with Serious Illness. Click here to access the free resource.

SAMHSA to Host Webinar on Certified Peer Specialist Career Outcomes Study

SAMHSA’s Office of Recovery will host a webinar later this month to discuss the results from the Certified Peer Specialist (CPS) Career Outcomes Study. Laysha Ostrow, Ph.D. will present some of the findings from the three-year study, including information about wages and financial wellbeing, workplace burnout, and CPS in rural areas. The webinar will start Monday, Nov. 27 at 1 p.m. ET. Click here to register.

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

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

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

Fact of the Week

More Americans used illicit drugs in 2022 than in 2021, with illicit marijuana being the most common. Nearly 62 million people used illicit marijuana last year, up from 52.5 million in 2021, according to the 2022 National Survey on Drug Use and Health.

Save the Date for the NABH 2024 Annual Meeting!

Please mark your calendars and plan to join us at the Salamander Washington, DC from May 13-15, 2024 for next year’s NABH Annual Meeting!

Happy Thanksgiving!

The NABH staff wishes its members and their families a very happy, healthy, and safe Thanksgiving! NABH will not publish CEO Update next week and will resume on Friday, Dec. 1, 2023. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 161

Written by Emily Wilkins (NABH) on November 9, 2023. Posted in CEO Updates.

Senate Finance Committee Advances ‘Better Mental Health Care, Lower-Cost Drugs and Extenders Act’

The Senate Finance Committee on Wednesday advanced the bipartisan Better Mental Health Care, Lower-Cost Drugs and Extenders Act in a unanimous vote. The healthcare package partially mitigates Medicare payment cuts for physicians, extends certain expiring Medicare and Medicaid provisions, targets pharmacy benefit manager practices, and extends several substance use disorder (SUD) measures that expired on Oct. 1 as lawmakers missed the deadline to reauthorize the SUPPORT Act. Included in the legislation is language from S. 3098, the Securing Advances and a Variety of Evidence-Based (SAVE) Institutions for Mental Diseases (IMD) Options Act that Sens. John Thune (R-S.D.), Maggie Hassan (D-N.H.), and Marsha Blackburn (R-Tenn.) introduced to make the state plan amendment option permanent, a provision also included in the House Energy & Commerce Committee-passed SUPPORT Act Reauthorization bill. Some states, including South Dakota and Tennessee, opted into a state plan amendment option authorized under the SUPPORT Act that allows states to avoid the IMD Exclusion. Without renewal, states avoiding the payment exclusion will be forced to terminate payments to IMD facilities or cover such costs through state funds. Other provisions in the legislation include prohibiting states from terminating Medicaid coverage for incarcerated individuals and expanding access to mental health and SUD services for Medicaid-eligible individuals 30 days prior to their release from incarceration. The legislation also requires the Centers for Medicare & Medicaid Services (CMS) to collect and publish data from Medicare Advantage plans on the number of prior authorization requests, denials, and appeals for mental health and SUD services at the plan level, including the timelines of prior authorization decisions and justifications for denials. Senate Finance Committee leaders said the goal is to include the Better Mental Health Care, Lower-Cost Drugs and Extenders Act legislation into a broader healthcare package, a second Continuing Resolution (CR), or end-of-year omnibus funding package.

CMS Extends MA Coverage to Additional Behavioral Healthcare Practitioners

In a proposed rule released this week, CMS proposed several changes to increase access to behavioral healthcare services for Medicare Advantage (MA) enrollees. As required by law, CMS proposed to expand network adequacy standards for MA plans by adding a new category of specialists, “outpatient behavioral health” providers, as a required element of each network. Practitioners in this new category would include marriage and family therapists, mental health counselors, opioid treatment program providers, community mental health centers, addiction-medicine physicians, and other providers already providing traditional Medicare-covered addiction medicine and behavioral health counseling or therapy services. Also, CMS would extend the existing 10% compensation boost to this new category of practitioners for any MA network that has at least one provider group providing telehealth services. Comments on this rule are due to CMS by Jan. 25, 2024.

White House, ONDCP, Domestic Policy Council, and 12 Federal Agencies Release Recovery-Ready Workplace Toolkit

The White House, the Office of National Drug Control Policy, the Domestic Policy Council, and a dozen federal departments and independent agencies released their Recovery-Ready Workplace Toolkit: Guidance and Resources for Private and Public Sector Employers this week. The 140-page resource supports the fourth pillar of President Biden’s Unity Agenda for the Nation: beating the opioid and overdose epidemic. Specifically, the toolkit is designed to help businesses and other employers prevent and respond more effectively to substance misuse among employees, build their workforces through hiring of people in recovery, and develop a recovery-supportive workplace culture. It is also intended to serve as a resource to states, local governments, labor organizations, business groups, and non-profits considering launching multi-employer recovery-ready workforce initiatives at the local or state levels.

HHS Releases ‘Action for Adolescents: A Call to Action for Adolescent Health and Well-Being’

HHS recently released Action for Adolescents: A Call to Action for Adolescent Health and Well-Being, a new effort to promote collaboration and prompt action to improve the health and well-being of U.S. adolescents nationwide. Take Action for Adolescents is a research-based resource that outlines a vision, key principles, and eight goals, including: 1) Eliminate disparities to advance health equity, 2) Increase youth agency and youth engagement, 3) Ensure access to safe and supportive environments, 4) Increase coordination and collaboration within and across systems, 5) Expand access to health care and human services, 6) Strengthen training and support for caring adults, 7) Improve health information and health literacy, and 8) Support, translate, and disseminate research. The resource also includes a Take Action toolkit. In other HHS news related to the nation’s youth, HHS Secretary Xavier Becerra was recently named Chair of the U.S. Interagency Council on Homelessness and announced $6.1 million in new measures on affordable housing and support for runaway youth. Some of that funding will be used to enhance a variety of supportive services, including mental health services, on-site child care, financial literacy and coaching, GED preparation classes, transportation assistance, and early childhood and youth programs.

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

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

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

Fact of the Week

For young people between the ages of 15 to 24, time spent in person with friends has reduced by nearly 70% during the last two decades to 40 minutes per day in 2020 from roughly 150 minutes per day in 2003 to 40 minutes per day in 2020, according to The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community.

Save the Date for the NABH 2024 Annual Meeting!

Please mark your calendars and plan to join us at the Salamander Washington, DC from May 13-15, 2024 for next year’s NABH Annual Meeting!

Many Thanks to All Veterans!

This Veterans Day Weekend, NABH thanks its members and their families who have served or are serving in the U.S. military. We appreciate your sacrifice and service. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 160

Written by Emily Wilkins (NABH) on October 27, 2023. Posted in CEO Updates.

White House Asks Congress for $1.55 Billion to Address Nation’s Fentanyl Crisis

The Biden administration this week requested $1.55 billion from Congress for HHS’ Substance Abuse and Mental Health Services Administration (SAMHSA) State Opioid Response grants to provide treatment, harm reduction, and recovery support services in all states and territories to combat the nation’s ongoing fentanyl crisis. “Thanks to historic funding and bipartisan efforts, the rate of overdose deaths is slowing after a period of exponential increase, access to treatment is expanding, and historic amounts of fentanyl are being seized at our borders,” the White House said in a fact sheet about the Biden administration’s domestic spending requests to Congress. “But our work to beat the overdose epidemic is far from over and additional resources are needed to continue the Administration’s aggressive action to save lives.”

CDC: Healthcare Workers Report a Decrease in Odds of Burnout if They Trust Management

Healthcare workers continued to face a mental health crisis in 2022, although positive working conditions were associated with less burnout and better mental health, the Centers for Disease Control and Prevention (CDC) concluded in a Vital Signs report released this week. From 2018 to 2022, healthcare workers reported an increase of 1.2 days of poor mental health during the previous 30 days (to 4.5 days from 3.3 days), while the percentage who reported feeling burnout very often increased to 19% from 11.6%, the findings showed. However, the report found healthcare workers experienced a decrease in odds of burnout if they trusted management, had supervisor help, had enough time to complete work, and felt their workplace supported productivity. The report highlighted the CDC’s National Institute for Occupational Safety and Health (NIOSH), which has implemented efforts to promote the mental health and well-being of healthcare workers, including a national social marketing campaign, Impact Wellbeing, which emphasizes primary prevention strategies such as worker participation in decision-making, supportive supervision, and increasing psychological safety for help-seeking. “NIOSH has also developed burnout training for supervisors of public health workers and through its efforts has emphasized improving the work environment, rather than asking workers to be more resilient or fix problems themselves,” the report said.

SAMHSA Summary Report Shows Climate Change is a Social Determinant of Mental Health

A recent SAMHSA report concluded climate change is a social determinant of mental health; behavioral health systems should become “climate-informed;” and intergenerational trauma will be one of the layered effects of climate-related environmental change. The report summarized the findings from SAMHSA’s August 2022 request for information that sought feedback about potential agency actions regarding mental health and substance use wellbeing in the context of climate change and health equity. Respondents suggested SAMHSA should develop an agency-wide climate action plan to serve as a roadmap for change and integration of climate-informed behavioral health in SAMHSA research, programs, contracts, technical assistance, and reports. They also said SAMHSA should support increased resources and allowable costs that shift behavioral health systems toward public behavioral health strategies for mental health promotion, substance use prevention, community-level response, and community-based mental health resilience. “Respondents emphasized that a protective factor for healthcare workers is adequate training and preparation,” the report said. “Therefore, building out a climate-informed behavioral health system that provides resources to an increasingly diverse behavioral health workforce is protective to both the behavioral health workforce and the communities they serve,” it continued. “Timely and tailored interventions need to be designed in such a way that they can be altered over time to meet current and evolving needs.”

CMS Seeking Feedback to Improve Provider Resources

The Centers for Medicare and Medicaid Services (CMS) is conducting a study to help the agency improve user experience with Medicare program and billing resources. Responses are confidential, and the survey should take about 10 minutes to complete. Click here to take the survey, which is due Thursday, Nov. 9.

SAMHSA Releases 988 Lifeline Videos

SAMHSA has produced two new videos that promote the 988 Lifeline. Called “Impact of the 988 Lifeline” and “You Matter PSA,” the videos are included in SAMHSA’s 988 Partner Toolkit. In its announcement, SAMHSA noted that its 988 fact sheet, available in both English and Spanish, has been helpful in communicating about the 988 Lifeline’s services and successes.

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

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

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

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

The O’Neill Institute’s Addiction and Public Policy Initiative will host a webinar next month about the current state of recovery housing and the opportunities for improving recovery housing in the United States. As the O’Neil Institute explains, social determinants, such as housing, and expanded access to medications for substance use disorder are part of effective, long-term solutions. National standards for recovery housing, along with protecting the rights of individuals under the law, are central to facilitating a needed societal shift and maximizing opportunities for people with substance use disorder. Recognizing the critical role that housing plays in improving outcomes for people with substance use disorder (SUD), SAMHSA recently issued Best Practices for Recovery Housing, and the U.S. Justice Department protects the rights of individuals with SUD afforded under the Fair Housing Act and the Americans with Disabilities Act.

Fact of the Week:

More than 1 million hospital emergency department visits are attributed annually to children and adolescents with a mental health disorder diagnosis, according to a new CDC study. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 159

Written by Emily Wilkins (NABH) on October 24, 2023. Posted in CEO Updates.

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

NABH is seeking help from members as the NABH Selection Committee prepares to consider possible nominees to serve on the NABH Board of Trustees. Specifically, NABH requests that members help the association identify: ► Board Chair-Elect and ► Four Board seats that will become available in 2024 The Selection Committee is particularly interested in identifying senior managers who represent the broad diversity within the NABH membership, including various levels of care, organizational structures, and size. Please download a nomination form to share your recommendations of individuals you would like to see included in the single slate for 2024. Please attach a curriculum vitae (CV) for each person you recommend. This will help the Selection Committee in its deliberations. You are welcome to suggest yourself. Please return this form (and candidates’ CVs) by today, Oct. 20, 2023, to maria@nabh.org.

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

Sens. John Thun (R-S.D.), Maggie Hassan (D-N.H.), and Marsha Blackburn (R-Tenn.) on Thursday introduced the Securing Advances and a Variety of Evidence-Based (SAVE) Institutions for Mental Disease (IMD) Options Act. The bipartisan legislation would establish a permanent state plan option in Medicaid that allows states to provide patients between the ages of 21 and 64 with substance use disorder (SUD) treatment in an IMD. Current law does not allow federal Medicaid funds to be used for those patients at IMDs, which include hospitals, nursing facilities, or other institutions with more than 16 beds that provide care for mental health diseases, including SUD. NABH strongly supports the bill and is working with the lawmakers’ congressional staff to provide support. “Establishing a permanent state option in Medicaid for substance use disorder treatment provided in IMD will provide states with certainty and ensure individuals have access to this lifesaving treatment,” NABH President and CEO Shawn Coughlin said in a news release about the bill.

NABH Submits Parity Comments to HHS, DOL, and Treasury

NABH this week submitted comments to the U.S. Health and Human Services, Labor, and Treasury Departments on this year’s proposed parity rule and thanks all members who provided feedback. In its letter, NABH recognized the three departments for their collective determination to enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) that passed 15 years ago this month and has yet to be implemented fully and fairly nationwide. NABH’s letter also said the association especially supports the proposed rule’s requirement that each plan’s comparative analysis on parity compliance include substantive data on non-quantitative treatment limitations (NQTL), including network composition. These requirements will do much to enforce both the letter and spirit of the MHPAEA, NABH noted. The letter continued by categorizing NABH’s comments into the following sections: 1) parity in behavioral healthcare benefits, 2) NQTL comparative analysis requirements, 3) improving and expanding meaningful parity standards, and 4) network adequacy. “We appreciate that the rule addresses ambiguous definitions that contribute to the disparity between mental and physical healthcare,” the letter said in a section about clarifying meaningful coverage and scope of covered services. “Such ambiguity tends to yield overly flexible interpretations that generally favor health plans over patients. In particular, the proposed, more specific definitions for ‘meaningful coverage’ and ‘scope of covered services’ will bring valuable clarity and consistency to coverage determinations,” it continued. “Of notable benefit, we strongly support the proposed requirement for plans that provide behavioral healthcare benefits in any classification of care, to do so in all classifications of care. Similarly, we urge the departments to add to the final rule a definition of ‘meaningful’ as it applies to scope of covered MH and SUD benefits in each classification.”

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

In its 2024 Star Ratings released last week, the Centers for Medicare & Medicaid Services (CMS) gave 31 Medicare Advantage (MA) contracts a five-star rating, a notable drop from the 57 contracts that earned the top rating in 2023. An MA contract must earn at least a four-star rating to receive a quality bonus payment from CMS. MA open enrollment for 2024 kicked off on Oct. 15 using new MA requirements that CMS finalized in April and will take effect on Jan. 1, 2024. The 40 quality metrics that apply to MA plans with a drug benefit in 2024 will include new restrictions on deceptive marketing, multiple prior authorization improvements, and affordable drug pricing, with the latter required by law. CMS is in the process of remaking the star-rating system to remove incentives that inadvertently permitted lower quality and unnecessary spending. This effort includes applying more stringent criteria for star-rating quality metrics, which are expected to result in fewer insurers securing high ratings and greater financial benefits for insurers focused on treating disadvantaged populations. CMS’ effort also includes changes from the 2024 MA final rule, which strives to improve coverage, ensure timely access to care, and advance parity between MA and traditional fee-for-service coverage.

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

The National Academies is seeking suggestions for experts to participate in a White House Office of National Drug Control Policy-sponsored workshop to explore data-collection efforts, evidence gaps, and research needs on harm-reduction services for people who use drugs (PWUD). Specifically, the workshop will examine harm-reduction services that aim to prevent overdose and infectious disease transmission; enhance the health, safety, and wellbeing of PWUD; and offer low-threshold options for accessing SUD treatment. According to the National Academies, services include syringe services programs; providing fentanyl and xylazine test strips; distributing naloxone and other reversal medications; and facilitating connections to social services for PWUD in need of medical services, stable housing, food-assistance, or employment. Nominations are due next Wednesday, Oct. 25 to help the National Academies establish a 10-person, volunteer planning committee for the project. Click here to learn more and submit a nomination.

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

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

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

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

Fact of the Week:

New data from the Centers for Disease Control and Prevention show 1 out of 5 persons who died from drug overdoses in 2020 worked in construction or restaurants. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 158

Written by Emily Wilkins (NABH) on October 13, 2023. Posted in CEO Updates.

FDA Creates Advisory Committee to Examine Digital Health Technologies

The U.S. Food and Drug Administration (FDA) this week announced it has created a Digital Health Advisory Committee to help the agency explore the scientific and technical issues related to digital health technologies (DHTs), such as artificial intelligence/machine learning (AI/ML), augmented reality, virtual reality, digital therapeutics, wearables, remote patient monitoring and software. The new committee will advise the FDA on issues related to DHTs and provide expertise to help the agency better understand benefits, risks, and clinical outcomes associated with use of DHTs. “As one of our strategic priorities, our goal is to advance health equity in part through expanding access by bringing prevention, wellness, and healthcare to all people where they live – at home, at work, in big cities and rural communities,” Jeff Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health, said in an announcement. “Digital health technologies are critical for achieving this transformation in care delivery,” he continued. “As digital health technologies advance, the FDA must capitalize on knowledge from inside and outside of the agency to help ensure we appropriately apply our regulatory authority in a way that protects patient health while continuing to support innovation.” FDA’s announcement said the committee should be fully operational in 2024.

SAMHSA Releases Mental Health Client-Level Data 2021 Annual Report

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week released Mental Health Client-Level Data (MH-CLD) 2021: Data on Clients Receiving Mental Health Treatment Services Through State Mental Health Agencies, the annual report that details the total number of clients receiving mental health treatment services in 2021 by demographics, national outcomes measures, and the top five mental health diagnoses for children (ages 0-17) and adults (ages 18 and older) by geographic distribution. SAMHSA uses the MH-CLD data to better understand publicly funded mental health treatment service systems. The data are also used to inform decisions about how SAMHSA’s uses its mental health block grant funds, and are used to help the agency learn about the technical assistance and support needs of mental health providers and the communities they serve.

CMS Administrator Brooks-LaSure to Host Stakeholder Update Next Week

CMS Administrator Chiquita Brooks-LaSure and her leadership team will provide a stakeholder and partner update about the agency’s recent accomplishments and efforts to advance the CMS Strategic Plan on Tuesday, Oct. 17. Click here to RSVP for the hourlong call, which starts at 1 p.m. ET.

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

Manatt Health will host a webinar next week to help providers and health plans navigate the emerging landscape of fraudulent healthcare schemes and provide practical answers to the legal questions that resulted from recent litigation and enforcement actions. The free webinar will feature panelists — all of whom have successfully defended litigants who have been forced to deal with inducement-based lawsuits in both federal and state courts – who will share an overview of the current litigation and policy landscape and offer insights into how providers and plans can protect themselves and their organizations. The webinar also will discuss the findings from internal investigations that have uncovered fraudulent activities and improper conduct impacting patients’ health and safety and providers’ and plans’ financial viability. Click here to register for the hourlong webinar on Tuesday, Oct. 17, which starts at 1 p.m. ET.

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

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

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

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

NABH is seeking help from members as the NABH Selection Committee prepares to consider possible nominees to serve on the NABH Board of Trustees. Specifically, NABH requests that members help the association identify: ► Board Chair-Elect and ► Four Board seats that will become available in 2024 The Selection Committee is particularly interested in identifying senior managers who represent the broad diversity within the NABH membership, including various levels of care, organizational structures, and size. Please download a nomination form to share your recommendations of individuals you would like to see included in the single slate for 2024. Please attach a curriculum vitae (CV) for each person you recommend. This will help the Selection Committee in its deliberations. You are welcome to suggest yourself. Please return this form (and candidates’ CVs) by Friday, Oct. 20, 2023, to maria@nabh.org.

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

Fact of the Week:

Nearly 40% of primary care providers (PCPs) are screening patients for behavioral health conditions, according to a new report from The Advisory Board, which included survey responses from 300 PCPs. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 157

Written by Emily Wilkins (NABH) on October 6, 2023. Posted in CEO Updates.

DEA Extends Pandemic Telemedicine Rules Through December 2024

The Drug Enforcement Administration (DEA) on Friday said it will extend its eased, COVID-19 pandemic rules for prescribing controlled substances via telemedicine through Dec. 31, 2024. This is DEA’s second extension of these rules; the agency first extended its pandemic-era, telehealth regulations in May 2023, which are set to expire on Nov. 11, 2023. DEA said in its notice that DEA and HHS continue to consider revisions to the agency’s March 2023 proposed rule and that DEA’s telemedicine listening sessions last month helped inform this latest extension. NABH reported on those listening sessions in CEO Update on Sept. 15.

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

The U.S. Food and Drug Administration (FDA) this week issued draft guidance for developing drugs to treat stimulant use disorders. Stimulant Use Disorders: Developing Drugs for Treatment addresses the FDA’s current recommendations regarding the overall development program and clinical trial designs for developing drugs to treat moderate-to-severe cocaine use disorder, methamphetamine use disorder, or prescription drug stimulant use disorder. The FDA will accept public comments about the guidance through Monday, Dec. 4. Click here for comment submission instructions.

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

The Centers for Medicare & Medicaid Services (CMS) is seeking public comments about a set of questions regarding processes to assess compliance with mental health parity ad addiction equity requirements for Medicaid managed care arrangements, Medicaid Alternative Benefit Plans (ABPs), and the Children’s Health Insurance Program. (CHIP). The questions for comment address a variety of topics, including model formats (e.g., templates) and key questions to consider that could make documenting compliance with parity requirements more efficient and effective; processes that states and managed care plans use to determine whether existing coverage policies are comparable for mental health and substance use disorders compared with medical and surgical benefits; how data should be collected; and more. CMS will accept public comments here through Monday, Dec. 4. NABH will submit comments.

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

In a new report, the Congressional Budget Office (CBO) estimates federal subsidies for health insurance in 2023 to be $1.8 trillion, or 7% of the nation’s Gross Domestic Product. Meanwhile, the CBO and the Joint Committee on Taxation (JCT) together project those net subsidies to grow substantially–reaching $3.3. trillion, or 8.3% of GDP, by 2033. The CBO said this is the first time the projections reflect the entire population instead of only the civilian, noninstitutionalized population younger than 65.

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

NIMH Marks 75^th Anniversary with Podcast Series

The National Institute of Mental Health is honoring its 75^th anniversary with a podcast series that explores the stories behind influencers and innovators in mental health research and the lives of people with mental illness. The latest podcasts feature “Depression: The Case for Ketamine,” and “Understanding and Preventing Youth Suicide.” Click here to listen.

Please Nominate Members for the NABH Board of Trustees!

NABH is seeking help from members as the NABH Selection Committee prepares to consider possible nominees to serve on the NABH Board of Trustees. Specifically, NABH requests that members help the association identify: ► Board Chair-Elect and ► Four Board seats that will become available in 2024 The Selection Committee is particularly interested in identifying senior managers who represent the broad diversity within the NABH membership, including various levels of care, organizational structures, and size. Please download a nomination form to share your recommendations of individuals you would like to see included in the single slate for 2024. Please attach a curriculum vitae (CV) for each person you recommend. This will help the Selection Committee in its deliberations. You are welcome to suggest yourself. Please return this form (and candidates’ CVs) by Friday, Oct. 20, 2023, to maria@nabh.org.

Fact of the Week:

People who work shift work are 22% more likely to develop depression than those who work a regular daytime schedule, according to a recent study published in JAMA Network Open. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 156

Written by Emily Wilkins (NABH) on September 29, 2023. Posted in CEO Updates.

HHS Releases Contingency Plan as Federal Government Shutdown Looms

HHS this week released a government shutdown contingency plan if federal lawmakers don’t pass legislation by Saturday, Sept. 30 to extend government funding and maintain federal operations. If they don’t, critical federal services will end at 12:01 a.m. on Sunday. The ongoing government funding talks have put on hold consideration of all other bills that are set to expire after Sept. 30, including the SUPPORT Act reauthorization. NABH expects reauthorization to move through both chambers of Congress after lawmakers resolve the federal funding issue. Meanwhile, here are HHS’ plans for the agencies that affect NABH members: the Agency for Healthcare Research and Quality, Centers for Medicare & Medicaid Services, Health Resources and Services Administration, National Institutes of Health, and Substance Abuse and Mental Health Services Administration.

SAMHSA Announces $131.7 Million in Grants for Youth and Families

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week said it awarded $131.7 million in grant programs to connect youth and families with behavioral healthcare services. The awards will fund a variety of programs and services, including cooperative agreements for school-based, trauma-informed support services for mental healthcare, expanding substance use treatment capacity in adult and family drug courts, preventing youth overdose, and more. Click here to read more about the awards.

Joint Commission Revises Terms to Reflect Current Terminology in Addiction Medicine

The Joint Commission said it has revised two terms for Behavioral Health Care and Human Services to reflect current terminology in the addiction medicine field. “Medication-assisted treatment” has been updated to “medications for substance use disorders,” and, if the requirement needs to be more specific, the term used is “medications for opioid use disorder” or “medications for alcohol use disorder.” Meanwhile, the Joint Commission removed “detoxification,” which is now referred to as “withdrawal,” “withdrawal management,” or “medically supervised withdrawal management.” “These revisions are editorial in nature and do not change any requirements,” the Joint Commission said in its announcement, adding that any questions should be directed to the organization’s Department of Standards and Survey Methods. The changes take effect on Jan. 1, 2024.

October is Youth Substance Use and Misuse Prevention Month

As National Recovery Month draws to a close, the nation now turns to Youth Substance Use Prevention Month and Substance Misuse Prevention Month for October. SAMHSA has created a Prevention Month toolkit with shareable social media graphics to help people promote the message of prevention for kids and family and developed other resources and events to help communities participate. In conjunction with Prevention Month, SAMHSA this week announced it awarded $42.6 million in grants to 17 states and 60 communities—located across 33 states—as a foundational investment for substance use prevention. Click here to learn more.

Please Nominate Members for the NABH Board of Trustees!

NABH is seeking help from members as the NABH Selection Committee prepares to consider possible nominees to serve on the NABH Board of Trustees. Specifically, NABH requests that members help the association identify: ► Board Chair-Elect and ► Four Board seats that will become available in 2024 The Selection Committee is particularly interested in identifying senior managers who represent the broad diversity within the NABH membership, including various levels of care, organizational structures, and size. Please download a nomination form to share your recommendations of individuals you would like to see included in the single slate for 2024. Please attach a curriculum vitae (CV) for each person you recommend. This will help the Selection Committee in its deliberations. You are welcome to suggest yourself. Please return this form (and candidates’ CVs) by Friday, Oct. 20, 2023, to maria@nabh.org.

Fact of the Week:

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

CEO Update 155

Written by Emily Wilkins (NABH) on September 22, 2023. Posted in CEO Updates.

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

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

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

About 70 million U.S. adults aged 18 and older perceived they ever had a substance use and/or mental health problem, according to a new report SAMHSA released this week. Using data from the 2021 National Survey on Drug Use and Health, the report also showed that for substance use specifically, 29 million adults perceived they ever had a substance use problem, and 20.9 million people (or 72.2%) considered themselves to be in recovery or to have recovered from their drug or alcohol use problem. For mental health, of the 58.7 million adults who perceived they ever had a mental health problem, 38.8 million (or 66.5%) considered themselves to be in recovery or to have recovered from their mental health problem. Click here to read the report, Recovery from Substance Use and Mental Health Problems Among Adults in the United States.

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

NABH has extended the deadline for system members to submit changes about their organizations for the 2023 NABH Directory to Wednesday, Sept. 27. NABH’s online-only 2023 Membership Directory is an essential member benefit that helps the association advance its advocacy efforts. Last month NABH sent system members a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use the link to verify your system’s information. The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all your system’s facilities to help provide NABH with an accurate picture of our membership. If you need assistance, please contact Maria Merlie maria@nabh.org or 202-393-6700, ext. 104.

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

Senate Health, Education, Labor, and Pensions (HELP) Committee Ranking Member Sen. Bill Cassidy, M.D. (R-La.) announced earlier this month he’s seeking information from stakeholders about ways to improve the privacy protections of health data in a way that safeguards sensitive information while balancing the need to support medical research. According to a Senate HELP Committee announcement, Cassidy, an NABH Champion, hopes to use the stakeholder feedback to identify solutions to modernize HIPAA and ensure that all health data are safeguarded properly. The deadline to submit feedback is Thursday, Sept. 28. Click here to read Cassidy’s full request and here to submit comments.

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

CMS’ Medicare-Medicaid Coordination Office recently announced an upcoming webinar that will examine how traditional silos of care impede comprehensive approaches to care coordination and explore potential solutions to improve behavioral health condition management in persons with intellectual and developmental disabilities. Presenters include Andrea Witwer, Ph.D., associate clinical professor in psychiatry and behavioral health at Ohio State; family caregiver Patricia Nobbie, Ph.D.; and Olivia Ayers, LMCH, LPC, clinical director at Elevate Certified Community Behavioral Health Clinic in Iowa. The 90-minute webinar will be held on Wednesday, Sept. 27 starting at 2:30 p.m. ET. Click here to learn more and to register.

Fact of the Week:

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

CEO Update 154

Written by Emily Wilkins (NABH) on September 15, 2023. Posted in CEO Updates.

NABH Comments on 2024 OPPS and Physician Payment Proposed Rules

This week NABH submitted a comment letter to the Center for Medicare & Medicaid Services (CMS) about the agency’s proposed rules pertaining to both the outpatient prospective payment system (OPPS) and physician fee schedule (PFS) for 2024. Outpatient PPS Proposed Rule. Among the rule’s multiple behavioral healthcare provisions, a key item was CMS’ proposed design and implementation of the congressionally mandated intensive outpatient program (IOP) as a new Medicare benefit in hospital outpatient departments, community mental health centers, federally qualified health centers, rural health clinics, and opioid treatment programs. NABH generally supports CMS’ proposed approach of basing many of the new IOP design features on the existing partial hospitalization program (PHP) framework because PHPs treat a similar mix of patients, although with a higher level of intensity. That said, NABH raised concerns regarding some of the proposed design features, including the need to align the new IOP patient eligibility criteria with the clinical characteristics of current IOP populations. Specifically, NABH urged CMS to remove these criteria: “adequate support system at home” and “risk of danger to self or others” as they would exclude a significant portion of the patient population for whom this benefit is intended. NABH expressed additional concerns related to the implementation of IOP benefit by opioid treatment programs including that the physician-driven IOP certification and treatment planning requirements do not align with the scopes of practice of non-physician professionals nor with the ASAM requirements for IOP and other level of care assessments; that additional specialty care settings should be considered for IOP services; and that CMS develop a contingency management bundle for individuals with stimulant use disorder. Physician Fee Schedule Proposed Rule. NABH’s comments about the PFS rule respond to CMS’ proposed 2.0% increase for psychiatric service payments, relative to CY 2023 rates, which starkly contrasts to the proposed decrease for overall PFS payments of negative 3.3%. Our comments recommend increases for both overall and psychiatric services due to significant workforce and other pressures facing all healthcare providers. We also support the agency’s provision to set payments to 150% of facility-based payments for “psychotherapy for crisis” services that are furnished in a setting other than a physician’s office or mobile unit or home. In addition, we support CMS’ proposal to allow three new behavioral healthcare practitioners to bill under Medicare Part B: marriage and family therapists, mental health counselors (MHCs), and addiction counselors that meet Medicare criteria for MHCs. NABH also called for a 10 percentage-point increase in payments for these providers and the addition of psychiatric mental health nurse practitioners to this group. We also recommended that telehealth services offered by community health integration, social determinants of health, and principal illness navigation specialists be covered; that remote monitoring codes be developed for opioid treatment programs and office-based opioid treatment providers; and that progressively decreasing buprenorphine reimbursement rates be re-evaluated and increased.

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

The Drug Enforcement Administration held a two-day listening session this week in response to almost 40,000 comments it received earlier in the year about its proposal to reimpose in-person visits for the prescribing of controlled substances, including buprenorphine. DEA Administrator Anne Milgram announced that the agency would provide an additional comment period for telemedicine. This would likely require an extension of the telemedicine flexibilities offered during the COVID-19 pandemic. Testimony over the course of two days addressed how changes to pandemic-era telemedicine rules would impede care for individuals needing medication for attention-deficit/hyperactivity disorder and opioid use disorder, individuals in end-of-life care needing opioids for pain relief, individuals receiving gender-affirming care, and many others. The listening session requested recommendations on a “special registration” process that Congress requested many years ago.

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

The National Academies of Sciences, Engineering, and Medicine is seeking suggestions for experts to participate in a study to develop a Blueprint for a National Prevention Infrastructure for Behavioral Health Disorders. The study also will identify funding needs and strategies to support the infrastructure; identify gaps in policy research and health services research that may serve as barriers to implementing the program; and recommend state and federal policies to support the financing and infrastructure, including workforce development and data interoperability for promoting behavioral health. Click here to learn more about the scope of work for the ad hoc committee that will develop the blueprint and click here to submit recommendations of volunteer experts. The deadline to submit recommendations is Wednesday, Sept. 20.

SAMHSA Releases Resources to Help Communities Address Opioid Overdose Crisis

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week released two resources to help community practitioners end America’s opioid crisis. SAMHSA commissioned RTI International to develop—together with a SAMHSA technical expert panel— Engaging Community Coalitions to Decrease Opioid Overdose Deaths and Opioid-Overdose Reduction Continuum of Care Approach. The guides are based on insights and tools from the ongoing National Institutes of Health (NIH) HEALing Communities Study. NIH and SAMHSA launched that study in 2019 to test the effect of an integrated set of evidence-based practices across healthcare, behavioral health, justice, and other community-based settings.

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

Senate Health, Education, Labor, and Pensions (HELP) Committee Ranking Member Sen. Bill Cassidy, M.D. (R-La.) last week announced he’s seeking information from stakeholders about ways to improve the privacy protections of health data in a way that safeguards sensitive information while balancing the need to support medical research. According to a Senate HELP Committee announcement, Cassidy, an NABH Champion, hopes to use the stakeholder feedback to identify solutions to modernize HIPAA and ensure that all health data are safeguarded properly. The deadline to submit feedback is Thursday, Sept. 28. Click here to read Cassidy’s full request and here to submit comments.

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

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

NABH has extended the deadline for system members to submit changes about their organizations for the 2023 NABH Directory to Wednesday, Sept.27. NABH’s online-only 2023 Membership Directory is an essential member benefit that helps the association advance its advocacy efforts. Last month NABH sent system members a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use the link to verify your system’s information. The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all of your system’s facilities to help provide NABH with an accurate picture of our membership. If you need assistance, please contact Maria Merlie maria@nabh.org or 202-393-6700, ext. 104.

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

Thank you to all members who have submitted data to NABH’s denial-of-care portal! We are still seeking data from additional members to support advocacy on health plan denials and prior-authorization timeliness. If you are a new participant, please e-mail NABH Administrative Coordinator Emily Wilkins for support.

Fact of the Week:

Recent research found that, overall, people with mental health conditions seemed to have an elevated risk of heat-related death. This was even more severe for people with schizophrenia: a 200% increase compared with typical summers. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 153

Written by Emily Wilkins (NABH) on September 8, 2023. Posted in CEO Updates.

CMS Announces AHEAD Model to Improve Overall Health of State Population

The Centers for Medicare & Medicaid Services on Thursday unveiled its States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model to better address chronic disease, behavioral health, and other medical conditions among state populations. CMS said the new approach is intended to help participating states be better equipped to promote health equity, increase access to primary care services, set healthcare expenditures on a more sustainable trajectory, and lower healthcare costs for patients. AHEAD also includes specific payment models for participating hospitals and primary care practices as a tool to achieve the model’s goals. Through AHEAD, CMS said it aims to strengthen primary care, improve care coordination for people with Medicare and Medicaid, and increase screening and referrals to community resources such as housing and transportation to address social drivers of health. CMS will issue awards to up to eight states, and each selected state will have an opportunity to receive up to $12 million from CMS to support state implementation. The agency said states interested in participating in the model may apply during two different application periods and elect to participate in one of three cohorts with staggered start dates and performance years. CMS will release the Notice of Funding Opportunity, which includes the specific application requirements, in the late fall.

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

CMS also announced it is now accepting applications for its recently introduced voluntary Making Care Primary, or MCP, model. Launching on July 1, 2024, the 10.5-year model will be tested in eight states – Colorado, North Carolina, New Jersey, New Mexico, New York, Minnesota, Massachusetts, and Washington – and is meant to give primary care clinicians the tools they need to form partnerships with healthcare specialists and leverage community-based connections to address patients’ needs. “This model will attempt to strengthen coordination between patients’ primary care clinicians, specialists, social service providers, and behavioral health clinicians, ultimately leading to chronic disease prevention, fewer emergency room visits, and better health outcomes,” CMS said in its announcement about accepting applications. CMS also said its new MCP care approach communicates the agency’s vision for three domains: care management, care integration, and community engagement. For the second domain of care integration, CMS said participants will strengthen their connections with specialty care clinicians while using “evidence based behavioral health screening and evaluation to improve patient care and coordination.” CMS will accept applications through Thursday, Nov. 30, 2023 by 11:59 p.m. ET. Click here for more details and eligibility requirements.

Cassidy Seeks Information to Improve Americans’ Health Data Privacy

Senate Health, Education, Labor, and Pensions (HELP) Committee Ranking Member Sen. Bill Cassidy, M.D. (R-La.) on Thursday announced he’s seeking information from stakeholders about ways to improve the privacy protections of health data in a way that safeguards sensitive information while balancing the need to support medical research. According to a Senate HELP Committee announcement, Cassidy, an NABH Champion, hopes to use the stakeholder feedback to identify solutions to modernize HIPAA and ensure that all health data are safeguarded properly. The deadline to submit feedback is Thursday, Sept. 28. Click here to read Cassidy’s full request and here to submit comments.

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

CMS’ Medicare-Medicaid Coordination Office this week announced an upcoming webinar that will examine how traditional silos of care impede comprehensive approaches to care coordination and explore potential solutions to improve behavioral health condition management in persons with intellectual and developmental disabilities. Presenters include Andrea Witwer, Ph.D., associate clinical professor in psychiatry and behavioral health at Ohio State; family caregiver Patricia Nobbie, Ph.D.; and Olivia Ayers, LMCH, LPC, clinical director at Elevate Certified Community Behavioral Health Clinic in Iowa. The 90-minute webinar will be held on Wednesday, Sept. 27 starting at 2:30 p.m. ET. Click here to learn more and to register.

2023 NABH Membership Directory Update Deadline is Next Week!

The deadline for NABH system members to submit changes about their organizations for the 2023 NABH Directory is Wednesday, Sept. 13. NABH’s online-only 2023 Membership Directory is an essential member benefit that helps the association advance its advocacy efforts. Last month NABH sent system members a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use the link to verify your system’s information. The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all your system’s facilities to help provide NABH with an accurate picture of our membership. If you need assistance, please contact Maria Merlie maria@nabh.org or 202-393-6700, ext. 104.

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

Fact of the Week:

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

CEO Update 152

Written by Emily Wilkins (NABH) on September 1, 2023. Posted in CEO Updates.

Biden Highlights Parity in National Recovery Month Proclamation

Today kicks off National Recovery Month, a nationwide observance every September since 1989 to promote and support new evidence-based treatment and recovery practices, the nation’s recovery community, and the dedication of service providers and communities who make recovery in all its forms possible. In his proclamation on the annual observance, President Biden noted that drug overdoses last year took more than 100,000 American lives and that addressing the country’s substance use disorder (SUD) crisis is a core pillar of his Unity Agenda. “That work starts by fulfilling the promise of true parity for mental health and substance use disorder treatment for all Americans,” Biden said in the proclamation. “Mental health and substance use disorder care is healthcare. It is essential to people’s well-being — to their ability to lead full and productive lives, to find joy and meaning, to take care of themselves and their loved ones, and to give back to their communities and our nation,” he continued. “It is about dignity. Health insurers should cover it the same way they would cover treatment for a broken bone or any other kind of health condition. And since I took office, that is what we have been fighting to do.” Click here to access the Substance Abuse and Mental Health Services Administration (SAMHSA) National Recovery Month toolkit. And please remember to follow NABH @NABHBehavioral and on LinkedIn at the National Association for Behavioral Healthcare to read and share our social media posts about National Recovery Month.

Appellate Court Vacates Earlier Ruling in Wit v. UBH Case

A three-judge panel in the 9^th U.S. Circuit Court of Appeals last week vacated its prior holdings in the ongoing Wit v. United Behavioral Health (UBH) case for the second time and issued this opinion. NABH consultant Meiram Bendat, JD, Ph.D, founder and president of Psych Appeal, summarized the decision: “Essentially, the appellate court affirmed the trial court’s findings that UBH’s medical necessity guidelines were inconsistent with generally accepted standards of care (GASC), but also held that the trial court erred in holding that UBH’s plans required it to cover all services consistent with GASC,” Bendat wrote, adding, “The appellate court affirmed the trial court’s class certification order to allow the classes to pursue their breach of fiduciary duty claim. The trial court findings that UBH violated the laws of jurisdictions requiring the use of state-mandated criteria also remain undisturbed,” he continued. “The appellate court also walked away from its previous holdings that remand is not an available remedy under ERISA and that all absent class members must exhaust their administrative remedies prior to pursuing their claims in court.” Bendat added that—absent another petition for review—the case will be sent back to the trial court, which will likely again clarify that it based UBH’s liability on UBH’s deviation from GASC in its medical necessity guidelines, which were intended to implement the GASC requirement in the plans. The trial court is also expected to answer several other questions the 9th Circuit posed. “In short, plaintiffs are now in a far better position than they were last year,” Bendat wrote. “Hopefully, folks can appreciate how important it is to have laws like SB 855, which require medical necessity to be made consistent with GASC and which don’t vest plan administrators with discretion to adopt self-serving clinical guidelines with which to deny claims.”

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

HHS’ Health Resources and Services Administration (HRSA) announced Thursday more than $80 million in awards to rural communities in 39 states to support key strategies that respond to the overdose risk from fentanyl and other opioids. HRSA funding will support interventions such as distributing the lifesaving overdose reversal drug naloxone to prevent overdose; creating and expanding treatment sites in rural areas to provide medications to treat opioid use disorder; expanding access to behavioral health care for young people in rural communities; and, caring for infants in rural areas who are at-risk for opioid exposure or experiencing symptoms related to opioid exposure. Click here to learn more and here to see the list of awardees.

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

As part of Overdose Awareness Week and the start of National Recovery Month, SAMHSA this week announced $57.6 million in seven grant programs to connect Americans who misuse substances to recovery and treatment supports. According to SAMHSA, the grant awards facilitate ongoing efforts throughout the nation in treatment, recovery support and harm reduction – three of the pillars of the HHS’ Overdose Prevention Strategy. Click here to read about the grant programs.

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

SAMHSA has released Best Practices for Successful Reentry From Criminal Justice Settings for People Living With Mental Health Conditions and/or Substance Use Disorders, which examines the types of interventions that support successful reentry for adults with mental health conditions and/or substance use disorders who are leaving jail/prison. The 85-page guide includes an issue brief on the topic, current evidence on three interventions, guidance for identifying and implementing evidence-based practices to support reentry, and more.

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

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

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

NABH is developing its online-only 2023 Membership Directory, an essential member benefit that helps the association in its advocacy efforts. NABH has sent members a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use the link to verify your system’s information. The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all your system’s facilities so that we have a better picture of our membership. The deadline to submit your changes to NABH is Wednesday, Sept. 13. If you need assistance, please contact Maria Merlie maria@nabh.org or 202-393-6700, ext. 104. As always, thank you for your time and for all you do to advance NABH’s Mission and Vision!

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

Fact of the Week:

This summer Texas lawmakers enacted Tucker’s Law. which mandates that middle schools and high schools educate students about fentanyl abuse prevention and drug-poisoning awareness. NABH wishes its members, their teams, and families a happy and safe Labor Day weekend! For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 151

Written by Emily Wilkins (NABH) on August 25, 2023. Posted in CEO Updates.

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

NABH is developing its online-only 2023 Membership Directory, an essential member benefit that helps the association in its advocacy efforts. Earlier this week NABH sent members a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use the link to verify your system’s information. The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all your system’s facilities so that we have a better picture of our membership. The deadline to submit your changes to NABH is Wednesday, Sept. 13. If you need assistance, please contact Maria Merlie maria@nabh.org or 202-393-6700, ext. 104. As always, thank you for your time and for all you do to advance NABH’s Mission and Vision!

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

NABH Board Chair Harsh Trivedi, M.D., M.B.A. this week commented on behalf of the association about the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2023-2026 Strategic Plan. Released last week, the plan presents a new person-centered mission and vision and identifies the following five priority areas to better meet the behavioral health needs of individuals, communities, and service providers: Preventing Substance Use and Overdose, Enhancing Access to Suicide Prevention and Mental Health Services, Promoting Resilience and Emotional Health for Children, Youth and Families, Integrating Behavioral and Physical Health Care, and Strengthening the Behavioral Health Workforce. In a Behavioral Health Business article published Aug. 23, NABH Board Chair Trivedi supported the plan and emphasized access, behavioral-physical healthcare integration, and preventing substance use and overdose. “Substance use is a chronic disease. We do not penalize people when their blood sugar goes out of whack or when their blood pressure goes a little too high,” said Trivedi, president and CEO of Sheppard Pratt. “We really do have to think about substance use in a different manner, which is that it’s going to be something that people battle over time. We can’t let a slip up mean that you, essentially, are out of treatment, which is exactly what you wouldn’t do for any other medical condition.” NABH board member David White, Ph.D., CEO of BayMark Health Services in Lewisville, Texas, was also interviewed for the article and noted that the behavioral healthcare industry needs to see a comprehensive implementation plan. “This agenda is huge, complex, and high-level,” White said. “The strategy, in most cases, is spot on, but it’s a very heavy lift for the execution phase and requires lots of great people with great abilities to impact each and every area in the way outlined.”

National Quality Forum to Join Joint Commission as An Affiliate

The Joint Commission and National Quality Forum (NQF) announced on Aug. 16 that NQF will join The Joint Commission enterprise, maintaining its independence in convening and developing consensus-based measures, implementation guidance, and practices that benefit all stakeholders. The organizations said in an announcement that the affiliation allows The Joint Commission and NQF to build upon their shared expertise in measuring quality and rationalizing the measurement landscape so the focus shifts from competing measures to advancing key outcomes. In addition, the affiliation is intended to strengthen The Joint Commission’s national and international accreditation and certification processes to be more evidence-based, data-driven, and outcomes-oriented.

Cigna Removes Prior Authorization Requirement for 25% of Medical Services

Cigna Healthcare on Thursday announced it would remove nearly 25% of medical services from prior authorization (or precertification) requirements. With the removal of these more than 600 additional codes, Cigna Healthcare has now removed prior authorization on more than 1,100 medical services since 2020, with the goal of simplifying the healthcare experience for both customers and clinicians, Cigna said in an announcement. More information about Cigna Healthcare’s approach to prior authorizations is available here.

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

An Op-Ed published in the journal Health Affairs this week outlined five specific steps to address violence against nurses in the workplace, starting with enacting federal legislation to address workplace violence in healthcare, social service, and other sectors. Seven authors collaborated on the opinion piece, including several nursing school professors and one psychiatric mental health nurse practitioner at the University of New Mexico College of Nursing. “We write today, as psychiatric mental health nurses and workplace violence and nursing workforce researchers, to express our alarm: Our nurse colleagues aren’t safe at the bedside,” the authors wrote. “The American Psychiatric Nurses Association reports that fewer than two-thirds of nurses report feeling either safe or very safe at work. As nurses reported in last year in the National Plan for Health Workforce Well Being, violent injury of nursing staff by patients results in nurses’ short- and long-term disability, psychological stress, post-traumatic stress disorder, burnout, reduced quality of care, errors, and accidents.” In addition to federal legislation, other steps to address the issue include: emphasizing quality indicators that elevate efforts to protect staff from harm; strengthening data systems to better monitor worker exposure to aggressive events; improving reporting of workplace violence; and holding educational institutions accountable for teaching about quality and safety standards that protect nurses and staff from injury.

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

Earlier this month the Drug Enforcement Administration (DEA) and U.S. Food and Drug Administration (FDA) issued a joint letter updating the public about the ongoing prescription stimulant shortages affecting patients nationwide and actions to resolve these shortages. The DEA and FDA said both agencies are committed to working together on this issue and providing up-to-date information to the public. “The FDA and DEA do not manufacture drugs and cannot require a pharmaceutical company to make a drug, make more of a drug, or change the distribution of a drug,” FDA Commissioner Robert Califf, M.D. and DEA Administrator Anne Milgram wrote in the letter to the public. “That said, we are working closely with numerous manufacturers, agencies, and others in the supply chain to understand, prevent, and reduce the impact of these shortages. Click here to read the full letter.

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

Fact of the Week:

Half of parents say their child’s emotional and physical health has improved over the past year, according to a new Harris poll. Meanwhile, half also say their schools provide neither academic nor mental health counseling. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 150

Written by Emily Wilkins (NABH) on August 11, 2023. Posted in CEO Updates.

Federal Lawmakers Introduce Bipartisan Behavioral Health IT Legislation

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

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

“Robust, interoperable EHRs are a core clinical and operational tool to expand coordinated, high-quality care – and now we must ensure that all of our behavioral health providers have access to these vital IT systems,” Rep. Matsui said in an announcement about the bill. “Despite widespread recognition of the value of health IT, behavioral health providers do not have the resources to utilize these tools,” she added. “The Behavioral Health IT Coordination Act will bridge this gap and ensure we invest the necessary resources for widespread adoption throughout the behavioral health community.” Rep. Matsui originally co-authored H.R. 3331, a bill to promote testing of incentive payments for behavioral healthcare providers to adopt and use certified electronic health record technology. In 2018, Congress included this legislation as Section 6001 of the SUPPORT Act. The BHIT Coordination Act seeks dedicated funding to fulfill the objectives of her previous efforts.

DEA Revises Existing Regulations to Expand Access to OUD Treatment Medication

The U.S. Drug Enforcement Administration (DEA) this week issued a final rule pursuant to the Easy Medication Access and Treatment of Opioid Addiction Act (the Act) that revises existing regulations to expand access to medications for Opioid Use Disorder (OUD). The Act directed DEA to revise its regulation to allow practitioners to dispense not more than a three-day supply of narcotic drugs to one person for one person’s use at one time to initiate maintenance treatment, detoxification treatment, or both. SAMHSA Report Highlights Cost and Financing Strategies for Coordinated Specialty Care for First- Episode Psychosis SAMHSA has released Coordinated Specialty Care for First Episode Psychosis: Costs and Financing Strategies, which offers states financing strategies to provide critical services for first-episode psychosis. SAMHSA estimates 100,000 people in the United States experience first-episode psychosis. Coordinated Specialty Care, or CSC, is a multi-component, evidence-based, early intervention service for individuals experiencing a first episode of psychosis who can improve their quality of life and social and clinical outcomes. The new report provides an overview of the costs and outcomes of providing services for first episode psychosis and strategies for financing the services in different states.

FDA Recommends Minimum of Six Months for Pivotal OUD Device Trials

The U.S. Food and Drug Administration (FDA) has released guidance cautioning device makers developing products to treat OUD to proceed carefully as they design clinical studies, recommending pivotal trials last at least six months. “Appropriate study duration is necessary because OUD is a condition with a high rate of relapse, and brief intervals of modification of drug use are unlikely to confer significant clinical benefit,” the guidance noted. FDA Commissioner Robert Califf, M.D. said in a statement that the guidance should prompt industry to collect more comprehensive, timely, and diverse data to support device submissions that may help improve the lives of those with OUD. “These and similar efforts will continue to advance within the agency, with the input from industry, stakeholders, and, most importantly, those managing opioid use disorder,” Califf added. Public comments about the guidance are due by Thursday, Oct. 26.

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

Clinical-stage biotechnology company Cessation has announced the FDA has authorized the Chapel Hill, N.C.-based company to initiate a clinical trial this month for CSX-1004, a monoclonal antibody designed specifically to prevent fentanyl overdose. The clearance follows the FDA’s review and approval of Cessation’s Investigational New Drug (IND) application and serves as a launching point for Cessation’s first in-human clinical trials, according to the company’s announcement. Cessation’s IND summarized years of the company’s safety and manufacturing data and included a detailed description of the planned clinical study in humans. Cessation’s announcement said CSX-1004 works by sequestering fentanyl molecules as they enter the bloodstream, effectively neutralizing them in the blood before they reach the brain and preventing them from exerting their harmful effects.

Reminder: 2023 NABH Annual Meeting Photos Now Available

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

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

CEO Update During the Congressional August Recess

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

Fact of the Week:

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

CEO Update 149

Written by Emily Wilkins (NABH) on July 28, 2023. Posted in CEO Updates.

CMS Releases FY 2024 IPF PPS Final Rule

The Centers for Medicare & Medicaid Services (CMS) on Thursday released its Fiscal Year (FY) 2024 Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) final rule. NABH’s Position While the final rule includes many NABH priorities, we remain concerned that it does not go far enough to account for the cost pressures IPFs face. The NABH team will meet with CMS to discuss the field’s health information technology and other obstacles that will greatly hinder compliance with the quality measures (QMs) to be added to the inpatient psychiatric facility quality reporting program (IPFQRP). Final Payment Update The rule finalizes a net increase in Medicare FY 2024 payments to IPFs of 2.3%, or $70 million, relative to FY 2023. While the agency’s final FY 2023 payment update is larger than the proposed rule’s 1.9% increase, NABH will continue to push policymakers to recognize fully the high costs that our members face. The FY 2024 update includes increases in the federal per-diem base rate to $895.63 from $865.63, and in the outlier threshold to $33,470 from $24,630, which will reduce the number of cases that qualify for an outlier payment. Updated IPF Marketbasket: The rule also finalizes CMS’ proposal to rebase and revise the IPF marketbasket using more recent cost report data from 2021 in place of 2016 data. Streamlined Process for Opening New IPF Units: The rule will allow new IPF units to open and begin billing Medicare at any time during its cost reporting year, following a 30-day advance notice. Final Updates to IPFQRP The final rule implements four new QMs and a data validation pilot, among other changes. The new QMs include these three QMs related to health equity and social drivers of health:

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

The new data validation pilot program will begin data collection in FY 2025. While NABH supported the general concept of this pilot, we urged CMS to postpone it because the field is currently focused on its first year of submitting patient-level quality data. Because the agency is moving forward, we will continue to emphasize that the pilot is too much, too fast. More information on these IPFQRP updates can be found in the NABH comment letter on this rule, as well as the final rule text using the link above.

HHS, DOL and Treasury Release Proposed Rules to Strengthen MHPAEA

The U.S. Health and Human Services (HHS), Labor (DOL), and Treasury Departments on Tuesday released proposed rules to bolster the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 and remove obstacles to behavioral healthcare access. The rules propose several amendments to the 2013 MHPAEA final regulations, as well as provisions that would establish the content requirements of the Non-Qualitative Treatment Limitations, or NQTL, comparative analyses required under amendments to MHPAEA included in the Consolidated Appropriations Act, 2021 (CAA, 2021). “In evaluating their compliance with these proposed rules, plans and issuers would be required to consider whether an NQTL is inhibiting access to treatment for mental health conditions and substance use disorders by examining whether the NQTL that applies to mental health or substance use disorder benefits is more restrictive than the predominant NQTL that applies to substantially all medical/surgical benefits within a classification of benefits set forth under the regulations,” the guidance noted. Meanwhile, the guidance said a plan or issuer would also be required to consider whether the processes, strategies, evidentiary standards, or other factors that it uses to design or apply an NQTL to mental health or substance use disorder benefits in a classification are comparable to, and applied no more stringently than, those used in designing and applying the NQTL to medical/surgical benefits in the same classification. The three departments also released a Technical Release on NQTLs that outlines principles and seeks public comment to inform future technical guidance about the application of proposed data collection and evaluation requirements to NQTLs related to network composition that the rule proposes. Along with the proposed rules, the departments released the 2023 MHPAEA Comparative Analysis Report to Congress that the CAA, 2021 requires. The report includes information about the agencies’ enforcement efforts and identifies plans and issuers that received final determinations of non-compliance with MHPAEA. The White House released a fact sheet about the rule and DOL’s Employee Benefits Security Administration posted all the related documents here. NABH is a member of the CEO Alliance on Mental Health, which released a statement about the guidance this week. “The Biden Administration, along with bipartisan leadership in Congress, has made great progress in increasing access to comprehensive mental health and substance use care, including expanding the Certified Community Behavioral Health Clinic (CCBHC) model, improving crisis services and suicide prevention, and addressing youth mental health,” the Alliance statement said. “However, more work is needed to ensure everyone can access high quality care as early as possible, so we thank President Biden for this focus on improving parity.” CMS will accept comments until 60 days after the rules are published in the Federal Register. NABH will seek feedback from members and submit comments about the proposed rules and Technical Release.

CMS Releases Ligature Risk Guidance

CMS has released guidance to state survey directors about ligature risk and assessment in hospitals. The agency’s guidance centers around three main elements CMS said hospitals should consider when ensuring patient safety related to ligature risk: patient assessment, staffing/monitoring, and environmental risk. “Based on their clinical evaluation, some patients may require both a more restrictive environment and an increased level of monitoring than other patients,” the guidance noted. “Therefore, it is not expected that hospitals have the same ligature risk configuration throughout their facility, but rather focus on the specific needs and risks of individual patients, based on their clinical or psychiatric assessment,” it continued. “Similarly, corrective actions implemented in response to deficiencies or adverse events should focus on appropriately addressing the findings or failures, rather than universal remedies.” The changes are effective 30 days from when CMS released the memorandum on July 17. Please send any questions to QSOG_Hospital@cms.hhs.gov.

Reminder: DEA Registration Training Requirement for Buprenorphine Prescribing

Early this year SAMSHA announced that clinicians no longer need a federal waiver to prescribe buprenorphine to treat opioid use disorder; however, clinicians must still register with the U.S. Drug Enforcement Agency (DEA) to prescribe controlled medications. In late June, the DEA announced that both new and renewing applicants must complete a new, one-time, eight-hour training course. Exceptions for the training requirement are practitioners who are board-certified in addiction medicine or addiction psychiatry, and those who graduated from a medical, dental, physician assistant, or advanced practice nursing school in the United States within five years of June 27, 2023. Click here to learn more about the training.

2023 NABH Annual Meeting Photos Now Available

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

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

CEO Update During the Congressional August Recess

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

Fact of the Week:

A new study published in Psychiatric Services reports disruptions in opioid use disorder outpatient and medications for opioid use disorder were marginal during the pandemic, possibly because of increased telehealth services. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 148

Written by Emily Wilkins (NABH) on July 21, 2023. Posted in CEO Updates.

House Energy and Commerce Committee Passes SUPPORT Act Reauthorization Bill

The House Energy and Commerce Committee this week voted unanimously to pass the SUPPORT for Patients and Communities Reauthorization Act (SUPPORT), which would renew programs from the 2018 law that would otherwise expire at the end of September. “Today’s SUPPORT Act reauthorization includes a number of key bipartisan wins, including agreements on lifting the IMD exclusion, helping people in our criminal justice system, and caring for foster youth in need,” House Energy and Commerce Committee Chair Cathy McMorris Rodgers said in a statement after the committee passed the bill on Wednesday. Rep. Michael Burgess, M.D. (R-Texas) sponsored a bill included in the reauthorization act to remove the decades-old Institutions for Mental Diseases (IMD) exclusion. “It is no longer the 1960s and there is no longer the same stigma against the treatment of mental health,” Burgess told the news outlet Politico. Burgess also pushed for boosting the healthcare workforce and supporting providers “to ensure that mental health and substance use patients have access to personalized care, personalized medicine.” The legislation also includes a provision that would allow federal funding to pay for test strips that can detect drugs such as fentanyl and the animal tranquilizer xylazine that drug dealers often mix with it. House lawmakers could vote on the measure before they leave Washington for Congress’ August recess. NABH will keep members apprised of developments.

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

U.S. Health and Human Services Department (HHS) Secretary Xavier Becerra and Substance Abuse and Mental Health Services Administration (SAMHSA) Assistant Secretary Miriam Delphin-Rittmon will host a 988 Lifeline anniversary stakeholder webinar today, Friday, July 21 at 1 p.m. ET. Other Biden administration officials will join the event, which commemorates one year since the 988 Suicide and Crisis Lifeline launched. The webinar will last 30 minutes. Click here to register.

NABH Supports Bowman Family Foundation Report on Equitable Access

NABH supports the Bowman Family Foundation’s new report, Equitable Access to Mental Health and Substance Use Care: An Urgent Need, which examines strategies for bridging the gap in access to mental health and substance use care. The 33-page report found that 57% of patients sought mental health or substance use care but did not receive any care in at least one case, compared with 32% of patients seeking physical healthcare. For children and teens under 18 (defined here as “adolescents”), the “care not received” figure was 69% for mental health or substance use compared with 17% for physical health (see Figure 2 on p. 11 of the report). Meanwhile, 80% of patients in employer-sponsored health plans who received outpatient care from at least one out-of-network mental health or substance use provider said they went to out-of-network providers “all of the time,” compared with 6% of patients who said the same for physical healthcare. NABH strongly supports the report’s recommendation for the Departments of Labor, Health and Human Services, and the Treasury to issue additional guidance on detailed templates for MHPAEA compliance data reporting to employer group plans, third party administrators, and insurance issuers that indicates what data they should be prepared to submit upon request.

SAMHSA Seeking Comments on Harm Reduction Framework Draft

SAMHSA is seeking public comment on a draft of the agency’s Harm Reduction Framework, which is intended to inform SAMHSA’s harm-reduction activities as well as all related policies, programs, and practices. Comments are due by Monday, Aug. 14 at 5 p.m. ET.

SAMHSA Releases Advisory on Digital Therapeutics in Behavioral Health

SAMHSA this week released Digital Therapeutics for Management and Treatment in Behavioral Health, which describes the research, regulatory, and reimbursement implications for digital therapeutics, including those by various federal agencies. The advisory also maps out selection and implementation considerations for payers and providers and addresses issues related to equitable access to behavioral healthcare.

Kaiser Family Foundation Examines Federal Policy for SUD Treatment

A new Kaiser Family Foundation analysis found that 24% more buprenorphine was dispensed in 2022 than in 2019, the year before the COVID-19 global pandemic. Health policy researchers examined five essential federal policies governing SUD treatment, the changes they have undergone during the pandemic, and the implications for access and treatment to opioid use disorder. Click here to read the brief analysis.

Reminder: DEA Registration Training Requirement for Buprenorphine Prescribing

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

Fact of the Week:

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

CEO Update 147

Written by Emily Wilkins (NABH) on July 14, 2023. Posted in CEO Updates.

CMS Proposes to Expand Behavioral Healthcare Access in 2024 OPPS Rule

The Centers for Medicare & Medicaid Services (CMS) on Friday proposed expanding access to behavioral healthcare services through coverage of intensive outpatient services. Currently, Medicare covers and pays for various behavioral healthcare services, including inpatient psychiatric hospitalizations, partial hospitalizations services, and outpatient therapeutic services; however, there is a gap in coverage when Medicare beneficiaries require levels of services more frequent than individual outpatient therapy visits, but less intensive than a partial hospitalization program. The agency’s 2024 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule includes proposals to implement provisions of the Consolidated Appropriations Act, 2023 (CAA, 2023) that created a new benefit category for Intensive Outpatient Program (IOP) services. CMS proposed to establish payment and program requirements for the benefit across various settings, including hospital outpatient departments, Community Mental Health Centers (CMHCs), Federally Qualified Health Centers (FQHCs), and Rural Health Clinics (RHCs) effective Jan. 1, 2024. CMS also proposed to establish payment for IOP services provided by Opioid Treatment Programs (OTPs) effective Jan. 1, 2024, and is clarifying that these intensive behavioral healthcare services are available for individuals with mental health conditions and for individuals with substance use disorders. “This proposed rule reflects CMS’ commitment to ensure Medicare is comprehensive in its ability to address patient needs, filling gaps in the health care system including behavioral health,” Meena Seshamani, M.D., deputy administrator and director for CMS’ Center for Medicare, said in a news release. “Through these proposals, we will ensure people get timely access to quality care in their communities, leading to improved outcomes and better health.” CMS provided the following details about the scope of benefits for IOP and its proposals for each setting: Scope of Benefits for IOP: CMS proposed a scope of benefits for IOP services that the CAA, 2023 mandates. The agency noted an IOP is a distinct and organized outpatient program of psychiatric services provided for individuals who have an acute mental illness or substance use disorder, consisting of a specified group of behavioral healthcare services paid on a per-diem basis under the OPPS or other applicable payment system when furnished in hospital outpatient departments, CMHCs, FQHCs and RHCs. CMS proposed to base the per-diem costs of items and services included in IOP that have been, and are, paid for by Medicare either as part of the PHP benefit or under the OPPS more generally. Physician Certification and Plan of Treatment Requirements for IOP: The CAA, 2023 requires that a physician determine that each patient needs a minimum of nine hours of IOP services per week, and this determination must occur no less frequently than every other month. CMS proposes to codify this requirement in regulation for IOP provided in all settings and is soliciting comments on the recertification period. IOP Payment Rates and Policy in Hospital Outpatient Departments and CMHCs: CMS proposed to establish two IOP ambulatory payment classifications for each provider type: one for days with three services per day and one for days with four or more services per day. For CY 2024, CMS proposed to calculate hospital-based and CMHC IOP payment rates for three services per day and four or more services per day based on cost per day using a broader set of OPPS data that includes PHP days and non-PHP days. CMS noted that while no Medicare IOP benefit currently exists, the agency believes using the broader OPPS data set would allow us to capture data from hospital claims that are not identified as IOP, but that include the service codes and intensity required for an IOP day. Opioid Treatment Program (OTP) Settings: CMS proposed to extend IOP coverage to include OTPs. The agency also proposed to establish a weekly payment adjustment via an add-on code for IOP services furnished by OTPs for the treatment of opioid use disorder (OUD) and to revise the definition of OUD treatment services to include IOP services. The payment adjustment would also be updated based on the Medicare Economic Index and receive the Geographic Adjustment Factor if finalized. CMS proposed that Medicare would pay for IOP services that OTPs provide as long as each service is medically reasonable and necessary, and not duplicative of any service paid for under any bundled payments billed for an episode of care in a given week. For an OTP to receive the additional payment adjustment for IOP services, a physician must certify that the beneficiary requires a higher level of care intensity compared to existing OTP services, and the certification, plan of care, and all other applicable requirements are met. CMS said it believes that payment for IOP services that OTPs provide would improve continuity of care between different treatment settings and levels of care, expand access to treatment for Medicare beneficiaries with an OUD and further promote health equity for racial/ethnic populations and older beneficiaries. RHCs and FQHCs: For CY 2024, CMS proposed to make conforming regulatory text changes to applicable RHC and FQHC regulations related to the scope of IOP benefits and services, certification and plan of care requirements, and special payment rules for IOP services as the CAA, 2023 mandates. The scope of IOP benefits and certification and plan of care requirements will be the same for RHCs and FQHCs as described above for hospitals. CMS proposed to pay for three IOP services/day, and according to the statute, payment is based on the hospital rate. This means RHCs would be paid the three-services per day payment amount for hospital outpatient departments. For FQHCs, payment would be the lesser of a FQHC’s actual charges or the three-services per day payment amount for hospital outpatient departments. For grandfathered tribal FQHCs, payment would be the Medicare outpatient per visit rate as the Indian Health Service has established when furnishing IOP services, and payment is based on the lesser of a grandfathered tribal FQHC’s actual charges or the Medicare outpatient per-visit rate. Regarding OPPS payment rates, CMS proposed updating OPPS payment rates for hospitals by 2.8%. This update is based on the projected hospital market basket percentage increase of 3.0%, reduced by a 0.2 percentage point for the productivity adjustment.

CMS Includes Behavioral Healthcare Provisions in Proposed 2024 Physician Fee Schedule

CMS on Thursday included a provision to extend OTP periodic assessment flexibilities via audio-only telehealth through the end of 2024 in the agency’s proposed 2024 Physician Fee Schedule rule. CMS noted it will continue to consider the value of extending this flexibility permanently. For mental healthcare, the agency’s proposed rule included implementing the CAA, 2023’s requirements that marriage and family therapists (MFTs) and mental health counselors (MHCs) can bill through the Medicare program. The agency also proposed HCPCS codes for crisis psychotherapy services, and proposed permitting Behavior Assessments and Intervention to be performed and billed by clinical social workers, MFTs and MHCs. Increases for timed PFS behavioral health services will be implemented over four years, according to CMS.

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

This week the Biden administration announced it has added Spanish text and chat services as well as specialized services for LGBTQI+ youth and young adults to the nation’s 988 Suicide & Crisis Lifeline following a successful pilot test. This Sunday marks the one-year anniversary of 988’s launch, and the Biden administration reports the Lifeline has answered nearly 5 million contacts in the past year—2 million more than were received in the previous 12 months—following a $1 billion investment from the administration. Meanwhile, in June the National Alliance on Mental Illness (NAMI) released its 988 Suicide & Crisis Lifeline Tracker that found familiarity with 988 remains low despite increasing overall awareness since it launched last July. NAMI found that 63% of Americans report at least hearing something about 988, up 19% percentage points since September 2022 and up 41 percentage points since May 2022. Still, only 17% of Americans say they are very or somewhat familiar with it, while only 4% say they are very familiar with it. The study also found Americans 49 and under are more likely than older Americans to report having heard of 988, and LGBTQ+ Americans are twice as likely to say they are familiar with it than non-LGBTQ+ Americans.

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

The White House Office of National Drug Control Policy this week released a national response plan to combat the dangerous and deadly combination of xylazine mixed with fentanyl. Earlier this year, the Biden administration used its executive designation authority for the first time when it declared xylazine mixed with fentanyl as an emerging threat in the United States. “Since we announced the emerging drug threat earlier this year, we’ve been working tirelessly to create the best plan of attack to address this dangerous and deadly substance head-on,” Rahul Gupta, M.D., director of the White House Office of National Drug Control Policy (ONDCP), said in an announcement. “Now, with this National Response Plan, we are launching coordinated efforts across all of government to ensure we are using every lever we have to protect public health and public safety and save lives.” The plan outlines action steps and key responsibilities for departments and agencies across the federal government and directs them to develop and submit an Implementation Report to the White House in 60 days. As required by statute in the SUPPORT Act and the Criteria for Designating Evolving and Emerging Drug Threats (Dir. No. 2022-002), the national response plan’s goal is to terminate fentanyl combined with xylazine as an emerging threat. This will require a 15% reduction (compared with 2022 as the baseline year) of xylazine positive drug poisoning deaths in at least three of four U.S. census regions by 2025.

NABH Members Highlight Behavioral Health EMR Gap in Health Affairs Commentary

A recent Health Affairs commentary explores the 2009 HITECH Act’s failure to include behavioral healthcare providers in its $19 billion of meaningful use incentives and the resulting lag in electronic medical record (EMR) adoption in the behavioral healthcare segment. “There was no clear rationale for this exclusion beyond implicit prioritization of physical health over mental health in the competition for funding dollars. And this disparity continues to this day,” wrote the article’s authors William Shrank, M.D., Christopher Hunter, M.B.A., and Andrew Lynch, Ph.D., adding that EMR use has exceeded 95% since 2014 but only 6% of outpatient behavioral healthcare facilities and 29% of substance use disorder treatment centers use EMRs. Shrank is a venture partner at Andreeseen Horowitz; Hunter is CEO at NABH member Acadia Healthcare, and Lynch serves as Acadia’s chief strategy officer. The article reviews earlier legislative attempts to bridge the EMR gap, including the bill Rep. Doris Matsui (D-Calif.) introduced last year.

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

The Health Resources and Services Administration has announced that the Provider Relief Fund (PRF) Reporting Portal is now open for Reporting Period 5. Recipients who received one or more General Distribution, Targeted Distribution, or ARP Rural Distribution payments exceeding $10,000, in the aggregate, from Jan. 1, 2022 to June 30, 2022 are required to report on the use of their payments during Reporting Period 5. This latest reporting period will close at 11:59 p.m. ET on Sept. 30, 2023. Click here to learn more.

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

If you missed the 2023 Annual Meeting, be sure to access the workforce resources that the NABH Education and Research Foundation featured at the meeting and are available on the Foundation’s Resources page. First, watch speaker John Pallasch’s presentation and listen to the question-and-answer period from NABH members. Pallasch, founder and CEO of workforce consultancy One Workforce Solutions, served previously as the Senate-confirmed assistant secretary for employment and training at the U.S. Labor Department. Pallasch’s presentation challenged attendees to think beyond recruitment and retention and instead focus on re-designing the U.S. workforce system. He offered practical ideas for how NABH members can get involved in this process. Also be sure to use the workforce resource guide that the Foundation co-branded with One Workforce Solutions. The guide includes links to state workforce agencies, workforce development boards, and more.

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

Fact of the Week:

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

CEO Update 146

Written by Emily Wilkins (NABH) on July 7, 2023. Posted in CEO Updates.

Provider Relief Fund Reporting Portal Now Open for Period 5

NIH Research Shows Lack of Buprenorphine for Adolescents in RTFs

Only one in four residential treatment facilities that treat adolescents in the United States for opioid use disorder offer buprenorphine, the sole U.S. Food and Drug Administration-approved medication for 16- to 18-year-olds, the National Institutes of Health (NIH) reports. An NIH-funded research team identified 354 facilities nationwide that offered treatment for substance use in a residential treatment setting for people aged 17 and younger. Researchers called each facility to inquire about the treatments offered, and, in each case, a researcher posed as the relative of a 16-year-old with a recent, non-fatal fentanyl overdose. They found that 160 of these facilities, or 45%, provided residential treatment to patients younger than 18 years old. Of the facilities that treated adolescents, only 39, or less than 25%, offered buprenorphine to 16- to 18-year-old patients. In contrast, almost two-thirds of adult residential facilities offer buprenorphine. The likelihood of offering buprenorphine varied by region, from 40% in the Northeast to 18% in the West, the NIH reports. Meanwhile, the situations in which facilities offered buprenorphine also varied. Only 20 facilities—or one in eight—offered buprenorphine for ongoing treatment, and 12 offered it to patients younger than 16. “These residential treatment centers see some of the most vulnerable adolescents in our communities,” lead researcher Caroline King, M.P.H., and an M.D./Ph.D. student in the Oregon Health & Science University School of Medicine, said in an NIH announcement about the findings. “But they don’t offer the standard of care for these kids. With rising fentanyl-related overdoses among adolescents, we really need these centers to provide the best care.”

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

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

Fact of the Week:

New antitransgender legislation passed in several U.S. states is raising concern among psychologists about the effect on the mental health of trans individuals—in particular children and teens—as well as members of the LGBTQ+ community, the American Psychological Association reports. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 145

Written by Emily Wilkins (NABH) on June 30, 2023. Posted in CEO Updates.

MedPAC Report to Congress Analyzes Behavioral Health Services and Patients

In its annual report to Congress last week, the Medicare Payment Advisory Commission (MedPAC) examined behavioral health services covered under Medicare’s inpatient and outpatient prospective payments systems and physician fee schedule. The 76-page report’s behavioral health chapter addresses Medicare beneficiaries’ service utilization patterns, Medicare spending trends to providers and clinicians, and payment adequacy and margins. Regarding access, the report notes a drop in inpatient psychiatric facility (IPF) patient volume from 2019 through 2021 (the most recent data evaluated) due to the COVID-19 pandemic. Meanwhile, during the same period, the occupancy rates grew in government IPFs—an indicator of service shortages for patients with severe mental illness. Concerning the 2021 acuity level of IPF patients relative to beneficiaries in other settings, IPF patients were 3.5 times more likely to be disabled and 2.4 times more likely to have low-income status (eligible for Part D low-income subsidy or dually-qualified for Medicare and Medicaid), metrics used as proxy indicators of acuity, according to the report. For telehealth, among other findings, MedPAC cited the widely recognized increased use in telehealth services for behavioral health patients, which grew to 28% in 2021 from 1% of Part B behavioral health services in 2019. MedPAC recommends gathering more information to assess the alignment between payments and the cost of care for ancillary and other behavioral health services, as well as additional data about patient-level outcomes. These additional data would be used to better understand variation in Medicare margins across IPF facility types, including differences due to scale and the mix of patients in different IPFs. The report also provides data on service utilization for patients affected by the Medicare’s 190-day-limit policy.

DOJ Releases Guidelines for Managing Substance Withdrawal in Jails

The U.S. Justice Department’s (DOJ) Bureau of Justice Assistance and the National Institute of Corrections this week released Guidelines for Managing Substance Withdrawal in Jails: A Tool for Local Government Officials, Jail Administrators, Correctional Officers, and Health Care Professionals. In an announcement, DOJ said the document supports the department’s commitment to increasing access to evidence-based treatment for individuals with SUDs and those at risk for overdose, including individuals who are incarcerated or reentering their communities. “These guidelines are a critical and much-needed resource to support local government officials, jail administrators, correctional officers and healthcare professionals faced with the difficult task of managing substance withdrawal in jail settings,” Associate Attorney General Vanita Gupta said in a statement. “Providing this new, evidence-based tool and treatment guidance, developed by a committee of clinical and correctional experts, will better safeguard the health and well-being of individuals at risk for or experiencing substance withdrawal in jails.”

DEA Now Requires One-Time Training for Buprenorphine Prescribing

Starting this week, the Drug Enforcement Agency (DEA) requires clinicians who register to prescribe controlled medications to complete a new, one-time, eight-hour training. In January, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced clinicians no longer need a federal waiver to prescribe buprenorphine to treat opioid use disorder. Instead, the DEA now requires all clinicians prescribing any controlled substance to complete a one-time training. Exceptions for the training requirement include practitioners who are board-certified in addiction medicine or addiction psychiatry, and those who graduated from a medical, dental, physician assistant, or advanced practice nursing school in the United States within five years of June 23, 2023. In addition, Rural Health Clinics (RHCs) will have the opportunity to apply for a $3,000 payment on behalf of each provider who received buprenorphine waiver training between Jan. 1, 2019 and Jan. 25, 2023 (when Congress eliminated the waiver requirement). According to the Health Resources and Services Administration, about $900,000 in program funding remains available for RHCs and will be paid on a first-come, first-served basis.

The International Certification and Reciprocity Adopts SAMHSA’s National Model Standards for Peers

The International Certification and Reciprocity Consortium (IC&RC) has announced it has adopted SAMHSA’s National Model Standards for Peer Support Certification in the form of a new credential. In an announcement, the IC&RC said this national entry-level peer credential is intended to be the first rung of a career ladder that will lead to stronger substance use disorder (SUD) workforce development that is needed greatly nationwide. The IC&RC is the first—and currently only—nationally recognized, peer-certification organization to adopt the standards.

FDA Publishes First Draft Guidance on Psychedelic Drug Trials

The U.S. Food and Drug Administration (FDA) has published its first draft guidance on clinical trials for psychedelic drugs as research on using psychedelic drugs to treat conditions such as depression and post-traumatic stress disorder increases. In an announcement, FDA noted that developing psychedelic drugs poses several challenges, including minimizing the risk of the drugs being misused and addressing the role that psychotherapy plays in psychedelic drug administration. “By publishing this draft guidance, the FDA hopes to outline the challenges inherent in designing psychedelic drug development programs and provide information on how to address these challenges,” Tiffany Farchione, director of the division of psychiatry in FDA’s drug center, said in a news release. “The goal is to help researchers design studies that will yield interpretable results that will be capable of supporting future drug applications.”

GAO Examines Behavioral Healthcare Services in Critical Access Hospitals

A new Government Accountability Office (GAO) study of 10 critical access hospitals (CAHs) found that these providers offered behavioral healthcare services in a variety of ways in various settings, including emergency departments, inpatient services, and outpatient services. Unlike other hospitals, under Medicare fee-for-service, CAHs are paid based on the cost of providing services in most, but not all, care settings. GAO researchers received mixed views on how Medicare fee-for-service payment policies affect CAHs’ ability to provide behavioral healthcare services in various settings that are not paid solely based on cost. GAO said officials from multiple CAHs and stakeholders said factors outside Medicare were “substantial challenges” to their ability to provide behavioral healthcare services and patients’ access to these services. “Hiring and recruitment of behavioral health professionals, such as psychiatrists and licensed clinical social workers, was cited as one of their biggest challenges due to nationwide workforce shortages,” the study said. “In addition, they said shortages of inpatient psychiatric beds made it difficult to find inpatient treatment for their patients,” the study continued, adding that patients were sometimes stuck in an emergency department for several days waiting to be transferred to an open psychiatric bed elsewhere in their community or state.

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

Fact of the Week:

The two most common mental disorders among adults aged 18 to 65 were major depressive disorder (15.5%, or about 31.4 million adults) and generalized anxiety disorder (10%, or about 20.2 million adults), according to the SAMHSA-funded Mental and Substance Use Disorders Prevalence Study from RTI International. The NABH team wishes all its members, their teams, and their families a safe and happy Independence Weekend! For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 144

Written by Emily Wilkins (NABH) on June 30, 2023. Posted in CEO Updates.

2023 NABH Annual Meeting Presentations Now Available

Earlier this week NABH posted all 2023 Annual Meeting presentations for which the association has received permission to share publicly. Please remember to save the date for next year’s Annual Meeting: May 13-15, 2024 at the Salamander Washington, DC. We look forward to seeing you then!

We Want Your Opinion: Please Submit Your 2023 Annual Meeting Evaluation!

NABH welcomes your feedback on the 2023 Annual Meeting held in Washington, D.C. last week. If you attended this year’s Annual Meeting, please take a moment to complete NABH’s 10-question evaluation form if you have not done so already. Your comments help to inform future NABH Annual Meetings. Thank you for your time!

SAMHSA Releases Resource on Findings from Drug-Related ED Visits in 2022

Alcohol was reported in the highest percentage of drug-related emergency department (ED) visits (45.0%) in 2022, followed by opioids (12.7%) and cannabis (11.9%), according to data from the Drug Abuse Warning Network (DAWN): Findings from Drug-Related Emergency Department Visits, 2022 that the Substance Abuse and Mental Health Services Administration (SAMHSA) released this week. DAWN is a nationwide public health surveillance system that captures data on ED visits related to recent substance use directly from the electronic health records of participating hospitals. In 2022, DAWN identified 143,596 (unweighted) drug-related ED visits from 53 participating hospitals. These data were analyzed to generate 1) nationally representative weighted estimates for all drug-related ED visits, 2) the top drugs involved in drug-related ED visits, 3) for different opioid types involved in ED visits, 4) to describe polysubstance in ED visits, and 5) to identify newly mentioned drugs in 2022. The analysis for 2022 also showed heroin (5.6%) and prescription or other opioid (5.0%) were reported more often than fentanyl (2.7%) in drug-related ED visits.

CDC: Nearly One in Five U.S. Adults Report Having Ever Been Diagnosed with Depression

Data from the Centers for Disease Control and Prevention (CDC) show nearly one in five U.S. adults reported having ever been diagnosed with depression, although the rate – averaging at 18.4% in 2020 –varies significantly by state and county. State-level, age-standardized estimates ranged from 12.7% in Hawaii to 27.5% in West Virginia. Meanwhile, model-based, age-standardized, county-level prevalence estimates ranged from 10.7% to 31.9%, and there was considerable state-level and county-level variability. The CDC notes decisionmakers can use these estimates to guide resource allocation to areas where the need is greatest, possibly by implementing recommendations from The Guide to Community Preventive Services Task Force and SAMHSA.

NIH Study Deepens Understanding of Possible Mechanism Through Which Xylazine Affects Overdose Risk

A new study in rats suggests that xylazine, the active ingredient in a non-opioid veterinary tranquilizer not approved for human use, can worsen the life-threatening effects of opioids. Published in Psychopharmacology, the study’s findings imply that when used in combination with opioid drugs such as fentanyl and heroin, xylazine may damage the ability of the brain to get enough oxygen, one of the most dangerous effects of opioid drugs that can lead to death. Research has shown xylazine is often added to illicit opioids, including fentanyl, and that xylazine has been increasingly detected in the illicit opioid supply. “Drug mixtures containing both xylazine and opioids such as fentanyl demonstrate how rapidly the drug supply can change, and how dangerous products can proliferate despite rampant overdose deaths,” Nora Volkow, M.D, director of the National Institute on Drug Abuse – which led the study – said in a statement about the study. “Understanding the mechanisms behind how xylazine contributes to drug overdoses is essential to enable us to develop interventions that can reverse overdoses and save lives,” she continued. “In the meantime, naloxone, an opioid overdose reversal medication, should always be administered in the event of an overdose because xylazine is most often combined with opioids such as fentanyl.”

Fact of the Week:

Men had a two-to-three times greater rate of overdose mortality from opioids – such as fentanyl and heroin – and psychostimulants –such as methamphetamine and cocaine – than women, according to a new study published in Neuropsychopharmacology. For questions about CEO Update, please contact Jessica Zigmond.

CEO Update 143

Written by Emily Wilkins (NABH) on June 9, 2023. Posted in CEO Updates.

2023 NABH Annual Meeting Starts Monday!

We’re pleased to devote this week’s edition of CEO Update to details about the 2023 Annual Meeting that starts on Monday, June 12 in Washington, D.C. This year’s Annual Meeting celebrates two important milestones for NABH: the association’s 90^th anniversary and the 15^th anniversary of the Mental Health Parity and Addiction Equity Act (MHPAEA). We’re eager to remind our members of the many ways the behavioral healthcare community has helped change the U.S. healthcare system, and, in turn, helped improve and save lives in the last nine decades. Mostly, though, we’re looking ahead. This year’s Annual Meeting theme – Securing the Promise of Parity – is a call to action for the work that remains to ensure MHPAEA is implemented fully and fairly. NABH is pleased to welcome HHS Secretary Xavier Becerra, J.D. on Monday, and you also won’t want to miss our parity panel with NABH President and CEO Shawn Coughlin, U.S. Labor Department Assistant Secretary for Employee Benefits Security Lisa Gomez, and former U.S. Rep. Patrick Kennedy (D-R.I.), founder of The Kennedy Forum, on Tuesday. We’ll conclude our meeting on Wednesday with Sen. Chris Murphy (D-Conn.), who will address attendees at this year’s policy breakfast. Details about these and other sessions and events follow below. To prepare for the meeting, view our preliminary program, learn more about this year’s speakers, and see our list of exhibitors and sponsors.

Be Sure to Access the 2023 NABH Annual Meeting Mobile App

Again this year, attendees will have access to all Annual Meeting programming and materials through NABH’s online mobile app. On Monday, June 12, NABH will send all attendees an Annual Meeting alert with a link to the app that will display important details about sessions, events, exhibitors and sponsors, our 2023 advocacy priorities, restaurant recommendations in the Washington area, and more. Attendees can also access the link through a QR code near the Registration Desk at the meeting.

HHS Secretary Becerra to Kick Off Annual Meeting

HHS Secretary Xavier Becerra, the 25^th secretary of the U.S. Health and Human Services Department and the first Latino to hold that office, will open this year’s Annual Meeting on Monday, June 12 at 2:15 p.m. in the Salamander hotel’s Grand Ballroom. Secretary Becerra will offer brief remarks and then engage in a question-and-answer session with 2023 NABH Board Chair Harsh Trivedi, M.D., M.B.A., president and CEO of Sheppard Pratt. Previously Secretary Becerra was California’s attorney general and before that served for 12 terms in the U.S. House of Representatives, where he was the first Latino to serve as a member of the powerful House Ways and Means Committee. He also served as chairman of his party’s caucus and as the ranking member of both the Ways and Means Subcommittee on Health and Ways and Means Subcommittee on Social Security. Please join us in welcoming him and be sure to stay for additional remarks from NABH Board Chair Trivedi, who will introduce a brief video commemorating our 90 years as an advocacy association.

Monday’s General Sessions to Examine Workforce Challenges and Potential Solutions

Following Monday’s opening session, NABH will present back-to-back sessions that will examine current behavioral healthcare workforce challenges and how to address them. At 3 p.m., NABH will welcome John Pallasch, former Senate-confirmed assistant secretary for employment and training at the U.S. Labor Department (DOL) and the founder and CEO of One Workforce Solutions, a workforce consultancy in Aiken, S.C. He served previously as executive director of Kentucky’s Office of Employment and Training, and—in his first stint at DOL—as deputy assistant secretary in the department’s Mine Safety and Health Administration. Pallasch has spent more than 20 years influencing organizational personnel, efficiency, and productivity in the public and private sectors. He will draw from those experiences to help NABH members think more critically about their workforce challenges and more creatively about how to solve them. Following Pallasch’s presentation, the NABH Education and Research Foundation will lead a panel discussion about workforce challenges and potential solutions at 4 p.m. ET. New Season/Colonial Management Group CEO Jim Shaheen, the foundation’s vice president, will moderate the hourlong panel that will feature Hackensack Meridian Health Carrier Clinic President Donald Parker, the foundation’s president; Vanderbilt Psychiatric Hospital and Clinics President Mary Pawlikowski, the foundation’s secretary; and Susan Wright, director of BayCare Behavioral Health’s Behavioral Health Operations and this year’s Annual Meeting program chair. Panelists will discuss best practices on a variety of topics and answer questions from Shaheen and audience members. Earlier presenter John Pallasch will also participate in the panel’s question-and answer period. Please join us for both sessions in the Salamander’s Grand Ballroom.

Tuesday’s Parity Panel to Feature DOL Official Lisa Gomez and Former U.S. Rep. Patrick Kennedy on Tuesday, June 13

NABH President and CEO Shawn Coughlin will moderate a parity panel discussion with Lisa Gomez, assistant secretary for employee benefits security at the U.S. Labor Department, and former U.S. Rep. Patrick Kennedy (D-R.I.). on Tuesday, June 13 at 9:30 a.m., the Annual Meeting’s second day. Before she was sworn in last October, Gomez was a partner with the law firm Cohen, Weiss and Simon LLP and chair of the firm’s management committee. She has deep technical and practical experience in the field of employee benefits law and spent almost three decades representing various Taft-Hartley and multiemployer pension and welfare plans, single employer plans, jointly administered training program trust funds, a federal employees health benefit plan, and other plans covering employees in a range of industries. Gomez earned her bachelor’s degree at Hofstra University and her law degree at Fordham. Former Rep. Kennedy is the CEO of The Kennedy Forum, a not-for-profit he founded in 2013 to unite advocates, business leaders, and government agencies to advance evidence-based practices, policies, and programming mental health and addiction. During his time in Congress, Kennedy was the lead author of MHPAEA. Kennedy is also the founder of Don’tDenyMe.org, an educational campaign that empowers consumers and providers to understand parity rights and connects them to essential appeals guidance and resources; and co-founder of One Mind, an organization that pushes for greater global investment in brain research. The panel will take place in the Grand Ballroom and will discuss the landmark 2008 parity law and the work that remains to secure the law’s promise.

Center for Medicaid & CHIP Services CMO Aditi Mallick, M.D. to Address Attendees on Tuesday

Aditi Mallick, M.D., chief medical officer at the Center for Medicaid and CHIP (Children’s Health Insurance Program) Services (CMCS), will discuss her department’s mental health and substance use disorder initiatives at the 2023 Annual Meeting on Tuesday, June 13 at 11 a.m. Dr. Mallick leads the Center’s clinical strategy and cross-center work on health equity, social determinants of health, and innovation in whole-person care among other areas. Before joining CMCS, Dr. Mallick led the COVID-19 Response Command Center for the North Carolina Department of Health and Human Services (NCDHHS), where she oversaw strategic and operational efforts around vaccination, testing, case investigation, and contact tracing statewide. A core focus of her COVID-19 work was ensuring equitable access and improving outcomes for historically marginalized populations. Before her work at NCDHHS, Dr. Mallick worked closely with a range of healthcare stakeholders across the public and private sectors – including state Medicaid agencies, provider organizations, managed care organizations, and other payors – focusing on strategy, innovation, and data-driven change implementation. Dr. Mallick continues to care for patients and brings that experience to her work at CMS. She earned her bachelor’s degree with honors from Harvard College, her medical degree from Stanford University School of Medicine, and completed internal medicine residency at Massachusetts General Hospital and Harvard Medical School.

NABH President and CEO Shawn Coughlin to Address Attendees at Annual Meeting Luncheon

Please join us for this year’s Annual Meeting Luncheon on Tuesday, June 13 at noon to hear from NABH President and CEO Shawn Coughlin. Coughlin will provide updates on NABH’s work and initiatives and will help prepare any attendees who will head to Capitol Hill for congressional visits following the luncheon. This year’s Annual Meeting Luncheon will take place in the hotel’s Gallery Room.

Hill Day Returns!

For the first time since 2019, NABH is eager to welcome its members and guests back to Hill Day on Tuesday, June 13 from 1:30 to 5 p.m. ET. This year NABH is working with the firm Advocacy Associates to help schedule congressional meetings and briefings on Capitol Hill for interested Annual Meeting attendees during Hill Day. NABH will help prepare interested attendees by providing materials through a mobile app. For those attending Hill Day this year: please look for additional correspondence on Friday, June 9. Also, Hill Day participants—and all Annual Meeting attendees—can review the association’s 2023 Advocacy Priorities and Contingency Management fact sheet before or during the Annual Meeting.

U.S. Sen. Chris Murphy to Address Attendees at Annual Meeting Policy Breakfast

U.S. Sen. Chris Murphy (D-Conn.) will address attendees at the 2023 Annual Meeting policy breakfast on Wednesday, June 14 at 9:30 a.m. ET. Sen. Murphy serves on the Senate Foreign Relations Committee, the Health, Education, Labor and Pensions (HELP) Committee, and the Appropriations Committee. Before he was elected to the Senate, Sen. Murphy represented Connecticut’s fifth congressional district for three terms in the U.S. House of Representatives. Murphy is known in Congress as a leading voice for stronger anti-gun violence measures, a smarter foreign policy, and reform of our nation’s mental health system. Before he was elected to Congress, Murphy served for eight years in the Connecticut state legislature. Murphy graduated with honors from Williams College in Massachusetts and received his law degree from the University of Connecticut School of Law. Please help us welcome Sen. Murphy on Wednesday.

The NABH team wishes everyone a safe trip to Washington, and we look forward to seeing you soon!

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

CEO Update 142

Written by Emily Wilkins (NABH) on June 2, 2023. Posted in CEO Updates.

U.S. Sen. Chris Murphy to Address Attendees at Annual Meeting Policy Breakfast

NABH is pleased to announce U.S. Sen. Chris Murphy (D-Conn.) will address attendees at the 2023 Annual Meeting policy breakfast on Wednesday, June 14 at 9:30 a.m. ET. Sen. Murphy serves on the Senate Foreign Relations Committee, the Health, Education, Labor and Pensions (HELP) Committee, and the Appropriations Committee. Before he was elected to the Senate, Sen. Murphy represented Connecticut’s fifth congressional district for three terms in the U.S. House of Representatives. Murphy is known in Congress as a leading voice for stronger anti-gun violence measures, a smarter foreign policy, and reform of our nation’s mental health system. Before he was elected to Congress, Murphy served for eight years in the Connecticut state legislature. Murphy graduated with honors from Williams College in Massachusetts and received his law degree from the University of Connecticut School of Law. Please help us welcome Sen. Murphy on June 14. And if you haven’t done so yet, please be sure to register for the Annual Meeting.

NABH Education and Research Foundation to Present Workforce Panel at Annual Meeting

The NABH Education and Research Foundation is pleased to lead a panel discussion about workforce challenges and potential solutions during the Annual Meeting on Monday, June 12 at 4 p.m. ET. New Season/Colonial Management Group CEO Jim Shaheen, the foundation’s vice president, will moderate the hourlong panel that will feature Hackensack Meridian Health Carrier Clinic President Donald Parker, the foundation’s president; Vanderbilt Psychiatric Hospital and Clinics President Mary Pawlikowski, the foundation’s secretary; and Susan Wright, director of BayCare Behavioral Health’s Behavioral Health Operations and this year’s Annual Meeting program chair. Panelists will discuss best practices on a variety of topics and answer questions from Shaheen and audience members. The panel will follow a 3 p.m. workforce presentation from John Pallasch, founder and CEO of One Workforce Solutions and former assistant secretary for employment and training at the U.S. Labor Department. Pallasch will participate later in the panel’s question-and answer period. Please join us for both sessions in the Salamander’s Grand Ballroom on the Annual Meeting’s first day. We look forward to seeing you there!

Reminder: Hill Day is Back!

NABH is excited to welcome its members and guests back to Hill Day during the 2023 Annual Meeting! This year NABH is working with the firm Advocacy Associates to help schedule congressional meetings and briefings on Capitol Hill for interested Annual Meeting attendees during Hill Day on Tuesday, June 13 from 1:30 to 5 p.m. ET. NABH will help prepare interested attendees by providing materials through a mobile app. There is still time to take advantage of this free opportunity. Please indicate that you want to participate in Hill Day when you register for the 2023 Annual Meeting or contact Emily Wilkins at NABH.

SAMHSA Awards Grants to Bolster Mobile Response Teams for 988 Lifeline

The Substance Abuse and Mental Health Services Administration (SAMHSA) has awarded 13 grants to communities to create new or enhance existing mobile crisis response teams to support the national 988 Suicide and Crisis Lifeline. In an announcement, HHS noted the Biden administration has invested about $3.8 billion through the American Rescue Plan and more than $800 million through the Bipartisan Safer Communities Act through SAMHSA programs as part of President Biden’s effort to improve access to mental healthcare, prevent overdoses, and save lives. “The expansion of mobile crisis response across the country is a big part of our efforts to achieve comprehensive, responsive crisis care services,” HHS Assistant Secretary for Mental Health and Substance Use and SAMHSA leader Miriam Delphin-Rittmon, Ph.D., said in an announcement. “Responding effectively to behavioral health crises in our communities will involve strong partnerships among first responders, community-based support services, and 988 Lifeline call centers.” Click here to view the list of grant awardees.

Reminder: HRSA’s Substance Use Disorder Treatment and Recovery Loan Repayment Program Now Open

The Health Resources and Services Administration’s (HRSA) Substance Use Disorder Treatment and Recovery Loan Repayment Program (STAR LRP) application is open now through mid-July. Anyone who is a behavioral health clinician or support worker, clinical support staff, or trained in substance use disorders may apply to the STAR LRP and receive up to $250,000 in loan repayment. In exchange, loan recipients must work full time for six years in a STAR LRP-approved facility. The application process ends on Thursday, July 13 at 7:30 p.m. ET. Click here to learn more.

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

Fact of the Week

More than half of Americans who suffer from schizophrenia or another mental illness didn’t get the care they needed in 2021, the National Alliance on Mental Illness reports. A recent analysis in Kaiser Health News shows that coverage often depends on where you live—and how coverage of early psychosis treatment can be lifesaving. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 142

Written by Emily Wilkins (NABH) on May 26, 2023. Posted in CEO Updates.

NABH 2023 Annual Meeting is Approaching: Be Sure You’re Registered!

NABH’s 2023 Annual Meeting—Securing the Promise of Parity—is a little more than two weeks away! Please review our online preliminary program, learn about this year’s speakers, view the list of exhibitors and sponsors, register for the meeting, and reserve your hotel room, if you haven’t done so yet. We look forward to seeing you in Washington!

U.S. Surgeon General Releases Advisory on Social Media and Youth Mental Health

U.S. Surgeon General Vivek Murthy, M.D. this week released Social Media and Youth Mental Health, a new advisory that shows while social media may offer some benefits, there are “ample indicators” that social media can pose a risk of harm to the mental health and well-being of children and adolescents. The advisory notes that social-media use by young people is nearly universal, with up to 95% of young people ages 13-17 reporting using a social media platform and more than a third saying they use social media “almost constantly.” “The most common question parents ask me is, ‘Is social media safe for my kids?’” Murthy said in a news release about the advisory. “The answer is that we don’t have enough evidence to say it’s safe, and in fact, there is growing evidence that social media use is associated with harm to young people’s mental health,” he continued. “Children are exposed to harmful content on social media, ranging from violent and sexual content, to bullying and harassment. And for too many children, social media use is compromising their sleep and valuable in-person time with family and friends,” he added. “We are in the middle of a national youth mental health crisis, and I am concerned that social media is an important driver of that crisis – one that we must urgently address.” Murthy’s office reported that adolescents spending more than three hours per day on social media face double the risk of experiencing poor mental health outcomes, such as symptoms of depression and anxiety; yet one 2021 survey of teenagers found that, on average, they spend 3.5 hours a day on social media.

NIMH Finds Youth Suicide Rates Increased During the COVID-19 Pandemic

The National Institute of Mental Health this week released research that shows 5,568 youth died by suicide during the first 10 months of the COVID-19 pandemic, which was higher than the expected number of deaths had the pandemic not occurred. Higher-than-expected suicide rates were found a few months into the pandemic, starting in July 2020. According to the research, the increase in suicide deaths varied significantly by sex, age, race and ethnicity, and suicide method. For this period, researchers also found higher-than-expected suicide deaths among males, preteens aged 5–12 years, young adults aged 18–24 years, non-Hispanic American Indian or Alaskan Native youth, and non-Hispanic Black youth as compared with before the pandemic. Suicide deaths involving firearms were also higher than expected, the study showed.

CMS Reports to Congress on SUD Planning Grant Implementation

The Centers for Medicare & Medicaid Services (CMS) has released the Initial Report to Congress that the SUPPORT Act requires. The 2018 law directs CMS to release three reports to Congress, and the one released this week provides details on states awarded planning grants under the SUPPORT Act, the criteria used to select these states, and initial activities proposed or carried out under the planning grants. Findings in the report are from the first 13 months of the planning period of the demonstration: Sept. 30, 2019-Oct. 31, 2020.

Now Open: HRSA’s Substance Use Disorder Treatment and Recovery Loan Repayment Program

The Health Resources and Services Administration (HRSA) announced this week that the agency’s Substance Use Disorder Treatment and Recovery Loan Repayment Program (STAR LRP) application is open now through mid-July. Anyone who is a behavioral health clinician or support worker, clinical support staff, or trained in substance use disorders may apply to the STAR LRP and receive up to $250,000 in loan repayment. In exchange, loan recipients must work full time for six years in a STAR LRP-approved facility. The application process ends on Thursday, July 13 at 7:30 p.m. ET. Click here to learn more. Also this week, HRSA announced a grant program for professionals focused on behavioral health workforce education and training for children, adolescents, and transitional-aged youth. The grant’s purpose is to address the behavioral health needs of children, adolescents, and transitional-aged youth by increasing the supply and distribution of behavioral health providers in rural and underserved communities. Click here to view the grant opportunity.

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

Fact of the Week

A new study published in Health Affairs found that although almost all insurance plans covered immediate-release buprenorphine in 2021 (with a general trend of decreasing prior authorization requirements and quantity limits since 2017), only two payers had relatively low coverage of extended-release buprenorphine, with only 46% of commercial plans and only 19% of Medicare Advantage plans covering this formulation. The study authors recommended that policymakers and researchers “concerned with buprenorphine insurance barriers should shift their attention to extended-release buprenorphine.” For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 141

Written by Emily Wilkins (NABH) on May 19, 2023. Posted in CEO Updates.

Please Meet with NABH’s Exhibitors and Sponsors at the 2023 Annual Meeting Next Month!

NABH appreciates the generous support of our exhibitors and sponsors, whose valuable products and services help NABH members deliver quality behavioral healthcare every day to those who need it! Please make time to visit our exhibitors and sponsors at the Annual Meeting from June 12-14 at the Salamander Washington, DC. Before then, you can view a complete list of our exhibitors and sponsors on our Annual Meeting homepage. Also, please be sure to register for the Annual Meeting and reserve your hotel room today if you haven’t done so yet. We look forward to seeing you in Washington!

U.S. Labor Department Projects Five Mental Health Jobs Will Grow ‘Much Faster’ than Average from 2021-2031

The U.S. Labor Department’s (DOL) Bureau of Labor Statistics projects these five mental health-related careers will grow “much faster” than average between 2021-2031: mental health and substance abuse social workers; substance abuse, behavioral disorder, and mental health counselors; community health workers; healthcare social workers; and marriage and family therapists. “Together, they employed about 761,000 workers in 2021 —and they are expected to have more than 91,000 openings on average each year through 2031,” DOL reported in its blog. “The education typically required to enter these occupations ranges from a high school diploma to a master’s degree, and they all pay around or more than the $46,310 median for all occupations in 2022.” Click here to learn more about growth projection for each position.

CMS Releases Guide for Medicaid School-based Services

The Centers for Medicare & Medicaid Services (CMS) this week released a guide for Medicaid school-based services to make it easier for schools to deliver and receive payment for healthcare services to millions of eligible students. CMS worked with the U.S. Department of Education to produce the Comprehensive Guide to Medicaid Services and Administrative Claiming, which is a result of the Bipartisan Safer Communities Act. “With this guide, we are helping states and schools bring health care to kids where they are, rather than the other way around,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “Children spend most of their waking hours in school. We also know that children have suffered serious declines in access to mental and behavioral healthcare services during the COVID-19 pandemic. We’re making it easier for states and schools to maximize Medicaid coverage to grow connections to care.” Medicaid and CHIP cover more than half of all U.S. children, or more than 41 million children, according to CMS. The guide is intended to help states and schools leverage Medicaid and CHIP, and it maps out how they can build a bridge between education and healthcare, including mental healthcare, to support children enrolled in these programs and help them thrive.

House and Senate Committees Press Insurers for Information on Claims

Two congressional oversight committees this week pressed the nation’s insurers for information regarding denial of claims in one instance and denial of care in Medicare Advantage in the second. Republicans from the House Energy and Commerce Committee sent a letter to Cigna President and CEO David Cordani asking for clarification after online news source ProPublica released an investigative report that suggested the insurance company’s physicians reject claims without reading them. Meanwhile, the Senate Homeland Security & Governmental Affairs Committee Permanent Subcommittee on Investigations hosted a hearing about delays and denials of care in Medicare Advantage. That hearing follows an April 2022 report from the HHS Office of Inspector General that found Medicare Advantage insurers have denied some coverage or payment for services that would have been covered under traditional Medicare.

Federally Supported Study Finds More than Half of Physicians Ranked Stigma as Highest Barrier to Treating Patients for OUD

A University of Vermont study of more than 450 clinicians and counselors in rural New England found that more than half (55%) ranked stigma as the highest barrier to treating patients for opioid use disorder (OUD) among other factors that included time and staffing, medication diversion, and organizational/clinic barriers. Meanwhile, 60% of physicians and 51% of counselors surveyed disagreed that medications for OUD “replace addiction to one kind of drug with another.” However, among clinicians with the ability to prescribe, there was considerable difference in this belief, depending on whether they were currently treating with medications for OUD, or MOUD. “More than 80% of those currently treating with MOUD believed it is not an addiction replacement; among those not currently treating with OUD, fewer than half felt that way,” the Federal Office of Rural Health Policy (FORHP) announced. FORHP is part of HHS’ Health Resources and Services Administration and supports the Center on Rural Addiction at the University of Vermont, which conducted the study.

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

Fact of the Week

The Centers for Disease Control and Prevention reports that more Black Americans died from fentanyl overdoses than from any other drug in 2021 and at far higher rates than whites or Hispanics. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 140

Written by Emily Wilkins (NABH) on May 12, 2023. Posted in CEO Updates.

NABH to Host Parity Panel with DOL Official Lisa Gomez and Former U.S. Rep. Patrick Kennedy on Tuesday, June 13

NABH President and CEO Shawn Coughlin will moderate a parity panel discussion with Lisa Gomez, assistant secretary for employee benefits security at the U.S. Labor Department, and former U.S. Rep. Patrick Kennedy (D-R.I.). on Tuesday, June 13, the second day of the 2023 Annual Meeting. Before she was sworn in last October, Gomez was a partner with the law firm Cohen, Weiss and Simon LLP and chair of the firm’s management committee. She has deep technical and practical experience in the field of employee benefits law and spent almost three decades representing various Taft-Hartley and multiemployer pension and welfare plans, single employer plans, jointly administered training program trust funds, a federal employees health benefit plan, and other plans covering employees in a range of industries. Gomez earned her bachelor’s degree at Hofstra University and her law degree at Fordham. Former Rep. Kennedy is the CEO of The Kennedy Forum, a not-for-profit he founded in 2013 to unite advocates, business leaders, and government agencies to advance evidence-based practices, policies, and programming mental health and addiction. During his time in Congress, Kennedy was the lead author of the Mental Health Parity and Addiction Equity Act. Kennedy is also the founder of Don’tDenyMe.org, an educational campaign that empowers consumers and providers to understand parity rights and connects them to essential appeals guidance and resources, and co-founder of One Mind, an organization that pushes for greater global investment in brain research. The panel will begin at 9:30 a.m. ET in the Salamander’s Grand Ballroom and will discuss the landmark 2008 parity law and the work that remains to secure the law’s promise. Please be sure to register for the Annual Meeting and reserve your hotel room today, if you haven’t done so yet. We look forward to seeing you in Washington!

CMS Coverage for PHP Telehealth Services Ends With COVID-19 PHE’s Conclusion

The Centers for Medicare & Medicaid Services (CMS) has shared with NABH and other stakeholders the agency’s plans to end telehealth coverage for partial hospitalization program (PHP) services implemented during the COVID-19 Public Health Emergency (PHE) when the PHE concluded at the end of Thursday, May 11. In addition, CMS has explained that telehealth coverage will continue through December 2024 for Intensive Outpatient Program (IOP) services that qualify under the outpatient prospective payment system as “remote mental health services.” NABH continues to communicate with key Members of Congress to clarify the legislative intent behind the telehealth coverage extensions that were authorized in the Consolidated Appropriations Act, 2023 last December. The NABH team understands that some Members of Congress intended for the telehealth coverage extension to include PHP services. Given the persistent confusion on these matters, NABH has urged CMS to issue clarification in writing. NABH will keep members apprised of our efforts to extend telehealth coverage for PHP services.

DEA Rule to Extend Telemedicine Flexibilities for Prescription of Controlled Substances Effective May 11

The U.S. Drug Enforcement Administration’s (DEA) temporary extension of COVID-19 telemedicine flexibilities for prescription of controlled medications took effect Thursday, May 11. Under the DEA’s rule, the agency has extended the full set of telemedicine flexibilities adopted during the PHE for six months through Nov. 11, 2023. For any practitioner-patient telemedicine relationships that have been or will be established up to Nov. 11, 2023, the full set of telemedicine flexibilities regarding prescription of controlled medications established during the PHE will extend for one year through Nov. 11, 2024. In a letter to DEA on March 31, NABH advocated to remove requirements for in-person medical examinations for Schedule II stimulant medications for ADHD and Schedule III-V mental health medications. Please contact Sarah Wattenberg, NABH’s director of quality and addiction services, with questions or comments.

SAMHSA and FDA Officials Release Letter to Practitioners to Promote Medication First Model

Officials from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the U.S. Food and Drug Administration (FDA) this week sent a letter to healthcare practitioners noting that although counseling and other services are important parts of treatment plans, they should not be prerequisites for receiving medication. “An often-cited barrier to prescribing buprenorphine for the treatment of OUD is the perception that patients must engage in counseling and other services in order to start or continue receiving the medication,” wrote Miriam Delphin-Rittmon, Ph.D. and Patrizia Cavazzoni, M.D. “This letter serves to clarify the importance of counseling and other services as part of a comprehensive treatment plan, but to also reiterate that the provision of medication should not be made contingent upon participation in such services,” they added. Delphin-Rittmon serves as the assistant secretary for mental health and substance use at SAMHSA and Cavazzoni is the director of the FDA’s Center for Drug Evaluation and Research.

SAMHSA Announces Funding Opportunity for Cooperative Agreements for 988 Suicide and Crisis Lifeline Crisis Center Follow-Up Programs

SAMHSA has announced it anticipates funding a total of $5 million in 10 awards to expand efforts among 988 lifeline centers to support individuals in follow-up programs. Specifically, the money would support individuals post-contact to provide continued support and linkages to decrease suicide risk by 1) ensuring the systematic follow-up of suicidal persons who contact the 988 suicide and crisis lifeline; 2) providing enhanced crisis stabilization coordination, crisis respite, mobile crisis outreach response services, and other services on the crisis continuum of care; 3) reducing unnecessary police engagement; and 4) improving connections for high-risk populations. Click here to learn more.

SAMHSA Distributes Additional Grant Funding for Programs to Combat Overdose and SUD

Also this week, SAMHSA announced awards in four grant programs totaling nearly $11.3 million in additional funding to support the Biden administration’s ongoing efforts nationwide in prevention, treatment, recovery support, and harm reduction. The four grant programs are Screening, Brief Intervention to Referral Treatment (SBIRT) (nearly $6.9 million); Grants to Prevent Prescription Drug/Opioid Overdose-Related Deaths ($2.6 million); Target Capacity to Expansion-Special Projects ($1.1 million); and Provider’s Clinical Support System to universities (more than $725,000). Click here to learn more about the programs

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

Fact of the Week

The Centers for Disease Control and Prevention reports that overdose deaths increased by 279% for drug overdoses involving fentanyl during the five-year study period to 21.6 per 100,000 standard population in 2021 from 5.7 per 100,000 standard population in 2016. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 139

Written by Emily Wilkins (NABH) on May 5, 2023. Posted in CEO Updates.

Hill Day Returns to NABH Annual Meeting Program!

NABH is excited to welcome its members and guests back to Hill Day during the 2023 Annual Meeting! This year NABH is working with the firm Advocacy Associates to help schedule Capitol Hill meetings and briefings for interested Annual Meeting attendees during Hill Day on Tuesday, June 13 from 1:30 to 5 p.m. ET. NABH will help prepare interested attendees by providing materials through a mobile app. To take advantage of this free opportunity, please indicate that you want to participate in Hill Day when you register for the 2023 Annual Meeting, or contact NABH Administrative Coordinator Emily Wilkins. Please remember to reserve your hotel room at the Salamander Washington, DC, if you haven’t done so yet. We look forward to seeing you next month!

HHS Launches FindSupport.gov During First Week of Mental Health Awareness Month

HHS on Thursday launched FindSupport.gov, a website designed to help the public identify available resources, explore unbiased information about various treatment options, and learn how to find the support they need for problems related to mental health, drugs, or alcohol. HHS’ Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Medicare & Medicaid Services (CMS) developed the concept for FindSupport.gov as a response to research that people were looking for an unbiased, trustworthy source of information to receive support for mental health and substance use issues. The department also developed a brief video to highlight the new website. Also Thursday, HHS hosted its Support is Here to Strengthen Mental Health summit, where HHS Secretary Xavier Becerra said the Biden administration is saying to all who are struggling with mental health that support is here. “I am proud that we are changing the way mental health is viewed in this country because mental health is health, period.” Becerra tweeted. The summit and new website coincide with the first week of Mental Health Awareness Month, which the United States has observed since 1949. The month-long observance is meant to fight stigma, provide support, educate the public, and advocate for policies that support the millions of Americans affected by mental illness. Click here to learn more, and please remember to follow us @NABHbehavioral and on LinkedIn at the National Association for Behavioral Healthcare.

DEA Extends COVID-19 Telehealth Flexibilities for Prescription of Controlled Medications for Now

The U.S. Drug Enforcement Administration (DEA) on Wednesday said it will extend its COVID-19 telemedicine flexibilities for prescription of controlled medications as the agency works to determine how to move forward in a way that gives Americans access to needed medicine with the appropriate safeguards. An announcement from DEA noted the agency received a record number of comments on its proposed telemedicine rules, which prompted DEA and the U.S. Health and Human Services Department (HHS) to submit a draft temporary rule to the Office of Management and Budget requesting an extension. NABH submitted comments on this matter (see CEO Update, April 28, 2023). “Further details about the rule will become public after its full publication in the Federal Register,” the announcement said.

CMS’ Recent Proposed Rule Would Establish Network Adequacy Requirements and Payment Transparency in Medicaid MCOs

CMS’ recent Medicaid managed care proposed rule aims to strengthen standards for more timely access to care for Medicaid and Children’s Health Insurance Program (CHIP) managed care enrollees and establish new payment transparency requirements in fee-for-service and managed care programs. As NABH reported in last week’s CEO Update, CMS is proposing to establish maximum appointment wait-time standards for outpatient mental health and substance use disorder—adult and pediatric—and other services, including routine primary care. News reports offered details of a call that CHIP Services Director Daniel Tsai had with reporters, in which Tsai said, “The standards we established are what we call a national floor so a state is welcome to set a standard that is higher than that, [but] they must meet at least the standard that we outlined proposed in the proposed rule,” according to an article in Inside Health Policy, which noted the administration wants to align Medicaid wait-time standards with the two-week requirement for commercial plans. The proposed rule would also require states to employ an independent company to conduct yearly “secret shopper surveys” that confirm a managed care plan is complying with appointment wait-time standards and the insurer’s provider directory is up-to-date. Regarding payment rates, Tsai was reported as saying that, historically, CMS, advocates, and providers do not have a good way of understanding and benchmarking where Medicaid payment rates are across different state programs. “So what we do propose is that every state has to make their base rates of payments transparently available and easily accessible, and every state has to benchmark their base rates for Medicaid relative to Medicare payment rates, which is a national standard that allows for comparison and easy benchmarking across states,” Tsai said.

Joint Commission Seeks Feedback on Proposed Workplace Violence Prevention Requirements for BHC Program

The Joint Commission this week opened its field review to gather feedback from behavioral healthcare organizations about their experiences with workplace violence to help provide the most evidence-based and relevant requirements for its Behavioral Health Care and Human Services (BHC) accreditation program. In its announcement, the Joint Commission said its field review will ask for comments on the potential new requirements and the larger context of how behavioral healthcare organizations are currently experiencing, preventing, and monitoring workplace violence. The field review is open through June 9 and takes about 15 to 20 minutes to complete. Click here to complete the questionnaire. HRSA Payment Program for Rural Health Clinic Buprenorphine-Trained Providers Still Active HHS’ Health Services and Resources Administration (HRSA) has announced that Rural Health Clinics (RHCs) are still eligible to apply for a $3,000 payment on behalf of each provider trained to prescribe buprenorphine between Jan. 1, 2019 and Jan. 25, 2023. SAMHSA announced in January 2023 that clinicians no longer need a DATA 2000 Waiver to prescribe buprenorphine; however, the payment program to defray earlier training cost is still active. Launched in 2021, the program pays for providers who previously trained for the waiver to prescribe buprenorphine. HRSA said about $900,000 in program funding remains available for RHCs, which will be paid on a first-come, first-served basis until funds are exhausted. Send question to DATA2000WaiverPayments@hrsa.gov.

NIDA Study Finds Association Between Cannabis Use Disorder and Schizophrenia

A new National Institute of Drug Abuse (NIDA) study has found that young men between 21-30 years of age with a cannabis (marijuana) use disorder have an increased risk of developing schizophrenia. The findings are notable because they emphasize that cannabis use disorder appears to be a major modifiable risk factor for schizophrenia at the population level. After evaluating more than 6 million people in Denmark for more than five decades, researchers estimated that the percentage of cases of schizophrenia that may have been avoided by preventing cannabis use disorder was as high as 30% among men aged 21-30; 15% among men aged 16-49; and 4% among women aged 16-49. The study was a collaboration between authors at the Mental Health Services in the Capital Region of Denmark and NIDA at the National Institutes of Health.

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

Thank you to all members who have submitted data to NABH’s denial-of-care portal! We still seek data from additional members to support advocacy on health plan denials and prior-authorization timeliness. If you are a new participant, please e-mail NABH Administrative Coordinator Emily Wilkins for support.

Fact of the Week

A new study reports three in 10 Americans say they know someone affected by opioid addiction; within that group, more than half say they know someone who has died from opioid use. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 138

Written by Emily Wilkins (NABH) on April 28, 2023. Posted in CEO Updates.

NABH Pleased to Welcome HHS Secretary Xavier Becerra at 2023 Annual Meeting

U.S. Health and Human Services Department (HHS) Secretary Xavier Becerra, J.D. will address attendees at the 2023 NABH Annual Meeting on Monday, June 12 from 2:15 p.m. to 2:45 p.m. Secretary Becerra is the 25th secretary of HHS and the first Latino in U.S. history to hold the office. Previously Secretary Becerra was California’s attorney general and before that served for 12 terms in the U.S. House of Representatives, where he was the first Latino to serve as a member of the powerful House Ways and Means Committee. Secretary Becerra also served as chairman of his party’s caucus and as the ranking member of both the Ways and Means Subcommittee on Health and the Ways and Means Subcommittee on Social Security. Born in Sacramento, Secretary Becerra is the son of working-class parents. He was the first in his family to receive a four-year degree, earning his bachelor’s degree in economics from Stanford University. He earned his law degree from Stanford Law School. Please register for the Annual Meeting and reserve your hotel room today, if you haven’t done so yet. We look forward to seeing you in Washington!

CMS Releases FAQs About Transition Period Following End of Covid-19 PHE

The Centers for Medicare & Medicaid Services (CMS) has released a fact sheet of frequently asked questions to help providers prepare for the transition period after the Covid-19 public health emergency (PHE) ends on May 11. Although certain waivers and flexibilities CMS granted during the pandemic are set to expire, others will be permanent or extended due to congressional action. For instance, the Consolidated Appropriations Act, 2023 extended many telehealth flexibilities through Dec. 31, 2024, including: people with Medicare can access telehealth services in any geographic area in the United States, rather than only those in rural areas; people with Medicare can stay in their homes for telehealth visits that Medicare pays for rather than traveling to a healthcare facility; and certain telehealth visits can be delivered audio-only (such as a telephone) if someone is unable to use both audio and video, such as a smartphone or computer. The fact sheet also noted that Medicare Advantage plans may offer additional telehealth benefits and that individuals should check with their plan about coverage. “For Medicaid and CHIP, telehealth flexibilities are not tied to the end of the PHE and have been offered by many state Medicaid programs long before the pandemic,” CMS noted in the fact sheet. “Coverage will ultimately vary by state. CMS encourages states to continue to cover Medicaid and CHIP services when they are delivered via telehealth.

DEA Requests Extension on Agency’s Final Rule on Telehealth Prescribing of Controlled Substances

The Drug Enforcement Administration (DEA) has asked the White House for an extension on the release of the DEA’s final rule on telehealth prescribing of controlled substances. The extra time would permit telehealth services to continue under COVID-19 policies temporarily. NABH’s letter to DEA in late March was among the more than 18,000 comments that DEA received about telehealth services; the agency likely needs additional time to finalize the rule and avert disrupting current telehealth practices after the PHE ends on May 11.

CMS Releases Proposed Rules on Access and Quality in Medicaid & CHIP

CMS late Thursday released notices of proposed rulemaking (NPRMs)—Ensuring Access to Medicaid Services (Access NPRM) and Managed Care Access, Finance, and Quality (Managed Care NPRM) that NABH is reviewing. To improve access to care, the Managed Care NPRM proposes to establish maximum appointment wait-time standards for outpatient mental health and substance use disorder—adult and pediatric—and other services, including routine primary care (also adult and pediatric). CMS will accept comments on the proposed rules until Monday, July 3.

NIH Seeks to Expand Peer Reviewer Pool to Ensure Review Committees are Diverse and Inclusive

The National Institutes of Mental Health (NIMH) is seeking to expand its pool of peer reviewers with mental health researchers who can offer diverse perspectives in the peer-review process. The NIMH peer-review process aims to make certain that scientific experts evaluate grant applications in a manner free from what the National Institutes of Health deems as inappropriate incidences. Peer reviewers provide feedback on the scientific merit of those applications. Click here to learn more about eligibility requirements for peer reviewers and here to submit an application.

SAMHSA Announces Funding Opportunity to Promote Physical-Behavioral Healthcare Integration

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced it will award a total of about $29 million in a new grant funding opportunity intended to integrate physical healthcare and behavioral healthcare. The opportunity is not open directly to healthcare providers, but rather to the states. Specifically, states and state agencies—such as the state mental health authority, the single state agency for substance use services, the state’s Medicaid agency, and the state health department—are eligible to apply. SAMHSA’s announcement said it anticipates awarding 14 grants and the length of the project is five years. Click here to learn more.

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

Thank you to all members who have submitted data to NABH’s denial-of-care portal! We are still seeking data from additional members to support advocacy on health plan denials and prior authorization timelines. If you are a new participant, please e-mail NABH Administrative Coordinator Emily Wilkins for support.

Fact of the Week

A recent study in JAMA Psychiatry suggests that estimates of long-term exposure to multiple air pollutants were associated with increased risk of depression and anxiety. Researchers concluded that the non-linear associations may have important implications for policymaking in air pollution control. An article this week in Kaiser Health News also explored the connection between anxiety and pollution. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 137

Written by Emily Wilkins (NABH) on April 21, 2023. Posted in CEO Updates.

Former DOL Assistant Secretary for Employment and Training John Pallasch to Kick Off 2023 Annual Meeting

NABH is pleased to announce John Pallasch, former Senate-confirmed assistant secretary for employment and training at the U.S. Labor Department (DOL), will kick off the association’s 2023 Annual Meeting with his presentation on Monday, June 12 at the Salamander Washington, DC. Currently Pallasch is the founder and CEO of One Workforce, a workforce consultancy in Aiken, S.C. He served previously as executive director of Kentucky’s Office of Employment and Training, and—in his first stint at DOL—as deputy assistant secretary in the department’s Mine Safety and Health Administration. Pallasch has spent more than 20 years influencing organizational personnel, efficiency, and productivity in the public and private sectors. He will draw from those experiences to help NABH members think more critically about their workforce challenges and more creatively about how to solve them. Pallasch graduated from Ohio State and later earned a law degree from Pepperdine University School of Law. Please help us welcome him in the Salamander’s Grand Ballroom on Monday, June 12 at 2:45 p.m. ET. If you haven’t done so yet, please register for the Annual Meeting and reserve your hotel room today. We look forward to seeing you in Washington!

CMS Final Rule Establishes Mental Health Facilities and SUD Treatment Centers as Essential Community Providers

In a final rule this week, the Centers for Medicare & Medicaid Services (CMS) expanded access to care for low-income and medically underserved communities by establishing two new essential community provider (ECP) categories for mental health facilities and SUD treatment centers. The changes came in the Patient Protection and Affordable Care Act (ACA) notice of benefit and payment parameters (NBPP) for 2024. This annual notice administers policy changes for plans on the ACA exchanges and sets rates and risk-model specifications. The decision to categorize mental health facilities and SUD treatment centers as ECPs is a win for NABH; in late January, NABH advocated for these ECP categories in its comment letter to CMS about the agency’s proposed NBPP rule for 2024. “NABH strongly supports CMS’ proposal to expand its network adequacy criteria by creating two distinct essential community provider categories for mental health facilities and substance use disorder (SUD) treatment centers,” NABH President and CEO Shawn Coughlin wrote in the association’s letter. “To construct each county-level network, the rule would require insurers on the health exchanges to attempt to contract with at least one SUD Treatment Center and at least one Mental Health Facility.” The final rule takes effect 60 days after it appears in the Federal Register.

CMS Announces Opportunities to Increase Care Access, Including SUD Treatment, for Incarcerated Individuals

CMS this week announced a new opportunity for states to help increase care for individuals who are incarcerated in the period immediately before their release to help them thrive as they re-enter communities. The new Medicaid Reentry Section 1115 Demonstration Opportunity would allow state Medicaid programs to cover services that address various health concerns, including substance use disorders and other chronic health conditions. In an announcement Monday, CMS Administrator Chiquita Brooks-LaSure said the agency reached a milestone in expanding access through Medicaid. “This guidance outlines a pathway to implement historic changes for individuals who are incarcerated and eligible for Medicaid, she said. “By improving care and coordination prior to release from the justice system, we can help build a bridge back to the community and enhance individual and collective public health and public safety outcomes.” Click here to read the letter from Daniel Tsai, deputy administrator and director at the Center for Medicaid and CHIP Services, to state Medicaid directors.

NIH Study Shows Prevalence of Stimulant Therapy for ADHD Associated with Higher Rates of Prescription Stimulant Misuse in Teens

Researchers have found a strong link between the prevalence of prescription stimulant therapy for attention-deficit/hyperactivity disorder (ADHD) and rates of prescription stimulant misuse—taken in a way other than directed by a clinician— by students in middle schools and high schools. The study this week in JAMA Network Open emphasized the need for assessments and education in both schools and communities to prevent medication-sharing among teens. “This is especially important considering non-medical use of prescription stimulants among teens remains more prevalent than misuse of any other prescription drug, including opioids and benzodiazepine,” NIH noted in a news release about the study. The National Institutes of Health’s National Institute on Drug Abuse (NIDA) and the U.S. Food and Drug Administration supported the study, which used data between 2005 and 2020 by the Monitoring the Future (MTF) study. The MTF is a large, multicohort survey of legal and illicit drug use among American adolescents in eighth, 10^th, and 12^th grades. NIDA also funds the MTF.

Reminder: Public Comments on SAMHSA’s 2023-2026 Draft Strategic Plan Due April 27

The Substance Abuse and Mental Health Services Administration (SAMHSA) is seeking public comment on the agency’s draft 2023-2026 SAMHSA Strategic Plan that presents a person-centered mission and mission highlighting SAMHSA’s priorities and principles. SAMHSA’s five priority areas include preventing overdose; enhancing access to suicide prevention and crisis care; promoting resilience and emotional health for children, youth, and families; integrating behavioral and physical healthcare; and strengthening the behavioral healthcare workforce. The agency’s four core principles are equity, trauma-informed approaches, recovery, and commitment to data and evidence. Comments on the draft plan are due by 5 p.m. ET next Thursday, April 27. Click here to submit comments.

Reminder: 2023 NABH Exhibitor and Sponsor Guide Ad Deadline is Today, April 21

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

Thank you to all members who have submitted data to NABH’s denial-of-care portal. Your data will help NABH highlight problems in the field related to health plan denials and timeliness. Several policymaking entities are interested in these data, which could support advocacy for expanded access to care. For new participants, please e-mail Emily Wilkins, NABH’s administrative coordinator, for support.

Fact of the Week

The U.S. Drug Enforcement Administration’s (DEA) National Prescription Drug Take Back Day is tomorrow, Saturday, April 22. DEA reflects the agency’s commitment to health and safety, encouraging the public to remove unneeded medications from their homes as a measure of preventing medication misuse and opioid addiction from starting. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 135

Written by Emily Wilkins (NABH) on April 7, 2023. Posted in CEO Updates.

CMS Proposes 3% Increase in Payment Rates to Inpatient Psychiatric Facilities for 2024

The Centers for Medicare & Medicaid Services (CMS) is proposing to update Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) payment rates by 1.9% in fiscal year (FY) 2024, or $55 million, relative to current rates. This update includes a 3.2% market basket increase, a 0.2 percentage point productivity cut, and a 1.0% decrease to outlier payments. Other notable components of the agency’s proposed IPF PPS rule this week include: Proposed Modification to the Regulation on Excluded Units Paid Under the IPF PPS: Responding to increased mental health needs—including the need for available inpatient psychiatric beds—CMS is proposing greater flexibility for hospitals to open and bill Medicare for a new IPF distinct part unit. Specifically, beginning in FY 2024, CMS would allow hospitals to open a new unit at any time during the cost reporting period, with 30-day advance notice to the CMS regional office and Medicare administrative contractor. An announcement about the proposed rule said “CMS believes this proposal would alleviate unnecessary burden and administrative complexity placed upon hospitals when opening new psychiatric units, helping to expand access to behavioral healthcare” in line with the agency’s behavioral healthcare strategy. Proposed Updates to the IPFQR Program The rule also proposes to adopt three quality measures focused on health equity for the IPFQR Program. First, beginning in FY 2026, a Facility Commitment to Health Equity measure would ask IPFs to attest to its efforts to address health equity across five domains: (1) Equity is a Strategic Priority; (2) Data Collection; (3) Data Analysis; (4) Quality Improvement; and (5) Leadership Engagement. Second, a Screening for Social Drivers of Health (SDOH) measure would assess the percentage of patients over 17 who are screened for five specific health-related social needs (HRSNs) — food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety. Voluntary reporting would begin in the calendar year 2025, with payments affected beginning in FY 2027. Finally, CMS would adopt a Screen Positive Rate for SDOH measure beginning with voluntary reporting in CY 2024 and payment impact in FY 2027. This process measure assesses the percentage of patients who screen positive for each of the noted HRSNs in this quality measure. Request for Information (RFI) to Inform the Revisions to the IPF PPS Required by the Consolidated Appropriations Act, 2023 (CAA, 2023): Meanwhile, CMS noted in the rule that it has continued to analyze more recent IPF cost and claim information in an ongoing effort to refine the IPF PPS. In its FY 2023 IPF PPS proposed rule, CMS issued a technical report and sought comments on the results of the latest refinement analysis in preparation to propose IPF PPS patient-level and non-regression-derived refinements to be effective in FY 2024. Subsequently, new provisions in the CAA, 2023 require CMS to revise payments under the IPF PPS for Rate Year 2025 (or FY 2025 under the IPF PPS) as the U.S. Health and Human Services secretary determines appropriate. Consequently, CMS has included a request for information (RFI) that will be used to inform future payment revisions. Also in the proposed rule, CMS has addressed the specific types of data and information that the CAA, 2023 suggests CMS may collect, as well as soliciting comments on additional data and information that could be collected to inform future payment revisions. CMS will accept public comments on the proposed rule through Monday, June 5.

Final Medicare Advantage Rule for 2024 Addresses Many NABH Priorities

Earlier this week, the Centers for Medicare & Medicaid Services (CMS) issued its contract year 2024 final rule related to the Medicare Advantage (MA) program, which addresses multiple, long-standing concerns of the NABH. In particular, we are pleased with the rule’s extensive improvements related to prior authorization, network adequacy, and quality of care, including measures that:

Require MA plans to comply with the general coverage and benefit conditions of the Traditional Medicare program, along with national and local coverage determinations (LCD), and related regulations;
Apply prior authorization approvals to a patient’s full course of treatment for medically reasonable and necessary care, as determined by the treating physician;
Codify appointment wait time standards for behavioral healthcare and other services;
Add a 10 percentage point credit to insurers’ network adequacy assessment for the inclusion of clinical psychologists and licensed clinical social workers;
Exempt emergency behavioral health services from the prior authorization process;
Require MA organizations to:
- include behavioral health services in their care coordination programs;
- base medical necessity determinations on the individual circumstances of a specific patient, rather than on a proprietary algorithm or software;
- create a utilization management committee that annually reviews coverage policies to ensure that coverage is “no more restrictive than traditional Medicare coverage criteria;’ and
- include in their advertisements a specific Medicare Advantage plan name and ban the use words or imagery that is “misleading, confusing, or misrepresents the plan.”
Clarify that insurers may deny care using proprietary criteria, only if traditional Medicare coverage rules are not fully established and the in-house coverage standards are based on “current evidence in widely used treatment guidelines or clinical literature made publicly available to CMS, enrollees, and providers.”

Of concern, is CMS’ exclusion of providers of medication for opioid use disorder from its network adequacy criteria. This proposal was not finalized because the elimination of the x-waiver requirement for buprenorphine providers removed the data source necessary for CMS to track those providers. The rule also explained that there are too few opioid treatment programs (OTPs) to establish access standards, and reminded MA organizations that they are required to include OTPs as part of their Part B coverage for OTP services or arrange out-of-network care at in-network cost sharing.

New Resource: ‘Using Contingency Management To Combat Stimulant Use Disorder’ Fact Sheet

NABH has produced Using Contingency Management To Combat Stimulant Use Disorder, a brief fact sheet that explains contingency management (CM) and highlights the association’s legislative request for Congress to direct federal agencies to replace the current $75 CM incentive payment limitation with scientifically proven incentive levels. “Decades of research and peer-reviewed literature validate the effective use of CM, which uses positive reinforcement to encourage abstinence from stimulant use,” NABH’s fact sheet explains. “Positive behavior reinforcement takes the form of predictable and meaningful financial incentives, such as gift cards (with restricted purchase guidelines) or prizes, which can be earned only when specific ‘target behaviors’ are achieved, such as drug-free urine samples.” The new resource is available on NABH’s homepage under “Latest Content” and also posted on NABH’s “Be an Advocate” page.

Reminder: Please Submit NABH’s Behavioral Health Information Technology Survey by April 12

NABH is seeking feedback from all system members about their experiences with behavioral health information technology as the association urges Congress and the Biden administration to extend incentives to behavioral healthcare organizations for adopting electronic health records. Please submit this brief survey by Wednesday, April 12. Your responses will help NABH in its advocacy efforts to urge Congress and the Biden administration to extend these incentives to behavioral healthcare organizations. Please e-mail Rochelle Archuleta if you have questions.

2023 Exhibitor and Sponsor Guide Advertising Deadline is Approaching!

NABH will distribute the 2023 NABH Exhibitor and Sponsor Guide to all registrants at the 2023 NABH Annual Meeting from June 12-14, 2023 at the Salamander Washington, DC. Be sure your organization is included in it! All ads for the guide are due by April 21, 2023. Please click here for details about advertising options, requirements, payment, and more. The association also will send the guide to all NABH members after the meeting and post it on the NABH Annual Meeting webpage.

2023 ExNABH Annual Meeting Hotel Cut-Off Date is May 11!hibitor and Sponsor Guide Advertising Deadline is Approaching!

Please reserve your hotel room today at the Salamander Washington, DC (formerly the Mandarin Oriental hotel) for the 2023 NABH Annual Meeting from June 12-14, 2023! The hotel’s cut-off date is Thursday, May 11, 2023. And please visit our Annual Meeting webpage to register for the meeting, if you have not done so yet. We look forward to seeing you in Washington!

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

Fact of the Week

A recent Health Affairs study found that the proportion of adult primary care visits that addressed mental health concerns increased to 15.9% by 2016 and 2018 from 10.7% of visits in 2006–07. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 134

Written by Emily Wilkins (NABH) on March 31, 2023. Posted in CEO Updates.

NABH Releases 2023 Advocacy Priorities

NABH this week released its 2023 advocacy priorities, which reflect the association’s mission and outline the actions NABH will take to achieve its goals. Categorized under the headings “Mental Health” and “The Addiction Crisis,” NABH’s 2023 advocacy priorities include securing the promise of parity; persuading lawmakers to provide incentives for behavioral healthcare providers to establish and implement a solid behavioral health information technology infrastructure; advocating Congress to repeal the Institutions for Mental Diseases (IMD) exclusion; pushing the Centers for Medicare & Medicaid Services to ensure payment rates provide adequate and appropriate reimbursement for opioid treatment program services; maintaining tele-behavioral healthcare services, and more. Please review this document and share it with others. If you have questions, please contact nabh@nabh.org.

FDA Approves First Over-the-Counter Naloxone Spray

The U.S. Food and Drug Administration (FDA) on Tuesday approved Narcan, 4 mg. naloxone hydrochloride nasal spray for over-the-counter (OTC), non-prescription use, making it the first naloxone product approved to use without a prescription. Naloxone is a medication that reverses the effects of opioid overdose rapidly and is the standard treatment for opioid overdose. The FDA’s action clears the way for this life-saving medication to be sold directly to consumers in drug stores, convenience stores, grocery stores, gas stations, and online. The move comes at a time when the Centers for Disease Control and Prevention released provisional data earlier this month that showed 101,750 reported U.S. fatal overdoses in the 12-month period ending in October 2022, while the predicted number of fatal doses for that period is even higher at 107,669. “As a physician, I have used Naloxone on people to reverse an opioid overdose hundreds of times and have witnessed firsthand its life-saving effects,” Rahul Gupta, M.D., director of the White House Office of National Drug Control Policy, said in a statement this week. “FDA’s announcement to make Narcan available over-the-counter is an important step to make this medicine accessible to more people at a time when the majority of overdose deaths are being driven by illicit opioids like fentanyl,” he added. “This move will also build on the progress made under the Biden-Harris administration to get more Naloxone into communities, expand access to treatment for substance use disorder, and reduce the supply of illicit drugs, which has resulted in a decline or flattening of overdose deaths for seven months in a row.” According to the FDA, the manufacturer determines the timeline for availability and price of this OTC product. Click here to learn more.

SAMHSA Warns Providers and Grantees About Xylazine Risks

In a letter this week, the Substance Abuse and Mental Health Services Administration (SAMHSA) alerted providers to the risks of xylazine, a non-opioid agent increasingly found in combination with opioids such as fentanyl. The letter said xylazine—which the FDA has not approved for use in humans—can cause severe circulatory changes with devastating effects on human tissue, leading to painful open lesions, necrosis, and potentially limb loss. “Practitioners must be aware of risks posed by xylazine and prepare to manage patients accordingly, Miriam Delphin-Rittmon, Ph.D., assistant secretary for mental health and substance use, wrote to providers. “SAMHSA’s goal with this alert is to provide information about the consequences of xylazine exposure, what practitioners can do to mitigate harm, and how SAMHSA is responding to this emerging public health challenge.” Known as “tranq” or “tranq dope” in the illicit drug market, xylazine can cause drowsiness, lethargy, and, in rare instances, apnea and death. SAMHSA encourages healthcare professionals and patients to report adverse events resulting from possible xylazine exposure to their local health department, poison center, or the American Association of Poison Control Centers at 1-800-222-1222. FDA’s MedWatch Adverse Event reporting may be completed online at www.fda.gov/medwatch.

SAMHSA Announces Three Recovery-Related Funding Opportunities

SAMHSA this week announced it will accept applications through May for three separate funding opportunities to implement and strengthen recovery services in communities. The programs include the Treatment, Recovery, and Workforce Support grant to implement evidence-based programs to support individuals in substance use disorder (SUD) treatment and recovery to live independently and participate in the workforce; the Recovery Community Services Program-Statewide Network, intended to strengthen community-based recovery organizations, their statewide networks of recovery stakeholders, and specialty and general healthcare systems as key partners in delivering state and local recovery support services; and the Recovery Community Services Program, which would provide peer recovery support services to individuals with SUD or co-occurring substance use and mental disorders, including those in recovery from these disorders. SAMHSA will accept applications for all three funding opportunities until May 30.

Reminder: SAMHSA Funding Opportunity to Establish or Implement Opioid Recovery Centers

SAMHSA has announced it will grant up to $1.4 million in two awards to establish or implement comprehensive treatment and recovery centers that provide a spectrum of treatment, harm reduction, and recovery support services to address America’s opioid crisis. Applications are due Tuesday, May 16. Click here to learn more and apply.

Advertise in the 2023 NABH Exhibitor and Sponsor Guide!

Register and Reserve Your Hotel Room Today for the 2023 NABH Annual Meeting!

Please join us in Washington, DC from June 12-14, 2023 for this year’s NABH Annual Meeting at the Salamander Washington, DC (formerly the Mandarin Oriental hotel). NABH’s theme this year is Securing the Promise of Parity, which recognizes the Mental Health Parity and Addiction Equity Act’s (MPAEA) 15^th anniversary and that we have more work to do to ensure the landmark law is implemented fully. Our preliminary program will be available soon. Meanwhile, please visit our Annual Meeting homepage to register, reserve your hotel room, and view our Annual Meeting At-a-Glance. We look forward to seeing you in Washington!

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

Fact of the Week

Between 2009 and 2019, the number of pediatric mental health hospitalizations increased by 25.8%, and these hospitalizations accounted for a significantly higher proportion of pediatric hospitalizations, according to a study published in JAMA this week. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 133

Written by Emily Wilkins (NABH) on March 24, 2023. Posted in CEO Updates.

NABH Responds to Senate HELP Committee RFI About U.S. Healthcare Workforce Shortage

NABH thanks its many members who submitted comments detailing their workforce challenges and potential solutions, which helped form the association’s response to the Senate Health, Education, Labor & Pensions (HELP) Committee’s request for information earlier this week. In its six-page letter, NABH noted that America’s behavioral healthcare workforce shortage has reached a crisis point, with nearly 58 million adults reporting any mental illness, about 61 million people using illicit drugs, and more than 150 million people living in federally designated mental health professional shortage areas at a time when the U.S. psychiatrist workforce will contract through 2024 to a projected low of 38,821, equal to a shortage of between 14,280 and 31,091 psychiatrists. A diminished candidate pool, a limited employee pipeline, workplace violence, employee satisfaction in a post-pandemic environment, a highly competitive workforce, over-regulation, and an extremely limited health information technology infrastructure were the leading drivers of the segment’s workforce shortage, the association noted, based on NABH system member responses. The letter then summarized a range of solutions under the categories of reimbursement at parity, additional funding for training programs, and deregulation. NABH will discuss how to address the behavioral healthcare workforce shortage in two sessions at the 2023 NABH Annual Meeting on Monday, June 12.

NABH Addresses Federal Lawmakers’ Stigmatizing Comments about OTPs

NABH this week sent a letter to federal lawmakers expressing deep disappointment with the congressional leaders’ recent comments that compared the nation’s opioid treatment programs (OTPs) with drug cartels and characterized this behavioral healthcare segment as an industry protecting its profits. “These comments are highly stigmatizing to the approximately 18,000 staff who work in OTPs and have dedicated their careers to delivering life-saving services to individuals with opioid use disorders (OUD),” NABH wrote in a letter to Rep. Donald Norcross (D-N.J.) and Sen. Edward Markey (D-Mass.) “Your comments also perpetuate the ongoing stigma against medication-assisted treatment (MAT) that plagues our society,” the letter continued. “This stigma is one of the primary reasons that people with OUD do not seek, nor receive, MAT, even though it is the evidence-based, gold standard of care for patients suffering from OUD. We are confident you both agree that with our nation facing an overdose epidemic with one death every five minutes, we cannot afford to lose ground in the battle against stigmatization in addiction care.” The letter highlights strengths and weaknesses of recent regulatory reforms and current legislation. It also provides a series of recommendations for lawmakers, such as examining the effects of recent efforts to expand access, with a specific focus on understanding the root causes behind incremental overdoses as well as the disproportionate harm that marginalized populations suffer; addressing significant barriers to treatment; and studying the potential impact of leveraging community-based pharmacies in the United States to dispense methadone widely to patients while ensuring that adequate regulatory controls can be established, given the concerning behaviors by pharmacies that recent court proceedings have documented.

NABH Files Amicus Brief on Behalf of Nine Organizations in Wit v. UBH Ruling

NABH has filed an amicus brief that supports a petition for rehearing the ongoing Wit v. United Behavioral Health (UBH) case. A three-judge panel in the 9^th U.S. Circuit Court of Appeals on Jan. 26 replaced its March 2022 ruling in the Wit v. UBH case with a new opinion that was a major disappointment to both mental health patients and providers. NABH asserts the latest opinion will materially reduce the benefit of insurance because it does not protect medically necessary treatment based on generally accepted standards of care.

NIH Study Reveals Shared Genetic Markers Underlying SUD

Scientists have identified genes commonly inherited across addiction disorders, regardless of the substance used, according to a study published in Nature Mental Health. With support from the National Institute on Drug Abuse, the National Institute on Alcohol and Alcoholism, the National Institute of Mental Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Institute on Aging, researchers at Washington University in St. Louis, along with more than 150 coauthors worldwide, analyzed genomic data from more than 1 million people. Their findings also reinforce the role of the dopamine system in addiction, by showing that the combination of genes underlying addiction disorders was also associated with regulation of dopamine signaling. Click here to learn more.

SAMHSA Announces Funding Opportunity to Establish or Implement Opioid Recovery Centers

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced it will grant up to $1.4 million in two awards to establish or implement comprehensive treatment and recovery centers that provide a spectrum of treatment, harm reduction, and recovery support services to address America’s opioid crisis. Applications are due Tuesday, May 16. Click here to learn more and apply.

Advertise in the 2023 NABH Exhibitor and Sponsor Guide!

Register and Reserve Your Hotel Room Today for the 2023 NABH Annual Meeting!

Please join us in Washington, DC from June 12-14, 2023 for this year’s NABH Annual Meeting at the Salamander Washington, DC (formerly the Mandarin Oriental hotel). NABH’s theme this year is Securing the Promise of Parity, which recognizes the Mental Health Parity and Addiction Equity Act’s (MPAEA) 15^th anniversary and that we have more work to do to ensure the landmark law is implemented fully. Please visit our Annual Meeting homepage to register, reserve your hotel room, and view our Annual Meeting At-a-Glance. We look forward to seeing you in Washington!

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

Fact of the Week

The National Alliance on Mental Illness (NAMI) reports that research shows the effects of solitary confinement on mental health are often fatal, both during and after incarceration. A recent showed individuals were overall 24% more likely to die in the first year after release, including from suicide (78% more likely) and homicide (54% more likely). They were also 127% more likely to die of an opioid overdose in the first two weeks after release. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 132

Written by Emily Wilkins (NABH) on March 17, 2023. Posted in CEO Updates.

NABH Remembers Former Board Member Frank Fortunati, Jr., J.D., M.D.

NABH remembers with grateful appreciation Frank Fortunati, Jr., J.D., M.D., 58, who died March 5 after a protracted, courageous battle against prostate cancer. A psychiatrist, attorney, and pharmacist, Fortunati had served as assistant professor of psychiatry and deputy chair for Yale-New Haven Health System. Since 2016, he was the vice chief and medical director of psychiatry and behavioral health for Yale-New Haven Hospital, where he was also active in the department’s COVID Healthcare Worker Support Task Force and Anti-racism Task Force. Referred to as a true Renaissance Man, Fortunati was an accomplished musician who played saxophone, guitar, piano, and flute. His obituary noted that one of his great joys was performing with his friends and fellow psychiatrists in their band “Schedule II.” In the car, he enjoyed listening to jazz or classic Rock. He was also an avid gardener, spending hours growing and harvesting tomatoes, peppers, eggplants, grapes, and figs. Fortunati served as a member of the NABH Board of Trustees from 2018-2020 and was also an engaged member of NABH’s Quality Committee, Workplace Violence Prevention Workgroup, and COVID-19 Task Force. His fellow board members and the Washington-based NABH team will remember how he always listened well and offered thoughtful, practical solutions to any topic—and proposed solutions that made life better for patients and the healthcare teams who cared for them. “Fortunati led by example, often serving in multiple roles (vice chief, section head, inpatient medical director),” the Yale School of Medicine wrote in an announcement about his death. “He earned the respect of everyone who worked with him. His credibility enabled him to drive change and improve quality. He put others ahead of his personal needs, repeatedly declining to complete the paperwork necessary for his own promotion in the service of looking out for others.” Fortunati is survived by his wife, Karen; children Jenna and Frankie; other family members; and the Fortunati family’s three cherished dogs. Funeral services were held at Saint Mary Church (Precious Blood Parish) in Milford, Conn. on March 11.

NABH Raises Information System Limitations and Prior Authorization Concerns with CMS

NABH this week submitted comments to the Centers for Medicare & Medicaid Services (CMS) about the agency’s electronic prior authorization proposed rule as it pertains to behavioral healthcare patients and providers. Under the direction of the NABH Managed Care Committee, the association raised concerns that the current limitations of the behavioral healthcare sector’s information system infrastructure are such that, without federal investment in compliant information technology to enable behavioral healthcare connectivity, most behavioral healthcare providers will remain shut out of 1) the interoperable exchange of patient health information, and 2) the electronic prior authorization processes that the rule proposes. NABH’s letter also strongly supports modifying existing regulation to treat prior authorization approvals as a promise of payment that cannot be retracted, in addition to a determination of whether an item or service is medically necessary.

NABH Opposes Proposed FTC Ban on Non-Compete Clauses

In comments submitted today, NABH asked the Federal Trade Commission (FTC) to withdraw its proposed rule that would ban non-compete clauses. NABH’s opposition to this proposal was based on three distinct concerns: the rule proposes an overly simplified, one-size-fits-all approach for all employees across all industries; given the workforce disruptions related to the COVID-19 pandemic, now is not the time to upend the healthcare labor markets; and, finally, the FTC lacks the statutory authority to promulgate this wide-reaching regulation.

Members of Congress Request Telehealth Parity Guidance from DOL

A bipartisan group of Members of Congress have sent a letter to the U.S. Labor Department (DOL) urging the department to provide guidance regarding parity enforcement for mental health and substance use disorder (SUD) services delivered via telehealth. In the letter, House members expressed concern that health plans may be less motivated to cover behavioral healthcare telehealth services after the COVID-19 public health emergency is scheduled to end on May 11. “Since the onset of the pandemic, telehealth use has risen dramatically, with 41% of MH/SUD care delivered via telehealth by October 2020,” the letter noted. “Mental health conditions continue to be the top claims diagnosis in the commercial market rising from 30% in January 2020 to roughly 65% in November 2022,” it continued. “Given the immense need for MH/SUD services combined with acute behavioral health workforce shortages, we want to ensure insurance plans and issuers understand their responsibility under federal parity law as it relates to behavioral health services delivered via telehealth.” Click here to read the full letter.

SAMHSA Announces National Strategy for Suicide Prevention Funding Opportunity

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week announced it will grant five awards totaling $2 million to implement suicide prevention and intervention programs for adults that help implement the 2021 Surgeon General’s Call to Action to Implement the National Strategy for Suicide Prevention. With an emphasis on older adults, adults in rural areas, and American Indian and Alaskan native adults, the program is meant to address the Call to Action’s broad-based public health approach to suicide prevention through enhancing collaboration among stakeholders such as county health departments, workplace settings, criminal justice setting, senior-serving organizations, and community firearm stakeholders. Applications are due Monday, May 15. Click here for more information.

Advertise in the 2023 NABH Exhibitor and Sponsor Guide!

NABH will distribute the 2023 NABH Exhibitor and Sponsor Guide to all registrants at the 2023 NABH Annual Meeting from June 12-14, 2023 at the Salamander Washington, DC. Be sure your organization is included in it! All ads are due by April 21, 2023. Please click here for details about advertising options, requirements, payment, and more. The association also will send the guide to all NABH members after the meeting and post it on the NABH Annual Meeting webpage. Registration is Open for the 2023 NABH Annual Meeting: Securing the Promise of Parity! Please join us in Washington, DC from June 12-14, 2023 for this year’s NABH Annual Meeting at the Salamander Washington, DC (formerly the Mandarin Oriental hotel). NABH’s theme this year is Securing the Promise of Parity, which recognizes the Mental Health Parity and Addiction Equity Act’s (MPAEA) 15^th anniversary and that we have more work to do to ensure the landmark law is implemented fully. Please visit our Annual Meeting homepage to register, reserve your hotel room, and view our Annual Meeting At-a-Glance. We look forward to seeing you in Washington!

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

Fact of the Week

Black and Hispanic adults with co-occurring disorders were less likely to receive mental health or substance use treatment (47% and 43%, respectively) than White adults (64%), according to research from The Pew Charitable Trusts. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 131

Written by Emily Wilkins (NABH) on March 10, 2023. Posted in CEO Updates.

President Biden’s FY 2024 Budget Proposal Includes Strong Focus on Behavioral Healthcare Needs

Yesterday, President Biden issued his Fiscal Year 2024 budget proposal, which now goes to Congress for consideration. Key provisions include: Elimination of the 190-day Lifetime Limit on Psychiatric Hospital Services. The proposed budget would rescind the current law limiting Medicare enrollees to a lifetime limit of 190-days inpatient psychiatric care. The purpose of this provision is to increase access to hospital-level care and advance parity between mental health and physical health coverage for patients with serious mental illness. The budget estimates that this item would generate a $2.4 billion cost to Medicare over 10 years. Greater Psychiatric Hospital Flexibility when Restoring Compliance with Conditions of Participation. In cases where a psychiatric hospital is non-compliant with the Medicare conditions of participation for a deficiency that does not jeopardize patient health and well-being, the proposed budget would give CMS flexibility to continue issuing Medicare payments if the facility is actively working to correct the deficiency, rather than terminate Medicare participation. Workforce. The proposed budget also includes a $2 billion mandatory Mental Health System Transformation Fund for workforce development and service expansion. In part, this workforce development effort would augment FY 2023 funding already enacted in law to train about 18,000 behavioral health providers— including clinicians, peer support specialists, and others—and increase the number of providers practicing in areas of high demand throughout the country. Parity. The proposed budget would apply to Medicare Advantage the 2008 Mental Health Parity and Addiction Equity Act, requiring health plans to offer mental health and substance use disorder benefits that are no more restrictive than the medical and surgical benefits they offer. It also requires health plans to use medical necessity criteria for behavioral health developed by nonprofit medical specialty associations, as well as regulation of behavioral health network adequacy, and the creation of a standard for parity in reimbursement. The budget estimates a $760 million cost over 10 years for these parity items. Learn more about the Biden administration’s FY 2024 budget proposal here.

Study Shows Opioids Cause Half of All Poisonings in U.S. Kids Aged 5 and Under

About 52% of poisoning deaths of U.S. children aged 5 and under in 2018 involved the ingestion of an opioid, according to a study published online this week in the journal Pediatrics. Researchers also found that opioids accounted for a progressively greater proportion of the substances contributing to poisoning-related deaths during the study period, from 24% in 2005 to 52% in 2018. “As the types of opioids circulating during the current epidemic continue to evolve, policy and programmatic initiatives should focus on children in addition to adults,” the study’s authors wrote. “Regulatory changes have improved the safety of OTC medications, but a substantial proportion of pediatric fatalities are still associated with this medication class.”

Thank You to Members Who Submitted Comments on Workforce Challenges & Solutions

NABH thanks all members who responded to our request for feedback about their system’s most critical workforce challenges and potential solutions. The NABH Research and Education Foundation is seeking comments in these two areas to help NABH respond to a request for information (RFI) that the Senate Health, Education, Labor & Pensions (HELP) Committee announced last week. The RFI follows a Feb. 16 hearing the Senate HELP Committee held to examine the root causes of America’s current healthcare workforce shortages and explore potential solutions. If you haven’t sent comments and would like to contribute, please send your feedback as an attachment to foundation@nabh.org by the close of business on Monday, March 13.

Registration is Open for the 2023 NABH Annual Meeting: Securing the Promise of Parity!

Please join us in Washington, DC from June 12-14, 2023 for this year’s NABH Annual Meeting at the Salamander Washington, DC (formerly the Mandarin Oriental hotel). NABH’s theme this year is Securing the Promise of Parity, which recognizes the Mental Health Parity and Addiction Equity Act’s (MPAEA) 15^th anniversary and that we have more work to do to ensure the landmark law is implemented fully. Please visit our Annual Meeting homepage to register, reserve your hotel room, and view our Annual Meeting At-a-Glance. We look forward to seeing you in Washington!

Manatt Telehealth Webinar Recording Now Available

NABH thanks its members who helped the NABH Education and Research Foundation and Manatt produce a joint issue brief, Telehealth is Effectively Augmenting Traditional Partial Hospitalization and Intensive Outpatient Programs last month. In case you missed it, Manatt led a webinar on March 1 that highlighted the telehealth issue brief’s findings. Click here to submit a brief form to watch the recorded webinar. NABH is grateful to Abhi Pardeshi from UHS, Dylan Ross from Rogers Behavioral Health, and T.J. Vlavianos from Northwell Health’s Zucker Hillside Hospital for joining NABH President and CEO Shawn Coughlin as the webinar’s panelists.

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

Fact of the Week

Males make up 25% of people with anorexia. Because they are often diagnosed later than females, they are at higher risk of dying, according to the Center for Discovery. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 130

Written by Emily Wilkins (NABH) on March 3, 2023. Posted in CEO Updates.

Registration is Open for the 2023 NABH Annual Meeting: Securing the Promise of Parity!

Please join us in Washington, DC from June 12-14, 2023 for this year’s NABH Annual Meeting at the Salamander Washington, DC (formerly the Mandarin Oriental hotel). NABH’s theme this year is Securing the Promise of Parity, which recognizes the Mental Health Parity and Addiction Equity Act’s (MPAEA) 15^th anniversary and that we have more work to do to ensure the landmark law is implemented fully. Please visit our Annual Meeting homepage to register, reserve your hotel room, and view our Annual Meeting At-a-Glance. We look forward to seeing you in Washington!

Please Send Us Your Feedback on Workforce Challenges & Solutions

The NABH Research and Education Foundation is seeking comments from NABH members on 1) the main drivers of your system’s workforce shortages, and 2) your ideas for solutions. NABH will gather this collective feedback and respond to the request for information (RFI) that the Senate Health, Education, Labor & Pensions (HELP) Committee announced thursday. The RFI follows a Feb. 16 hearing the Senate HELP Committee held to examine the root causes of America’s current healthcare workforce shortages and explore potential solutions. Please send your comments as an attachment to foundation@nabh.org by the close of business on Monday, March 13. Thank you for your help with this critical issue!

DEA Proposes Two Telemedicine Regulations

The Drug Enforcement Administration (DEA) recently published two telemedicine rules that, taken together, largely revert to pre-COVID requirements for an in-person medical evaluation prior to prescribing controlled substances. DEA’s Notices of Proposed Rulemaking (NPRM) for buprenorphine and telemedicine without an in-person medical evaluation propose permitting the following two scenarios under which a telemedicine prescription can take place: Scenario A: Permitting a virtual first prescription by the prescribing practitioner without an in-person medical evaluation for an initial 30-days of non-narcotic Schedule III-V or buprenorphine-controlled substances. The NPRM proposes specific processes and documentation requirements for this scenario, such as checking the PDMP and noting ‘telemedicine’ on the face of the prescription. Scenario B: Permitting a qualified telemedicine referral in which a second DEA-registered practitioner performs an in-person exam and makes a referral to the prescribing practitioner. Under this scenario, Schedule II-V and narcotic substances can be prescribed. The NPRM proposes processes and documentation for these referrals, such as a written referral and transfer of medical records prior to prescribing. To continue prescribing after 30-days under Scenario A, a one-time in-person medical evaluation is required. The in-person evaluation requirement can be satisfied in three ways:

Through an evaluation by the telemedicine prescribing practitioner;

Through an evaluation conducted as a three-way audio-visual exam in which the prescribing practitioner, another DEA-registered referring provider, and the patient participate;

Through a ‘qualified telemedicine referral’ by another DEA-registered practitioner who has seen the patient in-person and who adheres to specific procedures and documentation for the referral.

Meanwhile, if a telemedicine prescription for a controlled substance was initiated during the public health emergency (PHE), the NPRM proposes a 180-day transition period during which time an in-person medical evaluation must take place. If the NPRM is finalized by May 11, 2023 (the designated end of the PHE), an individual inducted during the PHE would have to have an in-person medical evaluation by November 2023. This extends to all prescriptions for controlled substances II-V initiated during the PHE. The NPRM do not include the long-awaited special registration rule, which would have allowed certain clinicians to prescribe controlled substances via telemedicine without an in-person evaluation. Moreover, DEA said this NPRM satisfies its obligation to propose rules for a special registration. In addition, the revisions align with the Centers for Medicare & Medicaid Services’ updated definition of telehealth to include audio-only telemedicine of controlled substances for mental health where states permit it. These instances are both limited and situational. NABH will provide comments to DEA by the agency’s March 31 deadline. Please send any comments to Sarah Wattenberg at sarah@nabh.org by Friday, March 17.

SAMHSA Releases Report on Long COVID’s Effects on Behavioral Health

A meta-analysis of studies around the world showed that the overall prevalence of depression, anxiety, and sleep disturbances among COVID-19 survivors was 45%, 47%, and 34%, respectively, according to a report released this week from the Substance Abuse and Mental Health Services Administration (SAMHSA). The Centers for Disease Control and Prevention (CDC) defines Long COVID as “new, returning, or ongoing symptoms that last four or more weeks following acute COVID-19 diagnosis.” SAMHSA’s report, Overview of the Impacts of Long COVID on Behavioral Health, examines the effects of the deadly virus in a variety of areas, including cognitive and psychiatric symptoms associated with Long COVID, a widening of health disparity gaps, potential long-term implications, and future directions for Long COVID recovery. “Among the most common symptoms of Long COVID is a gradient of cognitive and psychiatric sequelae (e.g., depression, anxiety, PTSD), which may portend significant consequences for patient functioning and quality of life,” the report noted. The study also said that in comparison with those not affected, COVID-19 survivors show increased rates of mental health and cognitive problems.

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

Fact of the Week

Research has shown that, regardless of COVID-19 status, 53% of healthcare workers reported symptoms of at least one mental health condition, including depression (32%), anxiety (30%), PTSD (37%), and suicidal ideation (8%), according to SAMHSA’s Overview of the Impacts of Long COVID on Behavioral Health. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 129

Written by Emily Wilkins (NABH) on February 24, 2023. Posted in CEO Updates.

Registration is Open for the 2023 NABH Annual Meeting: Securing the Promise of Parity!

Please plan to join us in Washington, DC from June 12-14, 2023 for this year’s NABH Annual Meeting at the Salamander Washington, DC (formerly the Mandarin Oriental hotel). NABH’s theme this year is Securing the Promise of Parity, which recognizes the Mental Health Parity and Addiction Equity Act’s (MPAEA) 15^th anniversary and that we have more work to do to ensure the landmark law is implemented fully. Please visit our Annual Meeting homepage to register, reserve your hotel room, and view our Annual Meeting At-a-Glance. We look forward to seeing you in Washington!

Reminder: NABH-Manatt Telehealth Issue Brief Webinar on Wednesday, March 1

Manatt will host a webinar featuring NABH President and CEO Shawn Coughlin and NABH members as panelists on Wednesday, March 1 at noon ET to highlight findings from the telehealth issue brief that the NABH Education and Research Foundation and Manatt released this month. The telehealth issue brief is the first resource from the NABH Education and Research Foundation, which worked with NABH members and Manatt to compile and evaluate data to measure the impact that telehealth services have had on access and outcomes. The study showed how telehealth services effectively augment traditional partial hospitalization programs (PHP) and intensive outpatient programs (IOP). NABH urges its members to read the issue brief and share it with others. The association has also created a social media toolkit with shareable graphics that highlight key research from the study. Members can access the issue brief and social media toolkit on the NABH Education and Research Foundation’s Resources page. Click here to register for next week’s free webinar.

Biden Administration Will Allow States to Use Medicaid to Cover SUD for Incarcerated Persons

The Biden administration will allow states to use Medicaid funding to cover substance use disorder (SUD) treatment for incarcerated persons at state jails and prisons, news outlets reported this week. According to Politico, Rahul Gupta, M.D., director of the Office of National Drug Control Policy, said Tuesday that the Centers for Medicare & Medicaid Services (CMS) plans to release guidance this spring that outlines how states could use the program and federal dollars to pay for treatments before people are released. The story also quoted Gupta as saying the guidance is a “smart move” and that all 112 of the nation’s federal prisons will offer medication-assisted treatment for SUD by this summer.

NIH Trial to Compare Effects of Prescribed Buprenorphine or Methadone in Office Settings

The National Institutes of Health (NIH) will conduct a hybrid effectiveness/implementation trial to compare patients’ ability to remain in treatment when they’re prescribed buprenorphine or methadone in an office-based setting, STAT News reported today. According to the story, the clinical trial, scheduled for this year, is the first of its kind in the “fentanyl era.” “While we do have hints from the scientific literature that methadone has better outcomes with respect to retention in treatment and decreases in illicit drug use, we actually don’t have that literature in patients who are primarily using fentanyl,” David Fiellin, M.D., director of Yale Medical School’s Program in Addiction Medicine and the researcher overseeing the trial, said in the story. Click here for details about the NIH study.

CMS Releases Preliminary Medicaid and CHIP Data Snapshot

CMS this week released Medicaid and CHIP and the Covid-19 Public Health Emergency, a data snapshot that compares healthcare service utilization patterns, including behavioral healthcare services, in Medicaid and the Children’s Health Insurance Program (CHIP) during the Covid-19 pandemic from March 2020 through July 2022. Section five of the report presents the behavioral healthcare content, including services delivered via telehealth and a breakdown of services for adults and children enrolled in these programs. More than 137 million Americans—including children, pregnant women, parents, seniors, and individuals with disabilities—were enrolled across each state’s Medicaid or CHIP for at least one day during the public health emergency.

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

Fact of the Week

Black patients are 1.6 times more likely to experience an involuntary psychiatric hospital admission than non-Black patients, according to a study about racial and ethnic inequities published in Psychiatric Services. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 128

Written by Emily Wilkins (NABH) on February 17, 2023. Posted in CEO Updates.

FDA Advisors Recommend Over-the-Counter Use of Narcan

A U.S. Food and Drug Administration (FDA) advisory panel this week voted 19-0 to recommend the agency approve the anti-opioid overdose drug Narcan be made available as an over-the-counter drug. Narcan is currently available by prescription only, and the change would make it the first opioid overdose reversal drug to be made available over the counter. News reports noted the FDA advisors also asked that the manufacturer make it more clear to users how to administer the product. The FDA is expected to make a final decision by March 29.

CDC Releases Youth Risk Behavior Survey Data Summary & Trends Report: 2011-2021

Female students were nearly twice as likely to attempt suicide during the past year compared with their male peers, with nearly six in 10 feeling persistently sad or hopeless and more than one in 10 attempting suicide, the Centers for Disease Control and Prevention (CDC) reported in its Youth Risk Behavior Survey Data Summary & Trends Report: 2011-2021 this week. The data provide a critical view of U.S. adolescent health and well-being related to sexual behavior, substance use, experiences of violence, mental health, and suicidal thoughts and behaviors. This year’s report also includes data on students’ experiences of unstable housing, school connectedness, and parental monitoring to expand understanding of young people’s environments and opportunities to improve them. In the CDC’s words, the findings “tell a distressing story” about the health and well-being of our country’s young people. According to the report, female students experienced more violence, mental health challenges, suicidal thoughts and behaviors, and substance use than their male peers. For instance, the percentage of female students who had ever experienced forced sex increased for the first time in 10 years, with 14% of female students having this experience. Meanwhile, attempted suicide was higher among Black students than students from other groups and increased among Black and White students from 2011 to 2021. And LGBQ+ students were nearly four times as likely as their heterosexual peers to attempt suicide during the past year, with more than two in 10 reporting this experience.

CDC Provisional Data Show U.S. Drug Overdose Deaths High but Declining

Provisional data from the CDC this week show the number of U.S. drug overdose deaths, while still high, has declined. The CDC predicts there were 106,840 drug overdose deaths for the 12-month period ended September 2022 compared with 107,937 predicted drug overdose deaths for the 12-month period ended August 2021. And when comparing month-over-month statistics in 2022, the numbers show a steady decline, starting with 110,317 predicted overdose deaths in March 2022. In a statement last month, Office of National Drug Control Policy (ONDCP) Director Rahul Gupta, M.D. attributed the progress to the Biden administration’s efforts to remove barriers to treatment and disrupting the supply of illicit drugs.

SAMHSA Releases National Substance Use and Mental Health Services Survey, 2021

More than two-thirds of substance use treatment facilities (69.5%) offered pharmacotherapies as part of their treatment services, with a higher percentage of substance use facilities reporting they used medication-assisted treatment (MAT) for treating opioid use disorder (55.3%) than for treating alcohol use disorder (37.9%). Those were among the findings of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Substance Use and Mental Health Services Survey, 2021 released this week. Researchers gathered data from April 30, 2021 through January 10, 2022 for the 35-page report, which is the most comprehensive national source of data on substance use and mental health treatment facilities, its territories, and Washington, D.C.

NABH Submits Comments to SAMHSA on Opioid Treatment Program Regulations

This week NABH submitted a comment letter to SAMHSA on the Opioid Treatment Program (OTP) regulations 42 CFR part 8. In it, NABH wrote that the association appreciates SAMHSA’s flexibility to OTPs, including new authority to provide methadone induction via telehealth. NABH was the first organization to advocate for this change when COVID-19 social-distancing measures made it hard for individuals to access methadone treatment. NABH expressed concerns and called for SAMHSA to remove changes to accreditation standards that would prematurely trigger one-year or non-accreditation status. Click here to read NABH’s letter.

NABH Submits Comments to CMS on Medicare Advantage

Also this week, NABH submitted comments to the Centers for Medicare & Medicaid Services (CMS) about policy and technical changes to Medicare Advantage (MA) for calendar year 2024. NABH noted that the association appreciates the proposed rule’s focus on improving access to and quality of care through increasing both the oversight and transparency of insurers. In particular, NABH supports the rule’s proposed improvements related to prior authorization, network adequacy, and quality of care, many of which NABH and its partners have long pursued. The association outlined a series of recommendations to CMS on topics such as clarifying “Original Medicare” standards as minimum requirements for MA; improving medical necessity; streamlining prior authorization requirements; and, regarding the rule’s proposed reduction of the overpayment window, allowing a reasonable time of about six months for providers to conduct investigations, and, when necessary, process a refund. Click here to read NABH’s letter.

Reminder: NABH-Manatt Telehealth Issue Brief Webinar on Wednesday, March 1

Manatt will host a webinar featuring NABH President and CEO Shawn Coughlin and some NABH members as panelists on Wednesday, March 1 at noon ET to highlight findings from the telehealth issue brief that the NABH Education and Research Foundation and Manatt released this month. The telehealth issue brief is the first resource from the NABH Education and Research Foundation, which worked with NABH members and Manatt to compile and evaluate data to measure the impact that telehealth services have had on access and outcomes. The study showed how telehealth services effectively augment traditional partial hospitalization programs (PHP) and intensive outpatient programs (IOP). NABH urges its members to read the issue brief and share it with others. The association has also created a social media toolkit with shareable graphics that highlight key research from the study. Members can access the issue brief and social media toolkit on the NABH Education and Research Foundation’s Resources page. Click here to register for next month’s free webinar.

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

Details Coming Soon for the NABH 2023 Annual Meeting

Please plan to join us in Washington, DC from June 12-14, 2023 for this year’s NABH Annual Meeting at the Salamander Washington, DC (formerly the Mandarin Oriental hotel). Details coming soon.

Fact of the Week

Some data brokers are marketing highly sensitive data on individuals’ mental health conditions on the open market, with seemingly minimal vetting of customers and seemingly few controls on using purchased data, according to a study from Duke University’s Sanford School of Public Policy. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 127

Written by Emily Wilkins (NABH) on February 10, 2023. Posted in CEO Updates.

Becerra Renews COVID-19 Public Health Emergency Through May 11

U.S. Health and Human Services Department (HHS) Secretary Xavier Becerra on Thursday renewed the nation’s COVID-19 public health emergency (PHE) status for another 90 days through May 11. “Based on current trends regarding COVID-19, the U.S. Department of Health and Human Services is planning for this to be the final renewal and for the COVID-19 PHE to end on May 11, 2023,” Becerra wrote to the nation’s governors on Feb. 9. “Rather than 60 days’ notice, I am providing 90 days’ notice before the COVID-19 PHE ends to give you and your communities ample time to transition.” Becerra’s letter also noted that the Biden administration’s whole-of-government approach to combatting the deadly virus has helped transition the country away from the emergency phase. Since Omicron peaked at the end of January 2022, daily COVID-19 reported cases are down 92%; COVID-19 deaths have declined by more than 80%; and new COVID-19 hospitalizations are down nearly 80%, Becerra’s letter noted.

NIMH to Host Webinar Next Week on the Opioid Crisis and HEALing Communities Study

The National Institute on Mental Health (NIMH) will host a webinar next Tuesday to discuss how the HEALing Communities Study (HCS) is testing the prevention and treatment of opioid misuse in communities that the nation’s opioid crisis has hit hardest. Sharon L. Walsh, Ph.D., professor of behavioral science, psychiatry, pharmacology and pharmaceutical sciences at the University of Kentucky’s Colleges of Medicine and Pharmacy, will describe how the HCS has begun to expand access to evidence-based care, improve data availability and timeliness, address social determinants of health, reduce stigma through public health communications campaigns, and modify relevant policies. Walsh also serves as director of the Center on Drug and Alcohol Research and the Substance Use Disorder Priority Research Area. She is the principal investigator of the HCS at the University of Kentucky. The HCS tests the integration of prevention, overdose treatment, and medication-based treatment in select communities. Click here to register for the free webinar, which will begin at 2 p.m. ET on Tuesday, Feb. 14.

SAMHSA Announces Funding Opportunity for Assertive Community Treatment Programs for Youth and Adults with SMI

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week announced it will award more than $5 million to establish or expand and maintain Assertive Community Treatment (ACT) programs for transition-aged youth and adults with serious mental illness (SMI). The program’s purpose is to improve behavioral health outcomes for individuals by reducing rates of hospitalization, mortality, substance use, homelessness, and involvement with the criminal justice system. Click here to learn more about the opportunity. Applications are due by Monday, April 10.

NIDA Reports Increased Activity in ‘Blue Lotus’ Drug

The National Institute on Drug Abuse (NIDA) reported this week that, in response to mentions of blue lotus for the first time from a Rapid Street Reporting (RSR) site visit in Austin, the substance has experienced steady activity in the past three years, with activity peaking in early and late 2022. Also known as Nymphae caerulea, blue lotus is a water lily primarily found in East Africa and the Arabian Peninsula. The flower contains aphorphine, a dopamine agonist, and is sold primarily as tea extracts or incense. Click here to learn more about blue lotus and the RSR team’s other recent findings in NIDA’s Feb. 10 newsletter.

In Case You Missed It: NABH Education and Research Foundation and Manatt Produce Issue Brief on Telehealth Services in PHP and IOP

The NABH Education and Research Foundation on Feb. 1 released an issue brief that shows how telehealth services effectively augment traditional partial hospitalization programs (PHP) and intensive outpatient programs (IOP). The telehealth issue brief is the first resource from the NABH Education and Research Foundation, which worked with NABH members and Manatt to compile and evaluate data to measure the impact that telehealth services have had on access and outcomes. NABH urges its members to read the issue brief and share it with others. The association has also created a social media toolkit with shareable graphics that highlight key research from the study. Members can access the issue brief and social media toolkit on the NABH Education and Research Foundation’s Resources page. Manatt will host a webinar about the issue brief’s findings on Wednesday, March 1 at noon ET. Click here to learn more and register for the free webinar. The NABH Education & Research Foundation fields independent studies and partners with other organizations to identify and develop best practices and improve NABH members’ ability to support the country’s behavioral health needs.

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

Details Coming Soon for the NABH 2023 Annual Meeting

Please plan to join us in Washington, DC from June 12-14, 2023 for this year’s NABH Annual Meeting at the Salamander Washington, DC (formerly the Mandarin Oriental hotel). Details coming soon.

Fact of the Week

Medicare Advantage (MA) enrollment increased by 22.2 million beneficiaries, or 337%, from 2006 through 2022, while traditional Medicare enrollment declined by 1.0 million, or −2.9% during that period, according to a study published this week in the journal Health Affairs. The increase in MA enrollment and penetration “indicates that beneficiaries are reforming Medicare with their feet,” the study’s authors wrote. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 226

Written by Emily Wilkins (NABH) on February 3, 2023. Posted in CEO Updates.

NABH Education and Research Foundation Partners with Manatt to Produce Issue Brief on Telehealth Services in PHP and IOP

The NABH Education and Research Foundation this week released an issue brief that shows how telehealth services effectively augment traditional partial hospitalization programs (PHP) and intensive outpatient programs (IOP). The telehealth issue brief is the first resource from the NABH Education and Research Foundation, which worked with NABH members and Manatt to compile and evaluate data to measure the impact that telehealth services have had on access and outcomes. Results from the study show that using telehealth services improved access to care and optimized the reach of existing personnel. The initial findings from several NABH members also indicated that, relative to in-person services, telehealth delivery-of-care produced similar or better outcomes for PHP and IOP patients. The telehealth issue brief’s key findings also include: During the COVID-19 crisis, regulatory flexibilities enabled traditional in-person PHPs and IOP programs to implement telehealth services rapidly. Using telehealth to deliver PHP and IOP services has improved access to care for remote patients and those facing other access obstacles. Emerging research is showing that, relative to in-person care, the use of telehealth in PHPs and IOPs generally is improving the quality of clinical care, patient satisfaction and the overall efficiency of the healthcare system. NABH urges its members to read the issue brief and share it with others. The association has also created a social media toolkit with shareable graphics that highlight key research from the study. Members can access the issue brief and social media toolkit on the NABH Education and Research Foundation’s Resources page. Manatt will host a webinar about the issue brief’s findings on Wednesday, March 1 at noon ET. Click here to learn more and register for the free webinar. The NABH Education & Research Foundation fields independent studies and partners with other organizations to identify and develop best practices and improve NABH members’ ability to support the country’s behavioral health needs.

New 9th Circuit Court of Appeals Ruling Threatens Behavioral Healthcare Coverage

A three-judge panel in the 9^th U.S. Circuit Court of Appeals on Jan. 26 replaced its March 2022 ruling in the Wit v. United Behavioral Health (UBH) case with a new opinion that is a major disappointment to both mental health patients and providers. NABH asserts the latest opinion will materially reduce the benefit of insurance because it does not protect medically necessary treatment based on generally accepted standards of care. NABH refuses to allow insurers to deny medically appropriate care to those who need it and will file a new amicus brief and request that the 9^th Circuit rehear the case. The U.S. District Court for the Northern District of California’s initial ruling on this class action case in 2019 affects more than 100 million health insurance enrollees. The ruling, considered one of the most significant of the last decade, found that UBH’s reimbursement guidelines for psychiatric conditions were non-compliant with generally accepted standards of care and treatment. In its ruling, the District Court articulated a series of clinical standards for behavioral healthcare treatment that emphasized the need for treatment to sustain improvement, rather than only address an immediate clinical crisis. The District Court also applied a holistic approach that required treatment for both primary and comorbid impairments, such as the combination of depression and a substance use disorder. A year after this finding, the District Court ordered UBH to reprocess more than 50,000 claims it had initially denied. The 9^th Circuit Court of Appeals subsequently undid this ruling with its 2022 memorandum. While the latest ruling in this case is a disappointment, NABH and other behavioral healthcare groups found both positive and negative elements in it. These include: Positive Factors:

The 9^th U.S. Circuit Court of Appeals found that UBH violated its fiduciary duty to all class members by using medical necessity criteria that were infected by UBH’s financial conflict of interest.
The 9^th U.S. Circuit Court of Appeals upheld the U.S. District Court’s finding that UBH broke the laws of four states, which required UBH to apply specific substance use criteria to evaluate medical necessity.

Negative Factors:

The 9^th U.S. Circuit Court of Appeals held that UBH does not have to reprocess over 60,000 claims for class members denied coverage under UBH’s flawed guidelines, contrary to longstanding precedent on reprocessing as an ERISA remedy.
The 9^th U.S. Circuit Court of Appeals held that all ERISA class action members must first exhaust their administrative remedies, even if doing so would be futile, as the U.S. District Court found was the case here.
The 9^th U.S. Circuit Court of Appeals held that insurers may use medical necessity criteria that are inconsistent with generally accepted standards of care.

CMS Updates Audit Protocol for Medicare Advantage Payments

The Centers for Medicare and Medicaid Services (CMS) on Jan. 30 issued a final rule related to using risk adjustment to ensure accurate payment for services provided under Medicare Advantage (MA). Modifications to the risk adjustment audit protocol, called risk adjustment data validation (RADV), and the related overpayment refund process were initially issued in a 2018 proposed rule. Final action was delayed until now, in part, due to the COVID-19 pandemic. The final rule reflects estimates from the HHS Office of the Inspector General of more than $15 billion in MA overpayments in fiscal year 2019, or about 7% of total payments. The final rule takes effect April 3, 2023 and has an estimated recovery amount of $4.7 billion in over 10 years. NABH supports this final rule’s objective to increase oversight of payment accuracy under MA and improve the alignment between payments and medically necessary services for enrollees. To align MA payments with the clinical needs of enrollees, CMS risk-adjusts payments based on patients’ health status and key characteristics. The goal of risk adjustment is to pay less for healthier enrollees and more for more medically complex enrollees. To identify any inaccuracies in MA risk-adjustment’s impact on payments, CMS conducts retrospective RADV audits of a sample of each plan’s enrollees—typically about 200 per plan— to review their medical records to quantify any gaps between medically necessary care and reimbursed services. Extrapolation: Beginning with payment year (PY) 2018, rather than PY 2011, as proposed, the overpayments quantified through RADV audits will be extrapolated to the full MA contract. While not articulated in the final rule, CMS’ extrapolation methodology will be disclosed to MA insurers and be focused on insurers identified as being at highest risk for improper payments. CMS stated that its use of extrapolation is intended to incentivize meaningful steps by its contractors to reduce improper MA risk-adjusted payments. Overpayments identified for PYs 2011 through 2017 will be refunded to CMS without the application of extrapolation. FFS Adjuster: In addition, as proposed, the final rule will not apply an adjustment factor (known as an FFS Adjuster) to RADV audit findings, which is a form of risk adjustment. This final position is based on recent case law, which found that the FFS adjuster must be applied to MA payments but not refunded overpayments, including those identified during a RADV audit.

Congressional Research Services Releases Parity Report

The Congressional Research Service (CRS)—the public policy research institute of the U.S. Congress—this week released a report that explains mental health/substance use disorder benefit coverage and parity requirements and the types of private health insurance plans subject to those requirements. The report includes a brief review of relevant legislative history, including changes enacted in December 2022, and a discussion and examples of required federal agency activities. The CRS focused on federal private insurance requirements; it does not compare state requirements or actual plan variation in coverage. It also does not examine mental health benefits in Medicare and Medicaid. Click here to read the report.

National Institute of Mental Health Develops Strategic Framework to Address Youth Mental Health Disparities

The National Institute of Mental Health (NIMH) has developed the National Institute of Mental Health (NIMH) Strategic Framework for Addressing Youth Mental Health Disparities for fiscal years 2022–2031, a resource intended to provide a conceptual approach to help guide NIMH activities, including research funding, stakeholder engagement, and workforce development related to research on the mental health needs of youth affected by racial and ethnic health disparities. “Our country is in the midst of a youth mental health crisis, including alarming increases in youth suicide in recent years,” Christina P.C. Borba, Ph.D., M.P.H., wrote in the framework’s foreword message. “We also know that youth exposed to racism, discrimination, and other adverse experiences, as well as those from disadvantaged and underserved communities, are disproportionately impacted by mental illnesses, and frequently experience reduced access to high-quality, evidence-based mental health services and receive fewer follow-ups in a variety of provider settings,” Borba continued. “Addressing these challenges will require sustained attention, effort, and resources – all built on a foundation of high-quality research.”

News Report Shows How States are Responding to Synthetic Opioid Nitazene

The news outlet Axios recently examined how nitazene, a synthetic opioid thought to be 40 times more powerful than fentayl, is complicating the public health response to the opioid crisis in various states. Nitazene comes in powder, pill, and liquid form and requires significant lab work to trace. “Often laced into substances that users think is fentanyl or heroin, it’s potentially lethal or can cause a more severe onset of withdrawal symptoms,” the story noted. The Centers for Disease Control and Prevention (CDC) last September published a study on nitazene-related deaths in Tennessee from 2019-2021 and reported that nitazenes are an emerging group of highly potent psychoactive substances for which tests are not often included in standard toxicology panels. “Given their potency, raising awareness about nitazenes and implementing strategies to reduce harm through increased testing, surveillance, and linkage to treatment for substance use disorders are of vital importance,” the CDC study said. “More data are required to better understand this emerging group of psychoactive substances in the United States.”

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

Details Coming Soon for the NABH 2023 Annual Meeting

Please plan to join us in Washington, DC from June 12-14, 2023 for this year’s NABH Annual Meeting at the Salamander Washington, DC (formerly the Mandarin Oriental hotel). Details coming soon.

Fact of the Week

A new Pew Research Center study shows that 40% of parents report they are “extremely/very” worried that their children might struggle with anxiety or depression at some point. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 225

Written by Emily Wilkins (NABH) on January 27, 2023. Posted in CEO Updates.

NABH Submits Comment Letter on Federal and State Health Exchange Proposed Rule for 2024 Today, NABH submitted comments on the Contract Year 2024 proposed rule related to the federal and state health exchange marketplace. NABH expressed support for the generally positive rule, including its multiple proposals to assist consumers seeking to enroll in exchange-based health plans and, ultimately, to access mental health and substance use disorder treatments. Our comments also called for the Centers for Medicare & Medicaid Services (CMS) to, rather than merely requiring a minimal contracting attempt, as proposed, require health plans to meet a minimum contracting level based on a percentage of available mental health facilities and substance use disorder treatment centers. In addition, the letter urged CMS to evaluate the current level of actual coverage for mental health services being provided by plans on the federal and state marketplace. We also called on CMS to study the impact of insurer network expansion practices that result in some behavioral health sites and services being unilaterally added to, or “deemed” members of, health plan networks and paid an in-network rate that was already rejected by the provider. The comment deadline for this proposed rule is Monday, January 30. CMS Approves California’s Medicaid 1115 Demonstration Amendment to Support Care for Justice-Involved Individuals and Contingency Management The Centers for Medicare & Medicaid Services (CMS) approved a first-of-its-kind demonstration amendment in California which will provide a set of critical pre-release services and improve access to needed care for people returning home from jails and prisons. This approval marks the first time Medicaid will pay for pre-release services to incarcerated individuals. As part of the approval, California will also increase and sustain provider payment rates and Medicaid managed care payment rates in behavioral health and select other services. In another first for the country, the waiver also includes approval for the use of contingency management for individuals with stimulant use disorders (StUDs). The waiver outlines procedures and protocols for using financial incentives in a 24-week program to reinforce the non-use of stimulants. The protocol is followed by six or more months of additional recovery support services. Importantly, the protocols integrate measures to protect against fraud and abuse, first identified by the Motivational Incentives Policy Group, of which NABH is a member. The waiver introduced Medicaid reimbursable services provided by a Contingency Management Coordinator, a new job classification. It is believed that this pilot will serve as a template for other states that are seeking to integrate treatment for individuals with StUD.

SAMHSA Announces Funding Opportunity for Community Programs to Help Youth and Young Adults at High Risk for Psychosis

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced that applications are open for a program to provide trauma-informed, evidence-based interventions to youth and young adults who are at clinical high risk for psychosis. Award recipients are expected to use evidence-based intervention to improve symptomatic and behavioral functioning; enable youth and young adults to resume age-appropriate social, academic, and/or vocational activities; delay or prevent the onset of psychosis; and minimize the duration of untreated psychosis for those who develop psychotic symptoms. The deadline for applications is Tuesday, March 14. Click here to learn more and to apply.

CDC Study Shows that Treating Substance Use Disorders Costs Employer-sponsored Health Insurance over $35 Billion per Year

This week, the Centers for Disease Control and Prevention (CDC) released a study assessing the medical cost of substance use disorders for US employers, employees, and health insurance plans. The study assessed 162 million non-Medicare eligible enrollees with employer-sponsored health insurance in 2018. The study determined that the total annual medical cost in that population was $35.3 billion and alcohol-related disorders and opioid-related disorders were the most costly. It should be noted that this amount is a fraction of the $1.1 trillion of the total personal health care expenditures paid by private insurance in the US in 2018.

NABH Mourns Behavioral Healthcare Industry Leader Joey Jacobs

NABH mourns the passing of retired behavioral healthcare executive and leader Joey J. Jacobs, 69, who died Jan. 14 in Nashville following an extended illness. Jacobs held various roles at Nashville, Tenn.-based HCA Healthcare and co-founded Psychiatric Solutions before he sold the company 13 years ago. Jacobs was also the chair and CEO of Franklin, Tenn.-based Acadia Healthcare, all NABH system members. A former member, Jacobs served on the NABH Board from 2005 through 2009 when NABH was the National Association of Psychiatric Health Systems. In addition to his wife, Debbie Hammer Jacobs, Jacobs is survived by two sons, Brent and Scott; three grandchildren; and other family members. Services were held on Jan. 20.

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

Details Coming Soon for the NABH 2023 Annual Meeting

Please plan to join us in Washington, DC from June 12-14, 2023 for this year’s NABH Annual Meeting at the Salamander Washington, DC (formerly the Mandarin Oriental hotel). Details coming soon.

Fact of the Week

A new cross-sectional study including 74,474 opioid-involved deaths, buprenorphine was involved in 2.6% of opioid-involved overdose deaths during July 2019 to June 2021. Although monthly opioid-involved overdose deaths increased, the proportion of involving buprenorphine fluctuated—but did not increase. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 224

Written by Emily Wilkins (NABH) on January 20, 2023. Posted in CEO Updates.

SAMHSA Announces Monica Johnson as 988 & Behavioral Health Crisis Coordinating Office Director

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced this week that Monica Johnson, M.A., LPC is the new director of the 988 & Behavioral Health Crisis Coordinating Office. Johnson has worked in the behavioral health field for 26 years and most recently served as the interim commissioner for the Georgia Department of Behavioral Health & Developmental Disabilities. SAMHSA’s announcement noted that Johnson has overseen and implemented successfully several programs funded through SAMHSA, the Bureau of Justice Assistance, the Office of Juvenile Justice Delinquency Prevention, and the U.S. Education Department. Johnson earned an undergraduate degree in psychology from Kennesaw State University in Georgia and a graduate degree in professional counseling and psychology at Argosy University in Virginia. She is the recipient of the Intensive Cognitive Behavior Therapy for Schizophrenia Certification at the Aaron T. Beck Institute for Cognitive Behavior Therapy in Philadelphia.

CMS to Host Call About Administration Simplification Proposed Rule on Jan. 25

The Centers for Medicare & Medicaid Services (CMS) National Standards Group will host a call to discuss the Administrative Simplification: Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction proposed rule next Wednesday, Jan. 25 from 2 p.m. to 3:30 p.m. ET. The agency will use the 90-minutes session to provide an overview of the proposed rule and also offer background on the current standards, expectations of what the proposed rule is meant to do, and information about how to submit comments. Click here to register.

CMS to Host Educational Session on Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule

The CMS Office of Burden Reduction and Health Informatics will host a virtual education about the Advancing Interoperability and Improving Prior Authorization Processes proposed rule on Thursday, Feb. 9 from noon to 1 p.m. ET. On Dec. 6, CMS issued the prior authorization proposed rule, which aims to improve patient and provider access to health information and streamline processes. Click here to read the agency’s fact sheet. Next month’s educational session is intended to help participants learn about the rule’s provisions and hear how the proposed rule builds on current CMS interoperability policies. Participants will be permitted to ask questions. Click here to register by Feb. 8.

ASAM to Release Training Module on Level of Care Certification Next Month

The American Society of Addiction Medicine (ASAM) and CARF International announced that a training module to introduce updated rating elements to the ASAM Level of Care Certification (LOCC) will be available on Feb. 15. ASAM and CARF International announced the LOCC’s updated rating elements in July 2022, and residential treatment programs that are applying for the ASAM LOCC for levels 3.1, 3.5, and 3.7 will be responsible for meeting the updated elements as part of their certification survey. These facilities will also be responsible for meeting the existing rating elements listed in the ASAM LOCC manual.

Joint Commission Releases Sentinel Event Alert About Eliminating Racial & Ethnic Disparities in Pregnant and Postpartum Patients

The Joint Commission this week released a Sentinel Event Alert about eliminating barriers and racial disparities causing mortality and morbidity in pregnant and postpartum women. Along with the announcement, the Joint Commission released a Quick Safety that addresses mental health conditions and their role in maternal death.

SAMHSA Publishes Guide on Expanding Access to Behavioral Healthcare Services for People Experiencing Homelessness

SAMHSA this week released a guide that highlights strategies for behavioral healthcare and housing providers to conduct outreach and engage with individuals experiencing homelessness. The new resource also includes strategies for how to initiate behavioral healthcare treatment as individuals wait to receive housing and retain them in their recovery efforts after they find housing.

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

Details Coming Soon for the NABH 2023 Annual Meeting

Please plan to join us in Washington, DC from June 12-14, 2023 for this year’s NABH Annual Meeting at the Salamander Washington, DC (formerly the Mandarin Oriental hotel). Details coming soon.

Fact of the Week

A recent study found that those on medical addiction therapy had a 63% lower likelihood of an alcohol-related liver disease diagnosis. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 223

Written by Emily Wilkins (NABH) on January 13, 2023. Posted in CEO Updates.

HHS Awards Nearly $245 Million to Support Youth Mental Health and the Healthcare Workforce

The U.S. Health and Human Services Administration (HHS) announced this week it awarded nearly $245 million in funding from the Bipartisan Safer Communities Act to support youth mental health and help the healthcare workforce address mental health needs. The funding—released through the Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA)—is for a variety of programs and grants, including Project Advancing Wellness and Resiliency in Education (Project AWARE) to help develop and support school-based mental health programs and services; Mental Health Awareness Training grants to prepare and train school personnel, emergency first responders, law enforcement, and others to recognize the signs and symptoms of mental health challenges to enable early intervention; the National Child Traumatic Stress Initiative to improve treatment for children, adolescents, and families who have experienced traumatic events, and more. In its announcement, HHS noted that the Bipartisan Safer Communities Act included nearly $60 million to support the integration of mental health training into the training of primary care clinicians, with a specific focus on preparing primary care providers to treat the mental health needs of children and adolescents. “Often the first person you turn to when you or your kids need mental health support is your trusted primary care provider—yet for too long, we haven’t given those primary care providers the mental health training they need to help, HRSA Administrator Carole Johnson said in the announcement. “With funding from the Bipartisan Safer Communities Act, the Health Resources and Services Administration is investing in making mental health a part of primary care training so that there is no wrong door when your family needs support.”

National Academies to Host Virtual Webinars About 988 Implementation on Jan. 20 and 23

The National Academies Forum on Mental Health and Substance Use Disorders will host two virtual webinars about the challenges and opportunities related to the implementation of the 988 behavioral health crisis hotline at the state and local levels. The discussions will provide an overview of how 988 has been implemented and will also feature best practices. The two-hour webinars will be held on Friday, Jan. 20 and Monday, Jan. 23; both will begin at 12:30 p.m. ET. Click here to register.

CMS to Host National Stakeholder Call with Administrator Brooks-LaSure on Jan. 24

The Centers for Medicare & Medicaid Services (CMS) will host a national stakeholder call featuring CMS Administrator Chiquita Brooks-LaSure and her leadership team to discuss the agency’s accomplishments in 2022 and priorities for 2023. Click here to register.

Register Today for the 2023 Rx and Illicit Drug Summit in Atlanta

The 2023 Rx and Illicit Drug Summit will be held in Atlanta from April 10-13 and will include nearly 100 educational sessions organized in nine different tracks to highlight the most effective strategies for prevention, treatment, and recovery. The meeting’s advanced rate ends on Jan. 27. Click here to register.

NABH’s 2023 Priorities Featured in Mental Health Weekly & Alcohol and Drug Abuse Weekly

In case you missed it, NABH President & CEO Shawn Coughlin discussed the association’s priorities for 2023 and NABH Director of Quality and Addiction Services Sarah Wattenberg reflected on accomplishments of 2022 and hopes for the New Year in Mental Health Weekly and Alcohol and Drug Abuse Weekly, respectively.

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

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting! Details coming soon.

Fact of the Week

In a cohort study of 5,142,577 commercially insured adults across all 50 states, the weekly rate of in-person mental health service utilization decreased by more than 50% after the Covid-19 pandemic started; however, concurrent increases in telehealth led to a slight increase in total utilization for anxiety disorders and stability in total volume of service for other disorders, according to a new study published in JAMA Health Forum. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 222

Written by Emily Wilkins (NABH) on January 6, 2023. Posted in CEO Updates.

NABH Welcomes Harsh K. Trivedi, M.D., M.B.A as 2023 Board Chair

NABH is pleased to welcome Sheppard Pratt President & CEO Harsh K. Trivedi, M.D., M.B.A as the association’s board chair for 2023. Harsh has served as an NABH board member as well as a member of the association’s workplace violence prevention workgroup and Covid-19 task force. A graduate of the Mount Sinai School of Medicine, Harsh completed his general psychiatry residency at the Zucker Hillside Hospital/Albert Einstein College of Medicine. He completed his child and adolescent psychiatry training at Children’s Hospital Boston/Harvard Medical School. Harsh has served as president and CEO at Sheppard Pratt in Baltimore since 2016. NABH is eager to work with Harsh as the association celebrates its 90^th anniversary in 2023!

SAMHSA Releases National Survey on Drug Use and Health for 2021

About one in four U.S. adults had a mental illness and more than 16% of the population—or more than 46 million people—met the criteria for substance use disorder (SUD) in 2021, according to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey of Drug Use and Health (NSDUH). Released annually, the latest report for the 2021 calendar year also found that younger people reported even higher levels of mental illness—one in three for those between the ages of 18 and 25. Meanwhile, nearly 94% of people with SUD didn’t receive any treatment in 2021. “Every year since 1971, this survey has given us a window into our nation’s mental health and substance use challenges and 2021 was no different,” HHS Secretary Xavier Becerra said in an announcement about the survey. “As the findings make clear, millions of Americans young and old faced mental health and substance use challenges – sometimes both at once – during the second year of the pandemic,” he continued. “As we work to improve behavioral health across the nation, HHS is committed to ensuring that all people facing mental health or substance use challenges are connected to appropriate services and supports.” SAMHSA noted that estimates from the 2021 NSDUH should not be compared with estimates from previous years because the Covid-19 pandemic necessitated methodological changes to the data collection process.

CMS Issues Information Bulletin on Medicaid Provisions in Consolidated Appropriations Act, 2023

The Centers for Medicare and Medicaid Services (CMS) on Thursday issued an informational bulletin that highlights provisions in the Consolidated Appropriations Act, 2023 (CAA, 2023) related to the Medicaid continuous enrollment condition. The CAA, 2023 updates certain Medicaid and Children’s Health Insurance Program (CHIP) provisions, including significant changes to the continuous enrollment condition of the Family First Coronavirus Response Act. Under the CAA, 2023, expiration of the continuous enrollment condition will no longer be linked to the Covid-19 public health emergency (PHE); instead, the condition will end on March 31, 2023. After the condition ends, states will have up to 12 months to initiate, and 14 months to complete, a renewal for all individuals enrolled in Medicaid, CHIP, and the Basic Health Program. Click here for more details.

HRSA Urges Nurses to Apply for Nurse Corps Loan Repayment Program

The Health Resources and Services Administration (HRSA) this week announced a reminder that the Nurse Corps Loan Repayment Program opens soon. As part of the program, certain eligible nurses could qualify for up to 85% of unpaid debt. In return, they would be required to serve at least two years in a critical shortage facility in a high need area or accredited school of nursing in a U.S. state or territory. Nurses must work at eligible facilities for this program, which include public or non-profit medical facilities. Click here to learn about eligibility and application requirements.

Bipartisan Policy Center to Host Behavioral Healthcare Workforce Panel Discussion

The Bipartisan Policy Center (BPC) will host a panel discussion about the organization’s federal policy recommendations to address the huge gap between need and care on Tuesday, Jan. 24. The BPC noted that as of March 2021, about 37% of Americans lived in mental health shortage areas. Panelists will highlight findings of a new BPC report, Filling the Gaps in the Behavioral Health Workforce, which recommends ways to bolster the role of behavioral healthcare workers such as peer specialists, community health workers, and paraprofessionals, as well as community members who can help support the licensed workforce. Click here to register for the hourlong webinar that starts at noon ET on Jan. 24.

Reminder: Apply for HRSA Grants to Reduce Neonatal Abstinence Syndrome in Rural Settings

The Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy will invest $20 million in about 40 grants to reduce the incidence of neonatal abstinence syndrome (NAS) in the nation’s rural communities. According to HRSA’s announcement, grant recipients will collaborate with local, state, and regional stakeholders to provide coordinated, trauma-informed, and family centered behavioral and maternal healthcare services—including medication-assisted treatment—to rural pregnant and post-partum women and their families. Applicant organizations may be in either an urban or rural area; however, all activities supported by the program must exclusively occur in HRSA-designated, rural areas. The agency will accept applications through March 8, 2023.

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

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

While visits to pediatric emergency rooms rose 1.5% from 2015 to 2021, visits for mental health crises increased 8% a year, according to a new study in JAMA Pediatrics. The study also found that 13% of those young patients returned in six months. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 221

Written by Emily Wilkins (NABH) on December 16, 2022. Posted in CEO Updates.

Two Proposed Rules Would Improve Prior Authorization and Network Adequacy

The Centers for Medicare & Medicaid Services (CMS) this week released two proposed rules related to longstanding concerns with Medicare Advantage (MA) plans and other insurers that are designed to improve quality of care and plan accountability. These rules respond to the HHS Office of Inspector General’s report earlier this year about inappropriate prior authorization denials by MA plans as well as 4,000 comments in 2022 from stakeholders, including NABH, on related concerns. Contract Year 2024 Proposed Rule on Medicare Advantage: Released Wednesday, this proposed rule includes significant MA refinements related to behavioral healthcare, such as a prior authorization exemption for emergency mental health services needed to evaluate and stabilize patients. It also proposes implementing a 10-percentage point payment add-on for telehealth services provided by clinical psychologists, licensed clinical social workers, and those who prescribe medication for opioid use disorder. To assist patients seeking care, the rule proposes appointment wait-time standards for primary care and behavioral healthcare services. It would also require mid-year notices for enrollees with a behavioral health or primary care provider who dropped from their plan network. Regarding network adequacy, CMS proposes adding clinical psychologists, licensed clinical social workers, and those who prescribe medication for opioid use disorder to the list of specialty types that CMS uses to evaluate MA networks. To improve parity in access, the proposed rule would also require most MA organizations to include behavioral healthcare services in care coordination programs. In addition, the rule clarifies that plans should include both physical and mental conditions in their coverage of emergency medical care. Also, to address stakeholders’ concerns regarding the dramatic increase in opioid overdose deaths during the Covid-19 pandemic, the rule proposes that MA organizations designate in their provider directories those who obtained a waiver from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration to treat patients with medications for opioid use disorder and are listed on SAMHSA’s Buprenorphine Practitioner Locator. Comments to CMS are due by Monday, Feb. 13, 2023. Federal Health Exchange Notice of Benefit and Payment Parameters for 2024: On Monday, the agency issued a proposed rule related to all health insurers participating in federal and state health insurance exchanges. Specifically, CMS would categorize mental health facilities and substance use disorder (SUD) treatment centers as essential community providers and require insurers to include at least one of these providers in each network. Previously, mental health facilities and SUD treatment centers had been designated in the “other” category. In addition, the rule would require contract reviews to assess the actual availability of SUD and mental health services. To address concerns about reduced access to care after the Covid-19 public health emergency ends, CMS has proposed extending by 60 to 90 days those who would otherwise lose Medicaid or Children’s Health Insurance Program coverage in January 2024. Comments on this rule will be accepted during the 45-day period after the rule is published in the Federal Register.

SAMHSA’s Proposed Rule Permits Methadone Prescribing for New Patients via Telemedicine

SAMHSA this week proposed updating federal regulations to permit using audio-visual telehealth services for any new patient treated with methadone in an Opioid Treatment Program (OTP) under specific conditions. In a proposed rule, SAMHSA said federal regulations should be updated to allow using audio-visual telehealth services for patients treated with methadone in OTPs only if a program physician, or an authorized healthcare professional under the supervision of a program physician, determines that an adequate evaluation of the patient can be accomplished via an audio-visual telehealth platform. This change is not extended to using audio-only telehealth platforms and applies only to ordering methadone that an OTP dispenses under existing OTP procedures. In addition, SAMHSA’s proposed changes would update 42 CFR Part 8 by removing stigmatizing or outdated language; supporting a more patient-centered approach to treatment; and reducing barriers to receiving care. SAMHSA’s proposed changes also would revise standards to reflect an OTP accreditation and treatment environment that has evolved since Part 8 became effective in 2001. Consequently, SAMHSA said its proposed revisions reflect evidence-based practice, language that aligns with current medical terminology, effective patient engagement approaches, and the workforce providing services in OTPs, including:

expanding the definition of an OTP treatment practitioner to include any provider who is appropriately licensed to dispense and/or prescribe approved medications. The current Part 8 rule defines a practitioner as being: “a physician who is appropriately licensed by the State to dispense covered medications and who possesses a waiver under 21 U.S.C.823(g)(2).” During the Covid-19 public health emergency, this has been formally expanded to align with broader definitions of a practitioner (nurse practitioners, physician assistants, etc.), and OTPs reported that this change was essential in supporting workflow and access;
adding evidence-based delivery models of care, such as split dosing, telehealth, and harm-reduction activities;
removing such outdated terms as “detoxification”;
updating criteria for provision of take-home doses of methadone;
strengthening the patient-practitioner relationship through promoting shared and evidence-based decision-making;
allowing for early access to take-home doses of methadone for all patients, to promote flexibility in creating plans of care that facilitate such every-day needs as employment, while also affording people with unstable access to reliable transportation the opportunity to also receive treatment; likewise, promoting mobile medication units to expand an OTPs geographic reach; and
reviewing OTP accreditation standards.

According to SAMHSA, the changes– which are part of President Biden’s National Drug Control Strategy – come at a time when fewer than one out of 10 Americans can access treatment for substance use disorder. SAMHSA will accept public comments on the proposed rule until Feb. 14, 2023.

NASHP Brief Highlights State Opioid Spending Plans

The National Academy for State Health Policy has released Understanding Opioid Settlement Spending Plans Across States: Key Components and Approaches, which highlights how states are implementing structures to disburse the more than $50 billion in opioid settlement funds awarded to them. Opioid settlement funds began pouring into states this year, including about $26 billion from a settlement that 46 states agreed to with Johnson & Johnson (J&J), AmerisourceBergen, Cardinal Health, and McKesson in July 2021. To understand common challenges and potential best practices for state leaders, NASHP engaged state leaders nationwide to understand both the structure and status of their current opioid settlement planning activities. NASHP is also analyzing governing materials and entities such as state legislation, opioid settlement agreements and spending plans, advisory committees, and other groups charged with disbursing state funding, which are referenced in NASHP’s tracker.

SAMHSA Releases Resource Highlighting Drug-Related ED Visits in 2021

SAMHSA has released Drug Abuse Warning Network (DAWN): Findings from Drug-Related Emergency Department Visits, 2021, an analysis of DAWN data with a variety of information for drug-related emergency department (ED) visits last year. The report highlights nationally representative weighted estimates, including percent and unadjusted rates per 100,000, for all drug-related ED visits; nationally representative weighted estimates for the top five drugs in drug-related ED visits; an assessment of trends and drugs involved in polysubstance ED visits in a subset of sentinel hospitals; and the identification of drugs new to DAWN’s Drug Reference Vocabulary.

Brookings Institution Releases Papers on Behavioral Health Integration and Youth Services

The Brookings Institution this week released two academic white papers related to behavioral healthcare: Making Progress on Integration of Behavioral Health Care and Other Medical Care and Meeting the Moment Children’s Mental Health: Recommendations for Federal Policy. The first is a 10-page analysis of recent policy efforts in the nation’s evolving healthcare system, and the second paper seeks to clarify the potential sources of the persistent problems in mental illnesses in children. The 22-page youth services white paper also considers what tools the federal government should employ to address the crisis.

Reminder: Apply for HRSA Grants to Reduce Neonatal Abstinence Syndrome in Rural Settings

The Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy will invest $20 million in about 40 grants to reduce the incidence of neonatal abstinence syndrome (NAS) in the nation’s rural communities. According to HRSA’s announcement, grant recipients will collaborate with local, state, and regional stakeholders to provide coordinated, trauma-informed, and family centered behavioral and maternal healthcare services—including medication-assisted treatment—to rural pregnant and post-partum women and their families. Applicant organizations may be in either an urban or rural area; however, all activities supported by the program must exclusively occur in HRSA-designated, rural areas. HRSA will offer a webinar for applicants on Wednesday, Jan. 4, 2023 from 2 p.m. to 3 p.m. ET; registration is not required. The agency will accept applications through March 8, 2023.

Reminder: NABH 2023 Board Election Ballots Due Friday, Dec. 30

NABH has e-mailed system members NABH Board of Trustees candidate profiles and a ballot to elect new members to the 2023 Board. If you have not done so, please vote for the open Board Chair-Elect position and one available Board seat; sign the ballot (it is not valid without a signature); and return it to NABH. You can do this by scanning your completed ballot and e-mailing it nabh@nabh.org or maria@nabh.org. NABH must receive all ballots no later than Friday, Dec. 30, 2022. New Board members and the Board Chair-elect will take office in January 2023.

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

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

Fentanyl is now the leading cause of death for Americans between the ages of 18 and 49, according to a Washington Post analysis of death data for 2021 from the Centers for Disease Control and Prevention. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO 220

Written by Emily Wilkins (NABH) on December 9, 2022. Posted in CEO Updates.

CMS Proposes Electronic Prior Authorization for Providers and Payers

The Centers for Medicare & Medicaid Services (CMS) this week released a proposed rule that would require certain providers and payers to implement an electronic prior-authorization process, shorten the timeframe for payers to respond to prior-authorization requests, and work to make the prior-authorization process more efficient and transparent. An announcement from CMS said the proposed requirements would apply to Medicare Advantage (MA) organizations, state Medicaid and Children’s Health Insurance Program (CHIP) agencies, Medicaid managed care plans, CHIP managed care entities, and qualified health plan issuers on the federally facilitated exchanges. The agency estimates that these proposed policies could create efficiencies that would save physician practices and hospitals more than $15 billion over a 10-year period. The rule would automate essential prior-authorization functions related to documentation, requests, and decisions. Also, payers would be required to provide a clear reason for denials and to respond to urgent prior-authorization requests within 72 hours and standard requests within seven days. The proposed electronic platform is the already-established “Patient Access API,” which uses the Health Level 7^®format. The rule also would enhance patients’ access to their own information on prior- authorization requests, approvals, and related information by requiring online reporting of certain performance metrics. CMS is seeking information from stakeholders on the following topics:

How to standardize data on patients’ social risk factors (e.g., housing instability, food insecurity) that influence patient health and health care utilization;
How to advance electronic data exchange among behavioral health providers;
How to improve the exchange of medical documentation between and among providers/suppliers and patients (for the purpose of care coordination);
How to enable the connection of health information networks to advance cross-organization interoperability, such as the prior-authorization improvements in this rule, including incentives for payers; and
Evidence-based policies that CMS could pursue to leverage health IT, data sharing, and interoperability to improve maternal health outcomes.

NABH will address these and the rule’s other key provisions in the association’s formal comments. CMS will publish the rule in the Federal Register on Dec. 13, 2022 and accept comments through March 13, 2023.

Biden Administration Launches Opioid Overdose Dashboard

The Biden Administration on Thursday unveiled a website featuring the Office of National Drug Control Policy’s (ONDCP) new Opioid Overdose Tracker to monitor non-fatal, opioid overdoses in the pre-hospital setting in an effort to prevent overdose deaths. Non-fatal overdoses are a good predictor of fatal overdoses, Biden administration officials said during a news briefing Wednesday according to Politico. People who experience at least one non-fatal overdose are about two to three times more likely to eventually die from one, they said. Earlier this year, the Centers for Disease Control and Prevention estimated that 80,816 Americans died from opioid overdoses in 2021, increasing from an estimated 70,029 in 2020. Using data submitted to the National Emergency Medical Services Information System (NEMSIS), the new dashboard contains one interactive page with a geo-surveillance view, and its data set includes all de-duplicated Emergency Medical Services (EMS) patient care reports for a rolling time period that meet specific inclusion criteria. In 2022, all 50 states, three territories (the Virgin Islands, Guam, and the Northern Mariana Islands), and Washington, D.C. had submitted data to the national database, according to NEMSIS. The NEMSIS Technical Assistance Center collects data from about 95% of all EMS agencies in the United States that respond to 911 requests for emergency care and transport patients to acute care facilities. According to a National Public Radio story, ONDCP Director Rahul Gupta, M.D. told reporters during a call that “We could see tens of thousands of additional lives saved” with the new tool, which Gupta said he hopes first responders, clinicians, and policymakers will use to connect people to care and also minimize response times and ensure that resources are available. NABH has advocated that the dashboard be updated in 2023 to use numbers at the state and county levels, as well as the national level.

New Report Shows Number of Patients Receiving Medications for Opioid Use Disorders in OTPs

Of the 512,224 patients in Opioid Treatment Programs (OTPs) who reported using medications for opioid use disorders (MOUDs), 476,763 reported using methadone, 33,473 reported buprenorphine, and the remaining 1,988 reported using naltrexone, according to a new report from the National Association of State Alcohol and Drug Abuse Directors (NASADAD). NASADAD partnered with the American Association for the Treatment of Opioid Dependence (AATOD) for the study, which was funded to determine the number of patients who receive MOUDs in OTPs, the types of federally approved medications that patients use in treatment, and the specific formulations of medication used among the patient population. Researchers analyzed data from 1,547 Opioid Treatment Programs (OTPs) nationwide that completed the survey, reflecting an 85-percent response rate. The Substance Abuse and Mental Health Services Administration funded the study through the agency’s Opioid Response Network.

MedPAC Discusses Draft Recommendations for 2024 Physician Payment Increases

The Medicare Payment Advisory Commission (MedPAC) this week discussed draft recommendations to increase the Medicare base payment rate for physician and other health professional services by 1.25% in 2024, a rate that is half of the forecasted increase in the Medicare Economic Index for 2024. Current law calls for no updates to 2024 payment rates relative to 2023 levels. The commission also discussed supporting a payment add-on for services for low-income Medicare beneficiaries (15% for primary care; 5% for non-primary care), which new Medicare spending would fund. The purpose of these items is to help maintain access to physician services for Medicare beneficiaries. Both measures received substantial support from the commissioners, and they are expected to be approved as formal recommendations to Congress when MedPAC convenes in January to vote on these and other Medicare payment adequacy recommendations for 2024.

HHS Highlights Progress to Mark One-Year Anniversary of HHS’ Overdose Prevention Strategy

Since the Biden administration released its Overdose Prevention Strategy a year ago, the number of healthcare providers with waivers to prescribe buprenorphine for opioid use disorder increased by 19% and the number of naloxone prescriptions filled in pharmacies has increased by 37%, HHS announced late last week. The announcements were made in conjunction with a news conference HHS Secretary Xavier Becerra held to mark the first anniversary of the Biden administration’s Overdose Prevention Strategy. During the news conference, Becerra highlighted some of the strategy’s recent actions, including an announcement from the Centers for Disease Control and Prevention (CDC) that state, local, and territorial awardees of the CDC Overdose Data to Action cooperative agreement can use a portion of their funds to purchase naloxone; and the U.S. Food and Drug Administration’s notice last month that certain naloxone products have the potential to be safe and effective for over-the-counter use.

HRSA to Invest $20 Million in Grants to Reduce Neonatal Abstinence Syndrome in Rural Settings

The Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy will invest $20 million in about 40 grants to reduce the incidence of neonatal abstinence syndrome (NAS) in the nation’s rural communities. According to HRSA’s announcement, grant recipients will collaborate with local, state, and regional stakeholders to provide coordinated, trauma-informed, and family centered behavioral and maternal healthcare services—including medication-assisted treatment—to rural pregnant and post-partum women and their families. Applicant organizations may be in either an urban or rural area; however, all activities supported by the program must exclusively occur in HRSA-designated, rural areas. HRSA will offer a webinar for applicants on Wednesday, Jan. 4, 2023 from 2 p.m. to 3 p.m. ET; registration is not required. The agency will accept applications through March 8, 2023.

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

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

A new study published in The Lancet Psychiatry found that people with severe mental illness have an elevated risk for several chronic health problems even before they receive their first diagnosis of a severe mental illness. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 219

Written by Emily Wilkins (NABH) on December 2, 2022. Posted in CEO Updates.

Senate Finance Committee Releases ‘Fifth and Final’ Mental Health Parity Discussion Draft

Senate Finance Committee leaders on Thursday released what they said is their fifth and final legislative mental health parity discussion draft in their effort to place access to behavioral healthcare on par with physical healthcare in Medicare and Medicaid. Previous iterations of the draft were released in May, June, September, and November this year. Policies in the final draft include: strengthening the accuracy of provider directories in Medicare Advantage plans; strengthening requirements in Medicaid for managed care organizations and states to maintain regularly updated provider directories that include, in part, information on accessing care from behavioral health professionals; directing the Government Accountability Office (GAO) to conduct a study of the differences in enrollee cost-sharing and utilization management between behavioral and non-behavioral health services in Medicare Advantage and compared with traditional Medicare; requiring Medicare to provide guidance to health care providers detailing the extent to which Medicare beneficiaries with substance use disorders can receive partial hospitalization program services; and directing GAO to report on Medicaid payment rates for behavioral health services compared to medical and surgical services across a sample of states. “Too often the notion of mental health parity falls short of reality,” Senate Finance Committee Chairman Ron Wyden (D-Ore.) said in an announcement about the discussion draft. “These policies represent the first step towards addressing the mental health parity and ghost network challenges that I intend to build on in the coming months—especially the challenges I hear about consistently from families at home who aren’t able to find available mental health professionals covered in their insurance networks,” he added.

HHS Releases Proposed Rule to Revise 42 CFR Part 2 Regulations

The U.S. Health and Human Services Department (HHS) this week released a proposed rule to revise regulations known as 42 CFR Part 2, or “Part 2,” which protect the confidentiality of substance use disorder (SUD) treatment records. Specifically, Part 2 protects “records of the identity, diagnosis, prognosis, or treatment of any patient which are maintained in connection with the performance of any program or activity relating to substance abuse education prevention, training, treatment, rehabilitation, or research, which is conducted, regulated, or directly or indirectly assisted by any department or agency of the United States.” The protections are meant to address concerns that discrimination and fear of prosecution deter people from entering treatment for SUD. The rule proposes a host of revisions, including, but not limited to: permitting Part 2 programs to use and disclose Part 2 records based on a single prior consent signed by the patient for all future uses and disclosures for treatment, payment, and healthcare operations; permitting the redisclosure of Part 2 records as permitted by the Health Insurance Portability and Accountability Act (HIPAA) privacy rule by recipients that are Part 2 programs, HIPAA-covered entities, and business associates, with certain exceptions; and expanding prohibitions on using and disclosing Part 2 records in civil, criminal, administrative, or legislative proceedings conducted by a federal, state, or local authority against a patient, absent a court order or the consent of the patient. HHS released a summary of the proposed rule’s provisions and will accept comments for up to 60 days after the proposed rule is published in the Federal Register.

DEA Lab Testing Reveals 6 out of 10 Fentanyl-Laced, Fake Prescription Pills Contain a Potentially Lethal Dose of Fentanyl

The Drug Enforcement Administration (DEA) this week alerted the public of a sharp rise nationwide in the lethality of fentanyl-laced, fake prescription pills. In a public safety alert, the agency said the DEA laboratory found that of the fentanyl-laced, fake prescription pills analyzed in 2022, six out of 10 contained a potentially lethal dose of fentanyl. This is an increase from DEA’s previous announcement in 2021 that four out of 10 fentanyl-laced fake prescription pills were found to contain a potentially lethal dose. According to the alert, the pills are largely made by two Mexican drug cartels, the Sinaloa Cartel and the Jalisco (CJNG) Cartel, to look identical to real prescription medications, including OxyContin®, Percocet®, and Xanax®, and they are often deadly. In 2021, the DEA seized more than 20.4 million fake prescription pills, and earlier this year, the DEA conducted a nationwide operational surge to target the trafficking of fentanyl-laced fake prescription pills and, seized 10.2 million fake pills in all 50 states in just more than three months. The DEA’s One Pill Can Kill campaign alerts the American public of the dangers of fake prescription pills.

NIDA Director Volkow Calls for Dismantling Stigma at Intersection of HIV and Meth Use

In her blog post to commemorate World Aids Day on Thursday, Dec. 1, National Institute on Drug Abuse (NIDA) Director Nora Volkow, M.D. promoted NIDA’s video “Sex, Meth and HIV,” to emphasize that in order to end the HIV epidemic it is important to recognize and respect both the complexity and needs of sexual and gender minorities who use drugs. “Like other drugs, methamphetamine may help individuals cope with mental health challenges like depression, anxiety, and trauma,” Volkow wrote. “Some gay and bisexual men use methamphetamine to enhance sexual experience and sense of connectedness,” she added. “It can also temporarily boost self-confidence among individuals who may experience stigma and shame surrounding sexuality or other aspects of their lives.” Volkow referenced a 2020 study in the Journal of Acquired Immune Deficiency Syndromes (JAIDS), which showed that a third of new HIV transmissions among sexual and gender minorities who have sex with men were in people who regularly use methamphetamine. On a related note, at a conference in Boston last month, Volkow said American physicians should “absolutely” be allowed to prescribe methadone to their patients. “There’s absolutely no reason why not,” Volkow said, according to a story in STAT. “There are countries where physicians are providing methadone, and the outcomes are actually as good as those they get [at] methadone clinics.”

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

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting! Fact of the Week The likelihood that someone with serious mental illness will be the victim of a violent crime is 11.8 higher when compared with the general public. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 218

Written by Emily Wilkins (NABH) on November 28, 2022. Posted in CEO Updates.

HHS Announces $350 Million Initiative to Boost Covid-19 Vaccinations

The U.S. Health and Human Services Department’s (HHS) Health Resources and Services Administration (HRSA) on Tuesday announced a $350 million initiative for HRSA-supported health centers to increase Covid-19 vaccinations in their communities, with a specific focus on underserved populations. The funding will help health centers provide Covid-19 vaccines through mobile, drive-up, walk-up, or community-based vaccination events, including working with community-based organizations and other efforts to increase administering Covid-19 vaccines. According to HHS, health centers have administered more than 22 million vaccines in underserved communities nationwide, of which 70% to patients of racial and ethnic minorities.

Study Shows Shortage of Mental Healthcare Providers Associated with Higher Youth Suicide Rate

Counties with a shortage of mental healthcare providers were connected to higher rates of youth suicide, researchers reported this week in JAMA Pediatrics. The study noted that that while the findings are based on data from 2015 and 2016, the report comes at a time with the number of Americans living in areas with a shortage of mental health professionals is growing. Federal data show more than 150 million people live in such areas. Meanwhile, researchers initially found that counties with provider shortages had a 41% higher youth suicide rate: 5.09 per 100,000 youths compared with 3.62 per 100,000 in counties without shortages. And when the researchers controlled for socioeconomic and other confounding factors—rural and high-poverty areas are known to have higher suicide rates—they still found that living in a county with a shortage of mental health workers was associated with a 16% higher youth suicide rate. “Strategies to ameliorate mental health professional workforce shortages…. may be considered in comprehensive youth suicide prevention programs,” the authors concluded.

NABH and Other Groups Urge Congress to Support Medicare Mobile Crisis Intervention Benefit

NABH is one of more than 50 organizations that sent a letter to House and Senate leaders urging the federal lawmakers to include a mental health crisis intervention benefit in the Medicare program in Congress’ end-of-year legislative package. The organizations represent mental health and substance use treatment providers, crisis centers, family members, advocates, justice-focused organizations, and payers committed to strengthening access to mental healthcare and substance use treatment. The letter explains that in the most recent discussion draft on Integration, Coordination, and Access to Care, the Senate Finance Committee included a key provision of payment for mobile crisis response intervention services under the Physician Fee Schedule, which would add this benefit to the Medicare program. Mobile crisis teams include mental health professionals and individuals who provide peer-support services who are trained to de-escalate a situation and help the individual connect with services and supports. “Since its launch in July, calls to the 988 Lifeline increased exponentially even more than predicted in SAMHSA’s December 2020 capacity report to Congress. Data from September 2022 vs. September 2021 show calls answered increased by 40%, chats answered increased by 218%, and texts answered increased by 1153%,” the letter said. “While one-time grant funds are helpful to initiate programs, they are not sufficient to sustain them, especially in light of increasing demand,” the letter continued. “In 2021, Congress provided incentives to states to increase Medicaid coverage of mobile crisis teams. Now, it should allow a mobile crisis intervention benefit in Medicare.”

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

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

Researchers have identified variations in 10 genes that significantly raise the risk for schizophrenia—information that could help identify new treatment targets, according to the National Institutes of Health, which funded one of the largest genetic studies of its kind.

Happy Thanksgiving from NABH!

The NABH staff wishes its members and their families a very happy, healthy, and safe Thanksgiving! For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 217

Written by Emily Wilkins (NABH) on November 18, 2022. Posted in CEO Updates.

News Reports Signal HHS Will Extend Covid-19 PHE Through April 2023

Several news outlets have reported that the U.S. Health and Human Services Department (HHS) intends to extend the existing Covid-19 Public Health Emergency (PHE) through April 2023. The current PHE—which has been extended many times since 2020—is effective through Jan. 11, 2023.

FDA Announces Preliminary Assessment of Certain Naloxone Products for Over-the-Counter Use

The U.S. Food and Drug Administration (FDA) this week issued a Federal Register notice that includes the agency’s preliminary assessment that certain naloxone drug products—up to 4 milligrams (mg) nasal spray and up to 2 mg autoinjector for intramuscular (IM) or subcutaneous (SC) use—may be approvable as safe and effective for nonprescription use. In its announcement about the notice, FDA said this move is “intended to facilitate both the development and approval of nonprescription naloxone products; however, it is not a final determination that certain naloxone drug products are safe and effective for nonprescription use, and it does not mandate an immediately effective switch to nonprescription/over-the-counter (OTC) availability for naloxone.” The announcement also said the FDA needs additional data, such as product-specific data on the nonprescription user interface design, including packaging and labeling, before it makes its final determination.

CMS Releases Medicaid and CHIP Access Data Brief

The Centers for Medicare & Medicaid Services (CMS) this week released a data brief that includes a snapshot of selected metrics in three essential dimensions of Medicaid and Children’s Health Insurance (CHIP) access. Culling data from various sources, CMS developed the brief to show access to Medicaid and CHIP coverage, measured by enrollment and retention; access to services, with a focus on mental health conditions and substance use disorders; and perceived access, measured by beneficiary experiences in managed care.

SAMHSA’s GAINS Center to Host Webinar About Project ECHO and SUD on Nov. 21

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) GAINS Center on Monday, Nov. 21 will host “Black Robes and White Coats: Using Project ECHO to Increase Judiciary Knowledge about Substance Use Disorder,” a webinar that will provide an overview of the pilot Project ECHO for the Judiciary. The purpose of Project ECHO for the Judiciary is for participating judges to learn about treatments for opioid disorder and develop a better understanding of substance use disorders to help inform their decisions in the courtroom. The webinar will begin at 2:30 p.m. ET on Monday. Click here to register.

FDA to Host Stakeholder Call About Naloxone Access on Nov. 28

The top leaders at FDA and SAMHSA will host a stakeholder call on Monday, Nov. 28 to discuss naloxone access and harm reduction. FDA Commissioner Robert Califf, M.D. and Marta Sokolowska, deputy center director for substance use and behavioral health in FDA’s Center for Drug Evaluation and Research, will lead the call, and SAMHSA Assistant Secretary for Mental Health and Substance Use Miriam Delphin-Rittmon, Ph.D. will participate. “Every person who experiences an opioid overdose, whether it is with prescribed medication or an illicit drug, should have access to naloxone,” FDA said in its announcement about the call. “Entities such as harm-reduction programs help save lives by making naloxone available in underserved communities,” it continued. “The agency intends to stand by these efforts by supporting their ability to acquire FDA-approved naloxone products, and we recently issued the guidance, Exemption and Exclusion from Certain Requirements of the Drug Supply Chain Security Act (DSCSA) for the Distribution of FDA-Approved Naloxone Products During the Opioid Public Health Emergency,” it said, adding that FDA recognizes this action alone is not enough and that there is more work to do. The hourlong Zoom call will begin at 2:30 p.m. ET. Click here to register.

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

Thank you to all members who have already submitted your data to NABH’s denial-of-care portal. Your data will help NABH highlight problems in the field related to health plan denials and timeliness. Several policymaking entities are interested in these data, which could support advocacy for expanded access to care. For new participants, please e-mail Emily Wilkins, NABH’s administrative coordinator, for support.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

Demand for anxiety and depression treatment remains high for the third consecutive year, and 60% of practitioners report they no longer have openings for new patients, according to the American Psychological Association’s 2022 Covid19 Practitioner Impact Survey. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 216

Written by Emily Wilkins (NABH) on November 4, 2022. Posted in CEO Updates.

CMS Releases Final Physician Fee Schedule and OPPS Rules for 2023

Telehealth services authorized temporarily during the Covid-19 public health emergency (PHE) will extend through at least 2023 and for at least 151 days after the PHE ends, the Centers for Medicare & Medicaid Services (CMS) announced in the agency’s final 2023 Physician Fee Schedule (PFS) this week. CMS’ decision to extend the telehealth services benefit will allow for additional data collection to evaluate a possible permanent addition as a Medicare benefit. CMS issued the regulation on the same day it released the final Outpatient Prospective Payment System (OPPS) rule for next year. In that regulation, CMS implemented a 4.1% payment increase for outpatient facilities in 2023. Please read below for additional details about the final regulations. 2023 Physician Fee Schedule Final Rule: The PFS final rule directs CMS to implement an approximately 4.5-percent reduction—reflecting a decrease of $1.55— in the conversion factor, which the agency uses to calculate payments for physicians and the other clinicians paid under the PFS. CMS also updated the payment amount for the drug component of the opioid treatment bundle using the Producer Price Index (PPI) for Pharmaceuticals for Human Use and will do so annually to account for inflation. CMS will also modify the payment rate for the non-drug bundle to base the rate on a 45-minute –rather than a 30-minute—session, which better comports with OTP practices. Under the final rule, OTPs may also use audio-visual and audio-only telehealth for buprenorphine intake if the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration (DEA) grant permission. Also pending authorization from SAMHSA and DEA, OTPs may furnish periodic assessments via audio-only when video is not available for the duration of 2023. CMS also made final billing for mobile units in accordance with SAMHSA and DEA guidance. Locality adjustments will be applied and based on the location of the OTP hub. Meanwhile, the PFS final rule implements an exception to supervision requirements to allow marriage and family therapists, licensed professional counselors, addiction counselors, certified peer recovery specialists, and others to provide behavioral healthcare services while under general supervision, rather than “direct” supervision. This means practitioners now will be able to provide services without requiring that a physician or nurse practitioner be present on site. Responding to comments from the behavioral healthcare field, CMS also made final a new behavioral health integration service that a clinical psychologist or clinical social worker can perform when mental health services are the focal point of care integration, along with allowing a psychiatric diagnostic evaluation to initiate such integration services. CMS also made final several provisions related to accountable care organizations to grow participation in the program, incorporate recent lessons related to episode payment approaches, and advance equity among program participants. Outpatient Prospective Payment System Final Rule: Although the 4.1% payment increase for outpatient services is larger than CMS had proposed, NABH does not consider this payment update adequate to address the intense cost pressures—stemming from considerable increases in labor, supplies, equipment, drugs, and other expenses—that the association had highlighted. Regarding payments for 340B hospitals, the final OPPS rule ends the cuts that the U.S. Supreme Court found to be unlawful. Per the high court’s ruling, 340B payments in 2023 will return to pre-2018 levels: the average sale price plus 6% with an offsetting reduction to make the measure budget neutral, as required by law. The final rule falls short of reimbursing 340B payment cuts from previous years. NABH expects additional 340B rules from CMS by the summer of 2023. Both the PFS and OPPS final rules will take effect Jan. 1, 2023. NABH and Other Organizations Urge Federal Appropriators to Include Behavioral Health Funding in Continuing Resolution NABH and a dozen other behavioral health organizations on Friday send a letter to House and Senate appropriators requesting that federal lawmakers include appropriate funding levels for behavioral health treatment in the upcoming Continuing Resolution (CR) to keep the federal government operating. Specifically, NABH and the other organizations—including the American Psychiatric Association, the American Psychological Association, Mental Health America, the National Association of State Mental Health Program Directors— requested that Congress include $1.42 billion for the Community Mental Health Block Grant (MHGB), including a 10% set-aside for mental health crisis services within the MHGB; $60 million to expand the Mental Health Crisis Response Partnership Pilot Program; $747 million for the 988 behavioral health crisis hotline, including $30 million to provide specialized services for LGBTQ+ youth; $400 million for Certified Community Behavioral Health Clinics; and $10 million for the Behavioral Health Crisis 988 Coordinating Office. “Additional federal investments are needed to strengthen the 988 system to transform how our country responds to people in crisis,” the organizations wrote in the letter. “A continuing resolution of any length threatens our ability to meet the high and growing need for behavioral health treatment and care.”

SAMHSA to Host Webinar About CCBHC Certification Criteria Next Week

SAMHSA will host a webinar open to the public next Wednesday, Nov. 9 regarding updates to the Certified Community Behavioral Health Clinic (CCBHC) certification criteria. SAMHSA will provide a brief overview of CCBHCs, describe key elements of certification criteria and SAMHSA’s process for soliciting feedback from the field, and discuss how the public can provide feedback. The Zoom webinar will begin at 4 p.m. ET. The meeting ID is 160 306 8999 and the passcode is 160547.

SAMHSA Names Jennifer Fan as Director of Center for Substance Abuse Prevention

SAMHSA this week named Capt. Jennifer Fan, Pharm.D., J.D. as the acting director of the agency’s Center for Substance Abuse Prevention (CSAP). A commissioned officer in the U.S. Public Health Service, Fan served in SAMHSA from 2007 through 2021 in several roles, including acting CSAP deputy director, special assistant for the CSAP director, and CSAP’s subject matter expert on opioids and prescription drug misuse. She also served as the senior editor for the Surgeon General’s Spotlight on Opioids Report and helped to create SAMHSA’s Strategic Prevention Framework for Prescription Drugs (SPF Rx) grants and the Grants to Prevent Prescription Drug/Opioid Overdose-Related Deaths (PDO). Fan earned her doctorate in pharmacy from the University of Maryland School of Pharmacy and her law degree from the University of Baltimore School of Law.

SAMHSA Introduces ‘Screen 4 Success’ to Help Parents and Caregivers Understand Wellbeing of Children

SAMHSA recently announced Screen4Success, a new screening tool from the agency’s “Talk. They Hear You.” national prevention campaign that can help parents and caregivers better understand children’s health, wellness, and wellbeing, and find resources to address needs. Parents and caregivers can access the new tool on mobile devices through the Talk. They Hear You. campaign mobile app, which is available for free on the App Store, Google Play, and Microsoft store.

Enhanced NABH Denial-of-Care Portal is Now Available

NABH recently made enhancements to its Denial-of-Care Portal that are intended to make the portal easier for members to use. A year ago, NABH developed the Denial-of-Care Portal to collect specific data on insurers who deny care—often without regard to parity or the effects on patients. Now the association has updated this resource to make it more user-friendly for members and also more aligned with what regulators need to identify parity violations. The updated portal includes fewer questions, which will require less time for members to complete. In addition, all questions are now optional. NABH hopes this will make it more likely for members to share the data they have. Lastly, NABH has added a checklist of “red flags” that were included in the 2022 MHPAEA Report to Congress from the U.S. Health and Human Services, Labor, and Treasury Departments in January. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

Fifty-three percent of those polled said the new 988 behavioral health crisis hotline will be effective to keep people in crisis out of jail, with Black (64%) and Hispanic (54%) adults more optimistic, the American Psychiatric Association reports. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 215

Written by Emily Wilkins (NABH) on October 28, 2022. Posted in CEO Updates.

GAO Report Identifies Challenges and Opportunities to Recruit and Retain Behavioral Health Workforce

Financial, educational, and workplace challenges are three categories that pose the greatest challenges to recruiting and retaining behavioral health providers, the Government Accountability Office (GAO) concluded in a new report. The GAO was assigned to review what is known about the behavioral health workforce, offer information regarding both barriers to and incentives for recruiting and retaining providers, and identify what actions various U.S. Health and Human Services department (HHS) agencies are taking to recruit and retain these providers. In its comprehensive review, the GAO interviewed NABH staff as a stakeholder group. “Reimbursement rates and compensation for behavioral health services are low, according to stakeholders from multiple research organizations and behavioral health associations,” the report noted, adding that many programs designed to recruit diverse behavioral health providers only benefit individuals already studying in a behavioral health field and do not address the lack of a pipeline for underserved populations to enter the workforce. The GAO recommended that incentives such as loan repayment and scholarships for students seeking behavioral healthcare professions could help to address some of the barriers to entering the field. Learn more in highlights from the study and the full report.

HHS and U.S. Surgeon General’s Office to Host Mental Health Briefing Monday, Oct. 31

HHS and the U.S. Surgeon General’s office will host a briefing on Monday, Oct. 31 to discuss the Surgeon General’s Framework for Workplace Mental Health & Well-being, which will outline the foundational role that workplaces should play in promoting the health and well-being of workers and communities. The briefing will highlight the five essentials for workplace mental health and is intended to help organizations develop, institutionalize, and update policies, processes, and practices that best support the mental health and well-being of all workers. Click here to register for the 30-minute briefing, which will begin at 1:30 p.m. ET.

Commonwealth Fund Study Examines How Changing Opioid Addiction Treatment Delivery Could Reduce Death and Suffering

A new study from the Commonwealth Fund analyzes how government regulation and inadequate treatment capacity can limit patients’ access to lifesaving care and what policymakers could do to help combat opioid addiction. According to the report’s findings, opioids are involved in almost 75% of overdose deaths in the United States, which claim more than 100,000 lives per year. But while opioid addiction can be treated with effective medications, only 10% to 15% of U.S. residents with opioid use disorder receive them. “During Covid-19, the federal government showed flexibility by allowing OTPs (opioid treatment programs) to provide more take-home methadone doses, allowing buprenorphine treatment initiation via telehealth, and removing buprenorphine waiver training requirements for providers treating 30 or fewer patients,” the report noted. “Data indicate that methadone take-home flexibilities have not been associated with worse outcomes or significant misuse, and telehealth services have been associated with improved medication retention and lower overdose risk,” it continued. “Some of these provisions are temporary and could sunset or change after the COVID-19 public health emergency ends.”

CMS Administrator Brooks-LaSure to Host Webinar Next Week on CMS’ Strategic Plan

Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure and her leadership team will provide an update on the agency’s strategic plan next Tuesday, Nov. 1. This is the agency’s fourth national stakeholder call with the administrator this year, and it’s intended to provide an opportunity for stakeholders to learn how they can partner with CMS to implement the agency’s strategic plan. The hourlong call will begin next Tuesday at 3 p.m. ET. Click here to register.

SAMHSA to Host Behavioral Health Services Information Virtual Workshop on Nov. 2

SAMHSA will host a virtual workshop next week to help providers learn how to access the agency’s available data on Behavioral Health Services Information System (BHSIS) and online treatment locator. Herman Alvarado, a supervisory social science analyst at SAMHSA’s Center for Behavioral Health Statistics and Quality, will provide an overview for participants. The event is intended to provide technical assistance to National Network to Eliminate in Behavioral Health (NNED) members and minority-service and under-resourced community-based organizations. The 90-minute virtual workshop will begin at 3 p.m. next Wednesday, Nov. 2. Click here to register.

NIH’s HEAL Initiative Highlights Examples of Successful Programs to Prevent and Treatment Opioid Misuse and Addiction

The National Institutes of Health’s (NIH) Helping to End Addiction Long-term, or HEAL, initiative— a trans-NIH research effort focused on improving prevention and treatment for opioid misuse and addiction and enhancing pain management—recently released examples of programs that have helped some of the youngest patients battling opioid misuse or addiction. HEAL funds more than 1,000 research projects in every U.S. state and is a $2.5 billion effort that has grown substantially this year, adding 10 new programs and more than 200 new projects that are seeking scientific solutions to prevent overdose and connect people to treatment for pain and addiction. Click here to learn about some innovative programs related to mobile apps.

Enhanced NABH Denial-of-Care Portal is Now Available

Fact of the Week

By 2030, HHS’ Health Resources and Services Administration (HRSA) estimates a 20% decrease in the supply of adult psychiatrists to 27,020, while the agency estimates a 22% increase in the supply of child and adolescent psychiatrists to 9,830. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 214

Written by Emily Wilkins (NABH) on October 21, 2022. Posted in CEO Updates.

MHA Releases ‘State of Mental Health in America’ Report for 2023

More than 50 million Americans experienced a mental illness between 2019 and 2020, while more than one in 10 youth in the United States experience depression that is severely impairing their ability to function at school or work, at home, with family, or in their social life, according to a new report from Mental Health America (MHA). The State of Mental Health in America is a nearly 40-page chartbook that provides a baseline to answer some questions about how many people in America need and have access to mental health services. The report is a companion piece to interactive data available on MHA’s website. Using publicly available data from the 50 states and Washington, D.C., MHA used a set of 15 measures, such as adults with any mental illness, adults with thoughts of suicide, and youth with substance use disorder in the last year. MHA noted that the Covid-19 pandemic negatively affected the ability to collect data for national surveillance in 2020; consequently, the indicators in this year’s report cannot be compared with previous years. The findings also reported that the majority of individuals with a substance use disorder in the U.S. are not receiving treatment, and that there are about 350 individuals for every one mental healthcare provider in the United States.

SAMHSA Announces $15 Million in Early 2023 for CCBHCs

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week announced it will award $15 million early next year to expand access to planning grants for certified community behavioral health clinics (CCBHCs) to all 50 states. This funding—along with the $300 million that SAMHSA awarded in September for both new and existing CCBHCs—comes from the Bipartisan Safer Communities Act that President Biden signed in June.

CMS Releases FAQs About Medicaid and CHIP Determinations and Renewals After PHE Ends

The Centers for Medicare & Medicaid Services on Oct. 17 answers to frequently asked questions about the agency’s March 2022 guidance to states regarding planning efforts to resume Medicaid and Children’s Health Insurance Program (CHIP) eligibility determinations and renewals after the Covid-19 public health emergency ends. The FAQs address the unwinding period, renewals and changes in circumstances, non-MAGI ex parte renewals, section 1902(e)(14)(A) waivers, premiums, fraud, and more.

New Reports Examine Telehealth Laws & Medicaid Policies and Trauma & Recovery for Youth

The Center for Connected Health Policy (CCHP) this week released its Fall 2022 summary of telehealth laws and Medicaid program policies, which allows users to export data for each state into a PDF document. CCHP provides bi-annual summary reports to provide a snapshot of the progress made in the past six months. Also this week, the National Child Traumatic Stress Network released A Trauma-Informed Guide for Working with Youth in Multiple Settings, which is intended for people who work with youth involved in multiple systems (YIMS) and their families to use a traumatic stress perspective and provide trauma-informed care. The report defines YIMS as children and adolescents who are under the care or supervision of multiple child and family-serving systems. They include “crossover youth” or “dually involved youth” who are involved in child welfare (CW) and in the juvenile justice (JJ) system. In addition to CW and JJ involvement, YIMS are also often simultaneously involved in an array of other service systems including immigration, legal, education, family services, physical and behavioral health systems and systems designed to serve those with developmental disabilities or who experience homelessness.

Register Today for Oct. 27 Webinar on CPT Coding and Billing Changes for Mental Health in 2023

The Association for Behavioral Health and Wellness, the American Psychological Association, and the American Psychiatric Association will host a webinar about what to expect in CPT coding and billing changes for mental health in 2023 on Thursday, Oct. 27. Stephen Gillaspy, Ph.D., senior director of health and healthcare financing at the American Psychological Association, will lead the presentation about the Centers for Medicare and Medicaid Services’ (CMS) proposed changes outlined in the agency’s 2023 physician fee schedule proposed rule. The webinar will focus on new CPT codes and changes to existing codes, expanding the outpatient Evaluation and Management (E/M) documentation guidelines to the facility setting, and other CMS proposals, such as “incident to” billing that, if implemented, will have a significant effect on mental and behavioral clinicians beginning Jan. 1, 2023. The hourlong webinar will begin at 12:30 p.m. ET. Click here to register.

Enhanced NABH Denial-of-Care Portal is Now Available

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

More seniors in 2022 (28%) than in 2021 (20%) said the cost of care affected their ability to seek treatment for a mental health condition, according to a survey of seniors that the Pan Foundation conducted in May 2022. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 213

Written by Emily Wilkins (NABH) on October 14, 2022. Posted in CEO Updates.

NABH 2023 Board Position Nominations Due Today!

The deadline to submit nominations for the 2023 NABH Board Chair-Elect and two available NABH Board seats is today, Friday, Oct. 14. The NABH Selection Committee is seeking senior managers who represent the association’s diverse membership related to levels of care, organizational structures, and size. Please download a nomination form to recommend individuals for the single-slate ballot in 2023. Also, please attach a curriculum vitae (CV) for every individual you recommend. This will help the Selection Committee in its deliberations. All NABH members are welcome to suggest themselves. Please return this form and candidates’ curricula vitae by Friday, Oct. 14, 2022, to maria@nabh.org.

Becerra Extends Covid-19 PHE for Another 90 Days

HHS Secretary Xavier Becerra on Thursday renewed the Covid-19 public health emergency (PHE) for an additional 90 days. Former HHS Secretary Alex Azar declared the Covid-19 PHE for the first time in January 2020 Since then, it has been renewed—either by Azar or Becerra— 10 times, making this week’s announcement the 11^th renewal.

Bipartisan Policy Center Recommends Extending Medicare Telehealth Benefits for Two Years Post Pandemic

Congress and the Biden administration should extend most of the Medicare program’s telehealth flexibilities for beneficiaries for two years after the Covid-19 pandemic ends and then evaluate the effects, the Bipartisan Policy Center (BPC) recommended in a report released this week. And that’s for a start. The report—totaling more than 80 pages—also concluded that researchers should evaluate the benefits of hybrid (both in-person and virtual) care models for primary and specialty care, including for which conditions and specialties it is most effective; further evaluate full telehealth flexibilities in the context of value-based payment models; and assess rigorously the quality of audio-only care. “Throughout this report, BPC recommends targeted adjustments to the current telehealth flexibilities; all recommended changes are in response to emerging evidence on benefits versus risks and to stakeholder concerns,” the researchers noted. “This approach would enable beneficiaries to maintain their access to telehealth services while minimizing risks to patients and the Medicare program, as well as provide time for policymakers to continue to review and assess the evidence.”

ONDCP to Host Webinar About Low-Threshold Buprenorphine on Monday, Oct. 17

The White Office of National Drug Control Policy (ONDCP) will host a webinar on Monday, Oct. 17 to examine low-threshold buprenorphine programs, which seek to reduce barriers that often limit access or reduce retention in care. ONDCP Director Rahul Gupta, M.D. will welcome participants to the webinar, which will feature evidence from experts in the field and include a panel discussion about policy and practice. The webinar will be held from 1 p.m. – 3 p.m. ET. Click here to register.

Register Today for Webinar on CPT Coding and Billing Changes for Mental Health in 2023

JAMA Pediatrics Examines Continued Rise of Unintentional Ingestion of Edible Cannabis in Toddlers

An analysis in JAMA Pediatrics this week concluded that immediate action should be taken to alter the current trajectory of unintentional pediatric ingestion of edible cannabis products. The article noted that cannabis is the third most used psychoactive substance worldwide, with use continuously rising in the U.S. adult population. Meanwhile, cannabis products are used commonly and stored in homes in which children are present and education from healthcare professionals about safe storage is lacking, the article continued. Consequently, children are at risk of being drawn to THC (tetrahydrocannabinol, the psychoactive compound of marijuana)-infused products that resemble their favorite snacks or candy. “Children with THC intoxication can present with neurologic impairment, including lethargy, ataxia, tachycardia, mydriasis, seizures, altered mental status, and hypotonia,” the article said. “However, given the unpredictability of the dose ingested, patient presentation can vary. Altered mental status in children results in broad differential diagnoses ranging from traumatic to infectious causes.”

Enhanced NABH Denial-of-Care Portal is Now Available

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

A 2016 parent survey shows 64% of children with Attention Deficit/Hyperactivity Disorder (ADHD) had at least one other mental, emotional, or behavioral disorder, the Centers for Disease Control and Prevention reports. October is ADHD Awareness Month. Help the National Institute of Mental Health raise awareness by sharing these resources. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 212

Written by Emily Wilkins (NABH) on October 7, 2022. Posted in CEO Updates.

NABH Seeking Candidates for 2023 Board Positions

The NABH Selection Committee is seeking nominations to fill the NABH Board Chair-Elect and two NABH Board seats that will become available in 2023. In particular, the committee wants to identify senior managers who represent the association’s diverse membership related to levels of care, organizational structures, and size. Please download a nomination form to recommend individuals for the single-slate ballot in 2023. Please attach a curriculum vitae (CV) for every individual you recommend. This will help the Selection Committee in its deliberations. All NABH members are welcome to suggest themselves. Please return this form and candidates’ curricula vitae by Friday, Oct. 14, 2022, to maria@nabh.org.

Harris Poll Shows Strong Public Support for Mental Health and Uncertainty on How to Help

Two in three U.S. adults say they believe they don’t have enough knowledge to tell if someone is considering suicide, while eight in 10 adults say they are open to learning how to help someone in need, according to a Harris Poll survey released this week. Since 2015, the American Foundation for Suicide Prevention (AFSP), the National Action Alliance for Suicide Prevention (Action Alliance), and the Suicide Prevention Resource Center (SPRC) have commissioned the Harris Poll to conduct bi-annual, nationally representative survey of adults in the United States to understand the public’s beliefs and attitudes about mental health and suicide. The survey evaluates what the public knows about to support someone who is struggling and their perceptions of barriers to help those at risk for suicide. This latest poll offers an early read on public awareness of 988, the national behavioral health crisis hotline that launched in July. Researchers found that while gains have been made in valuing mental health, there is not consistent societal support for mental healthcare. The findings show that 76% of Americans surveyed said they perceive mental health as equal to physical health, while 51% said they feel that physical health is treated as more important of the two. Meanwhile, 67% of those surveyed said they believe they have had a mental health condition at some point in their lives, up from 60% who said so in 2018 and 57% in 2018. “Overall, the poll indicates that progress has been made, but there is more to do,” the report noted. “We must continue to learn more about suicide and mental health particularly through increased research efforts, teach everyone how to help prevent suicide and strengthen mental health, and advocate for improved access to care and robust crisis services.”

ONDCP to Host Webinar About Low-Threshold Buprenorphine on Oct. 17

The White House Office of National Drug Control Policy (ONDCP) will host a webinar on Monday, Oct. 17 to examine low-threshold buprenorphine programs, which seek to reduce barriers that often limit access or reduce retention in care. ONDCP Director Rahul Gupta, M.D. will welcome participants to the webinar, which will feature evidence from experts in the field and include a panel discussion about policy and practice. The webinar will be held from 1 p.m. – 3 p.m. ET. Click here to register.

HRSA Previews Behavioral Health Training Opportunities for Primary Care Residents

The Health Resources and Services Administration (HRSA) this week announced a funding opportunity totaling nearly $60 million during a five-year period to support training to expand the public health workforce. The new program will train primary care residents in the prevention, identification, diagnosis, treatment, and referral of services for mental and behavioral health conditions. It is intended to benefit pediatric, adolescent, young adult, and other populations who are at-risk or have experienced abuse, trauma, or mental health and/or substance use disorders, including those related to the effects of gun violence. According to HRSA, awards will support both classroom training and clinical rotations that focus on mental and behavioral health conditions. Eligible entities include accredited public or not-for-profit private hospitals; schools of allopathic medicine or osteopathic medicine; residency programs accredited by the Accreditation Council for Graduate Medical Education in family medicine, general internal medicine, general pediatrics or combined internal medicine and pediatrics (“med-peds”); and tribes and tribal organizations, if otherwise eligible. Click here to be notified when this funding opportunity opens.

Enhanced NABH Denial-of-Care Portal is Now Available

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

A Harris Poll survey released this week found that more than half of adults in the United States say seeing a mental health professional is a sign of strength. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 211

Written by Emily Wilkins (NABH) on September 30, 2022. Posted in CEO Updates.

House to Vote Friday on Senate-Approved Stopgap Spending Measure

The House of Representatives is expected to vote Friday on the short-term spending bill the Senate approved Thursday to avert a federal government shutdown and increase aid to Ukraine. Included in the legislation is a provision to continue funding the national 988 behavioral crisis hotline through Sept. 30, 2023, for which Congress has appropriated $62,000,000.

TODAY: SAMHSA to Moderate Recovery Month Panel at 1:15 p.m. ET

Acting Deputy Assistant Secretary Tom Coderre of the Substance Abuse and Mental Health Services Administration (SAMHSA) will moderate a panel discussion at 1:15 p.m. ET today, Friday, Sept. 30, the last day of National Recovery Month. Titled “Making Small Choices, Every Day,” the event will feature panelists who will discuss their recovery experiences while sharing success stories and providing hope that recovery is possible. The panel will address seeking treatment for mental illness or substance use disorders, overcoming challenges such as stigma, and helping the public understand the importance of helping those in recovery. SAMHSA will livestream the event on the agency’s Facebook page.

House Passes Bill to Bolster Mental Health Parity Protections for Workers

The House earlier this week passed the Mental Health Matters Act of 2022, a bill intended to hold employer-based health plans more accountable for inappropriate denials of mental health and substance use benefits. The legislation would give the U.S. Labor Department more authority to enforce plan requirements under the Mental Health Parity and Addiction Equity Act and the Employee Retirement Income Security Act. It also would ban forced arbitration agreements when plans deny benefits improperly, and ensure a fair standard of review from the courts. Before the bill passed, the White House released a Statement of Administrative Policy supporting the legislation. The White House noted that the Mental Health Matters Act also would improve the well-being of young children in Head Start and K-12 schools by building on President Biden’s efforts to increase the number of school-based mental health services providers, as well as authorizing grants to partnerships between high-need, local educational agencies, and institutions of higher education. NABH will continue to track developments related to this bill.

CMS Releases Latest Enrollment Figures for Medicare, Medicaid, and CHIP

The Centers for Medicare & Medicaid Services (CMS) this week released the agency’s latest enrollment figures for Medicare, Medicaid & the Children’s Health Insurance Program (CHIP), and the health insurance marketplaces, reporting that 156.5 million Americans have coverage in these federal health insurance programs. According to the latest figures, there are 89.4 million enrollees in Medicaid and CHIP, 64.6 million enrollees in Medicare, and 14.5 million people enrolled in state-based and federal health insurance marketplaces. The agency reported a subtotal figure of 168.5 million enrollees, which CMS then adjusted by subtracting 12 million to account for Americans who are dually eligible for both Medicare and Medicaid. Click here for a breakdown of the individual programs.

Former ONDCP Leaders Pen Opinion Piece on Increasing Recovery Services

On this last day of National Recovery Month, two former leaders at the White House Office of National Drug Control Policy wrote an opinion piece in The Hill newspaper to call for more training in addiction science and policymaking. In their blog, former ONDCP Director Michael Botticelli and Regina LaBelle, a former acting director at ONDCP and director of the Addiction and Public Policy Initiative at the Georgetown University Law Center’s O’Neill Institute, recognized the role that people in recovery play by building healthier communities. They also emphasized the need to remove barriers to healthcare, housing, and employment and education, including modifying the regulatory hurdles that reduce access to methadone.

Enhanced NABH Denial-of-Care Portal is Now Available

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

Early intervention in psychosis programs contributed to, on average, 3.2 fewer hospitalizations and 2.7 more years employed during the course of patients’ lives compared with individuals with the same diagnosis who received standard care, according to a study published in Psychiatric Services. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 210

Written by Emily Wilkins (NABH) on September 23, 2022. Posted in CEO Updates.

Biden Administration Announces More Than $1.6 Billion for Communities to Address Addiction & Overdose Crises

The U.S. Health and Human Services Department (HHS) on Friday announced it will award more than $1.6 billion in investments to communities nationwide to address America’s addiction and overdose crises. Funding will come from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) State Opioid Response (SOR) program and Tribal Opioid Response (TOR) grant program and the Health Resources and Services Administration’s (HRSA) rural communities’ opioid response programs. “I have heard many stories of despair from individuals battling addiction and from families who have lost loved ones to overdose,” HHS Secretary Xavier Becerra said in the grant announcement. “Through these grants, we are investing in evidence-based supports and services for individuals, families, and communities on the road to recovery.” Click here to learn about the four individual grant opportunities.

Covid-19 PHE Will Likely Be Extended Due to Absence of 60-Day Termination Notice from HHS

The Covid-19 public health emergency (PHE) will most likely be extended for another 90 days after the PHE’s current Oct. 13, 2022 expiration date because HHS has not given states 60 days’ notice before termination. In January 2021, HHS’s Administration for Strategic Preparedness & Response (ASPR0 sent a letter to the nation’s governors outlining the commitment to a 60-day, PHE termination notice. HHS Assistant Secretary for Public Affairs Sarah Lovenheim posted a message on Twitter this past Monday, Sept. 19, that assured states and providers there will be at least two months’ notice before the PHE is allowed to expire. NABH will notify members about any updates related to the PHE’s end date.

National Center on Substance Abuse and Child Welfare to Host Sept. 27 Webinar on Contingency Management

SAMHSA announced this week that the National Center on Substance Abuse and Child Welfare will host a webinar on Thursday, Sept. 29 that highlights how contingency management can help families affected by substance use disorders. The webinar will provide an overview of contingency management, including details about implementation with different cultural populations. It will also show how Montefiore Medical Center in New York, a Regional Partnership Grant awardee, has implemented contingency management, and provide practical strategies for implementation. The webinar will begin next Thursday at 1:30 p.m. ET. Click here to register.

NIH-Led Study Shows Heart Medication Could Be Effective for Alcohol Use Disorder

A medication to treat heart problems and high blood pressure may also be effective for treating alcohol use disorder, according to a new study from researchers at the National Institutes of Health (NIH) and published in Molecular Psychiatry. The research shows evidence from experiments in mice and rats—as well as a cohort study in humans—that suggests the medication spironolactone could play a role in reducing alcohol drinking. Researchers from the NIH’s National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, as well as from the Yale School of Medicine, produced the study. “Combining findings across three species and different types of research studies, and then seeing similarities in those data, gives us confidence that we are onto something potentially important scientifically and clinically,” Lorenzo Leggio, M.D., Ph.D., chief of the clinical psychoneuroendocrinology and neuropsychopharmacology section, a joint laboratory of NIDA and NIAAA, and one of the senior authors, said in an announcement about the research. “These findings support further study of spironolactone as a potential treatment for alcohol use disorder, a medical condition that affects millions of people in the U.S.”

Enhanced NABH Denial-of-Care Portal is Now Available

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

Prenatal cannabis exposure following the middle of the first trimester is associated with attention, social, and behavioral problems in children that persist into early adolescence, according to a recent study in JAMA Pediatrics based on research funded by the National Institute on Drug Abuse. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 209

Written by Emily Wilkins (NABH) on September 16, 2022. Posted in CEO Updates.

NABH Annual Membership Updates Are Due Today, Sept. 16!

Today, Friday, Sept. 16, is the deadline for members to submit changes about their organizations for the online-only NABH 2022 Membership Directory. Last month NABH sent its system members a message with a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use this tool to verify your system’s information. NABH has added several new categories this year. The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all your system’s facilities so that we have a better picture of our diverse membership. If you need NABH to re-send the link, please contact Maria Merlie at maria@nabh.org. Thank you for your cooperation!

NABH Submits Comments on CMS’ Proposed Rule for Medicare Hospital Outpatient Prospective Payment System

NABH this week sent comments and recommendations to the Centers for Medicare & Medicaid Services (CMS) regarding the agency’s proposed Medicare Hospital Outpatient Prospective Payment System (OPPS) for calendar year 2023 (CY 2023). In its five-page letter, NABH proposed that CMS examine ways to account for increased costs to ensure that beneficiaries continue to have access to quality outpatient care and offered a range of recommendations, including: reducing the productivity cut for CY 2023; ensuring that non-340B hospitals remain unharmed; expanding telehealth services; and more.

CMS Announces Approval of Nation’s First Medicaid Mobile Crisis Intervention Services Program

The Centers for Medicare & Medicaid Services (CMS) this week announced approval of the Oregon Health Authority’s proposal to cover community-based stabilization services throughout the state. Oregon is the first state to seek and be granted approval for the new Medicaid option that became available to states in April 2022. The program will provide community-based stabilization services to individuals experiencing mental health and/or substance use crises by connecting them to a behavioral health specialist 24 hours a day, every day of the year.

Sound the Alarm for Kids Virtual Roundtable is Today, Friday, Sept. 16 at 1 p.m. ET

Sound the Alarm for Kids will host “Helping Girls Thrive: A Conversation Examining Trends in Girls’ Mental Health” is today, Friday, Sept. 16 at 1 p.m. ET. The virtual roundtable discussion will examine the national campaign to raise awareness about today’s mental health crisis among children and teens and how to create change. Some of the speakers include Christina Bethell, Ph.D., M.P.H., M.B.A, director of the Child and Adolescent Health Measurement Initiative at Johns Hopkins University and Kelley Haynes-Mendez, Psy.D., senior director of the human rights team at the American Psychological Association. Click here to register.

Enhanced NABH Denial-of-Care Portal is Now Available

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

Based on data from 14 state maternal mortality review committees, the Centers for Disease Control and Prevention (CDC) reports that mental health conditions—including suicide—are the 6th leading cause of pregnancy-related death. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 208

Written by Emily Wilkins (NABH) on September 9, 2022. Posted in CEO Updates.

NABH Welcomes Rochelle Archuleta as Executive Vice President for Government Relations and Public Policy

Rochelle Archuleta has joined NABH as executive vice president for government relations and public policy, effective Sept. 6. Rochelle brings to NABH 30 years of experience in the health policy, healthcare delivery system, and legislative arenas. During her 20-year tenure as a policy director for the American Hospital Association (AHA), Rochelle led AHA’s post-acute care policy team. In this role, Rochelle partnered with providers, policymakers, and leading trade associations on issues pertaining to the home health, skilled nursing facility/nursing home, inpatient rehabilitation facility, and long-term care hospital sectors. These advocacy efforts expanded to include issues of common concern to all post-acute care providers and their hospital partners, including issues pertaining to Medicare Advantage and commercial insurers, as well as the Medicare program’s effort to create a new, unified payment system to reimburse the aforementioned, post-acute care settings. “We are pleased to welcome Rochelle to our team,” said Shawn Coughlin, president and CEO at NABH. “Rochelle’s extensive work in healthcare policy, as well as her strong relationships with partner associations, will enhance NABH’s advocacy efforts—both with legislators and regulators.” Rochelle is a research fellow in the Georgetown University McCourt School of Public Policy and is a former David Winston Health Policy Fellow. She earned a master of science in health administration and a master of business administration from the University of Alabama at Birmingham School of Health Professions and a bachelor of arts in political science from the University of Colorado at Boulder.

NABH Submits Comments on CMS’ Proposed Medicare Physician Fee Schedule for 2023

NABH this week sent comments and recommendations to the Centers for Medicare & Medicaid Services (CMS) regarding the agency’s proposed Medicare physician fee schedule for fiscal year 2023. In its nine-page letter, NABH proposed revisions to the “Incident to” regulations and offered a range of recommendations related to the 2023 conversion factor, telehealth, opioid treatment services, coding and payment mechanisms, adjustments to the rate-setting methodology for behavioral health, and more.

HHS-OIG Report Shows Medicare Telehealth Fraud Was Rare During Covid-19 Pandemic

A new report from HHS’ Office of Inspector General (OIG) found a very small fraction of provider claims for Medicare telehealth services during the Covid-19 pandemic may have indicated fraud, waste, or abuse of those services. The OIG’s offices analyzed Medicare fee-for-service claims data and Medicare Advantage encounter data from March 1, 2020 to Feb. 28, 2021 and focused on about 742,000 providers who billed for a telehealth services. Examining seven measures on different types of billing, investigators identified 1,1714 providers whose billing for telehealth services during the first year of the pandemic posed a high risk to the Medicare program. Those providers billed for telehealth for about half a million beneficiaries and received a total of about $127.7 million in Medicare fee-for-service payments, according to the report. “Each of these 1,714 providers had concerning billing on at least 1 of 7 measures we developed that may indicate fraud, waste, or abuse of telehealth services,” the report noted. “All of these providers warrant further scrutiny. For example, they may be billing for telehealth services that are not medically necessary or were never provided.”

NABH Annual Membership Updates Are Due Next Friday, Sept. 16!

Next Friday, Sept. 16 is the deadline for members to submit changes about their organizations for the online-only NABH 2022 Membership Directory. Last month NABH sent its system members a message with a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use this tool to verify your system’s information. NABH has added several new categories this year. The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all your system’s facilities so that we have a better picture of our diverse membership. If you need NABH to re-send the link, please contact Maria Merlie at maria@nabh.org. Thank you for your cooperation!

Sound the Alarm for Kids to Host Virtual Roundtable on Friday, Sept. 16

Sound the Alarm for Kids will host “Helping Girls Thrive: A Conversation Examining Trends in Girls’ Mental Health” next Friday, Sept. 16 at 1 p.m. ET. The virtual roundtable discussion will examine the national campaign to raise awareness about today’s mental health crisis among children and teens and how to create change. Some of the speakers include Christina Bethell, Ph.D., M.P.H., M.B.A, director of the Child and Adolescent Health Measurement Initiative at Johns Hopkins University and Kelley Haynes-Mendez, Psy.D., senior director of the human rights team at the American Psychological Association. Click here to register.

Enhanced NABH Denial-of-Care Portal is Now Available

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

A recent study of 175,778 Medicare beneficiaries found that receipt of opioid use disorder-related telehealth services during the Covid-19 pandemic was associated with improved medications for opioid use disorder (MOUD) retention and lower odds of medically treated overdose, JAMA Psychiatry reports. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 207

Written by Emily Wilkins (NABH) on September 2, 2022. Posted in CEO Updates.

September is National Recovery Awareness Month

This week kicked off National Recovery Month, a national observance every September since 1989 intended to promote and support new evidence-based treatment and recovery practices, the nation’s recovery community, and the dedication of service providers and community leaders who make recovery possible. During this past week’s Overdose Awareness Week, which concludes tomorrow, President Biden issued a National Recovery Month proclamation in which he acknowledged the more than 20 million Americans recovering from substance use disorder and highlighted his administration’s efforts to support recovery. “This year, we secured nearly $22 billion from the Congress to support drug prevention, treatment, harm reduction, and recovery support services, with a focus on underserved communities,” the president said in his proclamation. “With the additional $4 billion investment from our American Rescue Plan, my administration is expanding recovery community organizations, recovery high schools, collegiate recovery programs, and recovery residences.” For more information about National Recovery Month, please visit the Substance Abuse and Mental Health Administration’s (SAMHSA) website, and please remember to follow NABH @NABHbehavioral and on LinkedIn at the National Association for Behavioral Healthcare. HHS Announces $47.6 Million in New Grant Funding for School-Based Mental Health The U.S. Health and Human Services Department (HHS) this week announced $47.6 million in new grant funding opportunities through this Bipartisan Safer Communities Act to support mental health programs in schools. Of that amount, $37.6 million is allocated for Project Advancing Wellness and Resiliency in Education, or AWARE, which is meant to develop a sustainable infrastructure for school-based mental health programs and services that promote the healthy social and emotional development of school-aged youth and prevent youth violence in schools. The remaining $10 million is for the Resiliency in Communities after Stress and Trauma (ReCast) grant program, which helps assist high-risk youth and families by promoting resilience and equity in communities that have recently experienced civil unrest, community violence, and/or collective trauma through evidence-based, violence prevention, and community youth engagement programs, as well as connections to trauma-informed behavioral health services.

Nonfatal Opioid-Involved Overdoses in Emergency Departments Are Rising

The rate of nonfatal, opioid-involved overdose emergency medical services (EMS) encounters increased by an average of 4% quarterly from January 2018 – March 2022, according to new research from the Centers for Disease Control and Prevention (CDC). The findings also reported that rates increased across most sociodemographic and county characteristics. Researchers noted that monitoring nonfatal, opioid-involved overdose trends in EMS data in near real time can help identify where overdose affects communities disproportionately and direct equitable response and prevention efforts, such as increased access to harm-reduction services and connections to care and treatment. Click here to read the full CDC report.

Reminder: HRSA Announces Funding for 2023 Rural Health Network Development Program

Both not-for-profit and for-profit organizations are eligible to apply for the Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy’s (FORHP) 2023 Rural Health Development Program, a four-year program to support integrated healthcare networks to improve outcomes and strengthen the nation’s rural healthcare system. The FORHP will make 44 awards of up to $300,000 each as part of the program, which focuses on four domains: improving access by addressing gaps in care, workforce shortages, better workflows and/or improving the quality of healthcare services; expanding capacity and services by creating effective systems through the development of knowledge, skills, structures, and leadership models; enhancing outcomes by improving patient and/or network development outcomes through expanding or strengthening the network’s services, activities or interventions; and establishing sustainability by positioning the network to prepare for sustainable health programs through value-based care and population health management. FORHP will hold a webinar for applicants on Wednesday, Sept. 7, 2022 from 2 p.m. to 3:30 P.M. ET. Click here for more information about the grants and here for next month’s webinar link.

NABH Submits Medicare Advantage Program Recommendations to CMS

NABH this week responded to a request for information from the Centers for Medicare & Medicaid Services (CMS) about the Medicare Advantage (MA) program and behavioral health. In its letter, NABH cited a recent study that found MA networks included only 23% of psychiatrists in a county on average — lower than all other medical specialties. “Not surprisingly, MA enrollees with depressive symptoms report more difficulty accessing needed treatment and rated their experience with the MA plans as worse than in traditional Medicare,” the letter said. The association provided information and outlined recommendations related to advancing health equity, expanding access, encouraging innovation to promote patient-centered care, and engaging partners.

Extended Deadline: NABH Annual Membership Updates Are Due Friday, Sept. 16

NABH has extended the deadline to Friday, Sept. 16 for members to submit changes about their organizations for the online-only NABH 2022 Membership Directory. Last month NABH sent its system members a message with a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use this tool to verify your system’s information. NABH has added several new categories this year. The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all your system’s facilities so that we have a better picture of our diverse membership. If you need NABH to re-send the link, please contact Maria Merlie at maria@nabh.org. Thank you for your cooperation!

Enhanced NABH Denial-of-Care Portal is Now Available

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

Since October, the use of hashtags related to self-harm – such as “#shtwt, short for Self-Harm Twitter – has increased roughly 500%, averaging tens of thousands of mentions per month, according to a new study from the Network Contagion Research Institute and Rutgers University. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 206

Written by Emily Wilkins (NABH) on August 26, 2022. Posted in CEO Updates.

Extended Deadline: NABH Annual Membership Updates Are Due Friday, Sept. 16

NABH has extended the deadline to Friday, Sept. 16 for members to submit changes about their organizations for the online-only NABH 2022 Membership Directory. Last month NABH sent its system members a message with a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use this tool to verify your system’s information. NABH has added several new categories this year. The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all your system’s facilities so that we have a better picture of our diverse membership. If you need NABH to re-send the link, please contact Maria Merlie at maria@nabh.org. Thank you for your cooperation!

NABH and Partner Groups Ask HHS Secretary Becerra to Integrate Mental and Physical Health Within ASPR

NABH and more than 50 other advocacy organizations this week sent a letter to U.S. Health and Human Services Department (HHS) Secretary Becerra that urged the Biden administration to integrate mental and physical health within the Administration for Strategic Preparedness and Response (ASPR). Last month HHS announced that Becerra had elevated the then-existing Office of the Assistant Secretary for Preparedness and Response from a staff division to an operating division—taking the new name of the Administration for Strategic Preparedness and Response—in an effort to elevate ASPR to a standalone agency with the department, similar to the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and Substance Abuse and Mental Health Services Administration (SAMHSA). HHS’ announcement said the change would allow ASPR to mobilize a coordinated national response more effectively and efficiently during future disasters and emergencies. This week, NABH was one of many organizations that called on HHS to use this opportunity to integrate mental and physical health when forming a national response to such events. “Therefore, with the elevation of ASPR within HHS, the Biden administration must seize this important opportunity to integrate our mental and physical health response in order to truly ensure ASPR is able to fulfill its mission to prepare and respond to health crises,” the organizations wrote in their letter to Becerra. “Needed steps include having senior positions within ASPR dedicated to ensuring the integration of mental health and substance use into all of ASPR’s work, as well as broader staff training to ensure personnel have sufficient background on why mental health is so important to emergency preparedness and response.” Click here to read the entire letter.

CEO Alliance for Mental Health Releases Updated Unified Vision for Transforming Mental Health and Substance Use Car

The CEO Alliance for Mental Health—of which NABH is a member organization— this week released an update Unified Vision for Transforming Mental Health and Substance Use Care for 2022. Please read the updated vision, which includes information related to the national 988 behavioral health crisis line that launched last month. Also, please remember to follow us @NABHbehavioral and on LinkedIn at the National Association for Behavioral Healthcare to share our posts about the vision.

HRSA Announces Funding for 2023 Rural Health Network Development Program

Coalition on Physician Education in Substance Use Disorders Extends Submission Deadline for Curriculum Innovation Challenge

The Coalition on Physician Education in Substance Use Disorders (COPE), a partner organization to the Opioid Response Network, has extended the deadline for its Innovative Learning and Teaching About Substance Use/Opioid Use Disorders Curriculum Innovation Challenge to next Wednesday, Aug. 31 at 11:59 p.m. ET. The challenge is intended to support teams of medical school faculty and students in integrating addiction medicine/psychiatry content into core clerkship rotations. It is designed to foster engagement and collaboration between addiction medicine experts, medical school faculty (clerkship directors or the equivalent), and medical students using cutting-edge concepts and training tools. Through a series of virtual conferences, winning teams will be led in developing addiction medicine/psychiatry curriculum and planning subsequent implementation based on the needs of their school. Click here to learn more and apply.

Marijuana and Hallucinogen Use Among Young Adults Reached All-Time High in 2021

Marijuana and hallucinogen use reported by young adults 19 to 30 years old increased significantly in 2021 compared with five and 10 years ago, reaching historic highs in this age group since 1988, according to statistics released this week from the National Institute on Drug Abuse. The findings came from the Monitoring the Future panel study, which also reported that rates of past-month nicotine vaping, which have been gradually increasing in young adults for the past four years, also continued a general upward trend in 2021, despite leveling off in 2020. Past-month marijuana vaping, which had significantly decreased in 2020, rebounded to pre-pandemic levels in 2021. Click here to learn more.

Enhanced NABH Denial-of-Care Portal is Now Available

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

About 6% of behavioral health providers and 29% of substance use treatment centers use electronic health record (EHR) technology, compared with more than 80% of hospitals that use EHRs, according to the Medicaid and CHIP Advisory Committee’s June report to Congress (see p. 84). For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 205

Written by Emily Wilkins (NABH) on August 19, 2022. Posted in CEO Updates.

CMS Releases ‘Roadmap’ for Providers to Prepare for End of Covid-19 PHE

The Centers for Medicare & Medicaid Services this week released a series of fact sheets and resources to help the nation’s healthcare providers prepare for the end of the Covid-19 public health emergency (PHE), which will also end many of the flexibilities the agency offered during the global pandemic. A blog post from three CMS leaders noted that the agency learned from providers, facilities, insurers, and other stakeholders about what worked well—and didn’t—in relation to the agency’s waivers and other temporary measures. “Expanding telehealth is an example of a congressional change,” said the blog post from Jonathan Blum, CMS’ chief operating officer and principal deputy administrator; Carol Blackford, director of the agency’s hospital and ambulatory policy group; and Jean Moody-Williams, deputy director of the Center for Clinical Standards and Quality. “The Consolidated Appropriations Act, 2021 expanded access to telehealth services for the diagnosis, evaluation, or treatment of mental health disorders after the end of the PHE,” the authors continued. “These services have been so important to the health and well-being of Americans affected by Covid-19.” The post also noted that U.S. Health and Human Services Department (HHS) Secretary Xavier Becerra will give the healthcare community 60 days’ notice before the PHE ends. Providers can refer to a host of fact sheets and resources from CMS in links at the end of the blog post to help prepare as the PHE winds down.

CMS Rule Proposes Requiring Behavioral Health Quality Data Reporting

CMS on Thursday released a proposed rule that would require annual state reporting for three quality measure sets, including the behavioral health measures in the Core Set of Adult Health Care Quality Measures for Medicaid. The Behavioral Health Core Set includes 13 measures: a depression measure under the Primary Care Access and Preventive Care domain; four measures related to individuals with substance use disorders including one related to medication assisted treatment; two related to the prescribing of opioids; and six measures related to individuals with mental disorders. These core sets are designed to measure the overall national quality of care for beneficiaries, monitor performance at the state level, improve the quality of health care, and provide a national view of quality. CMS has proposed that reporting these measures—currently a voluntary practice—become mandatory in fiscal year 2024. Data reported in 2024 will reflect care delivered in calendar year 2023. “The Medicaid and CHIP Core Sets of quality measures for children, adults, and health home services are key to promoting health equity,” CMS Administrator Chiquita Brooks-LaSure said in an announcement. “They will allow us not only to identify health disparities but also to implement interventions based on the very data that make those disparities clear.” In addition to the Child and Adult Core Sets, CMS has proposed establishing reporting requirements for states that elect to implement one or both of the optional Medicaid health home benefits under sections 1945 or 1945A of the Social Security Act, which will measure healthcare quality for states that choose to establish “health homes.” Public comments about the proposed rule are due Oct. 21, 2022. The rule will be published in the Federal Register on Monday, Aug. 22.

New JAMA Study Shows Pervasiveness of Methamphetamine Use in Rural America

Findings from a JAMA Network Open study released this week show that nearly four of five people taking drugs in rural areas across 10 states used methamphetamine in the past 30 days. Meanwhile, non-fatal overdoses in the past six months were higher among people using both methamphetamines and opioids (22%), compared with opioids alone (14%), or methamphetamines alone (6%). “The challenge is compounded in rural communities that often lack buprenorphine prescribers: more than one-half of U.S. counties (53.4%) do not have a buprenorphine prescriber, leaving 30 million people in those counties without access to treatment,” the researchers wrote. “Similarly, rural opioid treatment programs are rare, leading to long driving times to access methadone,” they continued, adding that educational interventions are needed to train primary care physicians, who are essential providers of opioid use disorder treatment in rural America. “For example,” they wrote, “contingency management training interventions could be adapted to support rural primary care practitioners.”

NABH Annual Membership Updates Are Due Today

The deadline to submit changes about your organization for the online-only NABH 2022 Membership Directory is today, Friday, Aug. 19. Last month NABH sent its system members a message with a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use this tool to verify your system’s information. NABH has added several new categories this year. The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all your system’s facilities so that we have a better picture of our diverse membership. If you need assistance, please contact Maria Merlie at maria@nabh.org. Thank you!

Enhanced NABH Denial-of-Care Portal is Now Available

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

A new study in The Lancet Psychiatry shows that up to two years after Covid-19 infection, the risk of developing conditions such as psychosis, dementia, brain fog, and seizures is still higher than after other respiratory infections; however, the findings also showed that while anxiety and depression are more common soon after a Covid-19 diagnosis, the mood orders are transient, becoming no more likely after the two months than following similar infections, such as the flu. To learn more, read this story in STAT. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 203

Written by Emily Wilkins (NABH) on July 29, 2022. Posted in CEO Updates.

Final 2023 IPF-PPS Rule Calls for 2.5% Payment Increase to IPFs in 2023

In a final rule released Thursday, the Centers for Medicare & Medicaid Services (CMS) said total estimated payments to inpatient psychiatric facilities (IPFs) are estimated to increase by 2.5%, or $90 million, in fiscal year 2023 relative to IPF payments in 2022. This is larger than the 1.5% payment increase the agency proposed this spring. For 2023, CMS is updating the IPF prospective payment system (PPS) rates by 3.8%, based on the final IPF market basket update of 4.1% minus a 0.3 percentage point productivity adjustment. CMS is also updating the outlier threshold so that estimated outlier payments remain at 2% of total payments. The agency estimates this will result in a 1.2% decrease to aggregate payments, due to updating the outlier threshold. CMS noted that due to rounding, the 3.8% increase to payment rates and the 1.2% decrease to outlier payments yield a 2.5% overall increase in IPF payments. A fact sheet from CMS highlights the final rule’s major provisions, including a permanent 5% cap policy to ease the impact of year-to-year changes in IPF payments related to decreases in the IPF wage index. Finally, CMS did not make final any changes for the IPF Quality Reporting Program in the 2023 final rule. Gov. Phil Murphy Announces ‘Strengthening Youth Mental Health Care’ as NGA Chair’s Initiative Incoming National Governors Association (NGA) Chair Gov. Phil Murphy (D-N.J.) announced “Strengthening Youth Mental Health Care” is his chair’s initiative as he leads the organization from 2022-2023. “We are all aware of the youth mental health crisis in our country,” Murphy said during the closing session of the NGA’s summer meeting in Portland, Maine. “It is a crisis that the pandemic did not create but exposed more fully,” he added. “It is one that we must tackle together, and tackle now.” Murphy also acknowledged access-to-care problems and highlighted the four pillars of his chair’s initiative: prevention and resilience building; increasing awareness and reducing stigma; access and affordability of quality treatment and care; and caregiver and educator training and support. Click here to read more about Murphy’s initiative. Opioid Response Network & National Association of Counties Offer Guidance on Managing Opioid Litigation Funds The Opioid Response Network (ORN) and the National Association of Counties (NACo) have partnered to strengthen the association’s new Opioid Solutions Initiative and resource center, which offers guidance to U.S. counties about how to use funding from litigation between states and opioid manufacturers and distributors. The support center provides guidance on managing opioid litigation funds, information about effective substance use prevention, treatment and recovery approaches that are approved uses of settlement funds, case studies on evidence-based practices, and — with help from the ORN — free, on-demand education and training. Click here to read more about NACo’s Opioid Solutions Center and click here to submit requests for free education and training. NABH Annual Membership Update: 2022 Membership Directory NABH is developing its online-only 2022 Membership Directory, an essential member benefit that helps the asssociation in its advocacy efforts. Earlier this week, NABH sent its system members a separate message that includes a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use the link to our membership-update tool and verify your system’s information. NABH has added several new categories this year. The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all of your system’s facilities so that we have a better picture of our diverse membership. The deadline to submit your changes to NABH is Friday, Aug. 19, 2022. If you need assistance, please contact Maria Merlie at maria@nabh.org. Thank you! Enhanced NABH Denial-of-Care Portal is Now Available! NABH recently made enhancements to its Denial-of-Care Portal that are intended to make the portal easier for members to use. A year ago, NABH developed the Denial-of-Care Portal to collect specific data on insurers who deny care—often without regard to parity or the effects on patients. Now the association has updated this resource to make it more user-friendly for members and also more aligned with what regulators need to identify parity violations. The updated portal includes fewer questions, which will require less time for members to complete. In addition, all questions are now optional. NABH hopes this will make it more likely for members to share the data they have. Lastly, NABH has added a checklist of “red flags” that were included in the 2022 MHPAEA Report to Congress from the U.S. Health and Human Services, Labor, and Treasury Departments in January. “We know the best way to advocate for parity enforcement with regulators is to provide hard data from our members that show how insurers are not complying with the landmark 2008 parity law,” said NABH President and CEO Shawn Coughlin. “We hope these new changes will make it easier—and faster—for our members to use so that we can gather that critical data.” Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal. Save the Date for the NABH 2023 Annual Meeting! Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting! Fact of the Week Calls to the new, national 988 behavioral health crisis hotline increased by 45% during the week after it transitioned to a three-digit number from a longer one. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 202

Written by Emily Wilkins (NABH) on July 22, 2022. Posted in CEO Updates.

ONDCP Director Identifies Gaps and Proposes Better System for Tracking Nonfatal Overdoses

In a recent JAMA commentary, the head of the White House Office of National Drug Control Policy (ONDCP) said the lack of real-time data for both fatal and nonfatal drug overdoses in the United States undermines the ability to respond accountably and restricts the potential to understand the effects of actions and investments. ONDCP Director Rahul Gupta, M.D., M.B.A., M.P.H., and David Holtgrave, Ph.D., also of ONDCP, argued that it’s essential to build the national data system while taking actions to prevent overdoses and save lives in the near term. “Once established, this national system should rapidly yield higher-quality, more complete, more timely, and more actionable data to inform increasingly effective policy making to prevent and treat overdose occurrences and build health equity,” the authors wrote. “Doing so will require the partnership of many, but there is not a moment to lose.”

Uniform Law Commission Agrees to Propose a Bill to State Legislatures That to Create More Consistency in Telehealth Laws

Politico reported this week that the influential Uniform Law Commission agreed to propose legislation to state legislatures that would try to create more consistency in telehealth laws and expand access to care across state lines. The commission nearly unanimously approved the model legislation after two years of deliberations and guidance from the American Medical Association, Federal Trade Commission, state medical boards, and telehealth groups. “It’s unclear how many states will move to create new laws around telehealth — or use the Uniform Law Commission’s model — but legislatures have embraced past proposals on issues ranging from regulation of organ donation to taxation of people who work in multiple states,” the story noted.

HRSA Payment Program for Rural Health Clinic Buprenorphine-Trained Providers Still Open

The nation’s rural health clinics (RHCs) still have an opportunity to apply for funding from the Health Resources and Services Administration’s (HRSA) program that pays providers who are waivered to prescribe buprenorphine, a medication used to treat opioid use disorder. Launched in 2021, HRSA’s program has about $1.2 million in program funding still available, and RHCs may apply for a $3,000 payment on behalf of each provider who trained to obtain the necessary waiver. HRSA said funds will be paid on a first-come, first-served basis until funds are exhausted. Please direct any questions to DATA2000WaiverPayments@hrsa.gov. In addition, the American Osteopathic Academy of Addiction Medicine and the Providers Clinical Support System are offering a free online course for waiver-eligibility training. Click here for more information.

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

NABH has made enhancements to its Denial-of-Care Portal that are intended to make the portal easier for members to use. A year ago, NABH developed the Denial-of-Care Portal to collect specific data on insurers who deny care—often without regard to parity or the effects on patients. Now the association has updated this resource to make it more user-friendly for members and also more aligned with what regulators need to identify parity violations. The updated portal includes fewer questions, which will require less time for members to complete. In addition, all questions are now optional. NABH hopes this will make it more likely for members to share the data they have. Lastly, NABH has added a checklist of “red flags” that were included in the 2022 MHPAEA Report to Congress from the U.S. Health and Human Services, Labor, and Treasury Departments in January. “We know the best way to advocate for parity enforcement with regulators is to provide hard data from our members that show how insurers are not complying with the landmark 2008 parity law,” said NABH President and CEO Shawn Coughlin. “We hope these new changes will make it easier—and faster—for our members to use so that we can gather that critical data.” Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us at the Mandarin Oriental Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

Sixty-four percent of dual-eligible beneficiaries have a mental health diagnosis, according to a recent profile from research firm. ATI Advisory. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 200

Written by Emily Wilkins (NABH) on July 8, 2022. Posted in CEO Updates.

CMS Proposes to Modernize Coverage for Behavioral Health Services in 2023 Physician Fee Schedule Rule

The Centers for Medicare & Medicaid Services (CMS) on Thursday proposed new policies to update coverage for behavioral health services in the agency’s physician fee schedule proposed rule for 2023. In the rule, CMS proposes to address the behavioral healthcare workforce shortage by allowing licensed professional counselors (LPCs), marriage and family therapists (LMFTs), and other types of behavioral health practitioners to provide behavioral health services under general, rather than direct, supervision. CMS also proposes to pay for clinical psychologists and licensed clinical social workers to provide integrated behavioral health services as part of a patient’s primary care team. In addition, the rule proposes to bundle certain chronic pain management and treatment services into new monthly payments to help improve patient access to team-based, comprehensive, chronic pain treatment. And the agency is proposing to cover opioid treatment and recovery services from mobile units, such as vans, to increase access to services for people who are homeless or live in rural areas. Meena Seshamani, M.D., Ph.D., director for the Center for Medicare at CMS, and Douglas Jacobs, M.D., M.P.H., chief transformation officer at the Center for Medicare, co-authored a blog post Thursday about the behavioral health changes in the proposed rule.

Federal Health Officials Recommend ‘Preaddiction’ to Treat SUDs

Directors at the National Institutes of Health and the founder of the Treatment Research Institute this week recommended that the DSM-5 diagnostic categories “mild to moderate SUD” be a starting definition for the term preaddiction, a term they said could generate greater attention to the risks associated with early state substance use disorder (SUD) and help direct policies and resources to support preventive and early intervention measures. Nora Volkow, M.D., director of the National Institute on Drug Abuse, George Koob, Ph.D., director of the National Institute on Alcohol and Abuse and Alcoholism, and Tom McClellan, founder of the Treatment Institute wrote a commentary in JAMA Psychiatry this week that pushed for using the term preaddiction and highlighted lessons learned from Type 2 Diabetes and the role of “prediabetes” in their argument. As the authors explained, the American Diabetes Association in 2001 suggested the term prediabetes (defined by elevated scores on two laboratory tests: impaired glucose tolerance and impaired fasting glucose) to leverage public motivation to avoid serious diabetes. “Intervening early is not a new concept, nor is it easy to implement,” the authors wrote. “The diabetes field likely succeeded owing to a broad, well-organized, and sustained strategy applied concurrently at the clinical, public, and policy levels,” they said, adding that if an analogous approach is to be effective in the SUD field, it will require similarly integrated efforts in three areas: measures to define and detect preaddiction; engaging, effective interventions for preaddiction; and public and clinical advocacy. “The diabetes example illustrates why a similar strategy has not yet happened in the SUD field: poor integration into the rest of mainstream healthcare, lack of a prominent advocacy group demanding clinical and policy changes, and little reimbursement for interventions with less severe SUDs,” the authors noted. “Nonetheless, the diabetes example shows that an early intervention approach can work given a comprehensive, sustained effort. That example also suggests the potential impact from a parallel strategy to reduce addiction problems by more aggressive efforts to identify and reverse preaddiction.” Volkow discussed the issue further in her blog on July 6.

HUD Announces $365 Million Package to Address Unsheltered Homelessness and Homeless Encampments

The U.S. Housing and Urban Development Department (HUD) recently announced $322 million for permanent housing, supportive services, and other costs, and $43 million to fund about 4,000 new incremental housing choice vouchers. The Initiative for Unsheltered and Rural Homelessness through HUD promotes partnerships with healthcare organizations, public housing authorities and mainstream housing providers, and people with lived experience and expertise of homelessness. “President Biden is following through on his promise to unite our country by delivering funding for healthcare and services that support individuals who are unhoused,” Rahul Gupta, M.D., director of the White House Office of National Drug Control Policy, said in an announcement. “As a physician I have seen firsthand how important it is to address the social and economic conditions of a person’s life in order for them to realize the health and well-being every American deserves.” Click here to learn more in the full HUD announcement.

SAMHSA Releases Advisory on Peer Supports Services in Crisis Care

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released an advisory that discusses the role of peer support workers and models that are available to help individuals in crisis. The 17-page resource includes information about the evidence base for peer support services in crisis care, what peer support workers should do, how the recovery process looks different for everyone, and more.

Reminder: National Academies’ Forum on Mental Health and SUD to Host Workshop Next Week

The National Academies’ Forum on Mental Health and Substance Use Disorders will host a public workshop that focuses on early intervention for psychosis, current data on the epidemiology and outcomes for people at high risk for psychosis and those who have experienced a first psychosis, and ways to improve care for these patients. Sessions will provide an overview of the epidemiology for people with psychosis, discuss what services are available and highlight successful models of care, and examine policy solutions and strategies that the most effective for coordinated specialty services. The workshop will be held on Monday, July 11 from 11 a.m. to 5 p.m. ET. Click here to register.

Reminder: 2022 Annual Meeting Evaluation

If you attended the 2022 Annual Meeting in Washington, please take a few moments to complete this evaluation via Survey Monkey. Your feedback will help inform our future programs. Thank you. Fact of the Week Comparing the Public Health Emergency (PHE) period (March 2020 to January 2022) with the pre-PHE period, mental health services for children covered by Medicaid has declined about 23%, according to preliminary data from CMS. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 199

Written by Emily Wilkins (NABH) on July 1, 2022. Posted in CEO Updates.

SAMHSA to Host Webinar on 42 CFR Part 2 Compliance Next Week

The Substance Abuse and Mental Health Services Administration (SAMHSA) will host a 90-minute webinar for business managers and compliance officers on July 7 to help ensure their organizations comply with SAMHSA’s 42 CFR Part 2 regulations. The lesson will highlight the latest updates released in January 2018; examine multiple scenarios and frequently asked questions related to SAMHSA’s mental health, substance abuse, and alcohol abuse records; and address proper ways to secure and/or release this information. SAMHSA urges practice managers, business associates who work with health records, compliance officers, physicians, and other medical professionals to attend the webinar on Thursday, July 7 at 1 p.m. ET. Click here to register.

White House Maternal Health Blueprint Aims to Increase Access to Behavioral Health Services

In its new White House Blueprint for Addressing the Maternal Health Crisis, the Biden administration has recommended 50 actions that more than a dozen federal agencies will take to improve maternal care in the United States, including some related to behavioral health. Released in June, the 68-page blueprint outlines five goals, starting with Goal #1: Increase Access to and Coverage of Comprehensive High-Quality Maternal Health Services, Including Behavioral Health Services. “We will continue to invest in maternal behavioral health by launching a 24/7 national support hotline for pregnant individuals and new mothers facing mental health challenges and improving provider education,” the blueprint noted in this first goal. “We will also strengthen access to perinatal addiction services by partnering with hospitals and community-based organizations to implement evidence-based practices,” it continued. “Congress must also take critical steps to bolster access to and coverage of maternal health services.” Other behavioral health-related action items include strengthening supports and access to perinatal addiction services for individuals with substance use disorder by partnering with hospitals and community-based organizations to implement evidence-based interventions, and appointing a dedicated associate administrator for women’s services at SAMHSA to lead its efforts in promoting positive mental health during pregnancy and in the postpartum period.

NABH Responds to AHRQ’s RFI About CAHPS Survey for Inpatient Mental Healthcare Settings

NABH this week responded to the Agency for Healthcare Research and Quality’s (AHRQ) request for information (RFI) regarding potential Consumer Assessment of Healthcare Providers and Systems (CAHPS) for Inpatient Mental Healthcare Settings. AHRQ’s detailed RFI seeks to identify the highest priority aspects patient experiences to include in measures and surveys, the benefits of collecting information about a patient’s experience from family members and caregivers, the challenges that exist in collecting this information, and much more. “During inpatient stays, patients are typically experiencing an increase in psychiatric symptomatology, including, but not limited to, hallucinations, paranoia, delusions, emotional lability, and fragmented cognitive processes,” NABH’s letter said in response to a question about the challenges in administering measures and surveys in mental healthcare settings. “Patients may thus be limited in their ability to express thoughts and feelings, to comprehend written material, or sustain their attention to complete a survey,” the letter continued. “For these reasons, we suggest limiting surveys to 20-25 questions, or 8-10.”

Reminder: National Academies’ Forum on Mental Health and SUD to Host Summer Workshop on Early Intervention for Psychosis on July 11

Reminder: 2022 Annual Meeting Evaluation

If you attended the 2022 Annual Meeting in Washington, please take a few moments to complete this evaluation via Survey Monkey. Your feedback will help inform our future programs. Thank you.

Fact of the Week

The United States requires about 6,600 new mental health practitioners to meet demand in regions the federal government has identified as health professional shortage areas, according to data from the Kaiser Family Foundation.

The NABH staff wishes you, your teams, and your families a happy and safe Independence Day weekend!

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

CEO Update 198

Written by Emily Wilkins (NABH) on June 24, 2022. Posted in CEO Updates.

Senate Passes Gun-Control Bill with Mental Health Provisions

The Senate on Thursday passed the most significant gun-control legislation since the mid-1990s in a bill that includes about $15 billion in mental health and school security funding. The House is expected to vote today, June 24, on the measure. The Bipartisan Safer Communities Act expands the existing Medicaid Certified Community Behavioral Health Clinic (CCBHC) demonstration program to all states; helps states to implement, enhance, and expand school-based health programs under Medicaid through updated guidance, technical assistance, and state planning grants; requires the Centers for Medicare & Medicaid Services (CMS) to provide guidance to states on how they can increase access to behavioral health services through telehealth under Medicaid and CHIP; appropriates $150 million to help implement the upcoming 988 behavioral health crisis hotline; provides $500 million through the School-Based Mental Health Services Grant Program to increase the number of qualified mental health service providers that provide school-based mental health services to students in school districts with demonstrated need; and more. President Biden said he intends to sign the bill into law. “Last month, President Biden spent hours with the family members whose lives were forever changed by the recent shootings at a grocery store in Buffalo, New York and an elementary school in Uvalde, Texas,” said a Statement of Administration Policy from the Office of Management and Budget. “The family members delivered a simple message, which the president then relayed to the American people: do something. Do something to stop the carnage of gun violence that leaves behind grief and trauma in communities, both big and small, across the country.” The statement added that the bill advances President Biden’s agenda to expand access to mental health services and address the trauma of gun violence affecting so many communities. Click here to read the legislation.

House Passes Mental Health Bill to Reauthorize Funds for SAMHSA & HRSA

In a 402-20 vote Wednesday, the House of Representatives passed H.R. 7666, the Restoring Hope for Mental Health and Well-Being Act, which would reauthorize essential Substance Abuse and Mental Health Services (SAMHSA) and Health Resources and Services Administration (HRSA) programs to address the nation’s mental health and substance use crises. The bill would reauthorize and modify several programs, including the Community Mental Health Services Block Grant, the Substance Abuse Prevention and Treatment Block Grant, and grants related to suicide prevention and the behavioral health workforce. In remarks on the House floor, House Majority Leader Steny Hoyer (D-Md.) applauded the House Energy and Commerce Committee and all House members whose legislation was included in the package. “I hope this strong vote today will help move these critical policies through the Senate and see them quickly enacted into law,” Hoyer added. On Tuesday, the Biden administration said it supported the bill in a Statement of Administrative Policy.

World Health Organization Releases First World Mental Health Report Since 2001

The World Health Organization (WHO) has released its largest review of world mental health since it released World Health Report 2001: Mental Health: New Understanding, New Hope. The latest iteration, Transforming Mental Health for All, provides a roadmap for governments, academics, health professionals, and others to support the world in transforming mental health. “As the world comes to live with, and learn from, the far-reaching effects of the Covid-19 pandemic, we must all reflect on one of its most striking aspects – the huge toll it has taken on people’s mental health,” the nearly 300-page report noted. “Rates of already-common conditions such as depression and anxiety went up by more than 25% in the first year of the pandemic, adding to the nearly one billion people who were already living with a mental disorder,” it continued. “At the same time, we must recognize the frailty of health systems attempting to address the needs of people with newly-presenting as well as pre-existing mental health conditions.” The report also said that since 2001, countries worldwide have formally adopted international frameworks that guide them to act for mental health. And, it continued, WHO member states have adopted the Comprehensive Mental Health Action Plan 2013-2030, which commits them to meeting 10 global targets for improved mental health. Categorized in eight sections, the report examines principles and drivers in public mental health, assesses world mental health today, argues for investment in mental health, considers promotion and prevention strategies for change, and explores how to restructure and scale up care.

MACPAC Examines How Medicaid Policy Can Support Adopting Behavioral Health IT

In its June report to Congress, the Medicaid and CHIP Payment and Access Commission (MACPAC) analyzed how Medicaid policy can be used to support adopting health information technology among behavioral healthcare providers. The report highlighted that Medicaid programs play a critical role in financing behavioral health services and that those programs are focused on ways to provide behavioral health in more integrated settings. Therefore, the Commission recommended, “…that CMS issue guidance to help states use Medicaid authorities and other federal resources to promote behavioral health IT adoption, and that the Office of the National Coordinator for Health Information Technology and the Substance Abuse and Mental Health Services Administration work together to develop voluntary standards that would encourage health IT uptake appropriate for behavioral health.” See chapter 4 of the report, Encouraging Health Information Technology Adoption in Behavioral Health: Recommendations for Action, to learn more.

CDC Introduces Tool to Check Drinking and Create a Plan to Drink Less

The Centers for Disease Control and Prevention (CDC) has launched an alcohol-screening tool for adults to check their drinking, identify barriers to drinking less frequently, and create a personalized plan to make healthier drinking choices—all anonymously. The resource is part of the Atlanta-based agency’s new Drink Less, Be Your Best campaign that highlights the harmful effects of alcohol and provides resources to help adults drink less. CDC noted in its announcement that the tool is not intended for medical diagnosis or treatment.

‘Hiding in Plain Sight: Youth Mental Illness’ Documentary to Air June 27 and 28

Award-winning filmmaker Ken Burns presents Hiding in Plain Sight: Youth Mental Illness, a two-part documentary film by Erik Ewers and Christopher Loren Ewers on Monday and Tuesday, June 27 and 28 at 9 p.m. ET on PBS. Click here to see a preview of the film, which includes a brief introduction from Burns.

2022 Annual Meeting Presentations Available Online

Please visit our Annual Meeting homepage to view available slide presentations from this year’s Annual Meeting. NABH will post recorded presentations on a later date. And if you attended the 2022 Annual Meeting in Washington, please take a few moments to complete this evaluation via Survey Monkey. Your feedback will help inform our future programs. Thank you.

Reminder: National Academies’ Forum on Mental Health and SUD to Host Summer Workshop on Early Intervention for Psychosis Next Month

The National Academies’ Forum on Mental Health and Substance Use Disorders will host a public workshop this summer that focuses on early intervention for psychosis, current data on the epidemiology and outcomes for people at high risk for psychosis and those who have experienced a first psychosis, and ways to improve care for these patients. Sessions will provide an overview of the epidemiology for people with psychosis, discuss what services are available and highlight successful models of care, and examine policy solutions and strategies that are the most effective for coordinated specialty services. The workshop will be held on Monday, July 11 from 11 a.m. to 5 p.m. ET. Click here to register.

Save the Date for the 2023 Annual Meeting!

Please save the date for NABH’s next Annual Meeting: June 12-14, 2023 at the Mandarin Oriental Washington, DC.

Fact of the Week

In 2019, nearly a billion people – including 14% of the world’s adolescents – were living with a mental disorder, the World Health Organization reports. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 197

Written by Emily Wilkins (NABH) on June 10, 2022. Posted in CEO Updates.

NABH Annual Meeting Kicks Off on Monday!

We’re pleased to devote this week’s edition of CEO Update to details about our Annual Meeting that starts on Monday, June 13! Our theme this year is Shaping the Future of Behavioral Healthcare, and our speakers—including HHS Secretary Xavier Becerra— will address topics that affect our industry today and in the years ahead. From parity and access to care, to the Biden’s administration’s behavioral health and drug control strategies, to the 2022 midterm elections, to workforce challenges and solutions, to the upcoming 988 behavioral health crisis hotline, this year’s program is one you won’t want to miss. On Monday, please be sure to look for an Annual Meeting Alert, which will include a link to our mobile app that contains important details about sessions, events, committee meeting room assignments, exhibitors and sponsors, our priorities for the 117^th Congress, restaurant recommendations in the Washington area, and more. We’ll open our meeting on Monday with two dynamic speakers: Ben Nemtin will discuss his personal battle with clinical depression and how to thrive personally and professionally, and journalist Sam Quinones will share his experiences writing his most recent book, The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth. Sam will sign copies of his book after his presentation. As with previous Annual Meetings, we will post presentations on our website after the meeting ends. Registration opens on Monday at noon, and our first session kicks off in the Mandarin Oriental’s Grand Ballroom at 2:30 p.m. I hope to see you there! -Shawn Coughlin, President and CEO

HHS Secretary Becerra to Address Attendees on Tuesday, June 14

HHS Secretary Xavier Becerra, the 25^th secretary of the U.S. Health and Human Services Department and the first Latino to hold that office, will address Annual Meeting attendees on Tuesday, June 14 at 8:30 a.m. in the Grand Ballroom. Secretary Becerra will offer brief remarks and then engage in a question-and-answer session with NABH President and CEO Shawn Coughlin. Previously Secretary Becerra was California’s attorney general and before that served for 12 terms in the U.S. House of Representatives, where he was the first Latino to serve as a member of the powerful House Ways and Means Committee. He also served as chairman of his party’s caucus and as the ranking member of both the Ways and Means Subcommittee on Health and Ways and Means Subcommittee on Social Security. Secretary Becerra will discuss the Biden administration’s comprehensive strategy to address America’s mental health crisis, which includes promoting the well-being of the nation’s frontline healthcare workforce, piloting new approaches to training behavioral health paraprofessionals, strengthening the country’s crisis care and suicide prevention infrastructure, integrating mental health and substance use treatment into primary care, expanding and strengthening parity, and more.

ONDCP Director Rahul Gupta, M.D., M.B.A., FACP to Present on Tuesday, June 14

Following Secretary Becerra’s presentation on Tuesday, Office of National Drug Control Policy (ONDCP) Director Rahul Gupta, M.D., M.B.A., FACP will provide a presentation at 9:30 a.m. in the Grand Ballroom. Dr. Gupta is the first medical doctor to serve as director and lead ONDCP, a component of the Executive Office of the President. ONDCP coordinates the nation’s $40 billion drug budget and federal policies, including prevention, harm reduction, treatment, recovery support, and supply reduction. Through his work as a physician, a state and local leader, an educator, and a senior leader of a national nonprofit organization, Dr. Gupta has dedicated his career to improving public health and public safety. He is also a buprenorphine-waivered practitioner, who has provided medication-assisted treatment for people with opioid use disorder. The son of an Indian diplomat, Dr. Gupta was born in India and grew up in the suburbs of Washington, D.C. At age 21, he completed medical school at the University of Delhi and later completed subspecialty training in pulmonary medicine. Dr. Gupta earned a master’s degree in public health from the University of Alabama-Birmingham and a global master’s of business administration degree from the London School of Business and Finance.

Panel to Examine Ways to Address Behavioral Healthcare Workforce Challenges

Workforce shortages have challenged NABH members for years before the pandemic worsened the problem. For this year’s Annual Meeting, NABH has developed a panel to discuss potential solutions. Please join us in the Grand Ballroom on Tuesday, June 14 at 11 a.m. to learn from panelists Megan Baird of the Office of Apprenticeship in the U.S. Labor Department’s Employment and Training Administration; Malissa Lewis, LL.M of the Health Resources and Services Administration; and David Long of Pinnacle Treatment Centers, an NABH member organization. NABH Director of Quality and Addiction Services Sarah Wattenberg, L.C.S.W. will moderate a discussion that will highlight apprenticeships, loan repayment programs, and more.

Political Commentator Amy Walter to Discuss 2022 Midterm Elections

Be sure to attend this year’s Annual Meeting Luncheon at noon on Tuesday, June 14 in the Oriental Ballroom to learn from political commentator Amy Walter, who will preview this fall’s midterm election season. Walter, editor in chief of the Cook Political Report with Amy Walter and a political commentator for the PBS NewsHour, provides analysis of the issues, trends, and events that shape the political environment. She is also a regular Sunday panelist on NBC’s Meet the Press and CNN’s Inside Politics and appears frequently on Special Report with Bret Baier on Fox News Channel. From 2017 until early 2021, Walter was the host of the weekly nationally syndicated program “Politics with Amy Walter” on The Takeaway from WNYC and PRX. She’s also the former political director of ABC News.

Learn Details about the Wit v. UBH Case During Wednesday’s Policy Breakfast

Join us on Wednesday morning, June 15 to hear from Meiram Bendat, J.D., founder and president of Psych Appeal and consultant to NABH, who will discuss details of the Wit v. UBH case. The policy breakfast will begin at 8 a.m. on Wednesday and the Annual Meeting will adjourn at 10 a.m. The NABH team wishes everyone a safe trip to Washington, and we look forward to seeing you soon! For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 196

Written by Emily Wilkins (NABH) on June 3, 2022. Posted in CEO Updates.

White House Releases Fact Sheet on Strategy to Address Nation’s Mental Health Crisis

The Biden Administration concluded Mental Health Month this week by announcing new actions to advance President Biden’s mental health strategy in three previously announced objectives: strengthening system capacity, connecting more Americans to care services, and creating a continuum of support. The White House noted that America’s mental health crisis is unprecedented, as two in five American adults report symptoms of anxiety and depression, and more than half of U.S. parents express concern about their children’s mental well-being. Meanwhile, the announcement continued, more than 40% of teenagers report they struggle with persistent feelings of sadness and hopelessness. “These growing demands have exposed longstanding cracks in our care infrastructure while compounding many other challenges, from criminal justice to homelessness to the labor shortage,” the White House announcement said. In a new fact sheet, the Biden Administration outlined applicable action steps to address the crisis, such as promoting the well-being of the healthcare workforce, piloting new approaches to training behavioral health paraprofessionals, bolstering the nation’s crisis care and suicide prevention infrastructure, building capacity for long-term care facilities to deliver behavioral health services, making care affordable across all types of health insurance coverage, integrating mental health services in ways that reduce stigma and access barriers, and more.

HHS’ Office on Women’s Health Announces Grant Program to Reduce Maternal Deaths Due to SUD

HHS’ Office on Women’s Health is accepting applications for projects designed to strengthen the perinatal (from conception to birth) and postnatal (up to 12 months after birth) to support structures for patients with substance use disorder (SUD) and reduce deaths during those two time periods. Applicants who receive funding will be expected to partner with hospital and community-based organizations to implement evidence-based interventions that strengthen perinatal and postnatal support structures for patients with SUD; create a technologically innovative education and outreach products to provide support accessible to perinatal and postpartum patients with SUD at home and on the go to reduce triggers, decrease stress, and increase feelings of support; and improve health outcomes and reduce deaths among perinatal and postpartum patients associated with SUD. Both for-profit and not-for-profit organizations are eligible to apply. Click here to learn more and apply.

National Academies’ Forum on Mental Health and SUD to Host Summer Workshop on Early Intervention for Psychosis

The National Academies’ Forum on Mental Health and Substance Use Disorders will host a public workshop this summer that focuses on early intervention for psychosis, current data on the epidemiology and outcomes for people at high risk for psychosis and those who have experienced a first psychosis, and ways to improve care for these patients. Sessions will provide an overview of the epidemiology for people with psychosis, discuss what services are available and highlight successful models of care, and examine policy solutions and strategies that are most effective for coordinated specialty services. The workshop will be held on Monday, July 11 from 11 a.m. to 5 p.m. ET. Click here to register.

NABH Working to Enhance Denial-of-Care Portal

NABH’s Denial-of-Care Portal is temporarily unavailable as the association works to enhance features of this member-only resource. NABH developed the portal so members could submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation and is intended to help the association in its advocacy efforts with policymakers and regulators. NABH will inform members when the updated portal is ready to use.

Learn About Our 2022 Annual Meeting Speakers!

The NABH 2022 Annual Meeting is fewer than two weeks away. Please be sure to learn more about this year’s speakers here on our Annual Meeting homepage. And please be sure to register for the meeting, if you have not done so yet. We look forward to seeing you soon in Washington!

Fact of the Week

A new study in JAMA Psychiatry found that after sustaining a mild traumatic brain injury (mTBI), some individuals—on the basis of education, race/ethnicity, history of mental health problems and cause of injury—were at substantially increased risk of post-traumatic stress disorder (PTSD) and/or major depressive disorder (MDD). For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 195

Written by Emily Wilkins (NABH) on May 27, 2022. Posted in CEO Updates.

HHS Leaders Encourage States to Prioritize Efforts to Support Children’s Mental Health Following Tuesday’s shooting at Robb Elementary School in Uvalde, Texas—the deadliest U.S. school shooting in 10 years in which a gunman killed 19 children and two teachers—U.S. Health and Human Services Department (HHS) agency leaders sent a joint letter to states, tribes, and jurisdictions urging them to maximize and prioritize their efforts to strengthen children’s mental health and well-being. According to the National Survey of Children’s Health, the number of children ages 3-17 years diagnosed with anxiety grew by 29% and those with depression by 27% between 2016 and 2020. Meanwhile, there was a 21% increase in children diagnosed with behavioral or conduct problems between 2019-2020. The letter provided a list of existing opportunities, partnerships, grants, and programs that states, tribes, and jurisdictions can access to support children’s mental health. Including HHS Secretary Xavier Becerra, leaders from the Administration for Children and Families, Administration for Community Living, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, Health Resources and Services Administration, and the Substance Abuse and Mental Health Services Administration (SAMHSA) signed the letter on May 25.

U.S. Surgeon General Releases Advisory on Health Worker Burnout

U.S. Surgeon General Vivek Murthy, M.D., M.B.A. this week released Addressing Health Worker Burnout, a 76-page advisory intended to draw the American people’s attention to an urgent public health issue and provide recommendations about how to manage it. In a video accompanying the advisory, Murthy noted that 54% of the nation’s physicians and nurses were experiencing burnout before the pandemic began, eight out of 10 health workers have experienced workplace violence, and 66% of U.S. nurses have considered resigning. “Healthcare systems, health insurance companies, and government must prioritize health worker well-being,” Murthy said in his recorded message. “This means increasing access to mental health services; reducing workplace burdens to prioritize time with patients; and protecting the health and safety of all health workers.” The advisory includes separate categories describing what healthcare organizations, federal, state, local, and tribal governments, insurers and payers, healthcare technology companies, academic institutions, clinical training programs, and accreditation bodies can do to help address health worker burnout.

George Washington University & Health Landscape Create Mental Health-SUD Workforce Database

With support from a SAMHSA grant, the George Washington University Fitzhugh Mullan Institute for Health Workforce Equity and data research firm Health Landscape have developed a national database on the country’s mental health and substance use disorder workforce to provide evidence-based support for creating policy and targeting resources appropriately. The new Behavioral Health Workforce Tracker is a comprehensive national database that identifies almost 1.2 million behavioral health providers, including more than 600,000 behavioral health specialists, including psychiatric and addiction medicine specialists, psychologists, counselors, and therapists; about 400,000 primary care physicians and advanced practice providers who provided 11 more behavioral health medications, and an additional 173,556 physician specialists who also wrote more than 11 behavioral health medications. Click here to learn more about the database.

National Academies’ Forum on Mental Health and SUD to Host Workshop on Early Intervention for Psychosis

The National Academies’ Forum on Mental Health and Substance Use Disorders will host a public workshop this summer that focuses on early intervention for psychosis, current data on the epidemiology and outcomes for people at high risk for psychosis and those who have experienced a first psychosis, and ways to improve care for these patients. Sessions will provide an overview of the epidemiology for people with psychosis, discuss what services are available and highlight successful models of care, and examine policy solutions and strategies that are most effective for coordinated specialty services. The workshop will be held on Monday, July 11 from 11 a.m. to 5 p.m. ET. Click here to register.

NABH Working to Enhance Denial-of-Care Portal

NABH’s Denial-of-Care Portal is temporarily unavailable as the association works to enhance features of this member-only resource. NABH developed the portal so members could submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation and is intended to help the association in its advocacy efforts with policymakers and regulators. NABH will keep members apprised of when the updated portal is ready to use.

NABH 2022 Annual Meeting Hotel Reservation Cutoff Date is Wednesday, June 1

The Mandarin Oriental Washington, DC has extended the hotel reservation cutoff date for the 2022 NABH Annual Meeting this coming Wednesday, June 1, 2022. Please be sure to reserve your hotel room today! And please visit our Annual Meeting webpage to register for the meeting, if you have not done so yet. We look forward to seeing you in Washington!

Fact of the Week

There has been a 213% increase in the death rate of Black men from drug overdoses from 2015 to 2020, the American Psychological Association reports. Before 2015, Black men were considerably less likely than both White men and American Indian or Alaska Native men to die from drug overdoses. Since then, the death rate among Black men has more than tripled. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 194

Written by Emily Wilkins (NABH) on May 20, 2022. Posted in CEO Updates.

NABH and Other Healthcare Groups Request Review of Three-Judge Panel’s Ruling in Wit v. UBH

NABH last week requested that the full 9^th U.S. Circuit Court of Appeals review a recent ruling from a three-judge panel that erroneously reversed a trial court’s landmark decision last year in the mental health class action, Wit v. United Behavioral Health. NABH filed an amicus brief to request a “rehearing en banc.” If granted, a rehearing could vacate the appellate panel’s deeply flawed ruling. The American Hospital Association, American Psychological Association, American Association for the Treatment of Opioid Dependence, California Hospital Association, Federation of American Hospitals, National Association of Addiction Treatment Providers, National Council for Mental Wellbeing, and REDC added their organization names to the amicus brief. “Unfortunately, the likely consequence of the panel decision is that the gains achieved as a result of the district court’s rulings will be wiped out as even further restrictions are placed on the care patients receive for treatment of mental illness,” the amicus brief states. “Instead of medical necessity determinations based on GASC developed by non-profit expert bodies, the decision-making power will be left to the discretion of for-profit insurers such as UBH.” Click here to read the news release that NABH distributed on Monday, May 16.

SAMHSA Introduces First ‘Behavioral Health Recovery Innovation Challenge’

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week introduced its first “Behavioral Health Recovery Challenge” to identify innovations that peer-run or community-based organizations—and entities that partner with them, including hospitals and health systems—have developed to advance recovery. SAMHSA defines recovery as “a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.” SAMHSA’s announcement noted that the agency encourages participants to share details about the practices they use to advance recovery and also demonstrate how these practices have: 1) expanded on SAMHSA’s definition of recovery, or 2) helped them overcome challenges in incorporating recovery into their behavioral health services or systems. “By using this vehicle, we hope to gain a better understanding of effective and innovative recovery practices from a very diverse field,” HHS Assistant Secretary for Mental Health and Substance Use Miriam E. Delphin-Rittmon, Ph.D., said in an announcement. Delphin-Rittmon also leads SAMHSA. “We aim to take what works for a small group and scale up to a larger population.” Click here to learn more from SAMHSA’s Recovery Innovation Challenge webpage.

SAMHSA Announces Funding Opportunity to Establish Center of Excellence on Social Media and Wellbeing

SAMHSA this week announced a funding opportunity that will award $2 million per year up to five years to establish a national Center of Excellence (CoE) that will develop and disseminate information, guidance, and training on the effects of children and youth’s social media use, including both its risks and benefits. SAMHSA’s grant announcement noted that the new CoE will pay particular attention to the potential risks social media platforms pose to the mental health of children and youth, as well as the clinical and societal interventions that could be used to address those risks. Eligible applicants include states, political divisions of states, Indian tribes or tribal organizations, health facilities, programs operated by or in accordance with a grant contract with the Indian Health Service, or other public of private, not-for-profit entities. The deadline to apply is Monday, July 18. Click here to learn more.

SAMHSA Announces $1.5 billion for State Opioid Response Program

SAMHSA this week said the agency’s State Opioid Response Program grant will fund up to $1,439,500,000 in fiscal year 2022 to 59 states and territories, including a set-aside for states with the highest opioid use disorder-related mortality rates. Grant funds may be used on contingency management to treat stimulant use disorder. In announcement about the grant funding, Office of National Drug Control Policy Director Rahul Gupta, M.D., M.P.H., M.B.A., FACP said that fewer than one out of 10 people in the United States who need addiction care receive it. “That is why President Biden released a National Drug Control Strategy to beat the overdose epidemic by going after its drivers: untreated addiction and drug trafficking,” Gupta said in the announcement. “Today we are delivering on key parts of our Strategy through this new funding, which will expand access to treatment for substance use disorder and prevent overdoses, while we also work to reduce the supply of illicit drugs in our communities and dismantle drug trafficking.” The use of contingency management for the treatment off stimulant use disorder is a permitted use of grant funds. The application process opened on Thursday, May 19 and will remain open through Monday, July 18. Click here to learn more.

NABH Working to Enhance Denial-of-Care Portal

NABH’s Denial-of-Care Portal is temporarily unavailable as the association works to enhance features of this member-only resource. NABH developed the portal so members could submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation and is intended to help the association in its advocacy efforts with policymakers and regulators. NABH will keep members apprised of when the updated portal is ready to use.

NABH 2022 Annual Meeting Hotel Reservation Cutoff Date Extended Until June 1

The Mandarin Oriental Washington, DC has extended the hotel reservation cutoff date for the 2022 NABH Annual Meeting to Wednesday, June 1, 2022. Please be sure to reserve your hotel room today! And please visit our Annual Meeting webpage to register for the meeting, if you have not done so yet. We look forward to seeing you in Washington!

Fact of the Week

In a recent Cigna survey of 1,000 parents, 80% said their children are struggling with mental health, and nearly one-fifth (18%) say their child’s needs are negatively affecting their job performance and productivity. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 193

Written by Emily Wilkins (NABH) on May 13, 2022. Posted in CEO Updates.

CDC Predicts U.S. Overdose Deaths Surpassed 107,000 in 2021

More than 107,000 Americans died of drug overdoses in 2021, according to provisional data from the Centers for Disease Control and Prevention (CDC) released this week. The troubling statistic—the CDC predicts the total to be 107,622 lives lost— hit a new record, as the number of predicted overdose deaths in 2021 reflects a 15-percent increase in the previous record set in 2020. “It is unacceptable that we are losing a life to overdose every five minutes around the clock,” the Office of National Drug Control Policy Director Rahul Gupta, M.D., M.P.H., M.B.A., FACP, said in a White House statement. “That is why President Biden’s new National Drug Control Strategy signals a new era of drug policy centered on individuals and communities, focusing specifically on the actions we must take right now to reduce overdoses and save lives.” Separately this week, the United States Drug Enforcement Administration (DEA) recognized the first Fentanyl Awareness Day on Monday, May 9. The DEA reports that the synthetic opioid fentanyl is about 50 times more potent than heroin and 100 times more potent than morphine. It is also inexpensive, widely available, and highly addictive. DEA Administrator Anne Milgram released a video announcement about the dangers of fentanyl and the need for urgent action.

HRSA Extends Deadline to Submit for Extenuating Circumstances Request to May 18

HHS’ Health Resources and Services Administration (HRSA) this week announced it has extended the deadline for providers to request to submit a late Provider Relief Fund (PRF) Reporting Period 2 (RP2) report to Wednesday, May 18 at 11:59 p.m. ET. According to HRSA, providers may submit a request if certain extenuating circumstances prevented them from submitting their RP2 report by the initial deadline of March31. All requests must be completed through the PRF Reporting Portal.

Center for Connected Health Policy Releases Bi-Annual Summary of State Telehealth Policy Changes

The Center for Connected Health Policy (CCHP) this week released a summary of state telehealth policy changes for Spring 2022. Covering state telehealth policy updates between January and April 2022, the 11-page summary examines state laws and reimbursement policies, private payors, online prescribing, and more. The resource also includes a state summary chart and an infographic of CCHP’s essential findings.

NABH Working to Enhance Denial-of-Care Portal

NABH’s Denial-of-Care Portal is temporarily unavailable as the association works to enhance features of this member-only resource. The portal was developed so NABH members could submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation and is intended to help the association in its advocacy efforts with policymakers and regulators. NABH will keep members apprised of when the updated portal is ready to use.

NABH 2022 Annual Meeting Preliminary Program Now Available!

The NABH 2022 Annual Meeting online preliminary program is now available. Unless noted otherwise, meeting sessions are open to all Annual Meeting attendees. Please remember to register for the Annual Meeting and reserve your hotel room today, if you haven’t done so yet. We look forward to seeing you next month in Washington!

Fact of the Week

Adolescent female youth who attempted suicide had an elevated risk of substance use disorders up to three decades later, according to a new study in JAMA Psychiatry. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 192

Written by Emily Wilkins (NABH) on May 6, 2022. Posted in CEO Updates.

ASPE Report Studies Pandemic’s Effects on Hospital and Clinician Workforce

A comprehensive report from HHS’ Assistant Secretary for Planning and Evaluation (ASPE) examines the Covid-19 pandemic’s effects on the nation’s healthcare workforce and offers several recommendations, including removing barriers to practicing to the top of one’s license/certification, retaining Covid-19 flexibilities as appropriate, funding for scholarships, and more. The nearly 30-page report, Impact of the COVID-19 Pandemic on the Hospital and Outpatient Clinician Workforce, found that total employment in the healthcare industry declined during the early months of the pandemic but gradually recovered during the summer of 2020. Many hospitals reported critical staffing shortages during the course of the pandemic—especially when Covid case numbers were high—and during the recent Omicron surge in January and February 2022, the seven-day average of hospitals reporting critical staffing shortages peaked at 22% during mid-January 2022, the report noted. The report acknowledged that several provider types, including behavioral health providers, experienced staffing shortages before the pandemic began. “Even after the pandemic, many of the effects the pandemic has had on the health care workforce will likely persist,” the report noted. “Addressing these impacts as well as the underlying challenges that pre-dated the pandemic can help build a stronger and more resilient health care system for the future.”

Joint Commission’s Covid-19 Staff Vaccination Standard Takes Effect July 1

The Joint Commission said it has approved its new Infection Prevention and Control standard and its elements of performance as a response to the interim final rule from the Centers for Medicare & Medicaid Services (CMS) late last year. According to the Joint Commission, the accrediting organization began surveying to the Omnibus Covid-19 Health Care Staff Vaccination interim final rule—which was released on Nov. 5, 2021—on Jan. 27 this year. “While changes to Joint Commission standards requirements were under review by CMS, findings related to the COVID-19 staff vaccination regulatory requirements have been scored at Leadership (LD) Standard LD.04.01.01, EP 2, along with the applicable Medicare Conditions of Participation/Conditions for Coverage for each of the deemed programs,” the Joint Commission said in an announcement. “This scoring process will continue until June 30, 2022. Click here to learn more.

SAMHSA Senior Medical Advisor John Palmieri, M.D., M.H.A. to Address Attendees at Annual Meeting

NABH will welcome John Palmieri, M.D., M.H.A., senior medical advisor at the Substance Abuse and Mental Health Services Administration (SAMHSA) and acting director for the 988 behavioral health crisis hotline and Behavioral Health Crisis Coordinating Office, at the 2022 Annual Meeting in Washington on Tuesday, June 14. Prior to his arrival at SAMHSA, Dr. Palmieri was the division chief for behavioral healthcare at the Arlington County (Virginia) Department of Human Services. Dr. Palmieri is a licensed physician in Virginia and is board certified in adult psychiatry. He graduated from Brown University Medical School and completed his adult psychiatry residency at Massachusetts General Hospital. Please click here to learn about our 2022 Annual Meeting speakers.

National Prevention Week is May 8-14

SAMHSA’s National Prevention Week starts Sunday, May 8, and the agency will commemorate the 18^thannual National Prevention Day on Monday, May 9. Click here for an agenda of the day’s events. The week-long commemoration is part of Mental Health Awareness Month, which kicked off on Sunday, May 1. The White House issued a proclamation honoring Mental Health Awareness Month, and Mental Health America (MHA)—which established the monthly observance in 1949—is recognizing the 2022 observance with the theme “Back to Basics.” The campaign is intended to provide what MHA has referred to as “foundational knowledge” about mental health, mental health conditions, and information about what people can do if their mental health is cause for concern. Please remember to follow NABH on Twitter @NABHbehavioral and on LinkedIn at the National Association for Behavioral Healthcare throughout the month to learn what NABH members, federal agencies, and advocacy organizations are doing to promote Mental Health Month.

NABH Working to Enhance Denial-of-Care Portal

Please Visit the NABH 2022 Annual Meeting Exhibitors & Sponsors Page!

NABH appreciates the generous support from its exhibitors and sponsors each year at the association’s Annual Meeting. To learn who is exhibiting and sponsoring NABH in 2022, please visit the Exhibitors & Sponsors page on our Annual Meeting homepage. The page also includes general information, tips for exhibitors, and details about shipping materials to the Mandarin Oriental Washington, DC. And please remember to register for the Annual Meeting and reserve your hotel room today, if you haven’t done so yet. We look forward to seeing you next month in Washington!

Fact of the Week

Audio-only visits were the leading telehealth modality for primary care and behavioral health throughout the full pandemic study period of February 2019 through August 2021, according to a new research report from RAND. At the end of the study period, however, audio-only visits were eclipsed by in-person visits for primary care, but not for behavioral health, the study showed. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 191

Written by Emily Wilkins (NABH) on April 29, 2022. Posted in CEO Updates.

CMS Behavioral Health Strategy Aims to Strengthen Equity, Improve Quality, and Provide Outreach to Beneficiaries

The Centers for Medicare & Medicaid Services (CMS) recently released The CMS Behavioral Health Strategy, a five-goal plan that aims to remove barriers to care and services and also adopt a data-informed approach to evaluate the agency’s behavioral health programs and policies. Noting that the strategy “will strive to support a person’s whole emotional and mental well-being and promotes person-centered behavioral healthcare,” CMS set the following five goals: 1) strengthen equity and quality in behavioral healthcare, 2) improve access to substance use disorders treatment, prevention, and recovery services, 3) ensure effective pain treatment and management, 4) improve access and quality of mental healthcare and services, and 5) utilize data for effective actions and impact on behavioral health. Click here to learn about the objectives in each of those goals.

SAMHSA Announces New Director of the Center for Substance Abuse Treatment

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week named Yngvild Olsen, M.D., M.P.H. as the new director of the agency’s Center for Substance Abuse Treatment. An addiction medicine specialist and general internist, Olsen began her career as the medical director for the outpatient substance use treatment services while serving as a full-time assistant professor in the department of medicine at the Johns Hopkins School of Medicine. From 2011 to 2021, Olsen served as medical director for the Institutes for Behavior Resources/REACH Health Services, a comprehensive outpatient substance use disorder treatment program in Baltimore City.

ONDCP Director Rahul Gupta to Address Attendees at NABH Annual Meeting

NABH is pleased to announce that Director of National Drug Control Policy Rahul Gupta, M.D., M.P.H., M.B.A., FACP will address attendees at the 2022 Annual Meeting on Tuesday, June 14. Dr. Gupta is the first medical doctor to serve as director and lead the Office of National Drug Control Policy (ONDCP), a component of the Executive Office of the President. ONDCP coordinates the nation’s $40 billion drug budget and federal policies, including prevention, harm reduction, treatment, recovery support, and supply reduction. Through his work as a physician, a state and local leader, an educator, and a senior leader of a national nonprofit organization, Dr. Gupta has dedicated his career to improving public health and public safety. He is also a buprenorphine-waivered practitioner, who has provided medication-assisted treatment for people with opioid use disorder. The son of an Indian diplomat, Dr. Gupta was born in India and grew up in the suburbs of Washington, D.C. At age 21, he completed medical school at the University of Delhi and later completed subspecialty training in pulmonary medicine. Dr. Gupta earned a master’s degree in public health from the University of Alabama-Birmingham and a global master’s of business administration degree from the London School of Business and Finance. If you have not done so yet, please visit our Annual Meeting homepage and register today. We look forward to seeing you in Washington!

In Case You Missed It: Kennedy Forum Parity Webinar Recording Now Available

NABH President and CEO Shawn Coughlin participated in a webinar about mental health and substance use disorder treatment parity on Tuesday, April 26 with federal health officials and healthcare organization leaders. Coughlin joined fellow presenters HHS Secretary Xavier Becerra, Assistant Secretary for Mental Health and Substance Use Miriam Delphin-Rittmon, Ph.D., The Kennedy Forum founder and former U.S. Rep. Patrick J. Kennedy (D-R.I.), and American Medical Association President Patrice Harris, M.D. to discuss the Biden administration’s commitment to ensuring parity implementation, the recent Wit v. United Behavioral Health ruling, and ongoing problems with parity compliance. David Lloyd, senior policy advisor at The Kennedy Forum, moderated the event. During the webinar, Delphin-Rittmon, who serves as administrator of SAMHSA, discussed three parity resources that SAMHSA has developed to help patient families, providers, and policymakers understand parity: Know Your Rights, Understanding Parity: A Guide to Resources for Families and Caretakers, and The Essential Aspects of Parity: A Training Tool for Policymakers. NABH was the lead sponsor for this webinar and live Tweeted during the event. Click here to watch the recorded broadcast.

BPC to Host Webinar Monday on Combating the Opioid Crisis with Smarter Federal Spending

The Bipartisan Policy Center (BPC) will host a webinar on Monday, May 2 about new recommendations centered on enhancing federal spending and improving the federal response to America’s ongoing opioid crisis. Participants include Office of National Drug Control Policy Director Rahul Gupta, M.D., M.P.H., M.B.A., FACP; Sen. Joe Manchin (D-W.Va.); American Medical Association President Patrice Harris, M.D.; former U.S. Surgeon General Jerome Adams, M.D.; and former HHS Secretary Donna Shalala. The hour-long webinar will begin at 1 p.m. ET. Click here to register.

Mental Health Awareness Month Starts Sunday!

Mental Health Month kicks off this Sunday, May 1 to raise awareness about mental health in America. Mental Health America (MHA), which established the monthly observance in 1949, will commemorate Mental Health 2022 with the theme “Back to Basics” to provide what MHA has referred to as “foundational knowledge” about mental health, mental health conditions, and information about what people can do if their mental health is cause for concern. SAMHSA’s National Prevention Week is May 8-14 and the agency will commemorate the 18^thannual National Prevention Day on Monday, May 9. Click here for an agenda of the day’s events. And please remember to follow NABH on Twitter @NABHbehavioral and on LinkedIn at the National Association for Behavioral Healthcare throughout the month to learn what NABH members, federal agencies, and advocacy organizations are doing to promote Mental Health Month.

NABH Working to Enhance Denial-of-Care Portal

Fact of the Week

Mental health, developmental disorders, and substance use disorders collectively accounted for 48% of all telehealth claims, according to a new report from FAIR Health, a national, not-for-profit organization that produces data products and consumer resources about transparency in healthcare costs and health insurance. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 190

Written by Emily Wilkins (NABH) on April 22, 2022. Posted in CEO Updates.

President Biden Sends National Drug Control Policy to Congress

President Biden on Thursday sent his administration’s inaugural National Drug Control Policy to Congress with the goal of using a whole-of-government approach to combat the nation’s overdose crisis. The comprehensive strategy focuses on the main drivers of the crisis—untreated addiction and drug trafficking—as it directs federal agencies to take actions that will expand access to evidence-based prevention, harm reduction, treatment, and recovery services, while also reducing the supply of drugs. The plan comes as the nation continues to produce grim statistics: for the first time in America’s history, the country has passed the milestone of 100,000 deaths resulting from drug overdoses in a 12-month period. Meanwhile, since 1999, drug overdoses have killed approximately 1 million Americans. A message from President Bident to Congress at the beginning of the strategy explains the Office of National Drug Control Policy led the effort to produce the strategy in close collaboration with the 18 national drug control agencies. In addition, the Biden administration involved more than 2,000 leaders and stakeholders, including Congress, all 50 Governors, and advocates representing public safety, public health, community groups, local governments, and Tribal communities. An important component of the strategy is its emphasis on harm reduction, an approach that works with people who use drugs to prevent overdose and infectious disease transmission; improve the physical, mental, and social wellbeing of those served; and offer flexible options for accessing substance use disorder treatment and other health care services. “We are changing how we help people when it comes to drug use, by meeting them where they are with high-impact harm reduction services and removing barriers to effective treatment for addiction,” Rahul Gupta, M.D., M.P.H., M.B.A., director of National Drug Control Policy, said in the document, “while addressing the underlying factors that lead to substance use disorder head on.”

The Kennedy Forum to Host Parity Webinar on Tuesday, April 26

NABH President and CEO Shawn Coughlin will join HHS Secretary Xavier Becerra and other healthcare leaders in a webinar about expanding access to mental health and addiction treatment coverage on Tuesday, April 26. The webinar will also feature Assistant Secretary for Mental Health and Substance Use Miriam Delphin-Rittmon, Ph.D., former U.S. Rep. Patrick J. Kennedy, and American Medical Association President Patrice Harris, M.D. Click here to learn more and register for the hourlong webinar, which will start at 2 p.m. ET.

NABH Sends Comments to CMS About Access to Coverage in Medicaid & CHIP

NABH this week responded to a request for information from the Centers for Medicare & Medicaid Services (CMS) regarding access to coverage for Medicaid and the Children’s Health Insurance Program (CHIP). In the letter, NABH emphasized that inadequate access to acute care has led to a strong reliance on hospital emergency rooms to treat people with serious mental illness, even though these settings are not well-suited to address those particular patient needs. NABH also emphasized how the Covid-19 pandemic has heightened the already-increased need for mental health and addiction services. NABH outlined a series of recommendations, including strengthening network adequacy for the full continuum of mental health and addiction treatment; requiring Medicaid programs and plans to implement parity compliance documentation requirements in Medicaid and CHIP; improving Medicaid reimbursement for mental health and addiction treatment providers; and more.

CMS Opens Federal Independent Dispute Resolution Process for Providers

CMS late last week opened the Federal Independent Dispute Resolution (IDR) process for healthcare providers, facilities, health plans, and issuers to resolve payment disputes for certain out-of-network charges. According to CMS, an initiating party will need the following in order to start a dispute: information to identify the qualified IDR items or services; dates and location of items or services; type of items or services such as emergency services and post-stabilization services; codes for corresponding service and place-of-service; attestation that items or services are within the scope of the Federal IDR process; and the initiating party’s preferred certified IDR entity. A list of certified entities is available here. After the 30-business-day open negotiation period ends, initiating parties will have four business days to initiate a dispute via the portal.

BJA Accepting Applications for Variety of Behavioral Health-Related Grant Opportunities

The U.S. Justice Department’s Bureau of Justice Assistance (BJA) is accepting applications for a range of grant programs—eligible to both for-profit and not-for-profit organizations— that seek to improve outcomes for people with mental health and substance use disorders. BJA’s Residential Substance Abuse Treatment (RSAT) for State Prisoners Training and Technical Assistance Program offers funding to provide training and technical assistance (TTA) to grantees and practitioners to improve correctional substance use disorder treatment programming and post-release outcomes for individuals who are incarcerated. Of the four grant opportunities noted in this news item, this grant is the only one for which for-profit organizations other than small businesses are eligible. The Connect and Protect: Law Enforcement Behavioral Health Response Program is seeking applications for funding to support law enforcement-behavioral health cross-system collaboration to improve public health and safety responses and outcomes for people with mental health and substance use disorders. BJA is also accepting applications for its Improving Substance Use Disorder Treatment and Recovery Outcomes for Adults in Reentry for funding to establish, expand, and improve treatment and recovery support services for people with substance use disorders during their incarceration and upon reentry into the community. And the department is accepting applications for its Justice and Mental Health Collaboration Program to support cross-system collaboration to improve public safety responses and outcomes for individuals with mental health disorders or co-occurring mental health and substance use disorders who come into contact with the justice system. Please click on the hyperlinks above for more information and grant deadlines. Political Analyst Amy Walter to Address Attendees at 2022 Annual Meeting Luncheon NABH is pleased to welcome on-air political analyst Amy Walter as the association’s Annual Meeting Luncheon keynote speaker in Washington on Tuesday, June 14. For more than 20 years, Amy Walter has built a reputation as an accurate, objective, and insightful political analyst with unparalleled access to campaign insiders and decision-makers. Known as one of the best political journalists covering Washington, she is the publisher and editor-in-chief of the non-partisan Cook Political Report with Amy Walter, where she provides analysis of the issues, trends, and events that shape the political environment. As a contributor to the PBS NewsHour, Ms. Walter provides weekly political analysis for the popular “Politics Monday” segment. She is also a regular Sunday panelist on NBC’s Meet the Press and CNN’s Inside Politics and appears frequently on Special Report with Bret Baier on Fox News Channel. Please plan to join us for this year’s Annual Meeting luncheon. And if you haven’t done so yet, please remember to register for the meeting and reserve your hotel room today. We look forward to seeing you in Washington! Fact of the Week People with schizophrenia made up a lower proportion of telehealth encounters relative to in-person visits (1.7% versus 2.7%), while those with anxiety and fear-related disorders accounted for a higher proportion (27.5% versus 25.5%), according to a new study published in the April edition of Health Affairs. Researchers concluded the findings highlight the importance of broadening access to services through new modalities without supplanting necessary in-person care for certain groups. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 189

Written by Emily Wilkins (NABH) on April 15, 2022. Posted in CEO Updates.

U.S. Preventive Services Task Force Issues Draft Recommendations on Screening for Anxiety, Depression, and Suicide Risk in Children and Adolescents

In a set of draft recommendations this week, the U.S. Preventive Services Task Force (USPTF) recommended screening children 12 and older for depression and children 8 and older for anxiety. “There is not enough evidence to recommend for or against screening for anxiety and depression in younger children and screening for suicide risk in all youth,” the USPTF announced in a bulletin on April 12. Both the American Academy of Pediatrics (AAP) and the American Foundation for Suicide Prevention (AFSP) expressed serious concerns about the panel’s conclusion that there is insufficient evidence to weigh the benefits and harms of screening asymptomatic children and adolescents for suicide risk. The AAP is urging clinicians to screen all adolescents for suicide risk despite the panel’s finding that more research is needed. “Youth may keep suicidal thoughts to themselves and will not bring up the topic unless directly asked,” May Lau, M.D., M.P.H., a member of the AAP Section on Adolescent Health Executive Committee and a lead author of the Blueprint for Youth Suicide Prevention from AAP/AFSP, said in an article in AAP News. “By screening all youth for suicide, we can identify those that are at risk and connect them with the services they need.” Meanwhile, Christine Moutier, M.D., chief medical officer at the AFSP, told the Associated Press this week that the report “may actually set the field back.” “We have grave concerns that the recommendation citing ‘insufficient evidence’ to implement routine screening for suicide risk for any age youth is 1) flawed due to the incomplete data sources included in their review, and 2) may confuse the field just as major steps are being taken,” Moutier wrote in an e-mail message to NABH. Moutier added that the Blueprint for Youth Suicide Prevention recommends screening for youth ages 12 and older and outlines evidence-based care steps to take for youth who screen positive. A public comment period for the USPTF’s draft recommendations is open until May 9. Click here for details.

HRSA Announces More Than $1.75 Billion in Provider Relief Fund Phase 4 Distribution Payments

HHS’ Health Resources and Services Administration (HRSA) said it is making available more than $1.75 billion in Provider Relief Fund (PRF) Phase 4 General Distribution payments to more than 3,680 providers nationwide this week. According to HRSA, on April 13 providers received an email notification if their application was among those processed in this latest round, and the agency is working to process all remaining applications as quickly as possible. Also this week, HHS Secretary Xavier Becerra extended the PHE for an additional 90 days after the current PHE expires on April 16.

HRSA Announces it Will Offer ‘Extenuating Circumstances’ Option to Providers for PRF Reporting Period 2

HRSA this week said healthcare providers will have the opportunity to submit a “Request to Report Late Due to Extenuating Circumstances for Reporting Period 2” if applicable. Last week, HRSA announced the “extenuating circumstances” option for Reporting Period 1, which lasts from April 11 through April 22. The agency said providers will receive a notification regarding the process to submit a request for Reporting Period 2 in the coming weeks. For more information, visit the Request to Report Late Due to Extenuating Circumstances webpage, or call the Provider Support Line at (866) 569-352 from 9 a.m. to 11 p.m. CT, Monday through Friday.

The Kennedy Forum to Host Parity Webinar Featuring Leaders from HHS, SAMHSA, NABH, & AMA

NABH President and CEO Shawn Coughlin will join HHS Secretary Xavier Becerra and other healthcare leaders in a webinar about expanding access to mental health and addiction treatment coverage later this month. The webinar on Tuesday, April 26 will also feature Assistant Secretary for Mental Health and Substance Use Miriam Delphin-Rittmon, Ph.D., former U.S. Rep. Patrick J. Kennedy, and American Medical Association President Patrice Harris, M.D. Click here to learn more and register for the hour-long webinar, which will start at 2 p.m. ET.

AHA & IAHSS Release Toolkit to Help Mitigate Violence in Healthcare Settings

The American Hospital Association (AHA) and the International Association for Healthcare Security and Safety (IAHSS) have developed a toolkit for hospitals and health systems to establish procedures to prevent violence at all levels. Creating Safer Workplaces is an 11-page resource that provides a framework to build a safer workplace environment; outlines what leaders should consider to promote physical safety and teamwork; highlights how leaders can mitigate risk; describes the role of hospitals in violence intervention; and more.

NPR Story Reports Most State Medicaid Programs Won’t Text Enrollees Despite Urgency to Renew Coverage

A National Public Radio (NPR) story this week cited a recent Kaiser Family Foundation report that found just 11 states said they would use text messaging to alert Medicaid recipients about the end of the Covid public health emergency, while 33 states will use the U.S. Postal Service and at least 20 will rely on individual or automated phone calls. “It’s frustrating that texting is a means to meet people where they are and that this has not been picked up more by states,” Jennifer Wagner, director of Medicaid eligibility and enrollment for research group the Center on Budget and Policy Priorities, said in the story. NPR also noted that officials at the Centers for Medicare & Medicaid Services (CMS) have told states they should consider texting—along with other methods of communication—when trying to contact enrollees about the end of the public health emergency (PHE), but many states don’t have the technology or information about enrollees to do so.

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal. Deadline for 2022 NABH Exhibitor & Sponsor Guide Ads is Next Week The deadline to submit an ad in NABH’s 2022 Exhibitor and Sponsor Guide is Tuesday, April 19. Be sure your organization is included in this year’s edition! Please click here for details about advertising options, requirements, payment, and more. We hope to see you in Washington in June!

Fact of the Week

A recent National Institute of Mental Health-funded study showed that Stepped Care Trauma-Focused (TF) Cognitive Behavioral Therapy (CBT)—in which step one is a parent-led therapist-assisted treatment and step two provides therapist-led TF-CBT for children who did not benefit from step one and require more intensive treatment—can reduce costs by nearly 54%. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 188

Written by Emily Wilkins (NABH) on April 8, 2022. Posted in CEO Updates.

HRSA Announces ‘Extenuating Circumstances’ Option for Provider Relief Fund Reporting

HHS’ Health Resources and Services Administration (HRSA) this week said it will allow healthcare providers to submit a Request to Report Late Due to Extenuating Circumstances for the Provider Relief Fund (PRF) Reporting Period 1 if one or more certain extenuating circumstances apply to their situations. Starting Monday, April 11 and continuing through Friday, April 22 at 11:59 p.m. ET, providers who did not submit their PRF Period 1 report by the required deadline may request to submit a late Reporting Period 1 report, via a DocuSign form, if the following extenuating circumstances exist:

Severe illness or death: if a severe medical condition or death of a provider or key staff member responsible for reporting hindered the organization’s ability to complete the report during the reporting period

Impacted by natural disaster: if a natural disaster occurred during or in proximity to the end of the reporting period and damaged the organization’s records or information technology

Lack of receipt of reporting communications: if an incorrect email or mailing address on file with HRSA prevented the organization from receiving instructions prior to the reporting period deadline

Failure to click “submit”: if the organization registered and prepared a report in the PRF Reporting Portal, but failed to take the final step to click “submit” prior to deadline

Internal miscommunication or error: if an internal miscommunication or error regarding the individual who was authorized and expected to submit the report on behalf of the organization and/or the registered point of contact in the PRF Reporting Portal

Incomplete Targeted Distribution payments: if the organization’s parent entity completed all General Distribution payments, but a Targeted Distribution(s) was not reported on by the subsidiary

According to HRSA, requests to report late due to extenuating circumstances must indicate and attest to a clear and concise explanation, although the agency will not require supporting documents. If HRSA approves an organization’s request, the organization will receive a notification to proceed with completing the Reporting Period 1 report. Providers will have 10 days from the date they receive the notification to submit a report in the PRF Reporting Portal. Click here to learn more about reporting requirements, or call the Provider Support Line at (866) 569-3522 between 9 a.m. to 11 p.m. ET for additional information.

CMS Releases Two Sets of FAQ About ‘No Surprises Act’ Requirements

The Centers for Medicare & Medicaid Services (CMS) this week released two sets of frequently asked questions (FAQ) regarding requirements enacted in the No Surprises Act. CMS issued an FAQ on April 6 that provides additional explanation about the law’s requirements and prohibitions, as well as clarification regarding the independent dispute resolution process and associated fees. A day earlier, CMS released an FAQ with additional information about developing good-faith estimates for uninsured or self-pay patients.

Thorn Run Partners Memo Highlights Medicare & Medicaid Flexibilities During the PHE

Thorn Run Partners, a bipartisan lobbying firm that works with NABH, recently highlighted a host of flexibilities in the Medicare and Medicaid programs during the ongoing Covid-19 public health emergency (PHE). The 14-page memo includes information about recent guidance from CMS, PHE extensions, PHE-related policies in the $1.5 trillion omnibus spending package that President Biden recently signed into law, and more. Click here to read the memo.

NABH Supports ‘Behavioral Health Information Technology Now Act’

NABH is pleased to support the Behavioral Health Information Technology Now Act, a new bill that would offer financial incentives to behavioral healthcare providers for health information technology adoption. Reps. Doris Matsui (D-Calif.) and Markwayne Mullin (R-Okla.) introduced the bill in an effort to coordinate care between physical and mental healthcare—and also include behavioral healthcare providers from a key resource that they have been excluded from for years. “The National Association for Behavioral Healthcare applauds Reps. Matsui and Mullin for recognizing that for far too long, behavioral healthcare providers have not received health information technology funding that other providers have benefited from,” NABH President and CEO Shawn Coughlin said in a news release about the legislation on April 6. “Their legislation would enable behavioral healthcare providers to coordinate care across behavioral healthcare service systems, primary care facilities, and specialty medicine providers more efficiently.” Specifically, the bill would:

Finance behavioral health information technology (IT) adoption at $250 million

Condition funding allocations to providers based on: 1) acquisition of health IT systems that comply with 2015 certification standards, and 2) attestation of provider compliance with Trump Administration Interoperability and Data Blocking regulations

Direct the Office of the National Coordinator for Health Information Technology and the Substance Abuse and Mental Health Services Administration to develop voluntary behavioral health IT standards.

Reminder: NABH Denial-of-Care Portal is Open to Members

Register Today for the 2022 Annual Meeting!

NABH will host its 2022 Annual Meeting—Shaping the Future of Behavioral Healthcare—from June 13-15 at the Mandarin Oriental Washington, DC. Please remember to register for the meeting and reserve your hotel room today!

Fact of the Week

Veterans who take medications for opioid use disorder (OUD) for at least 15 days have more than a 50% decreased risk of dying by suicide compared with those not taking OUD medications, according to a study in the April issue of the American Journal of Psychiatry. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 187

Written by Emily Wilkins (NABH) on April 1, 2022. Posted in CEO Updates.

CMS Proposes 2.7% Increase to Inpatient Psychiatric Facilities in 2023

The Centers for Medicare & Medicaid Services (CMS) on Thursday proposed increasing payment rates to the nation’s inpatient psychiatric facilities by 2.7% in fiscal year (FY) 2023, reflecting a 1.5% increase in payments, or about $50 million, relative to FY 2022. According to the agency’s inpatient psychiatric facility prospective payment system (IPF PPS) proposed rule for FY 2023, the IPF PPS federal, per-diem base rate would increase to $856.80 from $832.94 and the electroconvulsive therapy payment rate would increase to $368.87 per treatment from $358.60 per treatment. CMS said the increase is based on the proposed IPF market basket update of 3.1% less a 0.4% percentage point productivity adjustment. For FY 2023 and subsequent years, CMS has proposed to apply a 5% cap on decreases in the IPF PPS wage index in order to mitigate instability in IPF PPS payments due to significant wage index decreases that may affect providers in any given year. CMS did not propose any changes for the IPF Quality Reporting Program for FY 2023. Meanwhile, the agency is seeking comments via a request for information (RFI) about what CMS should consider when advancing the use of measurement and stratification as tools to address healthcare disparities and advance healthcare equity. Specifically, CMS would like comments related to goals and approaches for measuring disparities and using measure stratification across CMS Quality Reporting Programs; guiding principles for selecting and prioritizing measures for disparity reporting; principles for social risk factor and democratic data selection and use; identification of meaning performance differences; guiding principles for reporting disparity measures; and measures related to health equity. CMS is considering and requesting comment about applying the following measures of health equity in the Inpatient Psychiatric Facility Quality Reporting Program: Health Equity Summary Score (HESS) and a structural measure assessing the degree of hospital leadership engagement in health equity performance data. Both of these measures are under consideration for the Medicare Inpatient Quality Reporting Program. Please send any comments that your organization may have to Kirsten Beronio, NABH’s director of policy and regulatory affairs.

President Biden’s 2023 Budget Seeks to Transform U.S. Behavioral Healthcare Delivery

President Biden proposed new, mandatory investments totaling $51.7 billion over 10 years to enhance behavioral healthcare in America in the fiscal year (FY) 2023 budget proposal that he released on March 28. Among the budget blueprint’s most notable behavioral health provisions is the president’s request of $697 million for the Substance Abuse and Mental Health Services Administration (SAMHSA) to ensure that 100% of contacts are answered for the new 988 behavioral health crisis hotline that will begin to operate in July. This is an increase of $590 million from what was enacted for fiscal year 2022. Another significant provision is the president’s proposal for a new, $7.5 billion Mental Health System Transformation Fund through Medicaid to increase access to mental health services through workforce development and service expansion, including the development of non-traditional health delivery sites, the integration of quality mental health and substance use care into primary care settings, and the dissemination of evidence-based practices. NABH is pleased to see President Biden’s 2023 budget proposal calls for improving compliance with behavioral health parity standards by requiring plans and issuers to use medical necessity criteria for behavioral health services that are consistent with the criteria developed by not-for-profit medical specialty associations. The proposal would also place limits on the consideration of profit in determinations of medical necessity. The president’s budget would authorize the secretaries of the U.S. Health and Human Services, Labor, and Treasury Departments to regulate behavioral health network adequacy, and to issue regulations on a standard for parity in reimbursement rates based on the results of comparative analyses submitted by plans and issuers at a cost of $720 million over 10 years. To learn more, please read the NABH Analysis that the association sent to members earlier this week.

Senate Finance Committee Releases ‘Mental Health Care in the United States: The Case for Federal Action’

In a bipartisan report released this week, the Senate Finance Committee concluded that “overwhelmingly, access to affordable, reliable, and high-quality behavioral health care escapes Americans when they need it most” and offered some potential solutions to address the nation’s myriad behavioral healthcare challenges. The 36-page report is divided into eight chapters and examines behavioral health definitions, prevalence, and spending; workforce; children, adolescents, and young adults; access, integration, and coordination; mental health and substance use disorder (SUD) parity; telehealth; and next steps. “As Chairman of the Senate Finance Committee, I am partnering with Ranking Member Mike Crapo on a major bipartisan effort to bring behavioral health care to the forefront of the U.S. health system by leveraging the programs under this Committee’s jurisdiction, including Medicare, Medicaid, and the Children’s Health Insurance Program,” Senate Finance Committee Chairman Ron Wyden (D-Ore.) said in a letter at the start of the report. Wyden added that 10 members of this committee, including five Democrats and five Republicans, are working on policy areas that Wyden deemed “vital for a path forward.”

The Center of Excellence for Protected Health Information Video Offers Guidance about SUD Personnel and 42 CFR Part 2

The Center of Excellence for Protected Health Information (CoE-PHI) has released a video that offers guidance about when identified SUD personnel within a general medical facility must follow the federal privacy protections for SUD treatment known as 42 CFR Part 2. The Substance Abuse and Mental Health Services Administration funds CoE-PHI to help people and organizations understand and apply federal health privacy laws and regulations at work that are specific to certain tasks and roles. CoE-PHI also works to help patients and families understand their rights when seeking treatment for SUD and mental health.

MHA, American Psychological Association, and American Psychiatric Association to Host Webinar on Digital Therapeutics in Mental Health and SUD

Mental Health America, the American Psychological Association, and the American Psychiatric Association will host a webinar next Wednesday, April 6 that examines the role digital therapeutics have in addressing America’s mental health and SUD crises. Participants will learn from Meena Seshamani, M.D., Ph.D., director of the Center for Medicare at CMS; Bakul Patel, director of the Digital Health Center of Excellence at the U.S. Food and Drug Administration; and other experts in the field. The hourlong webinar will begin at 2 p.m. ET. Click here to register.

Reminder: NABH Denial-of-Care Portal is Open to Members

Register Today for the 2022 Annual Meeting!

Fact of the Week

Of the approximately 5.9 million adults living with severe bipolar disorder in the United States in 2020, about 51%, or 3 million adults, were untreated at any given time, the Treatment Advocacy Center reports. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 186

Written by Emily Wilkins (NABH) on March 25, 2022. Posted in CEO Updates.

Three-Judge Panel in 9th U.S. Circuit Court of Appeals Overturns Wit v. United Behavioral Health

In a blow to parity, a three-judge panel of the 9^th U.S. Circuit Court of Appeals this week overturned a trial court’s Wit v. United Behavioral Health (UBH) decision, asserting that UBH’s interpretation that health insurance plans do not require consistency with generally accepted standards of care (GASC) “was not unreasonable.” On Thursday, NABH sent its members an NABH Issue Brief that highlighted the following main points of the earlier decision from the trial court and the three-judge panel’s reversal of that decision in its seven-page ruling:

The original Witdecision determined that patients’ health and safety are protected when clinicians provide services consistent with GASC that are established by not-for-profit, professional associations, rather than insurance companies whose financial incentives often conflict with what is best for patients.

The three-judge panel said it is “not unreasonable” for health insurers’ coverage determinations to be inconsistent with GASC; however, the trial court’s decision, including two 100-page decisions, described how UBH made medical coverage decisions based on financial interests.

In its ruling, the appellate court’s three-judge panel did not cite one holding or one fact that the trial court concluded, despite the trial court’s exhaustive trial findings.

The trial court’s decision explained UBH’s misrepresentation to regulators that UBH used American Society of Addiction Medicine (ASAM) criteria when, in fact, the company modified and ultimately undercut the actual ASAM criteria.

The appellate court’s three-judge panel ruled that UBH is not obligated to cover treatment consistent with GASC if the treatment is not a covered benefit; however, the plaintiffs did not argue that UBH was obligated to cover all services consistent with GASC. Instead, the plaintiffs argued that if services—such as outpatient, intensive outpatient, and residential treatment—are covered benefits, UBH must make medical necessity determinations that are consistent with GASC.

This flawed ruling has the potential to worsen America’s mental health and addiction crises as the critical need for mental health and addiction treatment services continues to rise during the ongoing Covid-19 pandemic. NABH will continue to fight for true mental health addiction treatment parity and expanded access to care for all who need it.

DEA Expands Access to Medication-Assisted Treatment for People with SUD

The U.S. Drug Enforcement Administration (DEA) on Wednesday announced a new option intended to broaden access for medication-assisted treatment (MAT) for people suffering from substance use disorder (SUD). The new option applies to DEA-registered practitioners working in hospitals, clinics, or emergency rooms, and also for DEA-registered hospitals and clinics that allow practitioners to operate under their registration number. Under this new option, the DEA will grant requests for an exception to the one-day supply limitation in 21 CFR 1306.07(b) to allow for the dispensing of up to a three-day supply of narcotic drugs, including buprenorphine and methadone, “to a person for the purpose of relieving acute withdrawal symptoms when necessary while arrangements are being made for referral for treatment.” Adhering to The Further Continuing Appropriations Act of 2021 and Other Extensions Act, DEA will grant such exception requests while it works to amend 21 CFR 1306.07(b) that the law directs. As part of this effort to save lives in the opioid overdose crisis, the DEA also announced that it is working to make permanent its Covid-19 public health emergency temporary regulations that allow for the initiation of buprenorphine to treat opioid use disorder via telemedicine. Finally, the DEA said it is partnering with the U.S. Health and Human Services Department (HHS) to engage “in regular outreach with pharmacists and practitioners to express support for the use of medication-assisted treatment for those suffering from substance use disorder.”

Provider Relief Fund Reporting Period 2 Deadline is Next Week

The Health Resources and Services Administration’s (HRSA) Provider Relief Fund (PRF) reporting portal remains open for healthcare providers who need to report their use of PRF funds in Reporting Period 2 (RP2) by the deadline next Thursday, March 31. According to HRSA, providers who received one or more payments totaling greater than $10,000 in the aggregate during a Payment Received Period must use the funds by the deadline and report for each application reporting period. HRSA’s announcement also said that providers who received PRF payments exceeding $10,000 in the aggregate between July 1, 2020 and Dec. 2020 and who do not submit a report on use of the funds by 11:59 p.m. ET on March 31, 2022 will be required to return all funds. HRSA said it will not grant grace periods or extensions. Click here to read HRSA’s PRF Reporting Non-Compliance fact sheet.

BJA Announces Adult Drug Court Discretionary Grant Program Funding Opportunity

The U.S. Justice Department’s Bureau of Justice Assistance (BJA) is seeking applications to plan, implement, and enhance drug court services, including service coordination, management of drug court participants, and recovery support services. Adult drug courts integrated evidence-based SUD treatment, mandatory drug testing, incentives, and sanctions, and transitional services in judicially supervised criminal court setting that have jurisdiction over persons with SUD treatment needs to reduce recidivism, increase access to treatment and support, and prevent overdoses. City or township governments, county governments, federally recognized Native American tribal governments, special district governments, and state governments, and others are eligible to apply for this grant opportunity. The deadline to apply is Friday, May 20. Click here to learn more and apply.

Commonwealth Fund Podcast Examines Closing the Mental Healthcare Gap for Black Teens

In its podcast The Dose, the Commonwealth Fund this week featured Boston Children’s Hospital psychiatrist Kevin Simon, M.D., who discussed how providers can work with families to help address the mental healthcare gap for Black and brown teenagers in America. The Commonwealth Fund notes that in the current overwhelming demand for behavioral health services, the unmet need for Black and brown teenagers stands out. One reason is they are not getting the care they need due to a shortage of child and adolescent mental health providers—especially providers of color—in the United States. Worsening the problem are the racial stereotypes that exist in how school officials, healthcare providers, and others perceive Black and brown teens. Simon suggests that the country diversify the mental healthcare provider workforce to correct the problem in the long term. In the short term, he adds, providers can work with families and teachers to strengthen the system and start by demonstrating “cultural humility” and a genuine curiosity about the lived experiences of Black and brown youth.

Reminder: NABH Denial-of-Care Portal is Open to Members

Register Today for the 2022 Annual Meeting!

Fact of the Week

Only 20% of U.S. adults received mental health treatment since the start of the Covid-19 pandemic, but 80% of those agreed they benefited from this care, the America Psychological Association reports. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 186

Written by Emily Wilkins (NABH) on March 18, 2022. Posted in CEO Updates.

CEO Alliance for Mental Health Announces Rollout to Prepare for 988 Hotline Launch

The CEO Alliance for Mental Health this week announced the start of coordinated effort to help prepare state and municipal officials for the nationwide 988 behavioral crisis hotline that will launch on July 16. NABH is a member of the CEO Alliance, a collaborative of 15 of the nation’s leading mental health professional organizations, advocacy groups, and funders that will push for leaders to adopt A Consensus Approach and Recommendations for the Creation of a Comprehensive Crisis Response System, a roadmap that outlines seven “pillars” for transforming mental health and substance use care in the United State. These are: early identification and prevention; emergency and crisis response; equity and inclusion; integration and partnership; fair and equivalent coverage; standards for care; and workforce capacity. The Alliance released the roadmap last November. The Alliance’s outreach efforts leading to the 988 hotline launch this summer include a social media campaign intended to direct state and municipal elected officials, civic leaders, policymakers, and advocates to the roadmap. In his State of the Union address earlier this month, President Biden announced his administration’s mental health strategy, of which the 988 hotline is a critical component.

Provider Relief Fund Reporting Period 2 Deadline is March 31

The Health Resources and Services Administration’s (HRSA) Provider Relief Fund (PRF) reporting portal remains open for healthcare providers who need to report their use of PRF funds in Reporting Period 2 (RP2) by the deadline on Thursday, March 31. According to HRSA, providers who received one or more payments totaling greater than $10,000 in the aggregate during a Payment Received Period must use the funds by the deadline and report for each application reporting period. HRSA’s announcement also said that providers who received PRF payments exceeding $10,000 in the aggregate between July 1, 2020 and Dec. 2020 and who do not submit a report on use of the funds by 11:59 p.m. ET on March 31, 2022 will be required to return all funds. HRSA said it will not grant grace periods or extensions. Click here to read HRSA’s PRF Reporting Non-Compliance fact sheet.

SAMHSA Announces $25.6 Million in MAT Grant Programs

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week announced two grant programs totaling $25.6 million intended to expand access to medication-assisted treatment (MAT) for opioid use disorder and prevent the misuse of prescription drugs. One is the Strategic Prevention Framework for Prescription Drugs program, which provides funding for state agencies, territories, and tribal entities that have completed a Strategic Prevention Framework State Incentive Grant plan—or similar state plan—to target prescription drug misuse. This program is intended to raise awareness about the dangers of sharing medications, fake or counterfeit pills sold online, and over-prescribing. This grant will fund a total of $3 million over five years for up to six grantees. Applications for this grant are due by Monday, April 25. The other is the Medication-Assisted Treatment-Prescribing Drug and Opioid Addiction grant program, which provides resources to help expand and improve access to medications for opioid use disorder. This program is intended to increase the number of individuals with opioid use disorder receiving medications for opioid use disorder and decrease illicit opioid use and prescription drug opioid misuse. This grant will fund a total of $22.6 million over five years for up to 30 grantees. According to SAMHSA, no less than $11 million will be awarded to Native American tribes, tribal organizations, or consortia. Applications for this program are due by Friday, April 29. DOJ Announces ‘Second Chance Act Pay for Success Initiative’ The U.S. Justice Department’s Bureau of Justice Assistance (BJA) is seeking applications to fund state, local, and tribal governments to either enhance or implement performance-based programs that reduce recidivism and address substance use disorders (SUD) that affect people who have been incarcerated. Specifically, the funds will be used in contracts with reentry, permanent supportive housing, or recovery housing providers in this effort. The Pay for Success Initiative is a performance-based and outcomes-based program that ties payment for services to reaching agreed-upon goals. Click here for more information.

O’Neil Institute Releases ‘Maximizing the Impact of Opioid Litigation to Address the Overdose Crisis’

The O’Neill Institute for National and Global Health Law at Georgetown University Law Center this week released Maximizing the Impact of Opioid Litigation to Address the Overdose Crisis, a five-page issue brief that describes the themes discussed during the Opioid Litigation Summit held at Georgetown Law Center in September 2021. The resource emphasizes that opioid litigation settlement proceeds must be used to advance a public health response to the nation’s opioid crisis. It also explains how the country can learn from its own history in this regard. “The tobacco litigation settlements of the 1990s evince the need for a comprehensive strategy of oversight and accountability to distribute and manage opioid litigation proceeds,” the issue brief states. “Despite the intent of the settling states’ Attorneys General that funds be used primarily for tobacco-related health initiatives, the lack of specificity in the settlement agreements led to less than 10% of the $206 billion award funding tobacco-related public health strategies.” According to the brief, these five themes emerged from last year’s opioid litigation summit: intentional collaboration leads to actionable policy; community needs should be reflected when distributing proceeds; existing opioid-related funding should be supplemented, not supplanted; oversight should be sustained; and other sources of funding should be maximized and coordinated to create a comprehensive plan to address SUDs.

Senate HELP Committee to Host Mental Health Hearing Next Week

The Senate Health, Education, Labor & Pensions (HELP) Committee will examine how to improve federal mental health and SUD programs in a hearing next week. Senators will hear from Assistant Secretary for Mental Health and Substance Use Miriam Delphin-Rittmon, Ph.D.; Joshua Gordon, M.D., Ph.D., director of the National Institute of Mental Health; Carole Johnson, administrator at the Health Resources and Services Administration; and Nora Volkow, M.D., director of the National Institute on Drug Abuse. Delphin-Rittmon addressed attendees at the 2021 NABH Annual Meeting last October. The hearing, “Strengthening Federal Mental Health and Substance Use Disorder Programs: Opportunities, Challenges, and Emerging Issues,” will be held Wednesday, March 23 at 10 a.m. ET.

National Drug and Alcohol Facts Week Starts Monday

National Drug and Alcohol Facts Week is from March 21-27, and The National Institute on Drug Abuse (NIDA) invites organizations to participate in the national observance meant to empower teens and young adults about making informed decisions about drugs, alcohol, and addiction. NIDA has developed five steps to hosting a NDAFW event and created lesson plans and other materials for educators, counselors, and prevention specialists. Please click here to learn how to register your organization’s event online.

Reminder: NABH Denial-of-Care Portal is Open to Members

Register Today for the 2022 Annual Meeting!

Fact of the Week

Telehealth represented less than 1% of outpatient care before the Covid-19 pandemic for both mental health and substance use and other concerns. At its pandemic peak, telehealth represented 40% of mental health and substance use outpatient visits and 11% of other visits (during the March- August 2020 period), according to research from the Kaiser Family Foundation. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 185

Written by Emily Wilkins (NABH) on March 11, 2022. Posted in CEO Updates.

Provider Relief Fund Reporting Period 2 Deadline is March 31

The Health Resources and Services Administration’s (HRSA) Provider Relief Fund (PRF) reporting portal remains open for healthcare providers who need to report their use of PRF funds in Reporting Period 2 (RP2) by the deadline on Thursday, March 31. According to HRSA, providers who received one or more payments totaling greater than $10,000 in the aggregate during a Payment Received Period must use the funds by the deadline and report for each application reporting period. HRSA’s announcement also said that providers who received PRF payments exceeding $10,000 in the aggregate between July 1, 2020 and Dec. 2020 and who do not submit a report on use of the funds by 11:59 p.m. ET on March 31, 2022 will be required to return all funds. HRSA said it will not grant grace periods or extensions. Click here to read HRSA’s PRF Reporting Non-Compliance fact sheet.

NABH Submits Comments to CMS about Network Adequacy in Medicare Advantage

NABH this week submitted comments to the Centers for Medicare & Medicaid Services (CMS) regarding the agency’s proposed rule about technical changes to the Medicare Advantage (MA) and Medicare Prescription Drug Benefit programs for the contract year 2023. In a letter to CMS Administrator Chiquita Brooks-LaSure, NABH described how MA plans can increase the number of behavioral healthcare providers and facilities in their networks and improve access to mental health and addiction treatment. “Unfortunately, Medicare beneficiaries do not have adequate access to mental health and addiction treatment,” NABH’s noted. “According to a CMS Data Brief, ‘[b]eneficiaries with depression, regardless of age, were more likely to report having trouble getting healthcare, obtaining prescription medicines, and not seeing doctors than those without depression.’ In addition, Medicare ‘[b]eneficiaries with depression regardless of age, were more likely to report that they have no usual source of care due to high cost.’ These difficulties accessing behavioral healthcare undoubtedly result from MA plans disproportionately lacking in-network behavioral healthcare providers,” NABH’s letter continued. “A recent study found that MA networks included only 23% of psychiatrists in a county on average — lower than all other medical specialties. Not surprisingly, MA enrollees with depressive symptoms report more difficulty accessing needed treatment and rated their experience with the MA plans as worse than in traditional Medicare.” NABH also provided a series of recommendations, such as establishing specific network adequacy standards for the full continuum of mental health and addiction treatment and requiring those standards be met prior to approval for participation in Medicare; requiring MA plans to demonstrate reimbursement rates for behavioral healthcare providers are comparable with rates for other similar healthcare services; and requiring MA plans to comply with parity requirements and use generally accepted standards of care for utilization management.

OSHA Launches Program to Protect Healthcare Workers at Facilities that Treat Covid-19 Patients

The U.S. Labor Department’s Occupational Safety and Health Administration (OSHA) has launched an initiative to protect healthcare workers who work in hospitals and skilled nursing facilities that treat or handle patients with Covid-19. An announcement from OSHA said the goal is to expand its presence to ensure “continued mitigation to control the spread of Covid-19 and future variants of the SARS-CoV-2 virus” and to protect the health and safety of healthcare workers. OSHA also said it will initiate focused inspections to emphasize monitoring for current and future readiness to protect workers from Covid-19 and will conduct follow-up inspections at sites that previously received citations. “OSHA intends to expand its presence in targeted high-hazard healthcare facilities during a three-month period from March 9, 2022 to June 9, 2022,” the announcement said. “Through this focused enforcement initiative, the agency will verify and assess hospital and skilled nursing care employers’ compliance actions taken, including their readiness to address any ongoing or future Covid-19 surges.”

Congressional Addiction, Treatment, and Recovery Caucus to Host Webinar on Opioid Crisis Next Week

The Congressional Addiction, Treatment, and Recovery Caucus will host a webinar titled “The Changing Landscape & New Challenges of the Opioid Epidemic” next Thursday, March 17 at 3 p.m. ET. Presenters include award-winning actor Michael Keaton; Beau Kilmer, Ph.D., director of RAND’s Drug Policy Research Center; and Arnold Alier Martinez, Ed.D., NRP, director of the division of pre-hospital medicine research and overdose prevention at the South Carolina Department of Health and Environment Control. Click here to register.

The Joint Commission to Host Webinar About Behavioral Health and Human Services Accreditation on March 22

The Joint Commission will host a complimentary webinar about behavioral health and human services accreditation on Tuesday, March 22 from 10 am. – 12:30 p.m. ET. In a live executive training, the Joint Commission will address the process, cost, requirements, and resources for assistance and will also leave time for questions. The Joint Commission’s announcement also said attendees will leave with a free, 90-day trial of the Joint Commission’s requirements and a copy of the webinar’s slides. Click here to register.

Register for National Drug and Alcohol Facts Week: March 21-27, 2022

National Drug and Alcohol Facts Week is approaching, and The National Institute on Drug Abuse (NIDA) invites organizations to participate in the national observance meant to empower teens and young adults about making informed decisions about drugs, alcohol, and addiction. NIDA has developed five steps to hosting a NDAFW event and created lesson plans and other materials for educators, counselors, and prevention specialists. Please click here to learn how to register your organization’s event online.

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Advertise in the 2022 NABH Exhibitor and Sponsor Guide!

NABH will distribute the 2022 NABH Exhibitor and Sponsor Guide to all registrants at the Annual Meeting from June 13–15, 2022 at the Mandarin Oriental Washington, D.C. Be sure your organization is included in it! All ads are due by April 19, 2022. Please click here for details about advertising options, requirements, payment, and more. NABH will also post the 2022 NABH Exhibitor and Sponsor Guide on the association’s website after the Annual Meeting. If you haven’t done so yet, please register for the Annual Meeting and reserve your hotel room today!

Fact of the Week

Between April 2021 and October 2021, the highest rates of telehealth visits were among those with Medicaid (29.3%) and Medicare (27.4%), Black individuals (26.8%), and those earning less than $25,000 (26.7%), according to data from HHS’ Assistant Secretary for Planning and Evaluation. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 184

Written by Emily Wilkins (NABH) on March 4, 2022. Posted in CEO Updates.

HHS Secretary Becerra Launches National Tour to Strengthen Mental Health

U.S. Health and Human Services (HHS) Secretary Xavier Becerra on Thursday kicked off the National Tour to Strengthen Mental Health as a way to hear directly from Americans about their behavioral health challenges and engage with local officials to strengthen the mental health and crisis care systems in the United States. The move came two days after President Biden announced his administration’s strategy to address America’s mental health crisis during the president’s first State of the Union address. Part of a broader “unity agenda,” the strategy aims to strengthen system capacity, connect more Americans to care, and create healthy environments where the country’s health and social services infrastructure addresses mental health holistically and equitably. “The pandemic has not only taken a physical toll on all of us, but also brought on greater behavioral health challenges for everyone,” Becerra said in an announcement. “From small towns to big cities, I’ll be traveling nationwide with members of my leadership team to meet with people who have been hit particularly hard and partnering with local leaders to find ways to save lives in our communities.” In the coming months, Becerra will make announcements about new initiatives and resources from HHS, such as increasing the number of behavioral health professionals and community and behavioral health supporter workers in underserved and under-resourced communities, expanding pediatric mental healthcare access through telehealth services, and transitioning to the national 988 behavioral health crisis hotline that will begin operating in July.

New CDC Data Show U.S. Suicides Peaked in 2018

The Centers for Disease Control and Prevention (CDC) this week reported that after rising from 2000 to 2018, the age-adjusted suicide rate in the United States declined after peaking in 2018. Suicide dropped to the 10^th leading cause of death from the 12^th leading cause in 2020, “due to the emergence of Covid–19 deaths and increases in deaths from chronic liver disease and cirrhosis,” the CDC reported in Suicide Mortality in the United States, 2000-2020. The new findings also showed that suicide rates were three to four times higher for males compared with females from 2000 through 2020. And for females, firearm-related suicide recently replaced poisoning as the leading means of suicide.

CMS Publishes Report to Congress on Medicaid Managed Care Regulations

The Centers for Medicare & Medicaid Services (CMS) recently released a report to Congress that focuses on coverage of services received in Institutions for Mental Diseases (IMD) by managed care plans through states in lieu of services (ILOS) authority. Required by the 21^st Century Cures Act, the report found that the majority of states that cover inpatient behavioral health treatments through risk-based managed care use the IMD ILOS authority, and that states primary rationale for using this authority is to increase access to behavioral health services.

Joint Commission Issues Statement on Dr. Lorna Breen Health Care Provider Protection Act

The Joint Commission recently released a statement after Congress passed the Dr. Lorna Breen Health Care Provider Protection Act. Passed in February, the legislation seeks to reduce and prevent suicide, burnout, and mental and behavioral health conditions among healthcare professionals. Lorna Breen was a physician who served as emergency room director at New York Presbyterian Hospital and died by suicide in April 2020 while on a break visiting family in Virginia. “The Covid-19 pandemic has increased to a devastating degree with the amount of burnout and stress among physicians, nurses and other health care providers,” Ana Pujols McKee, M.D. said in the statement. Pujols McKee serves as The Joint Commission’s interim president and CEO, executive vice president, chief medical officer, and chief diversity, equity, and inclusion officer. “While we share in the deep sadness of Dr. Breen’s death from across the health care community, it is not without hope for positive change,” Pujols McKee continued. “It is critical that we increase awareness and provide resources to support our nation’s health care providers as they continue to work tirelessly into the third year of the pandemic.” The Joint Commission’s announcement said research has shown that clinicians fear seeking mental health treatment because of questions related to their mental health history. Click here to read a statement from The Joint Commission about removing barriers to mental health for clinicians and other providers; here to read a “Quick Safety” on promoting psychosocial well-being of healthcare staff during a crisis; and here to read the organization’s sentinel alert regarding the well-being of healthcare staff. The Dr. Lorna Breen Health Care Provider Protection Act is awaiting President Biden’s signature.

Register for National Drug and Alcohol Facts Week: March 21-27, 2022

The National Institute on Drug Abuse (NIDA) invites organizations to participate in National Drug and Alcohol Facts Week (NDAFW), a national health observance meant to empower teens and young adults about making informed decisions about drugs, alcohol, and addiction. NIDA has developed five steps to hosting a NDAFW event and created lesson plans and other materials for educators, counselors, and prevention specialists. Please click here to learn how to register your organization’s event online.

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Register Today for NABH’s 2022 Annual Meeting!

Please visit our Annual Meeting homepage to view the 2022 Annual Meeting At-A-Glance for preliminary meeting details, register for the meeting, and reserve a hotel room. We hope to see you in Washington from June 13-15!

Fact of the Week

For the first time, Black Americans are dying from drug overdoses at a higher rate than white Americans, according to a new study in JAMA. The report suggests that the high potency of the illicit drug supply may be disproportionately harming racial and ethnic minoritized communities. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 183

Written by Emily Wilkins (NABH) on February 25, 2022. Posted in CEO Updates.

HHS Pays More Than $560 Million to Providers in PRF Phase 4 Distribution This Week

HHS on Thursday announced that the department’s Health Resources and Services Administration (HRSA) is making more than $560 million in Provider Relief Fund (PRF) Phase 4 Distribution payments to more than 4,100 healthcare providers nationwide this week. With this latest announcement, nearly $11.5 billion in PRF Phase 4 payments have now been distributed to more than 78,000 providers in all 50 states, Washington, D.C., and five territories, according to HHS. This is in addition to HRSA’s distribution of American Rescue Plan Rural Payments totaling about $7.5 billion in funding to more than 44,000 providers since November 2021. Click here to view a state-by-state breakdown of all Phase 4 distributions to date and here for a state-by-state breakdown of all American Rescue Plan Rural Payments to date. For more information about the PRF, click here.

Federal Judge in Texas Blocks Part of HHS’ Surprise Billing Rule

A federal judge in Texas on Wednesday struck down part of the Biden administration’s interpretation of a part of the federal law banning surprise medical bills. Siding with the Texas Medical Association, Judge Jeremy Kernodle of the Eastern District of Texas struck down a narrow part of the surprising billing rule that outlines how to resolve payment disputes between payers and providers regarding out-of-network claims. The ruling maintains the protections for patients against receiving bills for thousands of dollars in situations such as going to a hospital emergency room and later learning one of the physicians was not covered by the patient’s insurance. Click here to read news coverage about the ruling.

Neuroscientist and Former NIMH Director Tom Insel’s Book ‘Healing’ Now Available

Healing: Our Path From Mental Illness To Mental Health, the new book by former National Institute of Mental Health (NIMH) Director Tom Insel, M.D., was released this week. Insel, a neuroscientist and psychiatrist who led the NIMH from 2002 to 2015, spoke with The New York Times about this new book, which highlights failures in our nation’s behavioral healthcare system, including ineffective delivery of care, gaps in community services, and a reliance on police and jails for crises services. Insel—who addressed attendees at NABH’s Annual Meeting last year—said in the interview that he hopes his new book will sound an alarm for the country. “I want to ring the bell to tell people that we can do so much better today,” Insel said in the interview, “and there is no excuse for allowing people with these brain disorders to languish on our streets like this and die at age 55, eating out of trash bins.” Register for National Drug and Alcohol Facts Week: March 21-27, 2022 The National Institute on Drug Abuse (NIDA) invites organizations to participate in National Drug and Alcohol Facts Week (NDAFW), a national health observance meant to empower teens and young adults about making informed decisions about drugs, alcohol, and addiction. NIDA has developed five steps to hosting a NDAFW event and created lesson plans and other materials for educators, counselors, and prevention specialists. Please click here to learn how to register your organization’s event online.

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Register Today for NABH’s 2022 Annual Meeting!

Fact of the Week

Between 1990 and 2019, the global number of disability-adjusted life-years (DALYS) due to mental disorders increased to 125.3 million from 80.8 million, according to a recent study in the journal The Lancet. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 182

Written by Emily Wilkins (NABH) on February 18, 2022. Posted in CEO Updates.

Biden Administration Announces RFI on Access to Care for Medicaid and CHIP Enrollees

The Biden administration this week announced a request for information (RFI) in its effort to develop a comprehensive access strategy to ensure equitable access to healthcare for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. According to the announcement, this strategy will require the Centers for Medicare & Medicaid Services (CMS) to use regulations, guidance, and other tools to apply a multi-faceted approach to reducing health disparities. The agency is seeking feedback on topics such as enrolling in and maintaining coverage, accessing healthcare services and supports, and ensuring adequate provider payment rates. “With this RFI, we are taking a first step towards a broader perspective of what ‘access’ to Medicaid means,” Daniel Tsai, director of the Center for Medicaid and CHIP Services, said in an announcement. “Ensuring access to Medicaid includes addressing a range of barriers current and potential Medicaid beneficiaries may experience, from enrolling in Medicaid to maintaining coverage, to accessing care across both fee-for-service and managed care delivery systems,” Tsai continued. “Access must also cross physical healthcare, behavioral health, and home and community-based services.” Click here to learn more about the process and how to provide information to CMS. The 60-day comment period opened Feb. 17.

White House Issues Proclamation for National Eating Disorders Awareness Week: Feb. 21-25

President Biden on Friday issued a proclamation that announced National Eating Disorders Awareness Week next week to build awareness around this serious behavioral health issue that has increased in recent years. According to the announcement, nearly 1 in 10 Americans are expected to develop an eating disorder in their lifetime. Eating disorders include binge-eating, bulimia nervosa, and anorexia nervosa and can have serious or fatal consequences if left untreated. Please remember to follow NABH on Twitter @NABHbehavioral and on Linkedin for social media posts during National Eating Disorders Awareness Week.

ASAM Releases ASAM Criteria® Interview Guide

This week the American Society of Addiction Medicine (ASAM) and the University of California, Los Angeles Integrated Substance Abuse Programs (UCLA ISAP) released a paper-based resource to support more consistent and effective implementation of The ASAM Criteria, a national framework for patient-centered, evidence-based addiction care. The ASAM Criteria Assessment Interview Guide is the first publicly available, standardized version of The ASAM Criteria assessment. An announcement about the new resource said both ASAM and UCLA hope to increase both the quality and consistency of patient assessments and treatment recommendations. Center for Rural Opioid Prevention, Treatment & Recovery to Host Contingency Management Webinar on March 2 The Center for Rural Opioid Prevention, Treatment & Recovery will host Introduction to Contingency Management—a webinar that highlights the intervention in which tangible incentives are provided in exchange for evidence of drug or alcohol abstinence—on Wednesday, March 2 at 4 p.m. ET. Led by Michael McDonnell, Ph.D. and Sara Parent, ND, both of Washington State University, the webinar will be available on Zoom and will educate participants on how to describe contingency management; summarize evidence supporting contingency management as an intervention for stimulant use disorders; review guidelines for implementing contingency management; and formulate strategies for overcoming barriers to contingency management implementation. Click here to register.

Register for National Drug and Alcohol Facts Week: March 21-27, 2022

The National Institute on Drug Abuse (NIDA) invites organizations to participate in National Drug and Alcohol Facts Week (NDAFW), a national health observance meant to empower teens and young adults about making informed decisions about drugs, alcohol, and addiction. NIDA has developed five steps to hosting an NDAFW event and created lesson plans and other materials for educators, counselors, and prevention specialists. Please click here to learn how to register your organization’s event online.

Action Alliance to Host Webinar About 988 Hotline Messaging Framework on March 22

The National Action Alliance for Suicide Prevention (Action Alliance) will release a 988 Messaging Framework next month to help people transition to the national 988 behavioral health crisis hotline that takes effect in July. The hourlong webinar is free and will highlight how to use the resource in public messaging efforts. The Action Alliance will host the event on Tuesday, March 22 at 2 p.m. ET. Click here to register.

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

NABH 2022 Annual Meeting At-A-Glance Available Online

Registration is open for NABH’s 2022 Annual Meeting—Shaping the Future of Behavioral Healthcare—and this week NABH posted the meeting’s At-A-Glance online. Please visit our Annual Meeting homepage to view the At-A-Glance for preliminary meeting details, register for the meeting, and reserve a hotel room. We hope you join us from June 13-15 in Washington!

Fact of the Week

A new estimate from Forbes, the cost of America’s opioid crisis is now more than $1.3 trillion and rising. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 181

Written by Emily Wilkins (NABH) on February 11, 2022. Posted in CEO Updates.

2022 NABH Annual Meeting Registration is Open!

NABH is pleased to announce that registration opened this week for the 2022 NABH Annual Meeting: Shaping the Future of Behavioral Healthcare. Please join us from Monday, June 13 – Wednesday, June 15 at the Mandarin Oriental Washington, DC, and visit our Annual Meeting webpage to register for the meeting and reserve your hotel room. We look forward to seeing you in Washington!

U.S. Surgeon General Vivek Murthy, MD Testifies to Senate Panel About Youth Mental Health

U.S. Surgeon General Vivek Murthy, MD offered four recommendations to address the nation’s growing youth mental health crisis when he testified before the influential Senate Finance Committee this week. Speaking not only as the nation’s doctor, but also as someone who experienced bullying as a child, and as a parent, Murthy said there are number of longstanding, preventable factors that are driving feelings of loneliness and hopelessness among American youth. “The recent ubiquity of technology platforms, especially social media platforms, has had harmful effects on many children,” Murthy said. “Though undoubtedly they serve as a benefit to the lives of many in important ways, these platforms have also exacerbated feelings of loneliness, futility, and low self-esteem for some youth,” he continued. Murthy offered four recommendations to address the myriad youth mental health challenges in the United States: first, ensure that every child has access to high-quality, affordable, and culturally competent mental health care; next, focus on prevention, by investing in school and community-based programs that gave been shown to improve the mental health and emotional well-being of children at low cost and high benefit; third, better understand the impact that technology and social media have on mental health; and, finally, overcome stigma. For that last recommendation, Murthy said this area concerns both individual and community engagement, and it requires understanding the role we each have to play in overcoming stigma.

CDC, FDA Release Draft Guidance for Opioid Prescribing

The Centers for Disease Control and Prevention (CDC) on Thursday released its anticipated draft guidance on opioid prescribing for acute pain, subacute pain, and chronic pain in adults. The guidance includes recommendations on clinician-patient communication, improved safety and effectiveness, and reduction in risks of developing an opioid use disorder (OUD), overdose, and death. It also recommends periodic review of the state prescription drug monitoring program data, consideration for toxicology testing, caution when co-prescribing benzodiazepines, and arrangement of medication treatment for patients with OUD. This clinical practice guideline provides recommendations and does not require mandatory compliance. Public comments on the recommendations are due April 11. Also this week, the U.S. Food and Drug Administration (FDA) released guidance to develop non-addictive alternatives to opioids for acute pain, in response to the statutory requirements of section 3001(b) of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act. The FDA said it expects to address chronic pain in future guidance. Comments on the FDA guidance are also due April 11.

Register for National Drug and Alcohol Facts Week: March 21-27, 2022

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Fact of the Week

Beyond nursing home care, members of racial and ethnic minority groups are more likely to reside in areas that suffer from physician shortages, including shortages of primary care doctors, surgeons, and mental health providers, which is also a product of structural racism. Learn more in the February 2022 edition of Health Affairs, a theme issue devoted to system racism and its effects on health. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 180

Written by Emily Wilkins (NABH) on February 4, 2022. Posted in CEO Updates.

Federal Lawmakers Examine U.S. Mental Health Crisis in Committee Hearings

The influential Senate Health, Education, Labor & Pensions (HELP) and House Ways and Means Committees learned about the nation’s persistent mental health and substance use crises in separate hearings on Capitol Hill this week. On Tuesday, senators heard from five expert witnesses, including Mitch Prinstein, Ph.D., chief science officer at the American Psychological Association; Michelle Durham, M.D., M.P.H., vice chair of education in the psychiatry department and clinical associate professor of psychiatry and pediatrics at Boston Medical Center, Boston University School of Medicine; and Sara Goldsby, M.S.W., M.P.H., director of South Carolina’s Department of Alcohol and Other Drug Abuse Services. Senate HELP Committee Chairwoman Patty Murray (D-Wash.) acknowledged that the Covid-19 pandemic has worsened the country’s existing mental health and substance use crises and emphasized more than once that the behavioral healthcare workforce is stretched too thin. Murray also said it’s time to increase access to behavioral healthcare services. “If we’re going to respond to the behavioral health issues the pandemic has made worse … that will take legislative action,” Murray said. In a hearing the following day, members of the House Ways and Means Committee heard from experts representing UConn Health, the Legal Action Center, and the North Carolina Division on Mental Health, Developmental Disabilities, and Substance Abuse Services. The Senate Finance Committee will host a hearing on protecting youth mental health on Tuesday, Feb. 8 at 10 a.m. ET. Click here to watch the hearing next week.

CMS Releases Reminder About ‘Extraordinary Circumstance’ Exception to Quality Data Reporting

The Centers for Medicare & Medicaid Services (CMS) has released a notice to remind healthcare providers that CMS offers a process for hospitals or facilities to request exceptions to the reporting of quality data, including data for electronic clinical quality measures, for one or more quarters when providers experience an extraordinary circumstance beyond their control. Click here to read the announcement, which also includes information about performance-related extraordinary circumstance exception requests and promoting interoperability hardship requests.

Satcher Health Leadership Institute Adds ‘Behavioral Health’ Category and Indicators to Health Equity Tracker

The Satcher Health Leadership Institute (SHLI) has expanded its Health Equity Tracker (HET) outcomes to include a “behavioral health” category and six corresponding indicators. Named for David Satcher, M.D., the nation’s 16^th U.S. surgeon general, the SHLI works to transform health equity through policy, leadership development, and research as it focuses on three priority areas: the political determinants of health, health system transformation, and mental and behavioral health. The six indicators for the new behavioral health category include: frequent mental distress, depression, suicide, illicit opioid use, non-medical drug use, and alcohol use (excessive drinking). Click here to learn more.

National Academy of Medicine Releases Discussion Proceedings for Stigma of Addiction Summit

The National Academy of Medicine has released the discussion proceedings of the Stigma of Addiction Summit that the Academy held last summer. The summit’s six sessions cover topics including how stigma presents itself and interventions to prevent it. The new publication also outlines priorities to guide future actions.

Register Today for National Drug and Alcohol Facts Week: March 21-27, 2022

The National Institute on Drug Abuse (NIDA) invites organizations to participate in National Drug and Alcohol Facts Week (NDAFW), a national health observance meant to empower teens and young adults about making informed decisions about drugs, alcohol, and addiction. NIDA has developed five steps to hosting an NDAFW event and created lesson plans and other materials for educators, counselors, and prevention specialists. Click here to learn how to register your organization’s event online.

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Fact of the Week

U.S. universities are developing creative ways to provide mental health resources on their campuses. For example, the University of California-Davis embeds counselors in student groups such as the Cross-Cultural Center and the LGBTQIA Resource Center, while Stanford University’s Bridge Peer Counseling Center offers anonymous counseling 24/7 to students who are more comfortable speaking with a trained fellow student. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 179

Written by Emily Wilkins (NABH) on January 28, 2022. Posted in CEO Updates.

HHS, Treasury, and Labor Departments Release Parity Report to Congress

The Departments of Labor (DOL), Health and Human Services (HHS), and Treasury issued a report and fact sheet on Tuesday, Jan. 25 documenting widespread lack of compliance with federal parity rules among commercial health plans. The report specifically highlights lack of compliance with a new requirement enacted in late December 2020 that plans must document how their non-quantitative treatment limitations (NQTLs) comply with the Mental Health Parity and Addiction Equity Act (MHPAEA). During a webinar on Wednesday, Jan. 26, DOL representatives stressed that none of the responses to requests for documentation the agency sent to 156 plans and issuers were sufficient to demonstrate compliance with MHPAEA. Furthermore, despite insufficient documentation, DOL has already issued initial determination letters finding 48 NQTLs imposed on mental health or substance use disorder (MH/SUD) benefits violate parity. HHS reported that all the responses to requests for documentation of compliance with parity from issuers in states where the agency has direct enforcement authority and non-federal government plans similarly were insufficient. HHS has issued initial determination letters finding 16 NQTLs were out of compliance with parity. DOL officials also mentioned that the agencies plan to amend the federal regulations implementing MHPAEA. The Departments included a set of legislative recommendations for Congress in the report including authorizing the Departments to impose civil monetary penalties for parity violations and directly pursue parity violations by entities that provide administrative services to group health plans. In addition, the report recommends that Congress consider ways to permanently expand access to telehealth. The report also recommends that Congress amend MHPAEA to ensure that MH/SUD benefits are “defined in an objective and uniform manner pursuant to external benchmarks that are based in nationally recognized standards”. These developments regarding possible regulatory and legislative changes point to the importance of NABH member submissions to the denial-of-care portal. Please see additional information about the portal below.

CMS Issues Updated Guidance on Covid-19 Vaccination Requirements for Healthcare Workers

The Centers for Medicare and Medicaid Services (CMS) issued updated guidance and resources regarding Covid-19 vaccination requirements for personnel in Medicare-participating facilities including psychiatric hospitals and psychiatric residential treatment facilities. This updated information responds to the Supreme Court’s decision earlier this month to overturn the lower court decisions blocking implementation of CMS’ Covid-19 vaccination requirements in almost half of the states. These requirements now apply in all 50 states with various deadlines. In the 25 states not affected by the litigation, CMS had previously clarified that healthcare facility personnel had to have at least one dose of a Covid-19 vaccine (or be exempt due to religious conviction or medical condition) by Jan. 27, 2022, and a second dose (of any two dose regimen) by Feb. 28, 2022. New deadlines for healthcare facility personnel in states previously under a stay on enforcement are Feb. 14, 2022, for a first dose and March 15, 2022, for a second dose. Texas was affected by separate litigation and the new deadlines for Medicare-regulated healthcare facilities in that state are Feb. 22, 2022, for the first dose and March 21, 2022, for the second. Below are links to updated CMS guidance on the Covid-19 vaccination requirements:

Guidance memo (cms.gov) – This memo provides guidance for assessing and maintaining compliance with this new regulatory requirement for certain Medicare and Medicaid providers and suppliers.
CMS Omnibus COVID-19 Health Care Staff Vaccination Requirements FAQ (PDF cms.gov) (PDF) – These FAQs have been updated to explain the recent ruling and how it impacts employee vaccination requirements.
IFC-6 Vaccination Requirements Infographic (cms.gov) (PDF) – This infographic visually shows the types of providers and suppliers the vaccine requirement applies to, how the requirement can be met, and associated requirement enforcement actions.
Vaccine Requirement Implementation Timeline (cms.gov) (PDF) – This infographic illustrates the phases of the vaccination rule implementation, state-by-state, and their associated deadlines. Note that the phased deadlines vary by state.
Vaccine Requirement Decision Tree (cms.gov) (PDF) – This handy decision tree visually explains the steps in determining to which providers and suppliers the vaccine requirement applies.

OSHA Withdraws Vaccine-or-Test Requirement

The U.S. Supreme Court, on Jan. 13, 2022, blocked implementation of the Occupational Safety and Health Administration’s (OSHA’s) vaccination and testing requirements for employers with 100 or more employees. Accordingly, the agency withdrew its emergency temporary standard (ETS) on this topic. However, the agency clarified that “[a]though OSHA is withdrawing the ETS as an enforceable emergency temporary standard, the agency is not withdrawing the ETS to the extent that it serves as a proposed rule.” In a statement on the withdrawal, the agency clarified it is “prioritizing its resources to focus on finalizing a permanent Covid-19 Healthcare Standard.”

HHS Distributes More Than $2 Billion in PRF Phase 4 Funding

HHS’ Health Resources and Services Administration (HRSA) this week is making more than $2 billion in Provider Relief Fund (PRF) Phase 4 general distribution payments to more than 7,600 healthcare providers nationwide. These payments follow nearly $9 billion that HRSA released to providers last month. According to HRSA, a total of more than $11 billion in PRF Phase 4 payments have been distributed to more than 74,000 providers in all 50 states, Washington, D.C., and five territories. HRSA clarified that these payments reflect “full processing of approximately 82 percent of Phase 4 applications. The remaining applications require additional review as part of the risk mitigation and cost containment safeguards previously outlined in the Phase 4 methodology”.

NABH and Other Behavioral Health Groups Send Letter to CMS about ‘No Surprises Act’ Rules

NABH and 10 other behavioral health organizations this week sent a letter to the Centers for Medicare & Medicaid Services (CMS) expressing concern that the agency’s No Surprises Act regulations will have a disproportionately negative effect on behavioral healthcare providers and add to their administrative burdens. The No Surprises Act’s, signed into law in late 2020, requirements became effective this year. NABH and other groups have requested that CMS issue a stay on enforcement of the interim final rules (IFR) that affect routine mental and behavioral health services. If the agency insists on retaining the existing regulations, NABH and the other groups requested an exemption for behavioral healthcare providers. “The duty to furnish a “Good Faith Estimate” (“GFE”) of costs outlined in Part 2 of the regulations imposes an undue administrative burden on our members,” the letter said. “Our providers have a long-standing practice of being transparent about fees with their patients because it is required by their professional ethics. Requiring clinicians to fill out the GFE form and update it every time there is a minor change in the treatment plan that may or may not have an impact on costs takes away from valuable treatment time – which is in extremely high demand as more and more people are struggling with the mental health impact of the COVID pandemic,” it continued. “Demand is already so high that many patients are finding it difficult to find a provider with enough availability to meet their needs.”

ONC Seeks Request for Information on EHR Standards for Prior Authorization and More

HHS’ Office of the National Coordinator (ONC) on Jan. 24, 2022, requested information about electronic health record standards for prior authorization, implementation specifications, and certification criteria for the ONC certification program to inform future rulemaking. The request for information builds on a set of recommendations made in November 2020 from the HHS Intersection of Clinical and Administrative Data Task Force (ICAD) of the Health Information Technology Advisory Committee (HITAC). The task force is addressing methods for improving data interoperability across the health ecosystem. “We support efforts that can serve to advance electronic prior authorization for patients, providers, and payers,” Mary Greene, M.D., director of CMS’ Office of Burden Reduction and Health Informatics, said in an announcement. “We look forward to reviewing the input received on this RFI and to exploring opportunities for alignment between future ONC policymaking and ongoing CMS initiatives on this critical topic.” Click here to learn more about how to submit comments, which must be submitted by March 25.

CMS Releases Third Publication of T-MSIS-based Medicaid SUD Data Book

The percentage of Medicaid beneficiaries treated for a substance use disorder (SUD) who received any medication-assisted treatment increased by 7.8 percentage points to 31.6% in 2019 from 23.8% in 2018, according to CMS’ third publication of the Transformed Medicaid Statistical Information System (T-MSIS)-based Medicaid Substance Use Disorder (SUD) Data Book. Required by the Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT) that Congress passed in 2018, the resource is meant to help policymakers, researchers, and others better understand where to focus drug-prevention and treatment efforts. The data book contains 2019 data on Medicaid beneficiaries treated for SUD, the services they received by both type and setting, delivery system, and progression of care.

Register Today for National Drug and Alcohol Facts Week: March 21-27, 2022

The National Institute on Drug Abuse (NIDA) invites organizations to participate in National Drug and Alcohol Facts Week (NDAFW), a national health observance meant to empower teens and young adults about making informed decisions about drugs, alcohol, and addiction. NIDA has developed five steps to hosting a NDAFW event and created lessons plans and other materials for educators, counselors, and prevention specialists. Click here to learn how to register your organization’s event online

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Fact of the Week

A new study found that 62% of Americans surveyed prefer in-person mental health services. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 178

Written by Emily Wilkins (NABH) on January 21, 2022. Posted in CEO Updates.

HHS Announces $103 Million to Reduce Burnout and Promote Wellness in Healthcare Workforce

The U.S. Health and Human Services Department (HHS) this week announced it will award $103 million in American Rescue Plan funding for evidence-informed programs, practices, and training to retain healthcare workers, reduce burnout, and promote health and wellness among the nation’s healthcare workforce. HHS’ Health Resources and Services Administration (HRSA) will disburse the funding to 45 grantees and focus especially on healthcare providers in underserved and rural communities, according to HHS. “I have traveled to many health centers across the country and know that the Covid-19 pandemic has intensified issues that have long been a source of stress for frontline healthcare workers — from increased patient volumes to long working hours,” HHS Secretary Xavier Becerra said in an announcement. “This funding reflects the Biden-Harris administration’s commitment to ensuring we have enough critical frontline workers by supporting healthcare providers now and beyond as they face burnout and mental health challenges. We will continue to promote the well-being of those who have made so many sacrifices to keep others well.” HRSA is awarding the funds through the following three programs: Promoting Resilience and Mental Health Among Health Professional Workforce, Health and Public Safety Workforce Resiliency Training Program, and Health and Public Safety Workforce Resiliency Technical Assistance Center. Click here to see the list of award recipients. Also this week, the National Academy of Medicine released a Resource Compendium for Health Care Worker Well-Being, a collection that highlight tools and strategies to address healthcare worker burnout.

HHS Announces $13 Million to Improve Behavioral Healthcare Access in Rural America

HHS this week also announced it will award $13 million through HRSA to increase access to behavioral healthcare services in rural America, including through evidence-based, trauma-informed treatment for substance use disorder. These funds, similar to the funds to address healthcare worker burnout and wellness, are available through last year’s American Rescue Plan. “Our response to the Covid-19 pandemic must include meeting the behavioral health needs of individuals experiencing substance use disorder,” HRSA Administrator Carole Johnson said in an announcement. “In rural areas, accessing the care and services to address these needs can be a particular challenge,” she added. “The funding we are announcing today is directly targeted to the community needs of rural areas and will help expand access to behavioral health services to meet these needs.” HRSA’s Federal Office of Rural Health Policy will make the awards available through the Rural Communities Opioid Response Program-Behavioral Health Care Support. Interested applicants must apply by Tuesday, April 19 at 11:59 p.m. ET. Click here for more information.

CMS Seeks Comments on Time and Distance Standards for Network Adequacy in Marketplace Insurance Plans

The Centers for Medicare & Medicaid Services (CMS) is requesting comments on proposals that the agency made regarding specific standards for outpatient, clinical behavioral health providers, psychiatrists, and inpatient or residential behavioral health facilities among other provider types in qualified health plans offered in the federally qualified health insurance exchanges. Earlier this month, CMS released its Qualified Health Plan Notice of Benefit and Payment Parameters proposed rule for 2023. In it, CMS proposed specific time and distance standards for measuring network adequacy in qualified health plans offered in federally facilitated exchanges. Federally facilitated exchanges are offered in Alabama, Alaska, Arizona, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Kansas, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, Wisconsin, and Wyoming. The agency proposed time and distance standards for behavioral healthcare providers in a draft letter to issuers that clarifies specific provisions in the proposed rule. See pages 11 and 12 in the letter for proposed time and distance standards. Please send any comments regarding these proposals to Kirsten Beronio, NABH’s director of policy and regulatory affairs, Director of Policy and Regulatory Affairs, before next Thursday, Jan. 27.

The Joint Commission Publishes Covid-19 Vaccination Requirement FAQs

The Joint Commission (TJC) has released a series of Covid-19 vaccination requirement resources and frequently asked questions (FAQs) for providers. Beginning Jan. 27, TJC will start surveying to CMS’ Covid-19 vaccination healthcare staff vaccination interim final rule in all of the Commission’s applicable program surveys. As TJC noted in its announcement about the FAQs, “the CMS Covid-19 vaccination requirements apply to organizations that elect to use Joint Commission accreditation for deemed status purposes.”

Register Today for National Drug and Alcohol Facts Week: March 21-27, 2022

The National Institute on Drug Abuse (NIDA) invites organizations to participate in National Drug and Alcohol Facts Week (NDAFW), a national health observance meant to empower teens and young adults about making informed decisions about drugs, alcohol, and addiction. NIDA has developed five steps to hosting a NDAFW event and created lessons plans and other materials for educators, counselors, and prevention specialists. Click here to learn how to register your organization’s event online

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Fact of the Week

During 2015-2019, an estimated 10.6 million adults in the United States, or about 4.3% of the adult population, reported having had suicidal thoughts during the preceding year. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 177

Written by Emily Wilkins (NABH) on January 14, 2022. Posted in CEO Updates.

U.S. Supreme Court Allows Covid-19 Vaccine Mandate for Healthcare Workers

In a 5-4 vote Thursday, the U.S. Supreme Court ruled it will allow the Centers for Medicare & Medicaid Services’ (CMS) regulation to proceed that mandates the Covid-19 vaccine for about 10.3 million workers at approximately 76,000 healthcare facilities that accept money from the Medicare and Medicaid programs. Chief Justice John Roberts and Justice Brett Kavanaugh joined the Court’s liberal justices in the majority decision. In its other ruling, the Court voted 6-3 to block the Occupational Safety and Health Administration’s (OSHA) vaccine-or-test mandate for large businesses. CMS Administrator Chiquita Brooks-LaSure said in a statement that the agency is “extremely pleased” with the Court’s decision for healthcare workers and added that giving patients assurance of safe care is a critical responsibility for CMS. “CMS is already implementing its healthcare worker vaccination rule in 25 states and territories that were not covered by preliminary injunctions,” Brooks-LaSure continued in her Jan. 13 statement. “Today’s decision will enable us to fully implement this rule, and we look forward to working with healthcare providers and their workers to protect patients,” she continued. “We will continue our extensive outreach and assistance efforts encouraging individuals working in healthcare to get vaccinated.” As a result of Thursday’s decision, healthcare providers subject to the Omnibus Health Care Staff Vaccination rule in the 24 states (Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia, and Wyoming) covered by this decision will now need to establish plans and procedures to ensure their staff are vaccinated. CMS also said the decision does not affect compliance timelines for providers in the District of Columbia, the territories, and the 25 states where the preliminary injunction was previously lifted. CMS released guidance about this on Dec. 28, 2021.

Becerra Extends Covid Public Health Emergency for 90 Days

HHS Secretary Xavier Becerra has extended the Covid-19 public health emergency (PHE) for an additional 90 days, effective Jan. 16. Former HHS Secretary Alex Azar made the original determination on Jan. 31, 2020. Azar renewed the Covid-19 PHE four times, and this recent determination is the fourth time Becerra has renewed it.

SAMHSA and Partner Groups Launch National Survey of Mobile Crisis Teams

The Substance Abuse and Mental Health Services Administration (SAMHSA) has partnered with other groups to launch a survey that will gather information about mobile crisis teams (MCTs) across the United States. SAMHSA, along with organizations including the National Association of State Mental Health Program Directors and Vibrant Emotional Health (formerly the Mental Health Association of New York City) has released the survey to better understand the organization, operation, and financing of MCTs. The organizations encourage all mobile crisis, co-responder, and other field-based mental health crisis response teams to complete the 10-minute survey by Tuesday, Feb. 28 and to share the survey widely.

CMS Requests Information on Behavioral Health Networks Within Medicare Advantage Plans

CMS on Wednesday published a proposed rule that includes a request for information about how to improve behavioral health networks within Medicare Advantage (MA) health plans. NABH will develop a response to the regulation and welcomes comments from NABH members. Although all comments are welcome, CMS asked specifically for comments related to the following topics:

Challenges for behavioral healthcare providers to establish contracts with MA health plans;

Providers’ inability or unwillingness to contract with MA plans, including issues related to provider reimbursement; and

Opportunities to expand services for the treatment of opioid addiction and substance use disorders.

Please send comments to Kirsten Beronio, NABH’s director of policy and regulatory affairs. Public comments are due March 7.

GAO Offers Recommendations to Improve State Opioid Response Grant Program Assessment

In its recent review of SAMHSA’s State Opioid Response (SOR) grant program, the Government Accountability Office (GAO) concluded that SAMHSA did not fully leverage available information to adequately assess the program, and that the agency did not identify the program’s potential limitations. The GAO noted that SAMHSA assesses the SOR grant program through two annual performance reports, and it recommended that SAMHSA make those reports more useful by first identifying potential limitations and how those limitations may affect the conclusions that can and cannot be drawn; and second by further analyzing existing program information to provide a more comprehensive, in-depth assessment of the program to identify opportunities for improvement.

Register Today for National Drug and Alcohol Facts Week: March 21-27, 2022

The National Institute on Drug Abuse (NIDA) invites organizations to participate in National Drug and Alcohol Facts Week (NDAFW), a national health observance meant to empower teens and young adults about making informed decisions about drugs, alcohol, and addiction. NIDA has developed five steps to hosting a NDAFW event and created lessons plans and other materials for educators, counselors, and prevention specialists. Click here to learn how to register your organization’s event online.

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Fact of the Week

A new analysis in the JAMA Network Open found there were 10,292 fatal overdoses among people over the age of 55 in 2019, compared with 518 overdoses in the same age group in 1999. The study examined disparities by sex, race, and ethnicity in death rates due to opioid overdose during this time period. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 176

Written by Emily Wilkins (NABH) on January 7, 2022. Posted in CEO Updates.

CMS Issues Guidance on Covid-19 Vaccination Requirements for Most Medicare- and Medicaid-Certified Providers

The Centers for Medicare & Medicaid Services (CMS) on Dec. 29 issued guidance regarding the Interim Final Rule (IFR) regarding Covid-19 vaccination requirements for healthcare staff that the agency published in early November. In the Dec, 29 memo, CMS specified that this guidance does not apply to the following states that are still subject to preliminary injunctions that federal courts issued to block implementation of the IFR in those states: Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Texas, Utah, West Virginia, and Wyoming. To learn more, please read the NABH Issue Brief that NABH sent to members this week.

OSHA Withdraws Non-Recordkeeping Portions of Covid-19 Healthcare ETS

The U.S. Labor Department’s Occupational Safety and Health Administration (OSHA) last week said it is withdrawing the non-recordkeeping portion of the Covid-19 healthcare emergency temporary standard (ETS) that it adopted last June. Separate from a Covid-19 vaccine mandate, the healthcare ETS required that employers provide personal protective equipment, physical barriers, and ventilation, and also require screening of each individual who enters the facility. The temporary standard also provided paid leave to workers who must quarantine due to infections or exposure. “OSHA announces today that it intends to continue to work expeditiously to issue a final standard that will protect healthcare workers from COVID-19 hazards and will do so as it also considers its broader infectious disease rulemaking,” OSHA’s announcement said on Dec. 27. “However, given that OSHA anticipates a final rule cannot be completed in a timeframe approaching the one contemplated by the OSH Act, OSHA also announces today that it is withdrawing the non-recordkeeping portions of the healthcare ETS.

HHS’ Provider Relief Fund Reporting Portal for Reporting Period #2 Open Through March 31

HHS’ Health Resources and Services Administration (HRSA) announced the Provider Relief Fund (PRF) Reporting Portal for Reporting Period 2 (RP2) opened on Jan. 1 and will remain open through March 31, 2022. According to HRSA’s announcement, healthcare providers who received one or more general and/or targeted PRF payments exceeding $10,000, in the aggregate, from July 1, 2020 to Dec. 31, 2020 must report on their use of funds during RP2. In addition, HRSA created a stakeholder toolkit with content to share information about RP2 within organizations and networks. The agency has also developed the following resources for providers: What’s New in Reporting Period 2 Fact Sheet, Lost Revenues Guide, and a webpage for reporting on nursing home and infection control payments. To learn more, register for either of HRSA’s upcoming webinars: one for new reporting entities on Jan. 12 at 3 p.m. ET and one for returning reporting entities on Jan. 13 at 3 p.m. ET.

SAMHSA Invests $282 Million to Implement 988 Behavioral Health Crisis Hotline

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced it has invested $282 million in American Rescue Plan funding to help transition the current National Suicide Prevention Lifeline to the 988 three-digit dialing code from its current 10-digit number. Congress designated the new 988 dialing code in 2020 to operate through the existing National Suicide Prevention Lifeline. The new code will be available national for calls, texts, and chats, beginning in July 2022. According to SAMHSA, it has allotted $177 million to strengthen and expand the existing Lifeline network operations and infrastructure, including chat and text response, backup center capacity, and special services, such as a sub-network for Spanish language-speakers. The agency has invested $105 million to develop staffing across states’ local crisis call centers. SAMHSA is recruiting for a director for the crisis coordination office.

California’s Medicaid Program Receives CMS Approval to Implement Contingency Management

California Medi-Cal, the state’s Medicaid program, has received approval from the Centers for Medicaid & Medicare Services (CMS) to implement contingency management (CM) through a Section 1115 waiver. Several insurance companies are financing CM, an evidence-based intervention for stimulant use disorders, and some states have engaged in pilot programs for the practice. CMS’ approval of the California CM pilot represents the first time the treatment intervention has been approved formally as a benefit in a Medicaid program. While there is substantial research supporting the efficacy of CM, implementation has lagged for decades due to an Office of Inspector General opinion that raised concerns about fraud and abuse.

OSHA Publishes Workplace Violence Prevention Standard Fact Sheet

OSHA has announced it will convene a Small Business Advocacy Review (SBAR) panel of small entity representatives early this year to help OSHA in its work to develop a potential Prevention of Workplace Violence in Healthcare and Social Assistance standard. In the meantime, OSHA has published a fact sheet that describes who might be covered by a new workplace violence prevention standard, why OSHA is considering the standard, what the standard might include, what a small entity representative would do, and how small businesses and local government entities can participate.

NIMH to Host Webinar on School-based Suicide Prevention on Jan. 14

The National Institute of Mental Health (NIMH) will host a webinar next week about new practices in school-based suicide prevention for school administrators, researchers, practitioners, policymakers, and other stakeholders. The presentation will focus on identifying and supporting high-risk youth, as well as opportunities to evaluate these efforts. NIMH will host the webinar next Friday, Jan. 14 from 2 p.m. to 3:30 p.m. ET. Click here to register.

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Fact of the Week

A meta-analysis of 21 studies that analyzed interventions in prisons to address the needs of people with co-occurring serious mental illness and substance use disorders generally showed decreases in substance use and lower odds of committing a substance use-related offense after reentry into the community for those who were in a treatment program compared with those who were not, according to research published in Psychiatric Services. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 175

Written by Emily Wilkins (NABH) on December 17, 2021. Posted in CEO Updates.

President Biden Signs Debt Ceiling Increase, Staving Off Medicare Provider Cuts

President Biden on Thursday signed legislation that permits a federal debt ceiling increase and also forestalls expected Medicare payment cuts to providers. Passed by Congress this week, the bill to raise the federal government’s borrowing limit by about $2.5 trillion—and cover its obligations into 2023—also delays through March 2022 the 2% Medicare sequestration cuts that were to take effect in January. After the first quarter of 2022, a phased-in, 1% cut will take effect for the second quarter, followed by the full 2% cut for the third and fourth quarters of the year. Under the legislation, the sequestration will be increased to 2.25% for the first two quarters of 2030, increasing to 3% in quarters three and four of 2030. The bill would also extend the Medicare conversion factor through calendar year 2022 at a rate of 3%, marking a reduction in provider reimbursement by 0.75 percent from the 3.75 conversion factor in 2021.

Senate Majority Leader Schumer Says More Time Needed for ‘Build Back Better Act’

Senate Majority Leader Charles Schumer (D-N.Y.) on Friday signaled that the Biden administration’s Build Back Better Act will be delayed as discussions continue about the $1.7 trillion climate and social spending plan. Reports have noted that Democrats are continuing to push for action on the legislation before Christmas, but that ongoing conversations between the White House and Sens. Joe Manchin (D-W.Va.) and Kyrsten Sinema (D-Ariz.)—both of whom have expressed concern about passing another trillion-dollar spending bill—will push the legislation into 2022. “The president requested more time to continue his negotiations, and so we will keep working with him, hand in hand, to bring this bill over the finish line and deliver on these much-needed provisions,” Schumer said on the Senate floor.” Schumer did not say when the Senate will consider the measure.

HHS Releases 2022 Regulatory Priorities

The U.S. Health and Human Services Department (HHS) has included behavioral health in the department’s recently released Statement of Regulatory Priorities for 2022. Beginning on page 5 of the 15-page document, HHS noted it will propose two rules intended to extend telehealth flexibilities for substance use disorder treatments granted during the Covid-19 public health emergency. One rule will propose revisions to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) regulations that would make permanent regulatory flexibilities for opioid treatment programs to provide extended take-home doses of methadone to patients when it is safe to do so. In the other telehealth rule, HHS will propose revisions to SAMHSA regulations to permanently allow opioid treatment programs to provide buprenorphine via telehealth services. The document also describes HHS’ plans to work with the U.S. Labor Department on a rule related to the Mental Health Parity and Addiction Treatment Equity Act and the Consolidated Appropriations Act, 2021 related to compliance. Finally, the HHS plan said it will work on revisions related to Part 2 requirements to align rules about the confidentiality of SUD treatment records with rules that the Health Insurance Portability and Accountability Act of 1996 and the Coronavirus Aid, Relief, and Economic Security Act of 2020 require.

CMS Adds Mental Health and SUD Measures to Children’s Core Healthcare Quality Measurement Set

The Centers for Medicare & Medicaid Services (CMS) has added two measures to the 2022 updates to the core set of children’s healthcare quality measures. In Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence: Ages 13-17, the measure assesses the percentage of emergency department (ED) visits for beneficiaries aged13 and older with a principal diagnosis of alcohol or other drug (AOD) abuse or dependence who had a follow-up visit for AOD abuse or dependence. The other measure, Follow-Up After Emergency Department Visit for Mental Illness: Ages 6-17, assesses the percentage of ED visits for beneficiaries aged 6 and older with a principal diagnosis of mental illness or intentional self-harm and who had a follow-up visit for mental illness.

CDC Data Show Drug Overdose Deaths Involving Fentanyl Increasing

A new report from the Centers for Disease Control and Prevention (CDC) shows that in 2019 and 2020, deaths involving illegal fentanyl increased 94% in the West, 65% in the South, and 33% in the Midwest. “Pressed into counterfeit pills made to look like oxycodone or other painkillers, illegally made fentanyl has been showing up east of the Mississippi where heroin is sold and in two-thirds of drug overdose deaths charted by CDC through April,” the report noted. Meanwhile, HHS’ Office of the Inspector General (OIG) this week released a data brief that reported many Medicare beneficiaries are not receiving medication to treat their opioid use disorder. “About 1 million Medicare beneficiaries were diagnosed with opioid use disorder in 2020. Yet less than 16 percent of these beneficiaries received medication to treat their opioid use disorder, raising concerns that beneficiaries face challenges accessing treatment,” the OIG’s data brief noted. “Furthermore, less than half of the beneficiaries who received medication to treat their opioid use disorder also received behavioral therapy. These services may be provided in-person or via telehealth; however, the full extent to which beneficiaries use telehealth for behavioral therapy is unknown as Medicare does not require opioid treatment programs to report this information.”

SAMHSA Releases New Prescribing Tools for Buprenorphine in Primary Care Settings

SAMHSA has published a new resource to provide primary care providers with information on how to implement opioid use disorder treatment using buprenorphine. The publication highlights common barriers and identifies strategies to address them and also includes specific tactics to support buprenorphine implementation.

SAMHSA to Host Webinar on Harm Reduction Grant Program on Monday

SAMHSA is accepting applications for its first harm-reduction program and will host a webinar Monday, Dec. 20 to review the program’s requirements. The agency said it expects to award about $30 million in grants with funding from the American Rescue Plan for programs intended to increase access to a range of community harm-reduction services and to support harm-reduction providers as they work to prevent overdose deaths. The webinar will be held on Monday at 2 p.m. ET. Click here to register.

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Fact of the Week

From August 2019 to April 2021, only 7.4% of people in an emergency department for an opioid overdose received a prescription for naloxone within 30 days of the visit, according to a new study in Open Minds.

Happy Holidays from NABH!

NABH will not publish CEO Update for the next two weeks and will resume on Friday, Jan. 7, 2022. The entire NABH team wishes you, your families, and your teams a very happy, healthy, and safe holiday season! For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 174

Written by Emily Wilkins (NABH) on December 10, 2021. Posted in CEO Updates.

Surgeon General Issues Advisory on Nation’s Youth Mental Health Crisis

U.S. Surgeon General Vivek Murthy, M.D. this week issued the U.S. Surgeon General’s Advisory on Protecting Youth Mental Health, which outlines recommendations to address America’s youth mental health crisis. “Even before the pandemic, an alarming number of young people struggled with feelings of helplessness, depression, and thoughts of suicide — and rates have increased over the past decade,” Murthy said in a news release. “The Covid-19 pandemic further altered their experiences at home, school, and in the community, and the effect on their mental health has been devastating,” he continued, adding that the future of the country’s well-being depends on how we support and invest in the next generation. The 53-page advisory recommends that individuals, families, community organizations, technology companies, governments, and others recognize that mental health is an essential part of overall health; empower youth and their families to recognize, manage, and learn from difficult emotions; ensure that every child has access to high-quality, affordable, and culturally competent mental healthcare; support the mental health of children and youth in educational, community, and childcare settings and expand and support the early childhood and education workforce; address the economic and social barriers that contribute to poor mental health for young people, families, and caregivers; and increase timely data collection and research to identify and respond to youth mental health needs more rapidly. “This includes more research on the relationship between technology and youth mental health, and technology companies should be more transparent with data and algorithmic processes to enable this research,” the Surgeon General’s announcement said.

SAMHSA Announces $30 Million in Harm-Reduction Grant Funding

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week said it will issue about $30 million in American Rescue Plan funding for the agency’s first harm-reduction grant program to help prevent overdose deaths and reduce the health risks associated with drug use. SAMHSA will accept applications from state, local, tribal, and territorial governments; tribal organizations; not-for-profit, community-based organizations; and behavioral health organizations to increase access to a range of community services and supports. “The reality is, evidence-based harm reduction services are out of reach for far too many people,” Rahul Gupta, M.D., director of the Office of National Drug Control Policy, said in SAMHSA’s announcement. “Building on the Biden-Harris Administration’s efforts to expand evidence-based prevention, treatment and recovery support services, this historic funding will help make harm reduction services more accessible, so we can meet people where they are and save lives,” Gupta added.

HHS Report Shows Medicare Telehealth Visits for Behavioral Health Increased 32-Fold in 2020

The number of Medicare fee-for-service (FFS) beneficiary telehealth visits for behavioral health increased to 10.1 million in 2020 from 317,800 in 2019, reflecting a 32-fold increase, according to a new report from the U.S. Health and Human Services’ (HHS) Assistant Secretary for Planning and Evaluation’s (ASPE). Medicare Beneficiaries’ Use of Telehealth in 2020: Trends by Beneficiary Characteristics and Location showed that Medicare telehealth flexibilities “mitigated declines in in-person visits during the pandemic in 2020, but there is also evidence of disparities by race/ethnicity and for rural populations.” Researchers examined claims data from the 34.9 million Medicare FFS beneficiaries who had part A or B coverage and found that the number of Medicare FFS beneficiary telehealth visits rose 63-fold to nearly 52.7 million in 2020 from about 840,000 in 2019. Despite the increase in telehealth visits during the pandemic, total utilization of all Medicare FFS Part B clinician visits declined about 11% in 2020 compared with 2019 levels, the report showed. “Visits to behavioral health specialists showed the largest increase in telehealth in 2020,” the report noted. “Telehealth comprised a third of total visits to behavioral health specialists. While data limitations preclude clear identification of audio-only telehealth services, up to 70% of these telehealth visits during 2020 were potentially reimbursable for audio-only services,” it added.

CMS Updates State Medicaid & CHIP Telehealth Toolkit

The Centers for Medicare & Medicaid Services (CMS) this week released updates to the agency’s State Medicaid and Children’s Health Insurance Program (CHIP) Telehealth Toolkit: Policy Considerations for States Expanding Use of Telehealth, Covid-19 Version. CMS said it updated the resource to clarify that states may deliver covered services via audio-only telehealth both during the Covid-19 public health emergency and beyond. The toolkit provides quick facts, state considerations, pediatric considerations, a state checklist, and an appendix that includes frequently asked questions. “This guide is intended to help states identify which aspects of their statutory and regulatory infrastructure may impede the rapid deployment of telehealth capabilities in their Medicaid program,” the toolkit noted. “As such, this guide will describe each of these policy areas and the challenges they present below. The toolkit concludes with a list of questions state policymakers can use to ensure they have explored and/or addressed potential obstacles.”

NABH Submits Comments on Surprise Billing to Federal Agencies

NABH this week sent a letter to five federal agencies that expressed concerns about the second set of regulations issued to implement the No Surprises Act. NABH’s main concern in the interim final rule titled “Requirements Related to Surprise Billing; Part II” is the interpretation of the independent dispute resolution (IDF) provisions to highly favor health plans and issuers. “The interim final rule requires IDR entities to presume that the plan or issuer’s median in-network payment rate is the appropriate out-of-network reimbursement rate,” NABH said in its letter to HHS Secretary Xavier Becerra and top officials at the U.S. Labor Department, U.S. Treasury Department, Internal Revenue Service, and Office of Personnel Management. “This interpretation is contrary to the clear intent of Congress that required IDR arbiters to consider a long list of factors specified in the law including the median in-network rate. NABH added that it is also concerned about provisions in the interim final rule regarding good-faith estimates for uninsured and self-pay patients about the potential cost of care. “It is unclear how these requirements align with the price transparency requirements established earlier this year,” NABH wrote. “We urge you to issue additional guidance on how these two sets of rules overlap and differ.

CMS Hosts Open Door Forum to Highlight Provider Requirements in the ‘No Surprises Act’

CMS hosted an open door forum this week to explain provider requirements in the No Surprise Act that will take effect Jan. 1. Beginning next month, consumers will have new billing protections when receiving emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. The requirements apply mostly to items and services provided to people enrolled in group health plans, group or individual health insurance coverage, Federal Employees Health Benefits plans, and the uninsured. These requirements don’t apply to people with coverage through programs such as Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE that have other protections against high medical bills. Click here to view the presentation and here to access the provider requirements and resources page.

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Fact of the Week

Suicidal behaviors among high school students increased during the decade preceding the Covid-19 pandemic, with 19% seriously considering attempting suicide, a 36% increase from 2009 to 2019, and about 16% having made a suicide plan in the prior year, a 44% increase from 2009 to 2019, according to data from the Centers for Disease Control and Prevention. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 172

Written by Emily Wilkins (NABH) on November 19, 2021. Posted in CEO Updates.

U.S. Overdose Deaths Reach Record High During Covid-19 Pandemic

More than 100,000 Americans died of overdoses for the 12-month period that ended in April 2021, marking the first time the number of U.S. overdose deaths has surpassed 100,000 in a year, according to provisional data from the National Center for Health Statistics (NCHS). This record number represents a nearly 30% increase from the 78,000 deaths in the prior year. Meanwhile, the NCHS data show that overdose deaths in the United States have more than doubled since 2015. “This translates to an American perishing from a drug overdose death every five minutes,” Rahul Gupta, M.D., M.P.H., M.B.A., director of the Office of National Drug Control Policy (ONDCP) told National Public Radio in an interview on Wednesday. “This is unacceptable, and it requires an unprecedented response.” Also this week, Gupta’s office released a state model law to help make access to the prescription naloxone consistent nationwide. The law offers a template of recommended legislative provisions that states can enact so they can offer access to the life-saving treatment. The model law maps out ways to expand access to naloxone; addresses the need to provide uniformity in the ability of citizens to access antagonists such as naloxone; protects individuals administering opioid antagonists such as naloxone from unjust persecution; requires health insurance coverage of opioid antagonists, and more. “No one should die from an overdose, and naloxone is one of the most effective tools we have to save lives,” Gupta said in ONDCP’s announcement. “But sadly, today, people with substance use disorders are overdosing and dying across the country because naloxone access depends a great deal on where you live.”

SAMHSA Extends Take-Home Methadone Flexibilities to OTPs for One Year

The Substance Abuse and Mental Health Services Administration (SAMHSA) on Thursday said it will extend for one year the methadone take-home flexibilities it provided to opioid treatment programs (OTPs) at the start of the Covid-19 pandemic in March 2020 and is “considering mechanisms to make this flexibility permanent.” This flexibility has allowed OTPs to dispense 28 days of take-home methadone doses for stable patients and up to 14 days of take-home methadone medication to less stable patients, based on provider assessments. SAMHSA’s announcement said it is extending the flexibilities for a year “effective upon the eventual expiration of the Covid-19 Public Health Emergency. Click here to read SAMHSA’s announcement.

Provider Relief Fund Reporting Period 1 Ends Nov. 30

The Health Resources and Services Administration (HRSA) this week reminded providers that the 60-day grace period for the Provider Relief Fund (PRF) Reporting Period 1 ends Tuesday, Nov. 30. Non-compliant providers still have time to complete their reporting requirements, HRSA noted, by submitting their report to the PRF reporting portal by Nov. 30. Providers who fail to meet the deadline will be required to return their PRF payments by Dec. 30, 2021. HRSA also provided a Returning Funds Fact Sheet and additional information is available on the PRF Reporting Resources webpage.

OSHA Suspends Enforcement of Vaccine Mandate for Businesses

The U.S. Labor Department’s Occupational Safety and Health Administration (OSHA) announced it has suspended enforcement of its vaccine mandate for businesses, pending litigation. Earlier this month OSHA released an Emergency Temporary Standard that requires employers with 100 or more employees to develop, implement, and enforce a mandatory Covid-19 vaccination policy to minimize the risk of the deadly virus. “While OSHA remains confident in its authority to protect workers in emergencies, OSHA has suspended activities related to the implementation and enforcement of the ETS pending future developments in the litigation,” the agency announced on its website.

NABH and Other Behavioral Health Groups Release Plan for 988 Crisis Hotline Response

NABH and 14 other behavioral health organizations and advocacy groups this week released A Consensus Approach and Recommendations for the Creation of a Comprehensive Crisis Response System to help guide the mental health and substance crisis response mandated in the National Suicide Hotline Designation Act of 2020. The 17-page roadmap outlines the scope of implementing the 988 Crisis Hotline that will begin operating in July 2022. It also highlights the following seven pillars for transforming mental health and substance use care: early identification and prevention, emergency and crisis response, equity and inclusion, integration and partnership, fair and equivalent coverage, standards for care, and workforce capacity. “988 is not just a new number to call,” the guide states. “It is an opportunity to rethink how we approach mental health, substance use disorders, and suicide prevention in our communities.”

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Fact of the Week

In fiscal year 2020, SAMHSA’s Projects for Assistance in Transition from Homelessness (PATH) grantees enrolled 60,000 individuals and connected nearly 40,000 to community mental health services. Nearly 40% of these individuals reported co-occurring disorders and approximately 39% of these individuals experienced chronic homelessness. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 171

Written by Emily Wilkins (NABH) on November 12, 2021. Posted in CEO Updates.

CMS Freezes CY 2022 Methadone Reimbursement Rates in Interim Final Rule

In an interim final rule (IFR), the Centers for Medicare & Medicaid Services (CMS) said it will freeze methadone reimbursement rates for calendar year (CY) 2022. CMS is establishing a limited exception to the current CMS methodology for determining rates for the drug episode of care for methadone (HCPCS G2067-weekly bundle) and the add-on take-home for methadone (HCPCS G2708) by freezing rates at the CY2021 rate. The most recent average sale price (ASP) quarterly rates for oral methadone decreased by just more than 50% over last year’s rate, resulting in a reimbursement rate of 17.64 versus the CY 2021 rate of 37.38 (100% of ASP). CMS said the reduction is due to the inclusion of methadone tablets, where previously only the oral concentrate form was reflected in ASP sales. In addition, because ASP is not required for oral methadone, only a small number of manufacturers report ASP data. Moreover, CMS is not clear about OTP utilization rates for the oral and tablet forms of methadone; however, the agency has heard anecdotally that OTPs use oral methadone exclusively. CMS said that collectively, these three factors raised concerns about implementing such a “sudden and significant decrease in the rate for methadone” [that] could affect the ability of OTPs to continue to offer services to Medicare beneficiaries, thereby impeding access to treatment for OUD, at a time when overdose deaths are at an all-time high.” The freeze of reimbursement rates at the CY 2021 rates will allow time for further research and discussion with stakeholders to develop a new payment methodology in time for the CY 2023 payment rate determination. CMS requested information from stakeholders on the following are of interest:

The exception being made
Frequency of use of methadone oral concentrate compared with tablets, and how this should factor into rate setting
How the reduced payment changes (discussed above) will affect operations and beneficiary access to treatment

Public comments are due by Jan. 3, 2022. The rule will be published in the Federal Register on Nov. 19 and will become effective on Jan. 1, 2022.

NABH Sends Letters to U.S. Senate Finance and HELP Committees

NABH recently sent letters to members of the influential Senate Finance and Senate Health, Education, Labor, & Pensions (HELP) Committees that provided detailed information and recommendations about how to improve access to mental health and addiction treatment. The first letter to Senate Finance Committee Chairman Ron Wyden (D-Ore.) and Ranking Member Mike Crapo (R-Idaho) was a response to a request for information from the senators this summer. In it, NABH emphasized ensuring parity; expanding telehealth; strengthening workforce; increasing integration, coordination, and access; improving access for children and youth; and increasing Medicare Advantage accountability for mental health and addiction treatment. NABH also sent a letter to Senators Christopher Murphy (D-Conn.) and Bill Cassidy, M.D. (R-La.) of the Senate HELP Committee regarding their request for feedback on the programs authorized in the Mental Health Reform Act of 2016. “The pandemic has highlighted and amplified the need for improved access to mental health and addiction treatment,” NABH President and CEO Shawn Coughlin explained in both letters. “Studies have consistently found significantly higher levels of anxiety and depression and suicidal ideation. In addition, alcohol consumption has increased significantly,” he added. “Drug overdose deaths increased almost 30% in 2020 to more than 90,000 deaths, the highest number ever recorded over a 12-month period. Although suicide rates seemed to have leveled off and decreased last year, there have been troubling increases in suicides and suicidal ideation among certain subgroups including Black Americans and adolescent girls.” Both letters also noted that experts expect mental health and substance use disorders to remain elevated long after the Covid-19 pandemic ends.

NABH and Other Behavioral Health Groups Send Letter to OSHA on Workplace Violence

NABH led development of a stakeholder group letter to the U.S. Labor Department’s Occupational Safety and Health Administration (OSHA) about ensuring the safety of personnel in healthcare settings, including those focused on behavioral health. The letter from NABH, the American Nurses Association, the American Psychiatric Association, the National Alliance on Mental Illness, the National Association of State Mental Health Program Directors, and the National Council for Mental Wellbeing followed an early August meeting with representatives from all of the organizations and OSHA that focused on settings where people access mental health or substance use disorder treatment. NABH and the other organizations highlighted a variety of issues, including incorporating trauma-informed care to inform both environmental interventions and settings; conducting debriefing sessions when incidents do occur, including the patient’s perspective to inform additional prevention measures; and providing clinician and staff development/training on de-escalation techniques.

The Commonwealth Fund and Council of State Governments Release Policy Options to Advance Mental Health

The Commonwealth Fund and the Council of State Governments have released Mental Health Resource Guide for State Policymakers, a new resource based on state priorities, best practices, and perspectives from leaders in the field of mental health. Overseen by an advisory group of state legislators, health officials, and experts, the guide focuses on four policy areas: social isolation and loneliness, maternal mental health, social determinants of mental health, and mental health insurance parity. “The resource guide addresses the issue of workforce shortages, and also highlights ways to stretch existing resources, including, for instance, providing peer support and consultation between primary care and behavioral health providers,” The Commonwealth Fund noted in its announcement about the guide. “Some strategies include expanding telehealth psychiatric services and incorporating mental health screening and interventions into various settings like schools, senior centers, workplaces, primary care offices, and in law enforcement.”

ASAM and Well Being Trust Release Toolkit for Strengthening Patient-Centered Addiction Care

The American Society of Addiction Medicine (ASAM) and the Well Being Trust this week released Speaking the Same Language: A Toolkit for Strengthening Patient-Centered Addiction Care in the United States, a toolkit written by Manatt Health Strategies to emphasize the need for adopting a common framework to addiction care in the United States. The toolkit is meant to educate stakeholders about the strategies and tools available to support more effective implementation of The ASAM Criteria and also provide legislative, regulatory, and contractual language that interested states can use.

SAMHSA to Host Webinar on Behavioral Health Equity on Tuesday, Nov. 16

The Substance Abuse and Mental Health Services Administration (SAMHSA) will host Advancing Behavioral Health Equity: National CLAS Standards in Action on Tuesday, Nov. 16 at 2:30 p.m. ET. The webinar will examine real-world examples of behavioral health service providers who use the National Standards for Culturally and Linguistically Appropriate Services (CLAS) and the Behavioral Health Implementation Guide. Presenters include Assistant Secretary for Mental Health and Substance Use Miriam Delphin-Rittmon, Ph.D. and Rear Admiral Felicia Collins, M.D., M.P.H., director of the U.S. Health and Human Services Department’s Office of Minority Health. Click here to register.

NABH 2021 Annual Meeting Photos and Recorded Sessions Now Available!

Photos and recorded sessions from last month’s Annual Meeting are now available on the association’s Annual Meeting webpage. NABH looks forward to welcoming members to the 2022 Annual Meeting in Washington from June 13-15, 2022!

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Fact of the Week

A new study shows that the Centers for Disease Control and Prevention’s 2016 Guideline for Prescribing Opioids for Chronic Pain was associated with substantial reductions in dispensing opioids, including a reduction in patients’ rate of receiving at least one opioid prescription by about 20 percentage points by December 2018 with the counterfactual, no-guideline scenario. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 170

Written by Emily Wilkins (NABH) on November 5, 2021. Posted in CEO Updates.

CMS Issues Emergency Rule Requiring Covid-19 Vaccination for Medicare & Medicaid Providers

The Centers for Medicare & Medicaid Services (CMS) on Thursday issued an emergency regulation requiring Covid-19 vaccination for eligible staff at certain healthcare facilities that participate in the Medicare and Medicaid programs. Facilities covered under this regulation must establish a policy that ensures all eligible staff have received the first dose of a two-dose Covid-19 vaccine or a one-dose Covid-19 vaccine by Dec. 5, 2021 before they provide any care or treatment, CMS said in its announcement. All eligible staff must have received the necessary shots to be vaccinated—either two doses of the Pfizer or Moderna vaccines or one dose of the Johnson & Johnson vaccine—by Jan. 4, 2022. The regulation provides exemptions based on recognized medical conditions, religious beliefs, observances, or practices. “Ensuring patient safety and protection from Covid-19 has been the focus of our efforts in combatting the pandemic and the constantly evolving challenges we’re seeing,” CMS Administrator Chiquita Brooks-LaSure said in the announcement. “Today’s action addresses the risk of unvaccinated healthcare staff to patient safety and provides the stability and uniformity across the nation’s healthcare system to strengthen the health of people and the providers who care for them.” The regulations became effective today, Friday, Nov. 5, and CMS will accept comments on this interim final rule until Jan. 4, 2022. Click here for details about submitting comments.

OSHA Releases Covid-19 Vaccination and Testing Requirements in the Workplace

The Occupational Safety and Health Administration (OSHA) on Thursday released an emergency temporary standard (ETS) that requires employers with 100 or more employees to develop, implement, and enforce a mandatory Covid-19 vaccination policy to minimize the risk of the deadly coronavirus. In the highly anticipated rule, OSHA noted an exception for employers who instead adopt a policy that requires employees to choose either to get vaccinated or to undergo Covid-19 testing at least once per week in the workplace and wear a face covering at work. The testing requirement for unvaccinated workers is scheduled to begin on Jan. 4, 2022, and employers must comply with all other requirements in the ETS—such as providing paid time off for employees to get vaccinated and “reasonable time and paid sick leave” to recover from the vaccination’s potential side effects—by Dec. 6, 2021. Employees who fall under the ETS rule must have their final vaccination dose by Jan. 4, 2022. “We must take action to implement this emergency temporary standard to contain the virus and protect people in the workplace against the grave danger of Covid-19,” U.S. Labor Secretary Marty Walsh said in a news release. “Many businesses understand the benefits of having their workers vaccinated against Covid-19, and we expect many will be pleased to see this OSHA rule go into effect.” According to the rule, states and U.S. territories that have their own OSHA-approved occupational and health plans must “either amend their standards to be identical or ‘at least as effective’ as the new standard or show that an existing state plan standard covering this area is ‘at least as effective’ as the new federal standard.” Of the 28 states and territories with OSHA-approved state plans, 22 cover both public and private sector employees and six states and territories (Connecticut, Illinois, Maine, New Jersey, New York, and the Virgin Islands) cover only state and local governments. OSHA released a fact sheet about the ETS and will accept written comments about any aspect of the rule by Dec. 6, 2021. Click here to submit comments and attachments.

CMS Releases Final Medicare Physician Fee Schedule and OPPS Rules for 2022

CMS this week released both the final Medicare Physician Fee Schedule (PFS) and final hospital outpatient prospective payment system (OPPS) regulations for 2022. Highlights for both regulations are included below. PFS Highlights: The final PFS for next year includes a cut to practitioner rates due to a statutory budget neutrality requirement. In addition, a 3.75% payment increase provided in the Consolidated Appropriations Act for 2021 is expected to expire. Click here for additional details about the agency’s payment provisions. For telehealth services, the Medicare program will continue covering mental health and substance use disorder services via telehealth after the public health emergency ends. The frequency of in-person visits that will be required for those receiving care via telehealth has been modified to lessen the frequency. Instead of every six months, CMS changed its proposal to require in-person visits once every 12 months for those receiving behavioral health treatment via telehealth. CMS also will allow for exceptions to this 12-month interval if both the provider and patient agree the risks and burdens outweigh the benefits and this is documented. The requirement that beneficiaries receiving mental health treatment via telehealth must have been seen in-person during the prior six months before the first telehealth service will be maintained because this previous in-person visit requirement was established in the statute. Meanwhile, Medicare will continue to cover audio-only telehealth for mental health. CMS also clarified that MH services include treatment of substance use disorders for purposes of Medicare coverage of audio-only telehealth. Providers must have the capacity to offer telehealth via audio and visual technology. CMS is requiring use of a service-level modifier for services provided via audio-only telehealth. Medicare will continue to cover a long list of services covered via telehealth on a temporary basis during the pandemic until the end of CY 2023. Click here to see the telehealth services that will be covered for 2022. For the nation’s Opioid Treatment Programs (OTPs), the Medicare program will continue to cover individual and group therapy and substance use counseling provided by OTPs via audio-only, telehealth technology after the public health emergency ends. This coverage of audio-only is limited to situations when video is not available to the beneficiary or they do not consent to the use of video. In addition, CMS made final the proposal that new service-level modifier be appended to claims submitted for the counseling and therapy add-on code when services are furnished via audio-only. The agency is not finalizing the prior proposal to require additional documentation in the medical record to support the use of audio-only services. CMS also finalized its proposals to provide annual updates and locality adjustments for the add-on payments for the non-drug components for opioid antagonist medication (i.e., naloxone) that were new for CY 2021, to provide a new code for a higher dose of the naloxone nasal spray, pricing methodologies for this higher dose naloxone product; reaffirmed recoupment of duplicative payments for naloxone (where separately paid under Medicare Part B or D) from the OTP; and finalized a new code (G1028) for a higher dose 8mg naloxone nasal spray. The agency also published an interim final rule, the “Opioid Treatment Programs: CY2022 Methadone Payment Exception” in which CMS proposes to extend 2021 OTP reimbursement rates for methadone under the OTP benefit through 2023. OPPS Rule Highlights: In this rule, CMS made final its earlier proposal to set a minimum civil monetary penalty of $300 per day that would apply to smaller hospitals with bed counts of 30 or fewer beds and apply a penalty of $10 per bed, per day for hospitals with a bed count greater than 30 beds, not to exceed a maximum daily dollar amount of $5,5500. The maximum would be imposed if hospitals do not provide documentation of bed counts. CMS also finalized its proposal to maintain the existing methodology for per diem partial hospitalization rates using calendar year (CY) 2019 claims and cost report data to develop the CY 2022 rates. CMS will also use the CY 2021 finalized per diem costs as cost floors for CY 2022. CMS did not specify that Medicare will continue coverage of services by partial hospitalization programs (PHPs) via telehealth. The agency noted comments, including some from NABH, that expressed strong support for continued coverage and said it will consider these comments in future rulemaking. The agency did not address whether Medicare would continue to cover PHP facility fees for telehealth services, which could require a legislative change.

NABH Supports Sound the Alarm for Kids! Campaign

NABH is proud to be one of more than 75 organizations to support Sound the Alarm for Kids!, a campaign from the Children’s Hospital Association, American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatrists to urge Congress to enact legislation and increase funding to address children’s mental health. The campaign notes there has been a 25% increase in overall mental health-related emergency department visits for kids between the ages of 5 and 11 between 2019 and 2020, while emergency department visits for youth between the ages of 12 and 17 have seen a 31% increase in that same period. “The latest data from SAMHSA show that almost 3 million adolescents had serious thoughts of suicide last year, with more than 1 million who said they made suicide plans,” NABH President and CEO Shawn Coughlin said in the campaign’s news release on Nov. 2. “These statistics are even more troubling as we face significant shortages across behavioral healthcare professions and treatment settings,” he added. “We are eager to work with policymakers, workforce agencies, and partner organizations to identify where the gaps in access to care are—and how we can fill those gaps.”

Aaron Beck, M.D., ‘Father of Cognitive Therapy’ Dies at 100

NABH remembers with grateful appreciation psychiatrist Aaron Beck, M.D., who died Nov. 1 in Philadelphia, for his pragmatic approach to psychotherapy that changed the treatment of depression, anxiety, and other mental disorders in the United States. “He took a hundred years of dogma, found that it didn’t hold up, and invented something brief, lasting and effective to put in its place,” Steven Hollon, a psychologist at Vanderbilt University, told The New York Times. “He basically saved psychotherapy from itself.”

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Fact of the Week

Grant funding from the National Institute of Mental Health (NIMH) for research into bipolar disorder is lower than funding for other serious mental illness research and focuses heavily on basic science research instead of clinical research, according to an article published in Journal of Affective Disorders. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 168

Written by Emily Wilkins (NABH) on October 22, 2021. Posted in CEO Updates.

Provider Relief Fund Phase 4 Application Deadline is Next Week

The U.S. Health and Human Services Department (HHS) will accept applications for Phase 4 of the Provider Relief Fund (PRF) and American Rescue Plan (ARP) rural payments through next Tuesday, Oct. 26 by 11:59 p.m. ET. PRF Phase 4 is open to a broad range of healthcare providers affected by the Covid-19 pandemic, and ARP Rural is open to Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) providers who serve rural patients. Click here for more information and here to apply. And if you missed it, HHS hosted a briefing session to provide information about these funding opportunities. Click here to watch the video.

CDC Estimates About 20% of Adults Received Some Mental Health Treatment in 2020

A new report from the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics estimates that 20.3% of adults received any mental health treatment in 2020, including 16.5% who had taken prescription medication for their mental health and 10.1% who received counseling or therapy from a mental health professional. The data also showed that women were more likely than men to have received any mental health treatment, and that non-Hispanic white adults (24.4%) were more likely than non-Hispanic black (15.3%), Hispanic (12.6%), and non-Hispanic Asian (7.7%) adults to have received any mental health treatment. Meanwhile, as the level of urbanization decreased, the percentage of adults who had taken medication for their mental health increased, and the percentage who had received counseling or therapy decreased, the report showed.

Bipartisan Policy Center Webinar Discusses Mental Health Workforce Shortage

The Bipartisan Policy Center this week hosted a panel of healthcare and policy experts to discuss solutions to the nation’s mental health workforce shortage, including workforce expansion, community training, and behavioral healthcare and primary care service integration. Panelists included Benjamin Miller, Psy.D., president of the Well Being Trust; former U.S. Surgeon General Regina Benjamin, M.D., who is also founder and CEO of BayouClinic, Inc.; and Shekhar Saxena, M.D., professor of the Practice of Global Mental Health, Harvard T.H. Chan School of Public Health. Click here to watch the recorded webinar.

Urban Institute Study Examines Commercial Insurance Markups Over Medicare Prices

Psychiatry was among a group of medical specialties that had the lowest commercial markups relative to Medicare prices, according to a new study from the Urban Institute. The report shows that family medicine, obstetrics and gynecology, dermatology, ophthalmology, and psychiatry averaged about 110% of Medicare rates or less, while the following nine specialties received commercial payments between 120% and 150% of Medicare rates, on average: gastroenterology, cardiology, general surgery, and orthopedics. Researchers analyzed March 2019 to February 2020 data from FAIR Health’s private health insurance claims database covering more than 150 million people nationwide. The sample included 17 physician specialties and about 20 services per specialty that represent about 40% of total professional spending. FAIR Health is an independent, national, not-for-profit organization that provides information to consumers.

NABH Wants to Hear from You: Please Evaluate the 2021 Annual Meeting

NABH this week sent Annual Meeting attendees a survey to evaluate the 2021 Annual Meeting. If you attended the meeting and have not submitted an evaluation, please take a moment to complete the survey. As a reminder, our Speakers & Presentations page includes presentations that NABH has permission to post publicly, and the 2021 Exhibitor & Sponsor Guide is available on both the NABH Resources and Exhibitors & Sponsors pages on our website. Annual Meeting photos and videos will be posted to our Annual Meeting page later this month. We look forward to seeing everyone in Washington from June 13-15, 2022 for next year’s Annual Meeting!

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Fact of the Week

A new study published in Health Affairs found that people with mental health disorders had 50% higher rates of severe maternal morbidity compared with people without mental health disorders, and $458 higher costs per delivery hospitalization. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 167

Written by Emily Wilkins (NABH) on October 15, 2021. Posted in CEO Updates.

HHS Hosts Technical Webinars as Provider Relief Fund Phase 4 Application Deadline Approaches

The U.S. Health and Human Services Department (HHS) will accept applications for Phase 4 of the Provider Relief Fund (PRF) through Tuesday, Oct. 26. HHS’ Health Resources and Services Administration (HRSA) administers provider relief programs and is using a single application portal to make $17 billion in PRF phase 4 general distribution payments and $8.5 billion in American Rescue Plan Act (ARP) rural payments available to the nation’s providers. To offer guidance for providers, HRSA has produced a series of webinars for Phase 4 and ARP rural applications on how to navigate the application portal and provide the required financial documentation. These sessions include:

Phase 4 and ARP Rural: Overview and Portal Demonstration
- Thursday, Sept. 30: View the recorded webcast.
- Tuesday, Oct. 5: View the recorded webcast.
- Download the slides.

Phase 4 and ARP Rural: Providing Supporting Documentation
- Wednesday, Oct. 13: View the recorded webcast.
- Thursday, Oct. 21: 3 p.m. to 4 p.m. ET: Register to attend.

HHS also hosted a briefing session to provide information about these funding opportunities. Click here to watch the video.

NASHP Examines How States are Spending American Rescue Plan Act Funds

The National Academy for State Health Policy (NASHP) has developed a state-by-state analysis to show how states are using funds from the $1.9 trillion American Rescue Plan Act (ARP) that became law on March 11, 2021. The ARP provides considerable funding for continued pandemic response, including $195.3 billion in Coronavirus State Fiscal Recovery Funds for the 50 states and Washington, D.C. Those funds must be obligated by Dec. 31, 2024 and expended by Dec. 31, 2026. Click here to view NASHP’s map and accompanying state profiles to see the status of the State Fiscal Recovery Fund.

Palo Alto University Announces Training to Incorporate Digital Therapy Tools in Mental Health Practices

Palo Alto University has announced it will begin offering a 50-hour training program for incorporating digital therapy tools into mental health practices. According to the university, the new program—Foundations of Digital Mental Health— will offer “foundational knowledge, training, and best practices necessary” for delivering mental health services online. Course topics include Technology and Mental Health for Children and Adolescents: Screen Time, Digital Interventions, and Teletherapy; Suicide, Risk Assessment & Treatment Planning Via Tele-Mental Health; and Evidence-Based Internet Interventions to Reduce Health Disparities. Click here to learn more and to register.

NABH 2021 Annual Meeting Presentations & Exhibitor & Sponsor Guide Available Online

Thank you to all who attended NABH’s 2021 Annual Meeting in Washington last week! NABH was pleased to welcome in person top officials from SAMHSA and the U.S. Labor Department, former National Institute of Mental Health Director Tom Insel, M.D., New York Times bestselling author and four-time Emmy winner Larry Sabato, Ph.D. of the University of Virginia, award-winning singer and mental health advocate Judy Collins, and others. Please visit our Speakers & Presentations page to view the presentations that included slides and that NABH has permission to post publicly. Also, NABH mailed copies of the 2021 Exhibitor & Sponsor Guide to members this week, and the guide’s online version is available on both the NABH Resources and Exhibitors & Sponsors pages on our website. Annual Meeting photos and videos will be posted to our Annual Meeting page later this month. We look forward to seeing everyone in Washington from June 13-15, 2022 for next year’s Annual Meeting!

Please Nominate Members to the 2022 NABH Board of Trustees Slate of Candidates Today!

Please help the NABH Selection Committee identify potential candidates for Board Chair-Elect and two Board seats that will become available in 2022 The Selection Committee is particularly interested in identifying senior managers who represent the broad diversity within the NABH membership, including various levels of care, organizational structures, and size. Please download a nomination form to share your recommendations of individuals you would like to see included in the single-slate ballot for 2022. Please attach a curriculum vitae (CV) for each individual you recommend. This will help the Selection Committee in its deliberations. You are welcome to suggest yourself. Please return this form and candidates’ CVs to maria@nabh.org by the end of today, Oct. 15.

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Fact of the Week

An analysis of electronic health records of nearly 580,000 fully vaccinated people in the United States found that the risk of SARS-CoV-2 breakthrough infection among vaccinated patients with substance use disorders was low overall, but higher than the risk among vaccinated people without substance use disorders. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 166

Written by Emily Wilkins (NABH) on October 1, 2021. Posted in CEO Updates.

Reminder: Provider Relief Fund Phase 4 Application Deadline is Oct. 26

The U.S. Health and Human Services Department (HHS) is accepting applications for phase 4 of the Provider Relief Fund (PRF) through Tuesday, Oct. 26. HHS’ Health Resources and Services Administration (HRSA) administers provider relief programs and is using a single application portal to make $17 billion in PRF phase 4 general distribution payments and $8.5 billion in American Rescue Plan rural payments available to the nation’s providers. Click here to learn more about the programs and how to apply.

President Biden Honors Everyone in Recovery in Video Message

President Biden helped to conclude National Recovery Month this week with a brief video celebrating all Americans in recovery. The president acknowledged that about 23 million Americans are in recovery and millions more are affected by addiction. He also sent a clear message to people who are not in recovery, and to people with loved ones who are not in recovery. “You are not alone. This is personal to millions of families,” President Biden said. “This is personal to my family. My son has written about it. And I know—I know there is hope,” he added. “Treatment works. Recovery is possible. And my administration is here to support every person and their family on their journey to recovery.”

SAMHSA to Establish New Office of Recovery

The Substance Abuse and Mental Health Services Administration (SAMHSA) is launching an Office of Recovery within the Office of the Assistant Secretary for Mental Health and Substance Use to advance the agency’s commitment to recovery for all Americans. “We have identified recovery as a crosscutting principle throughout SAMHSA’s policies and programs,” Assistant Secretary for Mental Health and Substance Use Miriam Delphin-Rittmon, Ph.D. said in an announcement. “In standing up this new office, SAMHSA is committed to growing and expanding recovery support services nationwide.” SAMHSA’s announcement said the new office will have a dedicated team with an understanding of recovery to promote policies, programs, and services to those in or seeking recovery.

NABH 2021 Annual Meeting is Next Week

NABH is pleased to welcome attendees to the NABH 2021 Annual Meeting in Washington Oct.6-8! Please join us at the Mandarin Oriental hotel and hear from our speakers, including Acting Assistant Secretary Ali Khawar from the U.S. Labor Department’s Employee Benefits Security Administration, SAMHSA Administrator Miriam Delphin-Rittmon, Ph.D., former National Institute of Mental Health Director Tom Insel, M.D., folk singer and mental health advocate Judy Collins, and more. Learn more about our speakers on our Annual Meeting webpage, and please be sure to register if you have not done so yet. We look forward to seeing you next week!

Please Nominate Members to the 2022 NABH Board of Trustees Slate of Candidates

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Fact of the Week

Physicians have prescribed 44% fewer opioids over the past decade, yet fatal and non-fatal drug overdoses have continued to climb, according to a new report from the American Medical Association.

CEO Update Will Publish Next on Friday, Oct. 15

NABH will not publish CEO Update next week due to the Annual Meeting. Please look for our next edition on Friday, Oct. 15. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 165

Written by Emily Wilkins (NABH) on September 24, 2021. Posted in CEO Updates.

NABH to Welcome SAMHSA Administrator Miriam Delphin-Rittmon, Ph.D. at 2021 Annual Meeting

Assistant Secretary for Mental Health and Substance Use Miriam Delphin, Rittmon, Ph.D. will address attendees at the 2021 NABH Annual Meeting on Thursday, Oct. 7 at 1:30 p.m. Dr. Miriam Delphin-Rittmon serves as administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA). She previously served for six years as commissioner of the Connecticut Department of Mental Health and Addiction Services. Prior to her appointment at SAMHSA, Dr. Delphin-Rittmon was an adjunct associate professor at Yale University, where she served on faculty for 20 years. At Yale, Dr. Delphin-Rittmon served as the director of Cultural Competence and Research Consultation with the Yale University Program for Recovery and Community Health. In May 2014, Dr. Delphin-Rittmon completed a two-year White House appointment working as a senior advisor to the administrator at SAMHSA. In that position, she worked on a range of policy initiatives addressing behavioral health equity, workforce development, and healthcare reform. Throughout her career in the behavioral health field, Dr. Delphin-Rittmon has extensive experience in the design, evaluation, and administration of mental health, substance use and prevention services and systems and has received several awards for advancing policy in these areas. Please visit our Annual Meeting homepage to learn more about our speakers and register for the meeting, if you have not done so yet. We look forward to seeing you in Washington!

Joint Commission Names HCA’s CMO Jonathan Perlin, M.D., Ph.D. as Next President

The Joint Commission’s Board of Commissioners this week named Jonathan Perlin, M.D., Ph.D. as the organization’s next president, effect March 1, 2022. Perlin serves currently as president of clinical operations and chief medical officer of Nashville-based HCA Healthcare, where he leads a team of clinicians and data scientists in setting clinical and professional policy, implementing clinical data tools, and working to improve outcomes. Before he joined HCA in 2006, Perlin served as the under secretary for health at the U.S. Veterans Affairs Department and later served as chair of the Veterans Affairs’ secretary’s special medical advisory group. Perlin earned a master of science degree in health administration and a doctorate in pharmacology with his medical degree as part of the physician scientist training program at the Medical College of Virginia.

Joint Webinar to Present New Directions for Substance Use Prevention is Sept. 27

The National Institute on Drug Abuse (NIDA), the Partnership to End Addiction, and the American Psychological Association will host a webinar on Monday, Sept. 27 that will highlight how to establish a framework for an earlier and broad approach to substance use prevention. Former NIDA Director Nora Volkow, M.D. will serve as one of the speakers during the presentation, which will also help participants learn how to implement an earlier and broader approach using today’s policy environment. The webinar will begin at noon ET. Click here to register.

CMS to Host Webinar on Hospital Restraint and Seclusion on Sept. 28

The Centers for Medicare & Medicaid Services (CMS) will host a webinar titled “CMS Hospital Restraint and Seclusion: Navigating the Most Problematic CMS Standards and Proposed Changes” on Tuesday, Sept. 28. Webinar instructor Laura Dixon served as director of facility patient safety and risk management and operations for COPIC, a professional medical liability insurance provider, from 2014 until 2020. Dixon will lead the webinar, which will define the CMS restraint requirement of what hospitals must document in internal logs if a patient dies within 24 hours with having two soft restraints on; describe that CMS has restraint-education requirements for staff; discuss specific items that must be documented in the medical record for the one-hour, face-to-face evaluation on patients who are violent or self-destructive; and more. The hourlong webinar will begin at 1 p.m. ET on Sept. 28. Click here to learn more and register.

Please Nominate Members to the 2022 NABH Board of Trustees Slate of Candidates

Please help the NABH Selection Committee identify potential candidates for Board Chair-Elect and two Board seats that will become available in 2022. The Selection Committee is particularly interested in identifying senior managers who represent the broad diversity within the NABH membership, including various levels of care, organizational structures, and size. Please download a nomination form to share your recommendations of individuals you would like to see included in the single-slate ballot for 2022. Please attach a curriculum vitae (CV) for each individual you recommend. This will help the Selection Committee in its deliberations. You are welcome to suggest yourself. Please return this form and candidates’ CVs to maria@nabh.org by Friday, Oct. 15, 2021.

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Fact of the Week

From 2014 to 2018, emergency department visits made by adults with alcohol and substance use disorders increased by 30%, while hospitalizations among patients with those disorders increased by 57%, according to a new study in the Journal of General Internal Medicine. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 164

Written by Emily Wilkins (NABH) on September 17, 2021. Posted in CEO Updates.

HHS Provides More Information About Latest Covid Provider Relief Fund Announcement

The U.S. Health and Human Services Department (HHS) this week hosted a webinar to provide details about the department’s recent announcement that it is making available $25.5 billion in new Covid relief funding for providers. The department also released some fact sheets, including one about the payment methodology for phase three funding, information about the application process and eligibility, and provider relief funding reporting requirements. These materials are posted on NABH’s Covid-19 resources page.

NABH Comments on 2022 Medicare Physician Payment Schedule & OPPS Proposed Rules

NABH this week sent comment letters to the Centers for Medicare & Medicaid Services (CMS) about two proposed rules for fiscal year 2022: the Physician Payment Schedule and Hospital Outpatient Prospective Payment System. In the physician payment schedule letter, NABH provided an overview and statistics to support what behavioral healthcare providers have managed during the Covid-19 pandemic as the need for mental health and addiction treatment services continues to rise. NABH strongly supported Medicare coverage of audio-only telehealth mental health services and opioid treatment program services; opposed the agency’s in-person requirement for coverage of telehealth for mental health services; opposed the CMS’ proposal to reduce reimbursement for behavioral health providers to implement budget-neutrality requirements; encouraged CMS to seek comments on reimbursing for contingency management services; and more. Commenting on CMS’ hospital outpatient prospective payment system rule, NABH supported the agency’s proposals to use the 2021 calendar year reimbursement rates for partial hospital as the cost floor for 2022 rates and to use 2019 data to calculate the 2022 rates. The association also recommended that CMS continue to cover partial hospitalization program services via audio-only telehealth. “Our members are concerned that many of their more vulnerable patients are unemployed or under-employed and sometimes homeless and do not have access to video technology. Moreover, access to broadband service to support video and audio technology is often very limited in rural areas,” NABH’s letter said. “These regions also face the most severe shortages of behavioral healthcare providers— particularly PHP providers,” it continued. “Limiting coverage to PHP services via telehealth to video and audio technology will limit the utility of telehealth for reaching individuals that face the greatest barriers to accessing PHP providers.

Virtual Congressional Briefing Next Week to Highlight How Recovery Supports Save Lives

Substance Abuse and Mental Health Services Administration (SAMHSA) Administrator Miriam Delphin-Rittmon, Ph.D. will offer remarks at “Turning Policy Into Action—How Recovery Supports Save Lives,” a virtual congressional briefing on Tuesday, Sept. 21 at 2 p.m. ET. Other speakers will include U.S. Surgeon General Vivek Murthy, M.D., Rep. Paul Tonko (D-N.Y.), Rep. David McKinley, (R-W.Va.), and leaders from some addiction and recovery organizations. Click here to register.

Joint Webinar to Present New Directions for Substance Use Prevention is Sept. 27

The National Institute on Drug Abuse (NIDA), the Partnership to End Addiction, and the American Psychological Association will host a webinar on Monday, Sept. 27 that will highlight how to establish a framework for an earlier and broad approach to substance use prevention. Former NIDA Direct Nora Volkow, M.D. will serve as one of the speakers during the presentation, which will also help participants learn how to implement an earlier and broader approach using today’s policy environment. The webinar will begin at noon ET. Click here to register.

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

2021 NABH Annual Meeting Hotel Cut-Off Date is Today!

Please be sure to reserve your hotel room today at the Mandarin Oriental Washington, DC for the 2021 NABH Annual Meeting. The hotel’s room reservation cut-off date is today, Friday, Sept. 17, 2021. And please visit our Annual Meeting webpage to register for the meeting, learn about our speakers, and view the list of our exhibitors and sponsors. We look forward to seeing you in Washington!

Fact of the Week

A new survey of 1,250 U.S. military veterans who served in Afghanistan sometime between the period 2001-2021 showed that 90% of those veterans with a history of mental illness are experiencing new or worsening mental health systems since the Taliban takeover in late August. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 163

Written by Emily Wilkins (NABH) on September 10, 2021. Posted in CEO Updates.

HHS Announces $25.5 Billion in Covid-19 Provider Funding

The Biden administration announced Friday that the U.S. Health and Human Services Department (HHS) is making available $25.5 billion in new funding for healthcare providers affected by the Covid-19 pandemic. According to an announcement, the funding—which HHS is making available through the Health Resources and Services Administration (HRSA)—includes $8.5 billion in American Rescue Plan resources for providers who serve rural Medicaid, Children’s Health Insurance Program (CHIP), or Medicare patients, and an additional $17 billion for Provider Relief Fund (PRF) Phase 4 for a wide range of providers who can document revenue loss and expenses associated with the pandemic. “This funding critically helps healthcare providers who have endured demanding workloads and significant financial strains amidst the pandemic,” HHS Secretary Xavier Becerra said in the announcement. “The funding will be distributed with an eye towards equity, to ensure providers who serve our most vulnerable communities will receive the support they need.” HHS also said that consistent with requirements included in the Coronavirus Response and Relief Supplemental Appropriations Act of 2020, PRF Phase 4 payments will be based on providers’ lost revenues and expenditures between July 1, 2020 and March 31, 2021. The combined application for American Rescue Plan funding and PRF Phase 4 will open on Sept. 29.

Biden Administration to Expand Vaccination Requirements for Healthcare Facilities

The Biden administration on Thursday announced it will require Covid-19 vaccinations for staff within all Medicare and Medicaid-certified facilities to protect both healthcare workers and patients from the deadly virus and its more contagious Delta variant. The Centers for Medicare & Medicaid Services (CMS) said it is developing an interim final rule with comment period that it expects to release in October. “As the Delta variant continues to spread, we know the best defense against it lies with the Covid-19 vaccine,” CMS Administrator Chiquita Brooks-LaSure said in a news release. “Data show that the higher the level of vaccination rates among providers and staff, the lower the infection rate is among patients who are dependent upon them for care,” she continued. “Now is the time to act. I’m urging everyone, but especially those fighting this virus on the front lines, to get vaccinated and protect themselves, their families, and their patients from Covid-19.” The NABH team will continue to learn more and keep members apprised of how the new rule will affect providers who work in psychiatric facilities and addiction treatment centers.

SAMHSA Awards $17.8 Million for Mental Health Awareness Training

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced it has released 145 awards totaling $17.8 million to help communities build mental health awareness among individuals who interact with people who experience or exhibit symptoms of a mental health disorder and refer them to appropriate services. Each Mental Health Awareness Training grant recipient will receive up to $125,000 for the first year of this five-year grant program, which will train school personnel, emergency first responders, law enforcement, veterans, armed services members, and their families to recognize the signs and symptoms of mental health disorders, particularly serious mental illness and/or serious emotional disturbances, to respond safely and appropriately. Click here to read the list of grant recipients.

NABH Sends Comments to CMS on Surprise Billing

In a letter to CMS this week, NABH highlighted the increased need for mental health and addiction treatment during the pandemic and asked the agency to mitigate the extent to which new surprise billing rules impose additional burdens on behavioral healthcare providers. “Many psychiatric hospitals have negative net operating margins despite offering services that are in high demand in communities across the country,” NABH said in its letter about CMS’ requirements related to surprise billing. “The Covid-19 pandemic has added to the strain on these facilities with additional financial losses and unexpected costs, including those related to greatly increased use of personal protective equipment, increased screening of individuals coming into the facilities with additional staffing needs for screening, and other infection-control measures, including isolation rooms and units, software and hardware purchases to facilitate telework for administrative staff and telehealth for patients, and lost revenue due to 2 decreased patient volume because of infection concerns and reduced referrals.” NABH added that it supports the position in the agency’s rules to “exclude behavioral healthcare services from the prohibition on notice and consent to balance bill.” Click here to read CMS’ July news release about the surprise billing requirements and here to read the interim final rule.

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is available for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

2021 NABH Annual Meeting Hotel Cut-Off Date is Next Week

Please be sure to reserve your hotel room today at the Mandarin Oriental Washington, DC for the 2021 NABH Annual Meeting! The hotel’s cut-off date is next Friday, Sept. 17, 2021. And please visit our Annual Meeting webpage to register for the meeting, if you have not done so yet. We look forward to seeing you in Washington!

Fact of the Week

Findings from a new study suggest a co-response team could lead to a lower chance of an individual entering into the criminal justice system during a crisis call with police, which has major implications for reducing the criminalization of mental illness if alternatives to police response for people with serious mental illness continues to spread throughout the United States. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 162

Written by Emily Wilkins (NABH) on September 3, 2021. Posted in CEO Updates.

SAMHSA’s Distress Helpline Available for Victims of Hurricane Ida

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Disaster Distress Helpline (DDH) is providing immediate crisis counseling to people who have experienced Hurricane Ida, including survivors, first responders, witnesses, or those who have seen related media reports. In a statement, Assistant Secretary for Mental Health and Substance Use Miriam Delphin-Rittmon, Ph.D. urged people to access the helpline, adding that people who have lived through a traumatic event can experience anxiety, worry, or insomnia. Disaster survivors and responders can call the DDH at 1-800-985-5990 24 hours a day, seven days a week, 365 days a year. Click here for more information. NABH appreciates and thanks its members who have continued to provide quality behavioral healthcare services in regions of the United States that Hurricane Ida has affected.

MACPAC Publishes Briefs on Healthcare Needs in Criminal and Juvenile Justice Systems

The Medicaid and CHIP Payment and Access Commission (MACPAC) has released a series of fact sheets on topics related to behavioral healthcare, including two focused on the healthcare needs of adults in the criminal justice system and adolescents in the juvenile healthcare system. In its brief Health Care Needs of Adults in the Criminal Justice System, MACPAC reported that, “with few exceptions, Medicaid beneficiaries under community supervision reported higher rates of behavioral health conditions than their privately insured or uninsured peers. They also reported receiving mental health or substance use disorder (SUD) treatment at higher rates. However, Black beneficiaries with behavioral health conditions reported receipt of treatment at lower rates than their white peers.” Meanwhile, nearly one third (31.0%) of those with mental illness reported that they needed mental health treatment or counseling but did not receive it. These rates did not differ by coverage type. Female beneficiaries with a mental health condition who were under community supervision reported higher rates (41.0%) of unmet need than their male counterparts (21.3%). In addition, beneficiaries under community supervision with SUD were more likely to engage in treatment compared with those with private insurance, or adults who are uninsured (see Table 9 in the brief). Specifically, they were nearly twice as likely as privately insured or uninsured peers to report receiving such treatment in the past year. In its brief Health Care Needs and Use of Services by Adolescents Involved with the Juvenile Justice System, MACPAC concluded the following findings:

Roughly 21.7% of youth who stayed in jail or juvenile detention reported experiencing a major depressive episode (MDE) at some point in their lifetime, and approximately 16.4% reported experiencing one in the past year.

Among Medicaid beneficiaries who stayed in jail or juvenile detention, females were nearly three times as likely to experience a MDE in the past year compared with their male peers. They also reported receipt of specialty mental health treatment at higher rates.

Few Medicaid beneficiaries report receipt of mental health treatment while in jail or juvenile detention.

Roughly one in five beneficiaries who stayed in jail or juvenile detention had a substance use disorder in the past 12 months. However, only 16.9% received treatment in the past year.

MACPAC also released Medicaid Coverage of Qualified Residential Treatment Programs for Children in Foster Care, which offered a brief summary of the Centers for Medicare & Medicaid Services’ September 2019 guidance on the Institutions for Mental Diseases (IMD) exclusion and Qualified Residential Treatment Program (QRTPs), as well as information about how states are implementing changes to the Family First Prevention Services Act.

CAHPS Program Releases Questions to Ask Patients About Accessing Mental Healthcare Services

The Agency for Healthcare Research and Quality (AHRQ)’s Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) program has released new questions to gather information about patients’ experiences with access to mental healthcare services, including therapy and medication. An announcement noted that the six questions can be added to either the CAPHS Health Plan Survey or the CAHPS Clinician & Group Survey. Click here to review the mental healthcare questions for the Health Plan Survey 5.0 and 5.1, and here to review the mental healthcare questions for the Clinician & Group Survey 3.0 and 3.1. The agency noted that the new questions complement the CAHPS research team’s ongoing work to develop and test a standalone survey designed to assess patient experience with care for mental or behavioral health issues. Click here to learn more about CAHPS mental health surveys.

HRSA Reorganizes to Meet Priorities in Changing Healthcare Landscape

After a decade of growth, the Health Resources and Services Administration (HRSA) announced it has reorganized the agency to better meet its priorities. As part of that restructuring, HRSA has established a Provider Relief Bureau (PRB) to manage and distribute financial support for the nation’s healthcare providers as they continue to respond to the Covid-19 pandemic. HRSA also created an Office for the Advancement of Telehealth (OAT) within the Office of the Administrator to serve as HHS’ focal point for fostering telehealth use more broadly, and an Office of Special Health Initiatives (OSHI) to oversee the 340B Drug Pricing Program. Click here to see HRSA’s new organization chart and here for more details in the Federal Register.

U.S. Researchers Find Increased Likelihood of Arrhythmia Hospitalization in Youth With CUD

A new study from the American Academy of Addiction Psychiatry shows Cannabis Use Disorder (CUD) was associated with a 47% to 52% increased likelihood of arrhythmia hospitalizations in the younger population. The large, national study compared 570,000 patients between the ages of 15 and 54 who were admitted to the hospital between 2010-2014 for a primary diagnosis of arrhythmia, or an irregular heart rate, with 67,662,082 non-arrhythmia inpatients. According to the findings, atrial fibrillation was the most prevalent arrhythmia raising concerns for stroke and other embolic events. “The fact that atrial fibrillation is the most prevalent arrhythmia is of special concern since it can result in stroke and other embolic events,” researchers noted in the study. “Physicians need to familiarize themselves with cannabis abuse or dependence as a risk factor for arrhythmia.”

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is a new resource for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

2021 NABH Annual Meeting Hotel Cut-Off Date is Now Sept. 17!

Please be sure to reserve your hotel room today at the Mandarin Oriental Washington, DC for the 2021 NABH Annual Meeting! The hotel’s cut-off date is now Friday, Sept. 17, 2021. And please visit our Annual Meeting webpage to register for the meeting, if you have not done so yet. We look forward to seeing you in Washington!

Fact of the Week

Denver, Salt Lake City, and Minneapolis are reported to be the three best U.S. cities for mental health, while Dallas, Houston, and Jacksonville are the three worst, according to a new survey from telehealth company CertaPet. Researchers examined the following seven factors to determine the rankings: therapy session rate by state, total prescription charges by state, mandatory treatment laws grade by state, criminalization of mental illness by state, number of residents per one mental health provider by county, poor mental health days by county, and overall community wellbeing. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 161

Written by Emily Wilkins (NABH) on August 27, 2021. Posted in CEO Updates.

Mental Health Companies Headspace and Ginger Plan $3 Billion Merger

Mental health companies Headspace and Ginger this week announced plans to merge, forming a new company called Headspace Health with a reported value of $3 billion. A story in the publication Stat reported that the move will place the new company in the top echelon of companies competing for significant pieces of the mental health market. In addition, the pair of companies offer complementary services. Headspace sells directly to consumers and businesses and focuses on self-directed meditation, a way for companies to offer a basic mental health resource to workers. Meanwhile, Ginger is a mental health app that offers users an opportunity to chat with a trained behavioral health coach within seconds and meet with a licensed therapist or psychiatrist via video within days. Both companies were established in 2010 and claim to cover more than 100 million people worldwide, according to Stat.

Analysis of Multi-District Litigation Settlement Agreement Highlights Implications for Nation’s Overdose Crisis

A new report from two public health experts examines the implications from the recent settlement agreement that seven attorneys general announced with the three largest opioid distributors and Johnson & Johnson over lawsuits filed against them for their role in the nation’s opioid crisis. A bipartisan group of seven state attorneys general announced the settlement in July, and a key question has been whether the settlement funds—and other funds from opioid litigation—will be used wisely. The report noted that more than 50 organizations endorsed five principles to outline the process that states and local jurisdictions should implement when deciding how to use the money they will receive. NABH was among those organizations. The principles include spending the money to save lives; using evidence to guide spending; investing in youth prevention; focusing on racial equity; and developing a fair and transparent process for where to spend the funds. “Many parts of the settlement agreement are generally consistent with these principles,” wrote authors Josh Rising, M.D., a pediatrician and public health physician and Sara Whaley, a research associate at Johns Hopkins University. “However, considerable discretion in state and local implementation leaves a major role for advocacy. The best use of billions of dollars to address addiction and overdose are at stake.”

Ohio State Seeks Providers for Study on Traumatic Brain Injury Screening in Behavioral Healthcare Organizations

The Ohio State University College of Social Work is conducting a study to understand behavioral health providers’ attitudes and beliefs about screening for traumatic brain injury (TBI) in behavioral healthcare organizations. The university is currently seeking licensed behavioral health providers in the United States (i.e., psychologists, social workers, counselors, nurses, psychiatrists) to participate in this web-based study. Survey respondents will be asked to complete an online training on how to screen for TBI (approximately 30-45 minutes) and complete a 15-minute survey. Participants will receive a certificate of completion for one continuing education (CE) credit for completing the training, and also will be enrolled for the chance to win a $50 gift card. There will be 55 winners from the gift card drawing. The National Institute of Neurological Disorders and Stroke is funding the study (Grant #1F31NS124263-01), and Ph.D. candidate Kathryn A. Coxe is leading it. For additional information or questions, please contact Kathryn at: coxe.6@osu.edu. Click here to participate in the study.

Joint Commission to Start 11-part Behavioral Healthcare Accreditation Webinar Series on Aug. 28

The Joint Commission will present an 11-part Behavioral Healthcare and Human Services Accreditation Webinar Series to help providers prepare their staffs to maintain compliance. Session topics include information management, medication management, infection prevention and control, patient safety, environment of care, and more. The Joint Commission will present the series—which will be made available Aug. 28—on demand so that organization teams can view the webinars when it’s convenient for them. Click here to learn more, including information about special healthcare system discounts.

Center for Rural Opioid Prevention, Treatment & Recovery to Host Webinar Aug. 31

The Center for Rural Opioid Prevention, Treatment & Recovery (CROP+TR) will host a webinar later this month to review the prevalence of methamphetamine use and co-use with opioids, the effect of methamphetamine on the health of people with opioid use disorder, and potentially effective interventions for methamphetamine. The webinar will be held on Tuesday, Aug. 31 at 4 p.m. ET. Click here to register.

Reminder: NABH Denial-of-Care Portal is Open to Members

Singer Judy Collins and Former NIMH Director Tom Insel, M.D. to Kick Off 2021 Annual Meeting

Join us at the NABH 2021 Annual Meeting on Wednesday, Oct. 6 to hear from award-winning singer, songwriter, and author Judy Collins. A strong mental health and suicide-prevention advocate, Ms. Collins wrote Sanity and Grace in 2003 about her 33-year-old son’s death by suicide in 1992. NABH is also pleased to welcome Thomas R. Insel, M.D., co-founder and president of Mindstrong Health and former director of the National Institute of Mental Health (NIMH) at the National Institutes of Mental Health. If you have not done so yet, please register for the Annual Meeting and reserve your hotel room today. Our new hotel cut-off date is Friday, Sept. 17. We look forward to seeing you in Washington!

Fact of the Week

Research shows Black youth younger than age 13 die by suicide at nearly twice the rate of white kids, and, over time, their suicide rates have grown even as rates have decreased for white children. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 160

Written by Emily Wilkins (NABH) on August 20, 2021. Posted in CEO Updates.

SAMHSA Distributes $11 million to Train First Responders & Community Groups on Overdose Prevention

The Substance Abuse and Mental Health Services Administration (SAMHSA) has distributed 13 grants totaling $11 million to reduce the number of prescription drug and overdose-related deaths and adverse events by training first responders and other essential community groups. SAMHSA’s announcement said grantees will receive up to $850,000 per year over five years for a total of $55.2 million (this distribution was for the first year). “The more SAMHSA does to equip communities across the country to prevent fatal overdoses, the more opportunities our loved ones will have to pursue treatments for substance use disorders and experience long-term recovery,” HHS Assistant Secretary for Mental Health and Substance Use Miriam E. Delphin-Rittmon, Ph.D. said in an announcement. “This is a need that preceded the Covid-19 pandemic and has only grown more urgent over the course of the past 18 months,” added Rittmon, who leads SAMHSA. Click here to see a full list of the grant recipients.

Kaiser Family Foundation Examines Pandemic’s Effects on Parents and Children

A new report from the Kaiser Family Foundation has found that 36% of parents say their child fell behind in their social and emotional development, and about 29% said their child experienced mental health or behavioral health problems due to the Covid-19 pandemic. Kaiser’s latest Covid-19 Vaccine Monitor examines the pandemic’s effects on children’s academic and social development as a new school year approaches. Among the study’s notable conclusions is a finding that parents whose children attended school all or mostly online, or who had a mix of online and in-person schooling, were more likely than parents whose child attended school all or mostly in-person to say they had a child who had these adverse effects, even after controlling for other demographic factors and type of school setting. The study also showed that 42% of parents reported that their children experienced at least one new mental health symptom in the past 12 months that they had not experienced before the pandemic, including difficulty concentrating on schoolwork (27%), problems with nervousness or being easily scared or worried (19%), trouble sleeping (18%), poor appetite or overeating (15%), and frequent headaches or stomachaches (11%).

SAMHSA Releases Guide About Report to Congress on Preventing and Reducing Underage Drinking

SAMHSA has released a user’s guide about the agency’s report to Congress on how to prevent and reduce underage drinking. The brief resource provides an overview of the report for prevention professionals, state and local agencies, and community-based organizations.

Ohio State Seeks Providers for Study on Traumatic Brain Injury Screening in Behavioral Healthcare Organizations

Joint Commission to Start 11-part Behavioral Healthcare Accreditation Webinar Series on Aug. 28

Center for Rural Opioid Prevention, Treatment & Recovery to Host Webinar Aug. 31

Reminder: NABH Denial-of-Care Portal is Open to Members

Register Today for the NABH 2021 Annual Meeting!

Registration is open for the NABH 2021 Annual Meeting from Wednesday, Oct. 6 – Friday, Oct. 8, 2021 at the Mandarin Oriental Washington, DC. We hope you join us as we recognize our meeting theme, Expanding Access: Right Care. Right Setting. Right Time. Please visit our Annual Meeting webpage to register for the meeting and to reserve your hotel room. We look forward to seeing you in Washington!

Fact of the Week

Individuals who experience early episode psychosis (EEP) were more likely to visit the emergency department for mental health related issues and to have an inpatient psychiatric hospital stay than those with late episode psychosis (LEP), according to research published in Psychiatric Services this month. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 159

Written by Administrator on August 13, 2021. Posted in CEO Updates.

United Healthcare Sued by Labor Department

The US Department of Labor (DOL) has sued UnitedHealthcare and United Behavioral Health alleging the companies systematically limit coverage of mental healthcare more than medical and surgical care in violation of the Mental Health Parity and Addiction Equity Act and the Employee Retirement Income Security Act. The complaint filed by the DOL specifically points to discrepancies in reimbursement rates for out-of-network, non-physician mental health providers compared to rates for medical and surgical providers. In addition, the DOL complaint refers to a concurrent review program for outlier or unusual services that the companies apply broadly to all outpatient mental health benefits but only to a “very select set” of medical/surgical benefits. The complaint was filed as Walsh v. United Behavioral Health in the US District Court for the Eastern District of New York on Wednesday, Aug. 11, 2021.

The New York attorney general also sued UnitedHealth Group, United Behavioral Health, UnitedHealthcare and Oxford Health Plans, claiming the companies violated both federal and state mental health parity laws.

The companies will pay $2.5 million to resolve the Labor Department claims, $1.1 million to resolve the state’s claims, and $10 million to resolve private class action claims, according to two separate settlement agreements with the regulators and private parties.

Senate Finance Committee Launches Bipartisan Effort to Address Barriers to Mental Health Care

Senate Finance Committee Chairman Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) announced plans to develop bipartisan legislation addressing barriers to mental healthcare in a letter to Committee members issued Aug. 5, 2021. The letter requested proposals regarding the following issues in particular:

Addressing the behavioral health workforce shortage,
Supporting care integration, access, and coordination efforts,
Improving oversight, data reporting, and enforcement of mental health parity laws, and
Expanding access to telehealth services for behavioral health care.

The letter also cited Committee interest in enhancing mental health crisis care and addressing gaps in care for high need groups including individuals with serious mental illness, those experiencing homelessness, and individuals involved in the child welfare system. The letter also referred to the need to improve pediatric mental healthcare and strengthen prevention and treatment options for substance use disorders. Proposals from Committee members are due before Aug. 31, 2021. The letter also states the Committee will issue a separate request for input from public- and private-sector stakeholders. NABH is working on several fronts to ensure our legislative priorities are addressed as part of this initiative.

California Mandates Covid-19 Vaccine for Healthcare Workers

The California Department of Public Health issued an order on Aug. 5, 2021 requiring workers in healthcare facilities to be vaccinated for Covid-19 by Sept. 30, 2021. The order explicitly applies to hospitals, acute psychiatric hospitals, chemical dependency recovery hospitals, clinics and doctor offices (including behavioral health), residential substance use treatment and mental health treatment facilities, as well as other healthcare facilities. Workers subject to this requirement include those that are paid and unpaid including nurses and nursing assistants, technicians, therapists, students and trainees, contract staff not employed by the facility, and persons not involved in patient care but who could be exposed to infectious agents including clerical, dietary, environmental services, laundry, security, engineering and facilities management, and volunteer personnel. Workers may seek an exemption based on religious beliefs or qualifying medical reasons corroborated in writing by a state licensed medical professional. Exempt workers must wear masks and be tested weekly. Healthcare facilities are required to maintain records of workers’ vaccination status and provide such records to local or state public health officials upon request.

SAMHSA to Host Virtual Roundtable about Creating a Diverse Behavioral Health Workforce on Aug. 18

SAMHSA’s National Network to Eliminate Disparities in Behavioral Health will host a virtual roundtable later this month to discuss strategies that motivate racially and ethnically diverse individuals to consider behavioral healthcare as a career path. The event will address how community-based organizations are working to diversify the behavioral health workforce, such as recruiting and retaining a racially and ethnically diverse staff. SAMHSA will host the virtual roundtable on Wednesday, Aug. 18 at 1 p.m. ET. Click here to learn more and register.

Joint Commission Behavioral Healthcare and Human Services Webinar Series

The Joint Commission will hold weekly webinars starting Aug. 24 for behavioral healthcare professionals responsible for meeting accreditation standards and survey compliance. These sessions will address the following topics:

Information Management (IM), Record of Care, Treatment and Services (RC),
Medication Management (MM),
Environment of Care (EC), Life Safety (LS),
Human Resources Management (HRM),
Leadership (LD), Performance Improvement (PI),
Infection Prevention and Control (IC),
Care, Treatment, and Services (CTS),
Emergency Management (EM),
Safety Systems for Individuals Served (SSIS),
Rights and Responsibilities (RI), Waived Testing (WT), and
National Patient Safety Goals (NPSG).

Here’s a link to the registration page on the Joint Commission website.

Reminder: NABH Denial-of-Care Portal is Open to Members

Register Today for the NABH 2021 Annual Meeting!

Fact of the Week

Mental illness and substance use disorders were among the top five reasons for inpatient treatment in community hospitals among individuals under 45 years old in 2018 according to a statistical brief issued by the Agency for Healthcare Research and Quality. For questions or comments about this CEO Update, please contact Kirsten Beronio.

CEO Update 158

Written by Emily Wilkins (NABH) on August 6, 2021. Posted in CEO Updates.

Miriam Delphin-Rittmon Sworn in As Assistant Secretary for Mental Health and Substance Use

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced that Miriam Delphin-Rittmon, Ph.D., former commissioner of the Connecticut Department of Mental Health and Addiction Services, is the new assistant secretary for mental health and substance use and agency’s administrator. In May 2014, Delphin-Rittmon completed a two-year White House appointment working as a senior adviser to the then-assistant secretary for mental health and substance use and SAMHSA administrator. “Miriam’s experience in creating and administering mental health, substance use, and prevention services and systems will serve the nation well as we work to tackle the impact of the pandemic on behavioral health,” HHS Secretary Xavier Becerra said in a statement. “On top of that, her strong leadership at federal, state and local levels offers her considerable perspective,” he added. Delphin-Rittmon earned her bachelor’s degree in social science from Hofstra University in 1989, and her master and doctoral degrees in clinical psychology from Purdue in 1992 and 2001, respectively. Click here to read her full biography.

Experts Provide Advice and Templates on Writing a Medical Necessity Letter

Authors with medical, legal, public policy, and personal experience have published advice in the Journal of Psychiatric Practice on how to provide a routine, medical necessity letter as a way to improve access to care. Mark DeBofsky, M.D., Joseph Feldman, M.B.A., NABH member Eric Plakun, M.D., and Cheryl Potts, M.B.A. authored the eight-page article, which also includes a template letter for providers.

JAMA Psychiatry Publishes Study on Contingency Management for Patients Receiving Medication for OUD

JAMA Psychiatry this week published a study of the results from an investigation of contingency management for patients who receive medication for opioid use disorder (MOUD). The purpose of the study was to examine the association of contingency management, a behavioral intervention in which patients receive material incentives contingent on objectively verified behavior change, with end-of-treatment outcomes related to stimulant use, polysubstance use, illicit opioid use, cigarette smoking, therapy attendance, and medication adherence The study’s authors noted that the results provide evidence that supports using contingency management in addressing key clinical problems among patients receiving MOUD, including the ongoing problems of comorbid psychomotor stimulant misuse. The study importantly notes that a) CM is most effective with higher earnings potential, confirming that the level of financial incentives are critical to the success of the intervention; b) cases of Medicaid fraud have never been found involving CM; and c) targeting too many drugs simultaneously decreases the effect size, although the effect remains statistically significant. “Policies facilitating integration of contingency management into community MOUD services are sorely needed,” the authors wrote.

CMS to Host Webinar on Price Transparency on Wednesday, Aug. 11

CMS will host a Medicare National Stakeholder Webinar on Price Transparency next week to discuss how hospitals can meet the requirements of the Hospital Price Transparency Final Rule that became effective on Jan. 1, 2021. As a result of the rule, U.S. hospitals are required to 1) provide publicly accessible standard charge information online about the items and services with a comprehensive machine-readable file with all items and services, and 2) a display of 300 shoppable services in a consumer-friendly format. The agency will review the document “8 Steps to a Machine-Readable File of All Items & Services” and highlight both good and bad examples of hospital compliance. CMS will host the webinar on Wednesday, Aug. 11 from 2 p.m. to 3:30 p.m. ET. Click here to register.

SAMHSA to Host Virtual Roundtable about Creating a Diverse Behavioral Health Workforce on Aug. 18

Joint Commission to Start 11-part Behavioral Healthcare Accreditation Webinar Series on Aug. 28

Reminder: NABH Denial-of-Care Portal is Open to Members

Register Today for the NABH 2021 Annual Meeting!

Fact of the Week

In 2019, 22.1% of U.S. adults with chronic pain used a prescription opioid in the past three months, according to a new report from the Centers for Disease Control and Prevention. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 157

Written by Emily Wilkins (NABH) on July 30, 2021. Posted in CEO Updates.

CMS to Raise IPF PPS Payment Rates by 2% in 2022

The Centers for Medicare & Medicaid Services (CMS) said it will update payment rates for IPFs by 2.0% next year in the fiscal year (FY) 2022 Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) final rule the agency released Thursday. The calculation is based on the final IPF market basket estimate of 2.7% less a 0.7 percentage point productivity adjustment. CMS said it will also update the outlier threshold to maintain outlier payments at 2% of total payments, which will result in a 0.1% overall increase to aggregate payments. CMS said it estimates total payments to IPFs to increase by 2.1%, or about $80 million, in 2022 compared with payments in 2021. The final rule also made updates to the Inpatient Psychiatric Facility Quality Reporting Program (IPF QRP), including a final proposal to adopt the Covid-19 Vaccination Coverage Among Healthcare Personnel (HCP) measure to the IPF QRP for the FY 2023 payment determination. The Centers for Disease Control and Prevention (CDC) developed the process measure to track Covid-19 vaccination coverage among HCP in IPFs. The measure will be reported using the Covid-19 Modules on the CDC’s National Healthcare Safety Network web portal. In addition, the final rule said that for the FY 2024 payment determination, CMS is finalizing its proposal to adopt the Follow-up After Psychiatric Hospitalization (FAPH) measure to the IPF QRP. This measure uses an expanded cohort based on the Follow-up After Hospitalization for Mental Illness (FUH) measure—which is currently in the IPF QRP—to include patients with substance use disorders. The final rule also said CMS is not finalizing removal of the Alcohol Use Brief Intervention Provided or Offered and Alcohol Use Brief Intervention (SUB-2/2a) measure or the Tobacco Use Treatment Provided or Offered and Tobacco Use Treatment (TOB-2/2a) measure. This was a response to public comments that indicated these measures still provide benefits that outweigh the costs of retaining them in the IPF QRP measure set. More information is available in the agency’s fact sheet, and the final rule will be published in the Federal Register on Wednesday, Aug. 4.

NABH and Other Advocacy Groups Urge Congress to Invest in Children’s Mental Health

NABH and more than two dozen other advocacy organizations sent a letter to Senate leaders this week urging federal lawmakers to invest more funding in children’s mental health. The letter recommended that Congress strengthen Medicaid; extend and preserve telehealth flexibilities; strengthen systems of care through better coordination and integration; invest in infrastructure to promote care in the appropriate setting; and support growing the pediatric mental health workforce. The Children’s Hospital Association spearheaded the letter, and other organizations that signed on include the American Academy of Family Medicine, the American Academy of Pediatrics, the American Hospital Association, the American Association of Medical Colleges, Mental Health America, and the National Alliance on Mental Illness.

CMS to Host Webinar on Price Transparency on Wednesday, Aug. 11

CMS will host a Medicare National Stakeholder Webinar on Price Transparency to discuss how hospitals can meet the requirements of the Hospital Price Transparency Final Rule that became effective on Jan. 1, 2021. As a result of the rule, U.S. hospitals are required to 1) provide publicly accessible standard charge information online about the items and services with a comprehensive machine-readable file with all items and services, and 2) a display of 300 shoppable services in a consumer-friendly format. The agency will review the document “8 Steps to a Machine-Readable File of All Items & Services” and highlight both good and bad examples of hospital compliance. CMS will host the webinar on Wednesday, Aug. 11 from 2 p.m. to 3:30 p.m. ET. Click here to register.

SAMHSA Resource Summarizes How States Regulate Underage Drinking

The Substance Abuse and Mental Health Resources Administration (SAMHSA) has released Learn the Law: How Does Your State Prevent Underage Drinking?, a new publication that includes 24 legal policy summaries to help people track how states regulate underage drinking as a way to help inform prevention work.

Reminder: NABH Denial-of-Care Portal is Open to Members

Register Today for the NABH 2021 Annual Meeting!

Fact of the Week

Regardless of the primary medical risk factors for severe Covid-19, patients with mental illness were more likely to die of Covid-19 than their peers, according to new research consisting of 16 observational studies from seven countries that involved more than 19,000 patients. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 156

Written by Administrator on July 23, 2021. Posted in CEO Updates.

Life expectancy in the U.S. fell by 1.5 years in 2020, biggest decline since at least World War II

Provisional data released by the Centers for Disease Control and Prevention showed that life expectancy dropped to 77.3 years in 2020, the largest single-year decline recorded since 1943. Nearly 75% of the decline in the 2020 life expectancy was due to Covid deaths, the report estimates. A further 11% of the decline was due to accidental and unintentional injuries — more than a third of which were due to a spike in drug overdose deaths.

Public Health Emergency Extended

On July 19, HHS Secretary Becerra renewed the Coronavirus Disease 2019 (COVID-19) pandemic public health emergency for 90 days, effective July 20, 2021.

$26B Opioid Settlement Announced

Attorneys general from seven states across the country announced that they had entered into a $26 billion proposed settlement agreement with three of the largest pharmaceutical distributors — McKesson, Cardinal Health and AmerisourceBergen — and drugmaker Johnson & Johnson that could resolve thousands of lawsuits focused on their role in the ongoing opioid epidemic.

The proposed global agreement — if approved by a substantial number of states and local governments across the country — would resolve the claims of nearly 4,000 entities that have filed lawsuits in federal and state courts against the four companies. States have 30 days to sign onto the proposed agreement. Local governments in the participating states will have up to 150 days to join. The total funding distributed will be determined by the overall degree of participation by both litigating and non-litigating state and local governments with the substantial majority of the money to be spent on opioid treatment and prevention. Each state’s share of the funding will be determined by an agreement among the states using a formula that takes into account the impact of the crisis on the state — specifically, the number of overdose deaths, the number of residents with substance use disorder, and the number of opioids prescribed — and the population of the state.

CMS releases proposed Medicare Hospital Outpatient Prospective Payment System Rule

In the proposed 2022 Medicare Hospital Outpatient Prospective Payment System rule released Monday, CMS proposed significant increases to penalties that could be assessed on hospitals for non-compliance with price transparency requirements. If the rule is finalized as proposed, the maximum annual penalty would increase from $109,500 to $2 million per hospital. The agency also proposed halting the Trump Administration’s elimination of the inpatient-only list and included an RFI focusing on the health and safety standards, quality measures, reporting requirements, and payment policies for Rural Emergency Hospitals (REHs), a new Medicare provider type.

Regarding Medicare partial hospitalization program (PHP) calendar year (CY) 2022 payment rates, in this rulemaking, CMS is proposing to maintain the existing unified rate structure, with a single PHP Ambulatory Payment Classification for each provider type for days with three or more services per day. CMS is also proposing to use the community mental health center (CMHC) and hospital-based PHP geometric mean per diem costs, consistent with existing methodology, but with a cost floor that would maintain the per diem costs finalized for CY 2021. Following this methodology, CMS proposes to use the cost floor value of $136.14 for CMHCs as the basis for developing the CY 2022 CMHC APC per diem rate, and to use the cost floor value of $253.76 as the basis for developing the CY 2021 hospital-based APC per diem rate. In addition, CMS is proposing to use CY 2019 claims data and cost report data for each provider type consistent with a broader CY 2022 OPPS rate-setting proposal to use claims and cost report data prior to the public health emergency.

HHS Announces Grant Availability Based on NABH supported Dr. Lorna Breen Health Care Provider Protection Act

The Health Resources and Services Administration (HRSA) announced the availability of $103 million in grants over a three-year period to reduce burnout and promote mental health among the healthcare workforce. The grants will help health care organizations establish a culture of wellness among the health and public safety workforce and will support training efforts that build resiliency for those at the beginning of their health careers.

There are three funding opportunities now accepting applications:

Promoting Resilience and Mental Health Among Health Professional Workforce: Approximately 10 awards will be made totaling approximately $29 million over three years to health care organizations to support members of their workforce. This includes establishing, enhancing, or expanding evidence-informed programs or protocols to adopt, promote and implement an organizational culture of wellness that includes resilience and mental health among their employees.
Health and Public Safety Workforce Resiliency Training Program: Approximately 30 awards will be made totaling approximately $68 million over three years for educational institutions and other appropriate state, local, Tribal, public or private nonprofit entities training those early in their health careers. This includes providing evidence-informed planning, development and training in health profession activities in order to reduce burnout, suicide and promote resiliency among the workforce.
Health and Public Safety Workforce Resiliency Technical Assistance Center: One award will be made for approximately $6 million over three years to provide tailored training and technical assistance to HRSA’s workforce resiliency programs.

NABH Joins Amicus Brief in Support of Using Opioid Litigation Settlement Distributions to Supplement Rather Than Supplant Existing Funding

NABH joined the Kennedy Forum, the American Foundation for Suicide Prevention and other leading behavioral healthcare organizations in an amicus brief to the United State Bankruptcy Court in the Southern District of New York calling for funds distributed from the National Opioid Abatement Trust (NOAT) to be used for opioid use disorder and co-occurring mental health and substance use disorder services. The amicus argued that funds distributed from the NOAT should be used to supplement, rather than supplant, existing funding for such services.

CMS Webinar on Advancing Housing-Related Supports for Individuals with Substance Use Disorders CMS announced a national webinar entitled, Lessons Learned from the Advancing Housing-Related Supports for Individuals with Substance Use Disorders State Medicaid Learning Collaborative. This nationally focused webinar will focus on key activities and lessons learned from states that are working to develop and expand innovative strategies to provide housing-related supports for Medicaid beneficiaries with substance use disorders. This webinar is scheduled on August 19, 2021 from 3:00 to 4:30 EDT.

MACPAC Issue Brief Examines Implementation of the Mental Health Parity and Addiction Equity Act in Medicaid and CHIP

A newly issued MACPAC brief examines MHPAEA implementation in Medicaid and the State Children’s Health Insurance Program (CHIP). The brief provides a background on federal parity laws, describes Medicaid and CHIP requirements under MHPAEA, and includes findings from interviews with state Medicaid officials, managed care organizations (MCOs) and beneficiary advocates in three states, as well as officials from the Centers for Medicare & Medicaid Services (CMS) and representatives from other national organizations.

Report: State and Federal Officials Should Reduce Restrictions on New OTPs

A new report by the Pew Charitable Trusts calls on states and the federal government to make changes to support the accessibility of opioid treatment programs (OTPs). Noting that OTPs are vital components of our response to opioid use disorders, Pew calls on state and federal officials to reduce restrictions on opioid treatment programs (OTPs), including barriers that increase the difficulty of opening new facilities.

The Pew report cites integration issues in existing systems that prevent too many patients from accessing needed opioid use disorder treatment. To address these issues, the report calls for reforms to support the integration of OTPs into the broader healthcare system, using a hub-and-spoke model to better coordinate care and reduce wait times. The Pew report notes that Congress passed a law requiring states to temporarily cover OUD medications as a mandatory Medicaid benefit, but that provision ends in September 2025. Pew called on Congress to permanently require state Medicaid programs to cover all forms of medication for opioid use disorder.

New Report Examines Impact of Federal Law Requirements on Substance Use Disorder Care in Emergency Departments

A new report by the Legal Action Center examined the legal obligations of hospitals to provide evidence-based and lifesaving care to emergency department patients with substance use disorders. The report focuses on requirements to provide substance use disorder care under the Emergency Medical Treatment and Labor Act (EMTALA); the Americans with Disabilities Act (ADA); the Rehabilitation Act (RA); and Title VI of the Civil Rights Act (Title VI).

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients.

This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more.

The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts.

Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Register Today for the NABH 2021 Annual Meeting!

Registration is open for the NABH 2021 Annual Meeting from Wednesday, Oct. 6 – Friday, Oct. 8, 2021 at the Mandarin Oriental Washington, DC.

We hope you join us as we recognize our meeting theme, Expanding Access: Right Care. Right Setting. Right Time.

Please visit our Annual Meeting webpage to register for the meeting and to reserve your hotel room. We look forward to seeing you in Washington!

Fact of the Week

A new study of more than 1 million Medicaid enrollees with opioid use disorder (OUD) in 11 states between the years 2014-2018 found that prevalence of OUD in this population increased from around 3% in 2014 to 5% four years later.

CEO Update 155

Written by Emily Wilkins (NABH) on July 9, 2021. Posted in CEO Updates.

CMS Accepting Grant Applications for SUPPORT Act Demonstration Project

The Centers for Medicare & Medicaid Services (CMS) on Friday released a notice of funding opportunity to solicit applications for the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment Act (SUPPORT) 36-month demonstration project. Open only to the 15 states receiving planning grants, the demonstration project is intended to increase treatment capacity of Medicaid-participating providers to provide substance use disorder (SUD) treatment and recovery services. CMS also released a technical supplement that provides information about how the agency will implement the SUPPORT Act payment provision for those states selected for the demonstration. The agency will host an informational webinar for applicants on Thursday, July 29 (and will provide information on that later) and is expected to issue awards on Sept. 10. The period of performance is between September 2021 and September 2024.

Survey Shows 84% of Americans Want to Continue Receiving Mental Health Treatment via Telehealth After Pandemic

A recent online survey of more than 1,000 Americans shows that 74% of respondents said their provider made virtual mental health services available during the Covid-19 pandemic, while 84% said they want to continue receiving mental health treatment via telehealth services after the pandemic ends. Market research company Propeller Insights conducted the survey on behalf of DrFirst, which published a survey last October that found 44% of Americans used telehealth services during the pandemic, although some admitted they multitasked and did not pay close attention during their appointments. In the May 2021 survey, 68% of respondents said the pandemic had worsened their mental health, while 17% said they sought mental health assistance for the first time.

NABH Sends Comments to ONDCP on National Drug Control Strategy

NABH this week provided a series of recommendations to the Office of National Drug Control Policy (ONDCP) on the office’s biennial National Drug Control Strategy. In a letter to Regina LaBelle, ONDCP’s acting director, NABH offered detail suggestions related to telehealth and the Covid-19 pandemic, Medicare and Medicaid, contingency management, workforce management, and medication assisted treatment (MAT). “The Centers for Medicare & Medicaid Services (CMS) should review Medicare, Medicare Advantage, and Qualified Health Plan reimbursement levels and strategies for substance use treatment services (for telehealth and non-telehealth services alike) to bring reimbursement for addiction providers to levels that are more consistent with their education, credentialing, and medical peers,” NABH President and CEO Shawn Coughlin wrote, adding later that Medicare should cover all intermediate levels of care for addiction treatment (e.g., freestanding intensive outpatient, partial hospitalization, residential) for substance use disorders and reimburse facility fees; collaborate with stakeholders to establish new conditions of participation. Other suggestions include recommending that all workforce data collection and reporting efforts at the U.S. Labor Department separate substance use from mental health providers and services, and that the U.S. Justice Department assure individuals with a substance use disorder have access to all forms of MAT while in jail and prison.

NABH Asks OSHA to Delay ETS Compliance Deadline

NABH on July 1 sent a letter to the U.S. Labor Department’s Occupational Safety and Health Administration (OSHA) requesting that the agency delay the compliance deadline for its workplace safety rule. Last month OSHA released the rule, known as the Covid-19 Health Care Emergency Temporary Standard (ETS), to protect workers from exposure to the virus that causes Covid-19. Essential requirements of the ETS include, but are not limited to: developing and implementing a plan for each workplace; designating workplace safety coordinator(s), knowledgeable in infection control principles and practices, with the authority to implement, monitor, and ensure compliance with the plan; conducting a workplace-specific hazard assessment; and seeking the involvement of nonmanagerial employees and their representatives in the hazard assessment and plan’s development and implementation. “The new Covid-19 ETS final rule is long and complex,” NABH President and CEO Shawn Coughlin wrote in the association’s letter to James Frederick, acting assistant secretary of labor at OSHA. “It establishes many very specific requirements related to patient screenings, personal protective equipment, physical barriers, cleaning and disinfection, ventilation, vaccination, training, recordkeeping, reporting, etc. These provisions will likely require significant changes in the policies and procedures healthcare providers have already implemented to prevent Covid-19 infection.” The letter also said it’s important to consider the effects of the new requirements in the context of the challenges behavioral healthcare providers are currently facing. “Mental health and addiction treatment providers continue to experience increased need for their services as indicated by the dramatic increase in drug overdose deaths over the past year and continued elevated levels of anxiety and depression and suicidal ideation,” the letter said, adding that emergency department visits for mental health reasons were up 31% among children and adolescents earlier this year, and suspected suicide attempts were up 51% among teenage girls. NABH requested that OSHA delay the compliance deadline for the ETS—which became effective immediately when it was published in the Federal Register on June 17— for at least an additional six months.

SAMHSA to Host Third Webinar on Future of Telehealth Services in Drug Courts on July 21

The Substance Abuse and Mental Health Services Administration (SAMHSA) will host the final installment of its virtual learning community series on the future of telehealth services in drug courts on Wednesday, July 21. This last part of this three-part series will provide guidance on what to consider when delivering treatment court services in virtual formats, including both court proceedings and treatment services. The webinar will also feature a brief review of essential services elements, policies, and procedures necessary to support effective delivery, as well as strategies for ongoing quality assurance and ideas on how to track appropriate outcomes. The webinar will be held on Wednesday, July 21 at 1 p.m. ET, and a discussion segment will follow at 2 p.m. ET. Click here to register.

Reminder: NABH Denial-of-Care Portal is Open to Members

Register Today for the NABH 2021 Annual Meeting!

Fact of the Week

A new study in JAMA Psychiatry found that of the 14.1 million adults reported having alcohol use disorder (AUD), only 7.3% reported receiving any AUD treatment, and an even smaller percentage—1.6%–reported using medications for AUD.

CEO Update 154

Written by Emily Wilkins (NABH) on June 25, 2021. Posted in CEO Updates.

NABH Introduces Denial-of-Care Portal for Members

NABH this week introduced the NABH Denial-of-Care Portal, a resource for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee has worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. “One of the best ways we can advocate for parity enforcement with policymakers and regulators is to provide hard data from our members that show how insurers are not complying with the landmark 2008 parity law,” said NABH President and CEO Shawn Coughlin. “We hope to gather this critical data through our new Denial-of-Care Portal.” Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

LifePoint Health to Acquire Kindred Healthcare

Brentwood, Tenn.-based LifePoint Health and Louisville, Ky.-based Kindred Healthcare announced they have entered into an agreement for LifePoint to acquire Kindred in a deal expected to close in the fourth quarter of 2021. The deal will provide LifePoint with opportunities to “develop and expand critical behavioral health services across the country,” the companies said in a joint news release. LifePoint owns and operates community hospitals, regional health systems, physician practices, outpatient centers, and post-acute facilities nationwide, while Kindred is a specialty hospital company that delivers acute health services in long-term, acute-care hospitals, inpatient rehabilitation hospitals, acute rehabilitation units, and its behavioral health line business, all of which specialize in treating the most medically complex patients. Kindred Behavioral Health is an NABH member.

SAMHSA Distributes $3.3 Million in Garrett Lee Smith Campus Suicide Prevention Grants

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released $3.3 million in grant awards to 33 colleges through the agency’s Garrett Lee Smith Campus Suicide Prevention grant program. The program is named after former Sen. Gordon Smith’s (R-Ore.) son Garrett Lee Smith, who died by suicide at age 21 in 2003. In 2004, President George W. Bush signed the Garrett Lee Smith Memorial Act, which authorized $82 million for suicide-prevention and awareness programs at the nation’s colleges. The Biden administration is strengthening the program through American Rescue Plan of 2021 funding, which enables SAMHSA to expand the program’s reach by eight colleges. “This grant program provides crucial support to college and university communities at a critical time,” Acting Assistant Secretary for Mental Health and Substance Use Tom Coderre said in an announcement. “Pre-pandemic, college had already been a time and environment where young adults often experienced the onset or worsening of mental health problems,” he added. “The Covid-19 pandemic has exacerbated mental health crises for adolescents and young adults. We want this grant program to provide needed supports to as many students as possible, and we are grateful for the infusion of American Rescue Plan funding to strengthen that support.”

DEA to Publish Mobile Methadone Rule on June 28

The Drug Enforcement Administration (DEA) announced it will publish the final “mobile methadone” rule on Monday, June 28. The final rule will allow narcotic treatment programs (NTPs) to operate mobile components as a coincident activity permitted under the NTP’s registration. Based on these revisions, NTP registrants who operate mobile component to dispense narcotic drugs in schedules II-V at remote location(s) for maintenance or detoxification treatment do not need a separate registration for such mobile components. This final rule waives the requirement of a separate registration at each principal place of business or professional practice where controlled substances are dispensed. Operation is permitted only in the state where the registrant is registered.

LaBelle Says Biden Administration Supports Legislation to Eliminate Federal Crack and Powder Cocaine Sentencing Disparity

Regina LaBelle, the acting director of the White House Office of National Drug Control Policy, testified in a Senate Judiciary Committee hearing this week that the Biden administration supports legislation that would eliminate the disparity in sentencing between crack and powder cocaine, which she said disproportionately affects people of color. Sens. Dick Durbin (D-Ill.) and Cory Booker (D-N.J.), both members of the Senate Judiciary Committee, introduced the Eliminating a Quantifiably Unjust Application of the Law Act (EQUAL) in late January. The bill aims to eliminate the crack and powder cocaine sentencing disparity and ensure that those who were convicted or sentenced for a federal offense involving cocaine can receive a re-sentencing under the new law. NBC News reported that LaBelle told the Senate panel that “The current disparity is not based on evidence; it has caused significant harm for decades, particularly for individuals, families and communities of color,” and is “a significant injustice in our legal system.”

OSHA Releases Fact Sheet and Guidance on Covid-19 Healthcare ETS

The U.S. Labor Department’s Occupational Safety and Health Administration (OSHA) this week released a fact sheet about OSHA’s Covid-19 Healthcare Emergency Temporary Standard (ETS) that was published in the Federal Register this month. OSHA also published additional guidance and implementation information about the ETS. To learn more about the ETS, please see the June 11 edition of CEO Update.

CMS Publishes Frequently Asked Questions on Interoperability and Patient Access Rule

CMS published Frequently Asked Questions (FAQs) on various topics related to the agency’s May 2020 Interoperability and Patient Access final rule. The FAQs include additional guidance about the Admission, Discharge, and Transfer Patient Event Notification Conditions of Participation that apply to America’s psychiatric hospitals.

DEA Hires McCance-Katz as Legislative Policy Analyst

Elinore McCance-Katz, M.D., Ph.D., who served as the assistant secretary for mental health and substance use in the Trump administration, is now a senior civil servant in the Drug Enforcement Agency (DEA). DEA has hired McCance-Katz as a legislative policy analyst focused on drug diversion, or the illegal use of drugs. According to reports, officials said the role is GS-15, the highest level under the federal General Schedule, and it positions McCance-Katz to help shape the Biden administration’s strategy on drug enforcement. President Biden’s nominee to run DEA, former New Jersey Attorney General Anne Milgram, is still awaiting Senate confirmation.

Registration Now Open for the NABH 2021 Annual Meeting

Fact of the Week

Since 9/11, four times as many U.S. service members and veterans have died by suicides than have been killed in combat, according to a new report from Brown University.

CEO Update Will Publish Next on Friday, July 9

NABH will not publish CEO Update next Friday, July 2 and will publish the next issue on Friday, July 9. The NABH team wishes you and your families a happy and safe Independence Day weekend! For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 153

Written by Emily Wilkins (NABH) on June 21, 2021. Posted in CEO Updates.

SAMHSA Awards Grant to Vibrant Emotional Health to Administer 988 Crisis Hotline

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week announced Vibrant Emotional Health will be the administrators for the new 988 dialing code for the National Suicide Prevention Lifeline that will be available in July 2022. A pair of SAMHSA grants totaling $48 million—including $32 million in Coronavirus Response and Relief Supplemental Appropriations Act 2021 funding—will finance the effort to use technology to help Americans in mental health crisis and save lives. Vibrant has administered the lifeline since it was created in 2005. “These grants will work to expand the nation’s call centers’ capacity and technological readiness as the Lifeline’s shift to 988 becomes operational next summer,” Tom Coderre, acting assistant secretary for mental health and substance use and the interim head of SAMHSA, said in announcement. “Until that launch, we ask anyone who needs help or who has a loved one at risk of suicide to call or chat with Lifeline operators at 1-800-273-8255.”

Senate Finance Committee Examines Integrated Payment Models for Primary and Mental Healthcare

The Senate Finance Committee this week held a hearing to discuss mental healthcare in America and payment models that integrate mental health with primary care. In his prepared statement, Senate Finance Committee Chairman Ron Wyden (D-Ore.) said every American who needs mental healthcare should have it, “but the shameful reality is, the United States does not come close to meeting that bar today. Multiple federal laws say that mental healthcare is supposed to be on a level playing field with physical health care,” Wyden’s statement continued. “In practice, however, the system still reflects the dangerous, old stigma against recognizing and treating mental illness, and that’s why millions of people are falling through the cracks.” Members of the influential Senate panel heard from the executive director of the Wallowa Valley Center for Wellness Clinic in Oregon, one of the state’s dozen Certified Community Behavioral Health Clinics, which provides same-day treatment to patients through an integrated primary and mental healthcare model. A Modern Healthcare story reported that while the funding for the model—which comes from an enhanced Medicaid reimbursement rate based on expected costs of care—is not permanent, emergency department admissions for mental health in Wallowa County is down and the amount of veterans accessing behavioral healthcare is up 300% since the demonstration began.

NABH and Other Healthcare Groups Send Letter to United Healthcare About ED Policy

NABH was one of more than 30 healthcare and medical organizations this week that sent a letter to United Healthcare CEO Brian Thompson about the insurance company’s new policy to allow for the retroactive denial of coverage for emergency care in hospital emergency departments (EDs). The new policy will have serious medical consequences for patients, and the groups requested that United rescind the policy permanently. “Even before the Covid-19 pandemic, the need for access to mental healthcare and substance use services was reaching crisis levels,” the letter said. “In 2019, less than half of adults with mental health conditions received services, and nearly 90% of those with a substance use disorder did not receive treatment. EDs around the country often serve as the only safety net for a fragmented mental health infrastructure,” it continued. “For those in crisis for whom the ED is a lifeline for care, an added threat of a retroactive denial of coverage under this policy can be devastating.” Other groups that signed the letter include the American College of Emergency Physicians, the American College of Surgeons, the American Medical Association, the Emergency Nurses Association, the Federation of American Hospitals, The Kennedy Forum, and the Well Being Trust.

SAMHSA to Host Webinar on Behavioral Health Disorders and the Criminal Justice System on July 6

SAMHSA will host a webinar about strategies to create community-based crisis systems for people with behavioral health disorders who are at risk for involvement with the criminal justice system. The webinar will be held Tuesday, July 6 from 3:30 p.m. to 5:30 p.m. ET. Click here to register.

Register Today for the NABH 2021 Annual Meeting

Fact of the Week

In a new study of nearly 43,000 adults who responded to a national survey on drug and alcohol use in 2019, researchers found that roughly 6% had alcohol use disorder, fewer than 10% of whom reported receiving any treatment for their condition. The authors suggest the findings highlight the need for more even access to medication for alcohol use disorder. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 152

Written by Emily Wilkins (NABH) on June 11, 2021. Posted in CEO Updates.

OSHA Releases Covid-19 Workplace Safety Rule for Healthcare Workers

The U.S. Labor Department’s Occupational Safety and Health Administration (OSHA) on Thursday released a workplace safety rule intended to protect workers from exposure to SARS-Cov-2, the virus that causes Covid-19. Called an Emergency Temporary Standard (ETS), the rule applies only to workers in healthcare settings, a disappointment for unions and other workplace safety advocates. Essential requirements of the ETS include, but are not limited to: developing and implementing a plan for each workplace; designating workplace safety coordinator(s), knowledgeable in infection control principles and practices, with the authority to implement, monitor, and ensure compliance with the plan; conducting a workplace-specific hazard assessment; and seeking the involvement of nonmanagerial employees and their representatives in the hazard assessment and plan’s development and implementation. The ETS also includes requirements about personal protective equipment, physical distancing, cleaning and disinfection, training, vaccination, ventilation, and more. Click here for more information in OSHA’s summary of the rule.

Senators Murphy and Cassidy Introduce The Parity Implementation Assistance Act

Senators Chris Murphy (D-Conn.) and Bill Cassidy, M.D. (R-La.) this week introduced The Parity Implementation Assistance Act to offer incentives to states to comply with mental health parity requirements. The bill would authorize $25 million in grants for states to support their oversight efforts of health insurance plans’ compliance with parity. The new legislation builds on the Murphy-Cassidy Mental Health Parity Compliance Act of 2019, which became law last year and provided federal and state health insurance regulators with additional resources to monitor and assure compliance with mental health parity laws. U.S. Reps. Tony Cárdenas (D-Calif.) and Brian Fitzpatrick (R-Pa.) are introducing a companion bill in the House. “We applaud Senators Murphy and Cassidy and Representatives Cárdenas and Fitzpatrick for their continued leadership and steadfast commitment to improving compliance with MHPAEA,” NABH President and CEO Shawn Coughlin said in the senators’ joint news release about the bill this week. “The Parity Implementation Assistance Act would provide critically needed resources to state regulators so they can improve parity enforcement using the new documentation requirements,” he added.

Americans Identify Affordability and Provider Availability as Biggest Barriers to Accessing Care

A new Bipartisan Policy Center-Morning Consult national poll found that 51% of Americans surveyed cited affordability and 41% cited availability of providers taking new patients as the two biggest barriers to accessing the care they need. Meanwhile, a majority of Americans (58%) said the cost of a provider and whether the provider is in their insurance network (58%) are their top priorities when seeking treatment. “This survey shows that we must tackle the high cost and the enormous shortage of mental health professionals in our country by advancing the integration of primary care and mental health and substance use services,” Marilyn Serafini, the Bipartisan Policy Center’s health project director, said in an announcement about the poll. “We know integrated care works. It enhances treatment, improves outcomes, and is cost effective.”

MHA Names Schroeder Stribling as New President and CEO

Mental Health America this week named Schroeder Stribling as the community-based, not-for-profit’s new president and CEO, effective June 28. Stribling will start her new role after 18 years at N Street Village, a not-for-profit that provides housing support services for women and families in Washington, D.C. Most recently Stribling served as N Street Village’s CEO and helped the organization expand to eight locations from one. She also helped diversify revenue streams, create partnerships with government entities, and lead city-wide initiatives on homelessness. Before her time at N Street Village, Stribling was a senior social worker at Johns Hopkins Bayview Hospital, where she was responsible for implementing new mental health programs in the inner-city Head Start school system. Stribling earned a bachelor’s degree in political science from Wellesley College, a master’s degree in social work from Smith College, and a certificate in nonprofit management from Georgetown University.

Forbes Reports Venture Funding for Mental Health Hits Record High

Venture investors poured a record $1.5 billion into mental health startups in 2020, as 42% of U.S. adults reported symptoms of anxiety or depression, compared with about 11% who reported those symptoms in 2019, according to a recent article in Forbes. The article notes there are now seven mental health unicorns in the United States, up from only two a year ago. In venture capital, a unicorn is a privately held company valued at more than $1 billion. Forbes identifies the U.S.-based mental health unicorns as Genoa ($2.5 billion), Lyra Health ($2.3 billion), Calm ($2 billion), BetterUp ($1.7 billion), Talkspace ($1.4 billion), Modern Health ($1.4 billion), and Ginger ($1.1 billion). “I hope that the interest in mental health is now persistent,” Lisa Suennen, a healthcare investor who leads the venture fund at law firm and consultancy Manatt, Phelps & Phillips, said in the article. Suennen added that both the funding surge and ballooning valuations concern her. “Some of these valuations are beyond appropriate given the underlying fundamentals,” Suennen said. “And that’s not unique to mental health, that’s digital health across the board right now.”

AMA and Advocacy Resource Center Highlight National and State Research on America’s Overdose Crisis

The American Medical Association and Advocacy Resource Center have released a nearly 30-page issue brief that aggregates data on the nation’s drug overdose crisis from national, state, and local public health agencies, law enforcement, emergency medical services, hospitals, treatment centers, journals, and the media. Every state has reported an increase in overdose deaths during the Covid-19 pandemic, according to the issue brief.

HRSA Announces New Education Loan Repayment Program

The U.S. Health Department’s Health Resources and Services Administration (HRSA) announced a new loan repayment program that broadens the types of providers and facilities that are eligible to participate and provides a higher rate of repayment. The STAR-LRP will provide repayment of education loans for individuals working in a full-time substance-use disorder (SUD) treatment job that involves direct patient care at a STAR LRP-approved facility located in either a Health Professional Shortage Area (HPSA) designated for Mental Health, or a county/municipality where the average drug overdose death rate exceeds the national average. Participants will receive up to $250,000 in exchange for six years of full-time SUD employment (including fellowship) that involves direct treatment or recovery support of patients with or in recovery from a substance use disorder. The program expands access to SUD treatment through the inclusion of disciplines and treatment facilities that are not eligible for existing loan repayment programs. The STAR-LRP is open to master’s level social workers, psychologists, counselors, marriage and family therapists, psychiatric mental health practitioners, occupational therapists, psychology doctoral interns, and behavioral health paraprofessionals and physicians, physician assistants, and nurses, who are involved full-time in SUD treatment employment (including fellowships). Among the eligible facilities are for-profit programs, including but not limited to inpatient psychiatric facilities, inpatient rehabilitation, non-opioid SUD Treatment facilities, opioid treatment programs, office-based opioid treatment, outpatient rehabilitation. HRSA anticipates making $28 million available to fund approximately 112 loan repayment awards in FY 2021. Applications are due by July 22, 2021, 7:30 p.m. ET.

DOJ Accepting Applications for Opioid, Stimulant, and Substance Abuse Program Training and Technical Assistance Program

The U.S. Justice Department’s Office of Justice Programs and Bureau of Justice Assistance will accept grant applications for its Comprehensive Opioid, Stimulant, and Substance Abuse Program (COSSAP) Training and Technical Assistance Program through Monday, June 21. The program’s purpose is to identify one provider to support a collaborative team and coordinate training and technical assistance for state, tribal, and local criminal justice and substance abuse treatment agencies and their partner agencies for more than 400 COSSAP site-based programs. Click here to learn more and to apply.

Registration Now Open for the NABH 2021 Annual Meeting

Fact of the Week

Nearly one in four older U.S. adults between the ages of 50 and 80 reported they had three or more alcoholic drinks in one sitting, according to a new poll from the University of Michigan’s National Poll on Healthy Aging.

CEO Update 151

Written by Emily Wilkins (NABH) on June 4, 2021. Posted in CEO Updates.

President Biden’s $6 Trillion Budget Proposal Includes Funding Increases for SAMHSA

President Biden’s $6 trillion budget proposal for 2022 includes significant funding increases for several Substance Abuse and Mental Health Services Administration (SAMHSA) programs, including a $1.65 billion increase—including 10% set aside for recovery services—for the agency’s Substance Abuse Prevention, Treatment, and Recovery Block Grant for a total of about $3.51 billion in that program. The president’s budget—notable for mapping out the president’s priorities—also includes:

An $825-million funding increase for SAMHSA’s Community Mental Health Services Block Grant for a total of $1.58 billion, with $75 million set aside for crisis-stabilization services,

$750-million increase in State Opioid Response grants for a total of $2.25 billion,

An additional $125 million for Certified Community Behavioral Health Clinics,

A $78-million increase for the National Suicide Prevention Lifeline for a total of $102 million to prepare for the nation’s “988” behavioral health crisis hotline, and

$4.4-million increase for opioid treatment programs for a total of $13.1 million.

The budget also includes a $27-million increase for the U.S. Labor Department’s Employee Benefits and Security Administration to enforce the Mental Health Parity and Addiction Equity Act.

CMCS Releases Bulletin on American Rescue Plan’s Medicaid, CHIP, and BHP Provisions

The Center for Medicaid and CHIP Services (CMCS) this week released a bulletin that provides information to states on the Medicaid, CHIP, and Basic Health Program (BHP) provisions in the American Rescue Plan. Part of the guidance includes section 9813, the “State Option to Provide Qualifying Community-Based Mobile Crisis Intervention Services,” which adds a new section to the Social Security Act and provides states the option to provide for certain “qualifying community-based mobile crisis intervention services” to be covered under the Medicaid state plan or a waiver of such plan during a five-year period beginning on April 1, 2022. In addition, the bulletin said states will be eligible for a federal matching rate of 85% for qualifying community-based mobile crisis intervention services during each of the first 12 fiscal quarters between April 1, 2022 through March 31, 2027, in which a state meets the requirements in the statute. This provision also provides funding for the HHS secretary to issue planning grants to states to develop state plan amendments or waiver requests to provide such qualifying community-based mobile crisis intervention services. CMCS said it plans to issue additional guidance in the coming months on certain provisions and is available to provide states with technical assistance as they begin to implement these changes.

EEOC Releases Updated Guidance Regarding Covid-19 Vaccinations, Incentives

The U.S. Equal Employment Opportunity Commission (EEOC) recently released its first updated guidance about Covid-19 vaccinations since December 2020. The new guidance addresses mandatory vaccination policies, employer-provided vaccine incentives, confidentiality, and accommodating workers who may be unwilling or unable to obtain a vaccination. Click here to read a summary of the provisions.

National Guard Officers to Provide Temporary Staffing at Oregon State Hospital

The Oregon State Hospital will begin training 30 members of the National Guard on Monday to fill an unprecedented staffing shortage at the Salem-based psychiatric hospital, according to a news report in The Oregonian. National Guard members will spend about two weeks learning how to work directly with patients, including training on de-escalation and behavioral emergencies. The story noted that the National Guard will help serve patient meals, escort patients to and from treatment, and with other activities on the unit. The state hospital has faced a staffing shortage since last year when employees began taking Covid-19-related leave.

Kennedy Forum to Host June 7 Webinar on Future of Mental Healthcare

The Kennedy Forum will feature Mental Health America CEO Paul Gionfriddo and National Alliance on Mental Illness CEO Daniel Gillison, Jr. in a webinar about the future of mental healthcare on Monday, June 7. Other panelists will include Kennedy Forum founder and former U.S. Rep. Patrick Kennedy (D-R.I.); Peter O’Brien, chairman of The Kennedy Forum Illinois; and Cheryl Potts, executive director at The Kennedy Forum Illinois. The webinar will begin at 2 p.m. ET. Click here to register.

DOJ Accepting Applications for Opioid, Stimulant, and Substance Abuse Program Training and Technical Assistance Program

Registration Now Open for the NABH 2021 Annual Meeting

Fact of the Week

New research from Athenahealth shows women were twice as likely as men to receive a diagnosis of anxiety from their primary care provider (6.5% versus 3.3%), and were also diagnosed with depression at twice the rate (4.2% versus 2.1%). For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 150

Written by Emily Wilkins (NABH) on May 28, 2021. Posted in CEO Updates.

NABH Submits Comments on IPF-PPS FY 2022 Proposed Rule NABH on Friday submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the agency’s inpatient psychiatric facility (IPF) prospective payment system (PPS) proposed rule for fiscal year 2022. The eight-page letter provided an overview of how the Covid-19 pandemic has led to an increasing need for quality mental health and addiction treatment in America, and how previous pandemics have had an effect on behavioral health for years to come. NABH offered comments on labor market delineations, the wage index, and several issues related to the Inpatient Psychiatric Facility Quality Reporting Program. CMS will accept public comments until Monday, June 7. U.S. Senate Confirms Chiquita Brooks-LaSure as CMS Administrator In a 55-44 vote, the U.S. Senate this week confirmed Chiquita Brooks-LaSure to lead CMS as the agency’s administrator. Most recently Brooks-LaSure served as the managing director of the health division at Manatt, Phelps & Phillips. Previously she served as the director of coverage policy at the U.S. Health and Human Services Department (HHS) during the Obama administration, where she led implementation of the Affordable Care Act’s coverage and insurance reform policy provisions. Earlier, the Senate Finance Committee had split evenly on whether to advance Brooks-LaSure’s nomination, with all Republicans on the panel not supporting her. Senate Majority Leader Chuck Schumer (D-N.Y.) was able to bring her nomination vote to the Senate floor through a procedural vote.

HHS Commits $4.8 Billion to Reimburse Providers for Covid-19 Testing for the Uninsured

HHS this week announced it will dedicate $4.8 billion from the American Rescue Plan to support the Health Resources and Services Administration’s (HRSA) Covid-19 Uninsured Program. Specifically, the funding will allow the program to reimburse healthcare providers for testing uninsured individuals for Covid-19. “As we vaccinate the country, let’s continue taking the preventive measures necessary to keep the virus under control and prevent it from spreading,” HHS Secretary Xavier Becerra said in an announcement. “Testing remains critical and now it’s available at no cost to those who need it,” he added. “This funding will help ensure everyone has access to testing regardless of whether they have health insurance.” Click here to learn more about HRSA’s Covid-19 Uninsured Program.

NABH and Other National Organizations Urge Biden Administration to Name ONDCP Director

This week NABH coordinated an effort among several leading addiction treatment groups and other national organizations to send a letter urging President Biden to name a director to the White House Office of National Drug Control Policy (ONDCP). Regina LaBelle, on a leave of absence from her position as program director of the Addiction and Public Policy Initiative at Georgetown’s O’Neill Institute for National and Global Health Law, currently serves as the office’s acting director. NABH and the other organizations—including the American College of Emergency Physicians, the American Society of Addiction Medicine, the National Association of Addiction Treatment Providers, and the National Safety Council—expressed concern that a nominee to the post has not yet been named, especially when the Covid-19 global pandemic has accelerated the nation’s drug overdose deaths through a combination of treatment disruptions, social isolation, and other challenges. “The Biden-Harris Administration’s Statement of Drug Policy Priorities for Year One was a concise and focused document that clearly identified issues that need addressing,” the letter said. “An ONDCP director is now needed to implement, and build upon, those priorities for a nation that continues to be devastated by the preventable and treatable disease of addiction and drug overdoses.” Politico wrote a story about the letter on May 27, calling it “the first notable sign of public pressure on Biden to fill the drug czar role, which he’s long supported.”

NABH and Other Mental Health and Addiction Groups Urge Congress to Fund 988 Hotline Infrastructure

NABH was one of more than two dozen mental health and addiction organizations that sent a letter to congressional leaders, requesting that Congress provide funding to build the needed infrastructure to support the nation’s 988 crisis hotline. In its letter to the majority and minority leaders in the House and Senate, the organizations recommend that Congress, at a minimum, invest $10 billion in a 988 crisis hotline infrastructure package. “While there is a clear vision for what a successful 988 crisis response system requires, there are very few examples of systems that meet these standards,” the letter said. “Existing suicide prevention call centers rely on a patchwork of inadequate funding, leaving insufficient capacity to meet current needs, let alone the increased demand spurred by the adoption of 988,” it continued. “There is growing availability of mobile crisis teams, but demand still far outstrips supply, particularly for children and adolescents. And there is a nationwide dearth of crisis stabilization programs. Finally, there are widespread shortages of behavioral health professionals to staff crisis response systems.” The groups noted that the funding could provide for technology, training, and operations at crisis call centers; expand capital projects to include crisis receiving and stabilization and peer respite programs; broaden federal loan repayment criteria to include crisis call centers, mobile crisis teams, crisis receiving and stabilization programs; and develop behavioral health workforce training programs.

Napolitano, Kaptur, Lee Urge HHS to Expand Mental Health Workforce

NABH recently supported a letter from three House Democrats who are urging HHS to include mental health and substance use treatment providers within the $7.6 billion public health workforce expansion included in the American Rescue Plan. In their May 21 letter to HHS, Reps. Grace Napolitano (D-Calif.), Marcy Kaptur (D-Ohio), and Barbara Lee (D-Calif.) wrote that a section of the new law can support about 100,000 new positions. The congresswomen—with support from other Democrats—recommend that one-third of those positions be devoted to behavioral health. “This number would permit each small county to add five behavioral health providers, each mid-sized county to add 10 providers, and each large county to add 20 providers,” they wrote. “County public health workers should also receive basic training for the screening of common mental health and substance use disorders, which would allow them to identify struggling Americans and refer them to services,” they added. Click here to read the full letter.

New DOE Guidance on American Rescue Plan Funding for Schools Includes Mental Health

The U.S. Education Department (ED) recently released a set of frequently asked questions (FAQ) about how funding under the Elementary and Secondary School Emergency Relief (ESSER) Fund, including the American Rescue Plan’s ESSER program, and the Governor’s Emergency Education Relief Fund, may be used to address the pandemic’s effects on students in pre-K-12 education. The FAQ mentions mental health services throughout the document and includes providing “positive behavioral interventions and supports and mental health services for children with disabilities” and “meeting rising mental health and behavioral needs (for example, contracting with community mental health providers to support students virtually and/or on-site at school).” Members of the NABH team have had recent discussions with the ED staff and discussed several items outlined in the guidance.

AHRQ Seeking Information on Evaluation of Mental Health Applications

HHS’ Agency for Health Research and Quality (AHRQ) is seeking scientific information to help inform the agency’s review on Evaluation of Mental Health Applications, which AHRQ’s Evidence-based Practice Centers Program is conducting. The federal notice said access to both published and unpublished pertinent, scientific information will improve the quality of the review. Submissions are due 30 days from the May 21 notice. Click here to learn more.

NABH President and CEO Highlights IMD Repeal in LinkedIn Pulse Article

As Mental Health Month draws to a close, NABH President and CEO Shawn Coughlin this week reflected on improving America’s approach to mental healthcare in part by repealing Medicaid’s outdated Institutions for Mental Diseases (IMD) exclusion. In a LinkedIn Pulse article, Coughlin provided an overview of the IMD exclusion and highlighted congressional leaders who are working to solve this issue: Reps. Tom Emmer (R-Minn.) and Grace Napolitano (D-Calif.). Emmer has re-introduced Expanding Access to Inpatient Mental Health Act, which would eliminate the IMD exclusion’s arbitrary cap on mental health services. Specifically, it would eliminate the 15-day cap for Managed Care Organizations (MCOs) and Prepaid Inpatient Health Plan (PIHP) beneficiaries receiving care in an IMD. Meanwhile, Napolitano’s Increasing Behavioral Health Treatment Act would repeal the IMD exclusion and require states to submit a plan to: increase access to outpatient and community-based behavioral health care; increase availability of crisis stabilization services; and improve data sharing and coordination between physical health, mental health, and addiction treatment providers and first responders. “Efforts such as these,” Coughlin wrote, “could ensure Medicaid beneficiaries finally receive the professionally guided care they deserve, and we can ensure that clinicians, not artificial restrictions, govern mental healthcare for all Americans.”

Kennedy Forum to Host June 7 Webinar on Future of Mental Healthcare

Registration Now Open for the NABH 2021 Annual Meeting

Fact of the Week

A recent study of more than 2,800 U.S. coal miners showed that nearly 40% of these workers reported symptoms consistent with major depressive disorder and anxiety, while more than one in 10 reported actively thinking about suicide. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 149

Written by Emily Wilkins (NABH) on May 21, 2021. Posted in CEO Updates.

SAMHSA to Distribute $3 Billion in Block Grants; Becerra Forms Behavioral Health Council

The U.S. Health and Human Services Department (HHS) this week announced the Substance Abuse and Mental Health Services Administration (SAMHSA) will distribute $3 billion in American Rescue Plan funding, the largest aggregate funding amount to date for the agency’s mental health and substance use block grant programs. According to HHS’ announcement, the Community Mental Health Services Block Grant Program and Substance Abuse Prevention and Treatment Block Grant Program will disperse $1.5 billion each to states and territories. This funding amount follows a March announcement of supplemental funding of almost $2.5 billion for these programs. SAMHSA has expedited federal funding to grantees to help the nation’s communities manage their mental health and substance use needs during the Covid-19 pandemic. Meanwhile, HHS Secretary Xavier Becerra has formed a Behavioral Health Coordinating Council to collaborate what the department has described as “innovative, transparent, equitable, and action-oriented approaches” to addressing HHS’ behavioral health agenda. Assistant Secretary for Health Rachel Levine, M.D. and HHS’ assistant secretary for mental health and substance use will serve as co-chairs of the new coordinating council, which is composed of senior leaders across the department. Tom Coderre currently serves as the acting assistant secretary for mental health and substance use. “Behavioral health is a priority for the Department of Health and Human Services,” Becerra said in an announcement. “The Covid-19 pandemic has made clear the need to invest resources in our nation’s mental health and address the inequities that still exist around behavioral healthcare. That’s why we are making this historic investment in mental health and substance use services,” he added. “In addition, this national problem calls for department-wide coordination to address the issue. That’s why I am convening the Behavioral Health Coordinating Council to work across HHS to facilitate collaboration and strategic planning as we implement our behavioral health agenda.” Also this week, HHS announced the Health Resources and Services Administration (HRSA) will disperse $14.2 million from the American Rescue Plan to expand pediatric mental healthcare access by integrating telehealth services into pediatric primary care. The funding will go toward Pediatric Mental Health Care Access (PMHCA) projects in new states and geographic areas nationwide and will provide teleconsultations, training, technical assistance, and care coordination for pediatric primary care providers to diagnose, treat and refer children and youth with mental health conditions and substance use disorders.

CMS Data Show Vulnerable Americans Forgoing Mental Healthcare During Pandemic

The Centers for Medicare & Medicaid Services (CMS) late last week released new findings that show Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries have forgone millions of primary, preventive, and mental healthcare visits from March 2020 through October 2020 compared with the same period in 2019. The agency also reported that while some treatments have rebounded to pre-pandemic levels, mental health services have been the slowest to pick up. According to the data, there has been a 34-percent decline in the number of mental health services used by children under age 19, compared with the same time period in 2019, and a 22-percent decline in the number of mental health services used by adults aged 19 to 64, compared with the same time period in 2019. This translates to about 14 million fewer mental health services for children and approximately 12 million fewer mental health services for adults, for a total of nearly 26 million fewer mental health services used across both groups. Meanwhile, although preliminary reports show increased drug-related mortality due to the pandemic, substance use disorder services utilization fell by 3.6 million services (a 13-percent decline) when compared with the same time period in 2019. “More than 100 million Americans, including 43 million children, relied on us to deliver access to mental health and other services they needed through Medicaid and CHIP in 2020,” CMS Acting Administrator Liz Richter said in an announcement, adding that the new data provide a glimpse into how the pandemic has affected America’s most vulnerable people. “While we’re encouraged that people are accessing some healthcare services at pre-pandemic levels, there is work to do to connect people to mental healthcare services and to ensure we fill the gap in other types of services that was caused by the pandemic,” Richter said.

DOJ Accepting Applications for Opioid, Stimulant, and Substance Abuse Site-based Program Grants

The U.S. Justice Department (DOJ) has announced that applications for its Comprehensive Opioid, Stimulant, and Substance Abuse Program (COSSAP) are due June 21. Developed in the Comprehensive Addiction and Recovery Act (CARA), COSSAP is intended to reduce the effect of opioids, stimulants, and other substances on individuals and communities, including a reduction in the number of overdose fatalities. The program is also meant to mitigate the effects of crime victims by supporting collaborative initiatives. Click here for more information about how to apply.

SAMHSA to Host Meth and OUD Webinar Next Week

SAMHSA will host a webinar next week to discuss recent trends in co-occurring methamphetamine use and opioid use disorder (OUD), including overdose fatalities. The webinar, Meth 2.0 and Opioid Use Disorder—A Collision of Epidemics, will also address treatment approaches. Click here to register.

CMS to Host Quality Measurement Webinars Next Month

CMS will host CMS Quality Measurement: Where It’s Headed and How We’ll Get There, a webinar that will highlight the agency’s efforts to improve quality measures and provide information on available quality-measurement resources. The webinar, which will be presented twice in June, will address CMS’ goals for advancing quality measurement in the next five to 10 years, and agency staff will provide an overview of the agency’s new Digital Quality Measurement Blueprint. Click here to register for the June 15 webinar and here to register for the webinar on June 17.

Kennedy Forum to Host Parity Webinar Featuring U.S. Labor Secy. Martin Walsh on May 27

U.S. Labor Department (DOL) Secy. Martin Walsh will serve as a panelist during the Kennedy Forum’s webinar, “Mental Health Parity: Ending Discrimination in Health Insurance Coverage,” on Thursday, May 27. The hourlong webinar will address a range of issues, including DOL’s role in enforcing the 2008 Mental Health Parity and Addiction Equity Act; common parity violations and how they inhibit access to care; new statutory requirements requiring plans to conduct detailed parity analyses; and more. Free for attendees, the webinar will also feature Kennedy Forum founder and former U.S. Rep. Patrick Kennedy (D-R.I.) and Ann Marie Sullivan, M.D., commissioner for New York’s Office of Mental Health. Click here to register.

Registration Now Open for the NABH 2021 Annual Meeting

Fact of the Week

The Trevor Project’s 2021 National Survey on LGBTQ Mental Health reports that 42% of LGBTQ youth seriously considered attempting suicide in the past year, including more than half of transgender and nonbinary youth. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 148

Written by Emily Wilkins (NABH) on May 14, 2021. Posted in CEO Updates.

NABH and Other Healthcare Groups Urge HHS to Extend Provider Relief Fund Deadline

NABH and eight other healthcare associations this week urged the U.S. Health and Human Services Department (HHS) to extend the June 30 deadline by which providers must use their Covid-19 Provider Relief Fund (PRF) payments. Instead, the groups wrote in a letter to HHS Secretary Xavier Becerra, HHS should use the length of the public health emergency as a guideline for providers to finish using the funds. The letter also requested that HHS expedite distributing the remaining PRF resources. “Congress has allocated $178 billion to date to aid all types of health care providers through the PRF and designated in the most recent Covid-19 relief package an additional $8.5 billion through the Rural Relief Fund,” the letter noted. “However, not all of the funds have been distributed, and those that have may not yet have been fully utilized by the recipients,” it continued. “We previously noted the ongoing financial burden our members are facing; add to this the uncertainty regarding when the pandemic will ease more considerably to allow for a full return to “business as usual,” such as regular wellness visits and the resumption of scheduled surgeries,” the letter said, adding that the nation’s hospitals will continue to face challenges beyond the June 30 deadline. Separately this week, Secy. Becerra signaled his department is considering it. “Some folks have asked for an extension,” Becerra was reported as saying during a House Energy and Commerce Health Subcommittee hearing. “We’re looking at that very, very closely.”

Biden Administration Plans to Open Applications for Billions in Provider Grants

News outlets this week reported the Biden administration plans to open applications for billions of dollars in grants for hospitals and other healthcare providers before the end of May. Hospitals have asked administration officials to release more of the funds that Congress approved in December 2020. To date, providers have been reimbursed for only a portion of their losses through June 2020 due to the Covid-19 pandemic. According to the stories—which sourced people familiar with the plans—the next tranche of money will deplete most of the money in the $178 billion fund to help providers.

CMS Issues Guidance on Requirements Added to Medicare’s Conditions of Participation

The Centers for Medicare & Medicaid Services on May 7 released interpretive guidance on the new hospital admission, discharge, and transfer notification requirements that were added to the Medicare program’s Conditions of Participation. The new rules became effective on May 1, 2021, after having been delayed because of the pandemic.

Overdose Prevention Network to Host Youth Engagement Discussion on May 26

The Overdose Prevention Network will host a 30-minute online discussion about how youth engagement and providing stability can play a meaningful role in supporting overdose prevention and providing connections to treatment. Part of the organization’s “Meet the Partner” series, the “Saving Lives with Youth Engagement” session will feature Graciela Razo, harm reduction coordinator for Safe Horizon’s Streetwork Project in New York City. Click here to learn more and register.

Kennedy Forum to Host Parity Webinar Featuring U.S. Labor Secy. Martin Walsh on May 27

Registration Now Open for the NABH 2021 Annual Meeting!

Fact of the Week

A new study in JAMA found fatal drug overdoses in San Francisco increased by 50% during after the Covid-19 pandemic lockdown. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 147

Written by Emily Wilkins (NABH) on May 7, 2021. Posted in CEO Updates.

May 7 is National Children’s Mental Health Awareness Day

To honor National Children’s Mental Health Awareness Day today, NABH President and CEO Shawn Coughlin published a LinkedIn Pulse article about the critical role that residential treatment plays in youth behavioral healthcare. The article highlights Residential Treatment: A Vital Component of the Behavioral Healthcare Continuum, the white paper that NABH released in April. Please click here to visit our Youth Services webpage to download the paper and access shareable social media messages, especially during Mental Health Month throughout May. Also for Mental Health Month, the National Association of Medicaid Directors (NAMD) this week released fact sheets to promote the role that Medicaid programs play in ensuring access to mental health and addiction treatment. The first fact sheet shows how Medicaid supports crisis support systems, and the second resource highlights opportunities for Medicaid programs to provide addiction treatment.

Registration Now Open for the NABH 2021 Annual Meeting!

NABH Submits Comments to HHS on HIPAA Privacy Rules

NABH this week sent comments to the U.S. Health and Human Services Department’s (HHS) Office of Civil Rights (OCR) about the office’s proposed rule, “Proposed Modifications to the HIPAA Privacy Rule to Support, and Remove Barriers to, Coordinated Care and Individual Engagement.” HHS released the proposed rule in January, and the Biden administration’s freeze on certain regulations issued during the prior administration did not apply to this one. The letter includes sections about overlap among Health Insurance Portability and Accountability Act (HIPAA), interoperability, and 42 CFR Part 2 regulations; modifications to the right to inspect and obtain copies of protected health information; information disclosure to third parties; care coordination and case management; standards for disclosing information when in an individual’s interest or to prevent harm; and notices of privacy practices. “As Covid-19 continues to have a significant impact on behavioral health, mental health and addiction treatment providers must remain focused on improving access to care,” NABH President and CEO Shawn Coughlin wrote in the letter. “They continue to struggle with the new demands imposed by social distancing and precautions they must take to prevent Covid-19 infection. Healthcare staff and providers were already greatly strained by the ongoing stress and demands created by this pandemic,” he continued. “Moreover, behavioral healthcare providers and HIT vendors are still working to implement the new interoperability standards as they continue to face staffing shortages,” he wrote, adding that NABH urges OCR to delay the deadline of this and any additional regulatory changes such as those in the proposed rule.

Patients with Mental Health Conditions in EDs During Pandemic More Likely to Require Admission

New research from JAMA shows that patients with mental health (MH) conditions presenting for emergency department (ED) visits since the onset of the pandemic have been more likely to require admission and have had longer admissions. “The COVID-19 pandemic continues to place novel stressors on the provision of pediatric MH care,” the article noted. “Our findings may reflect challenges in disposition to definitive MH care and may suggest a scarcity of MH treatment resources.” The researchers went on to write that their limitations in the study include an inability to account for the complexity of presenting MH conditions and the limited generalizability to non-children’s hospitals. Still, they continued, the findings of the cross-sectional study underscore the need for increased pediatric MH services.”

HRSA to Host Provider Webcast on Covid-19 Coverage Assistance Fund on May 12

HHS’ Health Resources and Services Administration (HRSA) has announced a new program that covers the costs of administering Covid-19 vaccines to patients enrolled in health plans that either do not cover vaccination fees or cover them with patient cost-sharing. HRSA will host an informational webcast for providers to present an overview of its Coverage Assistance Fund on Wednesday, May 12 at 2 p.m. ET. Click here to learn more and register.

Fact of the Week

Nearly one in five adults between the ages of 50 and 80 said their overall mental health has gotten worse since the pandemic began in March 2020, and an equal percentage said their sleep suffered in that time too, according to a new aging study from the University of Michigan. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 146

Written by Emily Wilkins (NABH) on April 30, 2021. Posted in CEO Updates.

Mental Health Awareness Month Begins Saturday, May 1

Mental Health Awareness Month, also referred to as Mental Health Month, kicks off Saturday, May 1 to recognize the millions of Americans living with a mental illness. Please be sure to follow NABH on Twitter and LinkedIn to help promote Mental Health Month, and visit the websites for the National Alliance on Mental Illness (NAMI) and Mental Health America for more information and toolkits.

HHS Provides Exemptions for Buprenorphine Prescribers for Fewer Than 30 Patients

The U.S. Department of Health and Human Services (HHS) announced this week that practitioners prescribing buprenorphine, a controlled substance, for opioid use disorder to fewer than 30 patients are exempt from certain regulatory requirements codified under 21 U.S.C. 823(g)(2)(B)(i)-(ii). Under the new guidance, physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives are exempt from having to make certain training related certifications and certifying their capacity to provide counseling and other ancillary services. The guideline does not remove the DATA 2000 Waiver, otherwise known as the ‘X-Waiver.’ Providers are still required to file a Notice of Intent with the Substance Abuse and Mental Health Services Administration. The exemption applies to practitioners who are state-licensed and DEA-registered. It also generally limits prescribing to patients who are located in states where the practitioner is licensed. Practicing under this exemption does not count toward the time requirements for prescribing to a higher patient limit under 21 U.S.C. 823(g)(2)(B)(iii). This exemption also applies to other Schedule III, IV, and V drugs. Tuesday’s guidance encourages practitioners to provide access to psychosocial services to improve treatment retention and outcomes. In addition, medical education institutions are strongly encouraged to implement comprehensive training in substance use disorder diagnosis and management. In late January, the Biden administration placed a freeze on Trump administration guidelines that intended to exempt physicians from the X-Waiver. That notice cited clinical concerns and stated the Executive Branch did not have the legal authority to make the change.

GAO Releases Behavioral Health Study on Access, Claims Payments, and Covid-19 Effects

In a report released Friday, the Government Accountability Office (GAO) said evidence collected during the Covid-19 pandemic suggests the prevalence of behavioral health conditions has increased, while access to in-person behavioral health services has decreased. The report noted that Centers for Disease Control and Prevention (CDC) surveys found about 38% of respondents reported symptoms of anxiety or depression from April 2020 through February 2021, reflecting an increase of 11% since 2019. Meanwhile, U.S. emergency department visits for overdoses and suicide attempts from mid-March to mid-October 2020 were up 36% and 26%, respectively, since 2019. The study also highlighted issues related to payment for services. “Officials GAO interviewed from provider organizations offered anecdotal examples of problems with payments for behavioral health services, including examples suggesting that denials and delays were more common for these services than they were for medical/surgical services,” the report said. “However, most officials were not aware of published data that could confirm their concerns, and data from reports from two states on claims denials either did not support their concerns or were inconclusive,” it continued. “In addition, a report in one state that examined mental health parity—requirements that behavioral health benefits are not more restrictive than medical/surgical benefits—found that the rate of complaints associated with behavioral health services was notably lower than those for medical/surgical services.”

CMS Launches Behavioral Health Follow-up Care Learning Collaborative

The Centers for Medicare & Medicaid Services (CMS) has launched the “Improving Behavioral Health Follow-up Care Learning Collaborative” to support state Medicaid and Children’s Health Insurance Program (CHIP) agencies’ efforts to improve access, coordination, and follow-up care for beneficiaries who visit an emergency department or who are hospitalized for a mental health or substance use condition. In an announcement, CMS said state behavioral health agencies, managed care plans, and providers will learn about evidence-based interventions to improve access to timely follow-up behavioral healthcare during the global pandemic recovery period and beyond. The new learning collaborative includes a four-part webinar series beginning next month and an “affinity group” starting in July. According to CMS, states interested in acting on the concepts and strategies introduced in the webinar series will have an opportunity to participate in an action-oriented affinity group that will facilitate state-to-state learning and support state teams in designing, implementing, and scaling up quality-improvement projects in their state. Click here for more details about the webinar series and affinity group and here to register for the webinars.

NABH Welcomes Comments on Federal Privacy Regulations

Earlier this year, HHS issued a notice of proposed rulemaking (NPRM) that outlined significant changes to federal privacy regulations. The Biden administration’s freeze on certain regulations issued during the prior administration does not apply to this proposed rule, and the current administration has extended the deadline for comments on this NPRM to May 6, 2021. Notably, the NPRM includes a section entitled “Encouraging Disclosures of PHI [Personal Health Information] when Needed to Help Individuals Experiencing Substance Use Disorder (Including Opioid Use Disorder), Serious Mental Illness, and in Emergency Circumstances.” This link to that section discusses the following proposed changes to federal privacy regulations:

Revising the standard for determining when a disclosure or use of PHI is in the best interests of the individual to be based on a “good faith belief” instead of “exercise professional judgment”; and

Changing the standard for use or disclosure of PHI to prevent or lessen a “serious or imminent threat” to the health or safety of a person or the public to instead be allowable based on a “serious and reasonably foreseeable threat” to a person or the public.

This section of the proposed rule also includes scenarios illustrating how the proposed changes to the privacy rules would help improve care for patients. NABH welcomes comments about these changes and requests that members send any comments to Kirsten Beronio, NABH’s director of policy and regulatory affairs, by next Tuesday, May 4.

NIDA Director Says Addiction Should be Treated, Not Penalized in Health Affairs Blog

People with substance use disorders need treatment, not punishment, and drug use disorders should be approached with a demand for high-quality care and compassion for those affected. Those are the words of Nora Volkow, M.D., director of the National Institute on Drug Abuse, or NIDA, in a Health Affairs blog post this week. Volkow also noted that the Covid-19 pandemic has highlighted the large racial health disparities in America, and that Black Americans have experienced worse outcomes during the pandemic, continue to die at a greater rate than White Americans, and also suffer disproportionately from a wide range of other acute and chronic illnesses. “We have known for decades that addiction is a medical condition—a treatable brain disorder—not a character flaw or a form of social deviance,” Volkow wrote. “Yet, despite the overwhelming evidence supporting that position, drug addiction continues to be criminalized,” she continued. “The U.S. must take a public health approach to drug addiction now, in the interest of both population well-being and health equity. Separately this week, an opinion piece in Stat from former Office of National Drug Control Policy (ONDCP) Deputy Director Tom McLellan, Ph.D. and Jacob Crothers, M.D., an addiction medicine physician, proposed that the United States should engage in a rapid response similar to “Operation Warp Speed” (for the Covid-19 vaccine development and rollout) to address the nation’s ongoing opioid crisis. In their observations, McLellan and Crothers wrote the U.S. Drug Enforcement Administration surveillance of providers sends a confusing message about encouraging the use of U.S. Food and Drug Administration-approved addiction medications. They also warned against discharging patients for positive drug tests and prohibitive prior authorization policies, and they suggested extending the Medicare opioid treatment bundle to Medicaid.

NCOA to Host Older Adult Mental Health Awareness Day Symposium on May 6

The National Council on Aging (NCOA), along with the U.S. Administration for Community Living and the Substance Abuse and Mental Health Services Administration (SAMHSA) will host the 4^th Annual Older Adult Mental Health Awareness Day Symposium as a virtual event on Thursday, May 6. Registration is free, and the all-day event for public health practitioners, professionals in the aging networks, mental health providers, healthcare professionals, and others interested in the mental health of older adults will address topics such as access to behavioral health in diverse older adults, latest interventions related to SUDs, and socialization and engagement. Learn more from the program’s agenda and click here to register.

Save the Date: NABH 2021 Annual Meeting

NABH will host its 2021 Annual Meeting from Wednesday, Oct. 6 – Friday, Oct. 8, 2021 at the Mandarin Oriental Washington, DC. The association re-scheduled for this later date in 2021 due to the ongoing Covid-19 pandemic. We hope you can join us! After 2021, NABH will host its subsequent Annual Meetings in June. Please save the date for these future NABH Annual Meetings:

June 13-15, 2022

June 12-14, 2023

We look forward to seeing you again in Washington!

Fact of the Week

Nearly a quarter of all child and adolescent admissions to psychiatric hospitals are involuntary, according to a new study in The Lancet. The report also showed children admitted against their will more often had a diagnosis of psychosis, substance misuse, or intellectual disability. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 145

Written by Emily Wilkins (NABH) on April 23, 2021. Posted in CEO Updates.

HHS Secretary Becerra Extends Covid-19 Public Health Emergency U.S. Health and Human Services (HHS) Secretary Xavier Becerra has extended the public health emergency (PHE) due to the Covid-19 global pandemic, effective April 21. The declaration typically lasts for 90 days, which would extend the PHE to July 20, given that Becerra renewed the PHE on April 21. Researchers to Begin Work on Opioid Vaccine with $25 Million NIH Grant Using a $25 million grant from the National Institutes of Health Helping to End Long-term initiative (HEAL), scientists from Boston Children’s Hospital’s Precision Vaccines Program and professors of psychology and medicinal chemistry at the University of Houston have partnered to develop an adjuvant opioid use disorder (OUD) vaccine. An announcement from the University of Houston noted that an adjuvant molecule boosts the immune system’s response to vaccines, which is critical for the effectiveness of anti-addiction vaccines. The vaccine targets fentanyl, a synthetic opioid. Therese Kosten, Ph.D., professor of psychology at the University of Houston, said in the announcement that the vaccine could be a “game changer” for addiction. Kosten also serves as director of the university’s Developmental, Cognitive & Behavioral Neuroscience program. “Fentanyl is different than heroin or other opioids in the way that it stimulates the nervous system,” Kosten said. “It activates the same receptors in the brain as heroin or morphine but does so by a different mechanism, which makes drugs that can reverse a heroin overdose, like Narcan, almost ineffective against it,” she added. Kosten received $1.8 million of the grant to make the combination of the adjuvant with the vaccine as powerful as possible. The NIH HEAL initiative is a trans-NIH effort to speed scientific solutions to the nation’s opioid public health crisis. The program launched in April 2018 and is focused on improving prevention and treatment strategies for opioid misuse and addiction and enhancing pain management. Bipartisan Policy Center Establishes Opioid Task Force Former U.S. Surgeon General Jerome Adams, M.D. and former HHS Secretary Donna Shalala are among the members of the Bipartisan Policy Center’s (BPC) new Opioid Crisis Task Force that will develop evidence-based recommendations for Congress and the Biden administration. Announced this week, the new task force also includes former Gov. Steve Beshear (D-Ky.), former U.S. Rep. Mary Bono (R-Calif.), Richard Frank, Ph.D., professor of health economics at Harvard University, Patrice Harris, M.D., former president of the American Medical Association, and former Gov. Susanna Martinez (R-N.M.). The BPC’s announcement cited preliminary data from the Centers for Disease Control and Prevention (CDC) that show more than 90,000 Americans died from drug overdose deaths from October 2019 to September 2020, reflecting nearly a 30% increase from the previous year. “Congress has made substantial financial investments to tackle the opioid epidemic, yet drug overdoses and mortality rates continue to climb, driven by illicitly manufactured fentanyl, with the highest increase in mortality among Black communities,” Anand Parekh, M.D., the BPC’s chief medical advisor who leads the project, said in an announcement. “We must determine more effective ways to utilize federal investments to combat this epidemic and close the gap between those who are seeking treatment and those receiving it.” The task force will release a final report in early 2022. HHS Introduces Video Series on Disability Rights Protections that Apply to Some Individuals in Recovery from OUD HHS this week announced it has developed a five-part video series titled “Civil Rights Protections for Individuals in Recovery from an Opioid Use Disorder.” The series is intended to inform audiences about how to apply federal disability rights laws to child welfare programs and activities; discuss protections that apply to some individuals in recovery from an OUD; provide an overview of medication-assisted treatment, or MAT; and address common misconceptions about MAT as a treatment approach. HHS’ Office of Civil Rights, the Substance Abuse and Mental Health Services Administration, and the Administration for Children and Families have partnered with the National Center on Substance Abuse and Child Welfare to develop the series. Click here to learn more and to watch the videos. NCOA to Host Older Adult Mental Health Awareness Day Symposium on May 6 The National Council on Aging (NCOA), along with the U.S. Administration for Community Living and the Substance Abuse and Mental Health Services Administration (SAMHSA) will host the 4^th Annual Older Adult Mental Health Awareness Day Symposium as a virtual event on Thursday, May 6. Registration is free, and the all-day event for public health practitioners, professionals in the aging networks, mental health providers, healthcare professionals, and others interested in the mental health of older adults will address topics such as access to behavioral health in diverse older adults, latest interventions related to SUDs, and socialization and engagement. Learn more from the program’s agenda and click here to register. NIAA Alcohol Treatment Navigator Includes FAQs and Toolkit for Finding Quality Treatment The National Institute on Alcohol Abuse and Alcoholism (NIAA) Alcohol Treatment Navigator is available to direct adults and families to finding evidence-based care for alcohol treatment. The resource includes sections on what to know about alcohol treatment, how to find quality treatment, and how to get support through the process, as well as frequently asked questions and a toolkit. Because the NIAA developed the Navigator, it has no commercial sponsors. Save the Date: NABH 2021 Annual Meeting NABH will host its 2021 Annual Meeting from Wednesday, Oct. 6 – Friday, Oct. 8, 2021 at the Mandarin Oriental Washington, DC. The association re-scheduled for this later date in 2021 due to the ongoing Covid-19 pandemic. We hope you can join us! After 2021, NABH will host its subsequent Annual Meetings in June. Please save the date for these future NABH Annual Meetings:

June 13-15, 2022

June 12-14, 2023

We look forward to seeing you again in Washington! Fact of the Week After a year of trauma, three in 10 healthcare workers consider leaving the profession, according to a new Washington Post-Kaiser Family Foundation poll. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 144

Written by Emily Wilkins (NABH) on April 16, 2021. Posted in CEO Updates.

NABH Releases ‘Residential Treatment: A Vital Component of the Behavioral Healthcare Continuum’

NABH this week released Residential Treatment: A Vital Component of the Behavioral Healthcare Continuum, a white paper that emphasizes the importance and effectiveness of psychiatric residential treatment services for children and adolescents. Together the NABH team and Youth Services Committee developed the paper as a resource for policymakers, regulators, the media, and other stakeholders to help explain how and why residential treatment is a vital component in the behavioral healthcare continuum—and how children and adolescents benefit from services in this setting. NABH has posted the paper on the association’s new Youth Services page, which also includes shareable social media messages about the paper’s content for members to post on Twitter and LinkedIn. NABH urges all members to share the link to the new page and the messages with your teams. If you have questions about the paper or a comment to share with the Youth Services Committee, please contact John Snook, NABH’s director of government relations and strategic initiatives, who serves as the association’s staff liaison to the committee.

President Biden Signs Legislation to Extend Suspension of Medicare Sequestration

President Biden on Wednesday signed legislation to exempt Medicare from sequestration—a process of automatic, across-the-board, spending cuts—until Dec. 31, 2021. Late last year, the Consolidated Appropriations Act of 2021 provided a three-month extension of the Medicare sequestration moratorium, which expired on March 31. The Centers for Medicare & Medicaid Services (CMS) issued a notice in late March that said the agency would hold Medicare claims with service dates on or after April 1 “for a short period” to ensure providers would not be affected by the sequester’s 2% cut to payments.

Biden Administration Requests Investments in Mental Health and SUD Services for FY 2022

President Biden’s recent request for Fiscal Year (FY) 2022 discretionary funding asks Congress to make significant investments to expand access to mental healthcare services, help end America’s opioid crisis, and prioritize the physical and mental well-being of the nation’s students. Sometimes referred to as the president’s “skinny budget,” the White House’s discretionary funding request was sent late last week to Sen. Patrick Leahy (D-Vt.), chairman of the Senate Appropriations Committee, ahead of the president’s official budget in the coming months. As with the president’s formal budget, this funding request from the Office of Management and Budget is significant for highlighting the president’s priorities. “The opioid epidemic has shattered families, claimed lives, and ravaged communities across the nation—and the Covid-19 pandemic has only deepened this crisis,” OMB Acting Director Shalanda D. Young wrote in the request. “That is why the discretionary request includes a historic investment of $10.7 billion, an increase of $3.9 billion over the 2021 enacted level, to support research, prevention, treatment, and recovery support services, with targeted investments to support populations with unique needs, including Native Americans, older Americans, and rural populations.” The discretionary funding request also builds on the recent American Rescue Plan in providing $1.6 billion—more than double the 2021 enacted level—for the Community Mental Health Services Block Grant. It also asks for $1 billion to increase the number of counselors, nurses, and mental health professionals in schools, as well as $430 million for Full Service Community Schools, which provide comprehensive, wrap-around services to students and their families, from after-school programs to adult education opportunities, and health and nutrition services.

MACPAC’s April 2021 Public Meeting Addresses Behavioral Health

The Medicaid and CHIP Payment and Access Commission (MACPAC) included several presentations related to behavioral health at its recent public meeting. The two-day event addressed Access to Mental Health Services for Adults, Access to Behavioral Health Services for Children and Youth, Electronic Health Records as a Tool for Integration of Behavioral Health Services, and Promoting Physical and Clinical Integration Through EHRs. NABH has posted the presentations on the association’s website; click here to learn more.

Manatt Health and AMA to Host Webinars on 2020 Roadmap to End National Drug Overdose Crisis

Research firm Manatt Health and the American Medical Association (AMA) will host a series of webinars to highlight various topics addressed in the 2020 National Roadmap on State-Level Efforts to End the Nation’s Drug Overdose Epidemic, which the two organizations released in December. The first in this series, “Improving Access to Substance Use Disorder Treatment in Justice-Involved Settings,” is scheduled for Tuesday, April 20, and will feature presenters from the AMA, the American Civil Liberties Union, the Johns Hopkins School of Medicine, and North Carolina’s Health and Human Services Department. Click here to register for the free webinar.

NCOA to Host Older Adult Mental Health Awareness Day Symposium on May 6

Save the Date: NABH 2021 Annual Meeting

June 13-15, 2022

June 12-14, 2023

We look forward to seeing you again in Washington!

Fact of the Week

Female nurses die by suicide at twice the rate of the general population, according to a new study in JAMA Psychiatry. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 143

Written by Emily Wilkins (NABH) on April 9, 2021. Posted in CEO Updates.

CMS Proposes 2.1% Payment Increase to Per-Diem Base Rate for IPFs in FY 2022

The Centers for Medicare & Medicaid Services (CMS) this week proposed a 2.1-percent, Medicare payment increase to the per-diem base rate for inpatient psychiatric facilities (IPF) for fiscal year (FY) 2022. This adjustment would increase the per-diem base rate to $833.50 from $815.22 and the electroconvulsive therapy (ECT) rate to $358.84 from $350.97. CMS proposed several changes for inpatient psychiatric care in 2022, such as aligning an IPF policy regarding displaced residents from IPF closures and closures of IPF teaching programs with the policy changes that the agency made final in its FY 2021 IPPS rule. In its FY 2022 proposed rule, CMS recommended the following changes to the IPF Quality Reporting Program:

Starting in FY 2023, the agency would add a requirement to report Covid-19 Vaccination Coverage Among Healthcare Personnel in the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network web portal;

For FY 2024, CMS would substitute the Follow-up After Psychiatric Hospitalization (FAPH) measure for the Follow-up After Hospitalization for Mental Illness (FUH) measure. The FAPH includes patients with substance use disorders and also expands the provider types who can provide follow-up care to include primary care providers;

For FY 2024, the agency would remove the three following measures:
- Alcohol Use Brief Intervention Provided or Offered and Alcohol Use Brief Intervention Provided (SUB-2/2a),
- Tobacco Use Brief Intervention Provided or Offered and Tobacco Use Brief Intervention Provided (TOB-2/2a), and
- Timely Transmission of Transition Record -Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care.

CMS is requesting information about how to develop a patient experience-of-care measure, as well as comments on including a patient-reported outcomes measure that assesses functional outcomes. The agency also wants feedback on measures either included in the IPFQRP now or that could be added that would be appropriate for digital data collection. The agency is also seeking comment about how to modify reporting in a way that would improve collecting information on health disparities. CMS asked specifically for feedback on stratification of quality measure results by dual eligibility, race and ethnicity, improving demographic data collection, and potential creation of a facility equity score synthesizing results across multiple social risk factors. CMS will accept public comments on the rule until June 7.

U.S. Labor Department Issues Guidance on Parity Compliance

The U.S. Labor Department (DOL) has issued guidance on new implementation requirements for the Mental Health Parity and Addiction Equity Act (MHPAEA) that the 2021 Consolidated Appropriations Act requires. Enacted on Dec. 27, 2020, the 2021 Consolidated Appropriations Act requires group health plans and health insurance issuers offering group or individual health insurance to perform and document analyses of how they comply with MHPAEA in their application of non-quantitative treatment limits (NQTLs) to mental health/substance use disorder (MH/SUD) benefits, compared with their application of NQTLs to medical/surgical benefits. As of Feb. 10, 2021, health plans and insurers must make these comparative analyses available upon request to three federal agencies that oversee MHPAEA implementation: DOL, the U.S. Department of Health and Human Services, and the U.S. Treasury Department. The required NQTL analyses by health plans and insurance issuers must include the following information:

A description of the NQTL, plan terms, and policies at issue;

Identification of the MH/SUD and medical/surgical benefits to which the NQTL applies;

The factors used in applying the NQTLs to MH/SUD benefits and medical or surgical benefits;

The evidentiary standards used for these factors;

The comparative analyses demonstrating that the processes, strategies, evidentiary standards, and other factors used to apply the NQTLs to MH/SUD benefits, as written and in operation, are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, and other factors used to apply the NQTLs to medical/surgical benefits in the benefits classification; and

The specific findings and conclusions reached by the plan or issuer, including any results of the analyses that indicate that the plan or coverage is or is not in compliance with the MHPAEA requirements.

The new law also requires the federal agencies to share findings regarding these analyses of MHPAEA compliance with the state governments where the plans or issuers are located and submit an annual report to Congress on these findings. The guidance provides additional detail regarding the following topics:

What information plans and issuers must make available to support their comparative analyses demonstrating compliance with MHPAEA in their use of NQTLs;

Examples illustrating when the federal agencies might determine that a comparative analysis of NQTLs is insufficiently specific and detailed;

The types of documents that plans and issuers should be prepared to make available to the federal agencies to support their analyses and conclusions regarding their NQTL comparative analyses;

What actions the federal agencies will take if they determine that a plan or issuer has not submitted sufficient information or is not in compliance with MHPAEA;

Whether state agencies and plan participants and beneficiaries may request to see a plan or issuer’s comparative analysis of its use of NQTLs;

Which specific NQTLs the federal agencies plan to focus on in the near term when requesting comparative analyses from plans and issuers for review, namely:

- Prior authorization requirements for in-network and out-of-network inpatient services,
- Concurrent review for in-network and out-of-network inpatient and outpatient services,

Standards for provider admission to participate in a network, including reimbursement rates, and

Out-of-network reimbursement rates (plan methods for determining usual, customary, and reasonable charges).

New Federal Guidance Says Federal Grantees May Now Use Funds to Buy Fentanyl Test Strips

Guidance this week from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Disease Control and Prevention (CDC) says funding may now be used to purchase rapid fentanyl test strips (FTS) as a way to help curb the sharp rise in drug overdose deaths primarily from strong synthetic opioids, including fentanyl. FTS can be used to determine if drugs have been mixed or cut with fentanyl, which will provide people who use drugs and communities with information about fentanyl in the illicit drug supply so they can work to reduce their risk of overdose. “This is a major step forward in the ongoing and critical work to prevent overdose and connect people who have substance use disorders to evidence-based treatment options,” Acting Assistant Secretary for Mental Health and Substance Use Tom Coderre, interim leader at SAMHSA, said in an announcement. “This will save lives by providing tools to identify the growing presence of fentanyl in the nation’s illicit drug supply and – partnered with referrals to treatment – complement SAMHSA’s daily work to direct help to more Americans.”

AP Reports U.S. Suicides Fell Nearly 6% in 2020, Defying Global Pandemic Expectations

Citing preliminary government data, the Associated Press on Thursday reported the number of U.S. suicides dropped by about 6% in 2020, the largest annual decline in at least 40 years. The CDC has not reported national suicide rates for 2020, nor has it provided a breakdown of suicides by state, age, or race and ethnicity. The AP story quoted Christine Moutier, M.D., chief medical officer at the American Foundation for Suicide Prevention, as saying an increase in the availability of telehealth services and other efforts to address America’s suicide problem may have contributed to the decrease in the preliminary findings.

NABH and Other Organizations Offer to Work with OSHA to Ensure Safety and Quality of Care at Psychiatric Facilities

In a letter to the Occupational Safety and Health Administration (OSHA) this week, NABH and three other behavioral healthcare groups offered to work with the federal agency to develop well-informed policies that ensure the safety of patients and personnel at psychiatric facilities. NABH, the National Association of State Mental Health Program Directors, the National Alliance on Mental Illness, and the National Council for Behavioral Health sent a letter to James Frederick, the principal deputy assistant secretary of Labor for Occupational Safety and Health, that expressed concern about certain OSHA policies and implementation actions that do not align with other requirements that inpatient psychiatric facilities must follow to ensure both patient safety and quality care. For instance, one OSHA requirement calls for fully enclosing nursing stations with plexiglass—a practice that prevents patient-staff interactions that are critical for quality behavioral healthcare. “We recognize that regulatory entities face many difficulties in developing a consistent set of requirements intended to reduce hazards in the context of different treatment approaches and services offered by individual facilities, different patient populations, and various state regulatory requirements,” the letter said. “Therefore, we recommend that OSHA establish a collaborative process to gather input from leading psychiatric hospitals and units, state mental health agency officials, psychiatric providers, employee representatives, and representatives of mental healthcare consumers and their families regarding effective practices for ensuring the safety of inpatient psychiatric facilities without compromising the clinical care of patients.” The Kennedy Forum to Start Three-Part Webinar for Employers Next Week The Kennedy Forum next week will host the first in a three-part webinar series about what employers can do to accommodate the growing demand from employees for better access to mental health and addiction care. The series will explore the effects of mental health and addiction in the workplace, the pros and cons of different internal support options, and ways to collaborate with insurers to ensure better access to treatment. Part 1 is titled “Impact—There is No Health Without Mental Health” and will be hosted on Thursday, April 15 from 2 p.m. to 3 p.m. ET. Parts 2 and 3 will be held on April 29 and May 13, respectively, at the same time. Click here to learn more and to register.

Save the Date: NABH 2021 Annual Meeting

June 13-15, 2022

June 12-14, 2023

We look forward to seeing you again in Washington!

Fact of the Week

More than one year into the global pandemic, 76% of frontline healthcare workers say they feel “hopeful” when going to work these days, a new Kaiser Family Foundation/Washington Post survey found. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 142

Written by Emily Wilkins (NABH) on April 1, 2021. Posted in CEO Updates.

Biden Administration Releases Drug-Policy Priorities for Year One

The Biden administration on Thursday released a statement outlining its first-year, drug-policy priorities to address America’s overdose and addiction crises. White House Office of National Drug Control Policy (ONDCP) Acting Director Regina LaBelle noted in an announcement that these priorities will complement President Biden’s American Rescue Plan, which includes an investment of nearly $4 billion in behavioral health services. In the next year, the ONDCP will work across government to implement seven priorities:

Expanding access to evidence-based treatment

Advancing racial equity in our approach to drug policy

Enhancing evidence-based harm reduction efforts

Supporting evidence-based prevention efforts to reduce youth substance use

Reducing the supply of illicit substances

Advancing recovery-ready workplaces and expanding the addiction workforce

Expanding access to recovery support services

The strategy identified several issues that NABH has discussed with the ONDCP, including, but not limited to, enforcing parity, improving reimbursement for services, permitting medications through telehealth without an in-person evaluation, and removing policy barriers to using contingency management and motivational incentives. In addition, harm reduction appears to have a more visible role in the Biden administration than with previous administrations, as do issues related to workforce, recovery-ready workplaces, and recovery-support services.

Final Rule to Implement Cures Act Interoperability Requirements Takes Effect April 5

A regulation to implement interoperability requirements outlined in the 21^st Century Cures Act and prohibit “information blocking” takes effect Monday, April 5. Information blocking is defined as a practice by a health information technology (IT) developer, health information network, health information exchange, or healthcare provider that is likely to interfere with access, exchange, or use of electronic health information. There are certain exceptions. The Office of the National Coordinator for Health Information Technology (ONC) has posted information clarifying what qualifies as information blocking, as well as a number of exceptions.

CMS Alerts Providers that Repayment of Covid-19 Accelerated and Advance Began March 30

The Centers for Medicare & Medicaid Services (CMS) this week alerted Medicare-participating providers that the federal agency began recovering Covid-19 Accelerated and Advance Payments (CAAPs). A special edition MLN (Medicare Learning Network) Matters article informed all Medicare providers and suppliers who requested and received CAAPs that the agency began recovering those payments as early as March 30, depending upon the one-year anniversary of when providers received their first payment. “Please be sure your billing staff are aware that the recovery has begun, or will begin soon, but no sooner than 1 year from the date we issued the CAAP to you,” the article said.

Bipartisan Policy Center Report Urges Congress to Integrate Primary Care and Mental Health & SUD Services

The Bipartisan Policy Center on Thursday released Tackling America’s Mental Health and Addiction Crisis Through Primary Care Integration, a 124-page report with legislative and regulatory recommendations to integrate behavioral health into primary care. “Even before the Covid-19 pandemic, the unmet need for mental health and substance use services in the United States was significant,” the report noted. “Alarmingly, less than half of adults with mental health conditions received services in 2019, and the percentage was even lower in Black and Latino communities,” it continued. “As for substance use, nearly 90% of people with a substance use disorder did not receive treatment.” The report highlights these essential recommendations: establish core, minimum standards for integration; drive integration in new and existing value-based payment models; expand, train, and diversify the workforce for integrated care teams; and promote the use of EHRs, telehealth, and other technology to support integrated care. “Broader use of EHRs is critical for improving coordination among the different levels of behavioral healthcare, including inpatient, residential, and outpatient providers of mental health and addiction treatment,” NABH President and CEO Shawn Coughlin said in a news release about the report from the Behavioral Health Information Technology Coalition, of which NABH is a member. “The lack of federal funding to help behavioral healthcare providers implement health information technology has contributed significantly to relatively lower EHR use by these providers compared with other healthcare providers.” The Bipartisan Policy also developed infographics that highlight the recommendations outlined in the report.

Next Week’s Virtual Rx Drug Abuse & Heroin Summit to Feature President Biden

President Biden will deliver a recorded message to attendees at next week’s virtual Rx Drug Abuse & Heroin Summit on Monday, April 5 at 10:15 a.m. ET. Featured during the conference’s opening plenary session, the president’s remarks will focus on the Biden administration’s efforts to reduce overdose rates and save lives. Registration is still available for the 10^th annual conference, which will present more than 75 sessions across nine educational tracks and will cover topics ranging from prevention and treatment to public safety and technology. NABH Director of Quality and Addiction Services Sarah Wattenberg will present with representatives from the Office of National Drug Control Policy, the U.S. Drug Enforcement Administration, and the Veterans Affairs Department in a session titled, “Federal and Private Sector Responses to Opioid Treatment Issues During the Covid-19 Pandemic.” For additional information, download the conference brochure, and click here to register.

NIMH Issues Notice of Special Interest in Research to Examine Covid-19’s Mental Health Effects on Children

The National Institute of Mental Health (NIMH) has issued a Notice of Special Interest (NOSI) to highlight interest in research to understand the mental health effects of Covid-19 pandemic on school-aged children, specifically those between the ages of 3 and 12. The NOSI said the NIMH is interested particularly in the potential impact of primary instruction setting disruptions, such as pre-school and elementary school, on the mental health, cognitive, social, and emotional development of children. “Empirical data would aid in balancing health risks for various public health mitigation strategies affecting children in the current pandemic as well as inform how to both be prepared and respond to future public health emergencies, including pandemics and disaster scenarios,” the noticed said. Applications are due starting June 5 and ending on Sept. 8, 2021. Click here to learn more.

Save the Date: NABH 2021 Annual Meeting

June 13-15, 2022

June 12-14, 2023

We look forward to seeing you again in Washington!

Fact of the Week

From Jan. 20, 2021–Feb. 1, 2021, more than two in five adults aged 18 or older experienced symptoms of an anxiety or a depressive disorder during the past seven 7 days. Meanwhile, one in four adults who experienced these symptoms reported that they needed but did not receive counseling or therapy for their mental health. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 141

Written by Emily Wilkins (NABH) on March 26, 2021. Posted in CEO Updates.

NABH Priorities for the 117^th Congress Now Available

NABH this week released its updated advocacy agenda, NABH Priorities for the 117^th Congress, in a document available on the association’s homepage.

In previous years, NABH released its Legislative and Regulatory Priorities this time of year at the Annual Meeting in time for Hill Day. This year, NABH updated the resource’s name to reflect the association’s advocacy priorities for the new Congress.

Two notable additions this year include “Increase Crisis Stabilization Services for 988 Hotline Calls” and “Maintain Coverage of Tele-Behavioral Healthcare.” The former relates to the universal, toll-free crisis hotline that holds great promise to prevent tragic outcomes and increase access to mental health and addiction treatment, while the latter advocates for expanded coverage of mental health and addiction treatment services via telehealth that have been critical during the Covid-19 global pandemic.

Each of the priorities explains an important advocacy issue for NABH and also outlines specific next steps to address it.

NABH urges its members to review the NABH Priorities for the 117^th Congress and contact any member of the NABH team with questions.

Senate Passes Bill to Extend Medicare Sequestration, Staving Off Automatic Payment Cuts

The Senate this week passed legislation that would provide a 9-month extension of the Medicare sequester moratorium that the CARES Act established and that would cut Medicare provider payments by 2%.

Late last year, the Consolidated Appropriations Act of 2021 provided a three-month extension of the Medicare sequestration moratorium, which is set to expire on March 31. The House is expected to consider the Senate-passed bill when Congress returns the week of April 12.

It is also expected that the Centers for Medicare & Medicaid Services (CMS) will hold Medicare claims until the bill is signed into law, as the agency has done in the past.

Senate Confirms Vivek Murthy as U.S. Surgeon General

The Senate on Tuesday voted 57-43 to confirm Vivek Murthy, M.D. as U.S. surgeon general, a position Murthy held from 2014 through 2017.

As surgeon general, Murthy, 43, will oversee the U.S. Public Health Service commissioned corps, a uniformed service of about 6,000 public health workers who have helped manage the coronavirus response and administer vaccines.

Sen. Bill Cassidy (R-La.), a physician, as well as Sens. Susan Collins (R-Maine) and Mitt Romney (R-Utah) were among the seven Senate Republicans who supported Murthy’s confirmation.

Late last week, the Senate confirmed former California Attorney General Xavier Becerra as secretary of the U.S. Health and Human Services (HHS) Department. Earlier, Becerra served in Congress on the powerful House Ways and Means Committee.

The Senate also has confirmed Rachel Levine, M.D., a pediatrician who served most recently as the secretary of the Pennsylvania Department of Health, as assistant secretary of health at HHS.

HHS-OIG Highlights ‘Staff Burnout and Trauma’ in Report About Covid-19’s Effect on Hospitals

HHS’ Office of Inspector General (OIG) listed “Staff Burnout and Trauma” as one of U.S. hospitals’ main challenges in a report that concluded the Covid-19 pandemic has “significantly strained” U.S. healthcare delivery.

“Hospitals reported that increased hours and responsibilities, along with other stressors caused by the Covid-19 pandemic, resulted in staff being exhausted, mentally fatigued, and sometimes experiencing possible post-traumatic stress disorder (PTSD),” the 62-page report noted. “Several hospitals reported that witnessing Covid-19-related deaths especially weighed on staffs’ mental health.”

The OIG’s office spoke with representatives from 320 hospitals that were part of a random sample of 397 hospitals. Click here to read the full report.

Psychiatry Among Specialties With ‘Sizeable Increases’ in Last Five Years

Psychiatry joins the specialties of neurology, family medicine, emergency medicine, and internal medicine that have seen sizeable increases in the number of positions offered in the last five years, the National Residency Matching Program announced March 19.

The organization celebrated “Match Day” with the thousands of applicants and programs participating in the 2021 Main Residency Match, in which medical students and graduates from the United States and around the world learned which U.S. residency programs they will train for the next three to seven years.

This year’s results were highly anticipated, given the shift to virtual recruit due to the Covid-19 pandemic. The National Resident Matching Program noted that specialties serve as indicators of workforce supply, as match results may be a predictor of future physician workforce supply—especially when examining growth in specialties over time.

Register to Attend the 2021 Rx Drug Abuse & Heroin Summit

The annual Rx Drug Abuse and Heroin Summit, known as the largest annual conference that addresses America’s opioid and addiction crises, will be held virtually this year from April 5-8.

The conference will present more than 75 sessions across nine educational tracks and will cover topics ranging from prevention and treatment to public safety and technology. NABH Director of Quality and Addiction Services Sarah Wattenberg will present with representatives from the Office of National Drug Control Policy, the U.S. Drug Enforcement Administration, and the Veterans Affairs Department in a session titled, “Federal and Private Sector Responses to Opioid Treatment Issues During the Covid-19 Pandemic.”

For additional information, download the conference brochure, and click here to register.

Save the Date: NABH 2021 Annual Meeting

NABH will host its 2021 Annual Meeting from Wednesday, Oct. 6 – Friday, Oct. 8, 2021 at the Mandarin Oriental Washington, DC.

The association re-scheduled for this later date in 2021 due to the ongoing Covid-19 pandemic. We hope you can join us!

After 2021, NABH will host its subsequent Annual Meetings in June. Please save the date for these future NABH Annual Meetings:

June 13-15, 2022

June 12-14, 2023

We look forward to seeing you again in Washington!

Fact of the Week

The National Center for PTSD estimates that 28% of people who have witnessed a mass shooting will suffer from post-traumatic stress disorder, and about one-third from acute stress disorder.

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

CEO Update 140

Written by Emily Wilkins (NABH) on March 19, 2021. Posted in CEO Updates.

New Milliman Study Analyzes Behavioral Healthcare Utilization During Covid-19 Pandemic

An analysis of insurance claims comparing the same periods in 2019 and 2020 found that mental health and substance use disorder inpatient admissions dropped through April 2020—similar to decreases seen in physical healthcare services—but that subsequent behavioral health inpatient admissions increased through August 2020 at a much higher rate than medical services, with admission rates exceeding 2019 levels in the third quarter.

That was especially true among the Medicaid population, according to the new Milliman study that the Well Being Trust released this week. The report examined 12.5 million individuals’ commercial insurance, Medicaid Managed Care, Medicare fee-for-service, and Medicare Advantage claims between January-August 2019 and January-August 2020. The analysis seeks to understand how Covid-19 affected mental healthcare in a similar, and, at times, different, way than it did medical healthcare.

“When Covid-19 forced people to press pause on receiving non-emergent care, there was a lot of conversation about the impact delayed care would have on individuals unknowingly living with cancer, cardiac, or chronic conditions,” Benjamin F. Miller, Psy.D., chief strategy officer at Well Being Trust, said in an announcement about the report. “There was noticeably less conversation about the impact this would have on the millions of Americans confronting mental health and addiction issues, for whom there were already barriers to care even before the global pandemic.”

The study also found that with the exception of Medicare beneficiaries, when remote healthcare utilization was factored into individuals’ overall behavioral healthcare utilization numbers, there were primarily year-over-year increases across all insured populations.

“Mental healthcare utilization increased among the Medicaid population between 2019 and 2020, and only decreased by 1% in March and May among the commercially insured population,” the study noted.

NABH Supports SERVE Act During National Eating Disorders Awareness Week

NABH supports the Supporting Eating Disorders Recovery through Vital Expansion (SERVE) Act, a bipartisan bill introduced during this National Eating Disorders Awareness Week that would ensure TRICARE, the U.S. military’s health insurance program, provides members of the military and their families with comprehensive treatment for eating disorders.

“According to a recent study published by the Harvard T.H. Chan School of Public Health, at least 28.8 million Americans will suffer from an eating disorder in their lifetime,” Rep. John Katko (R-N.Y.) said in a news release about the legislation. “These disorders affect individuals from all backgrounds. But for service members and their families, some are not eligible to receive higher level eating disorders care under TRICARE due to their age,” he continued. “Our bipartisan bill extends the age limit for beneficiaries to the Medicare eligibility age for TRICARE coverage of eating disorders care, ensuring those who served our nation and their families have access to the support they deserve.”

Katko introduced the bill with Reps. Veronica Escobar (D-Texas) and Seth Moulton (D-Mass.). The legislation calls for healthcare services to treat eating disorders at both hospital-based and freestanding facilities that offer inpatient, residential, partial hospitalization, intensive outpatient, and outpatient services.

The SERVE Act would require the U.S. Defense secretary to take action to identify, treat, and rehabilitate service members affected by eating disorders, and also direct the U.S. Defense Department to establish clinical practice guidelines on eating disorder treatment.

Senators Jeanne Shaheen (D-N.H.) and Thom Tillis (R-N.C.) introduced a companion bill in the Senate earlier this month.

Center for Connected Health Policy Releases Updated Telehealth Billing Guide

The Center for Connected Health Policy (CCHP) this week released an updated telehealth billing guide for healthcare organizations managing the complexities of billing for telehealth and virtual services.

First released in 2020, the updated billing guide addresses whether or not there is reimbursement for telehealth both generally and/or during the Covid-19 public health emergency, as well as how to bill correctly for a telehealth service, which CCHP said is one of the most common policy questions it receives as the National Telehealth Policy Resource Center.

“Further complicating the billing process is the need to understand whether current rules are only applicable during the pandemic as well as the fact that payer policies continue to vary from payer to payer,” the CCHP said in a news release. “For example, policies that apply to a Medicare beneficiary remain different than those that apply to a state Medicaid enrollee or to patients that have private insurance.”

The 30-page guide includes infographics that highlight various patient scenarios, as well as a page of resources available in different regions of the country. SAMHSA to Host Opioid Crisis Webinar Next Week SAMHSA Chief Medical Officer Neeraj Gandotra, M.D. will lead a panel of experts in a webinar to explore how healthcare providers, government agencies, and not-for-profit organizations can work together to address the nation’s ongoing opioid crisis.

Healthcare software company WellSky will present the webinar, which is intended to help registrants learn about effective care coordination, effective strategies to produce better outcomes, and how advocates are working to align patient data sharing with the Health Insurance Portability and Accountability Act.

The webinar is scheduled for Thursday, March 25 at 1 p.m. Click here to register.

Register to Attend the 2021 Rx Drug Abuse & Heroin Summit

The annual Rx Drug Abuse and Heroin Summit, known as the largest annual conference that addresses America’s opioid and addiction crises, will be held virtually this year from April 5-8.

The conference will present more than 75 sessions across nine educational tracks and will cover topics ranging from prevention and treatment to public safety and technology. NABH Director of Quality and Addiction Services Sarah Wattenberg will present with representatives from the Office of National Drug Control Policy, the U.S. Drug Enforcement Administration, and the Veterans Affairs Department in a session titled, “Federal and Private Sector Responses to Opioid Treatment Issues During the Covid-19 Pandemic.”

For additional information, download the conference brochure, and click here to register.

Save the Date: NABH 2021 Annual Meeting

NABH will host its 2021 Annual Meeting from Wednesday, Oct. 6 – Friday, Oct. 8, 2021 at the Mandarin Oriental Washington, DC.

The association re-scheduled for this later date in 2021 due to the ongoing Covid-19 pandemic. We hope you can join us!

After 2021, NABH will host its subsequent Annual Meetings in June. Please save the date for these future NABH Annual Meetings:

* June 13-15, 2022
* June 12-14, 2023

We look forward to seeing you again in Washington!

Fact of the Week

Data pooled from 65 studies involving 97,333 healthcare workers across 21 countries identified a high prevalence of moderate depression, anxiety, and PTSD among healthcare workers during the Covid-19 pandemic. “Appropriate support is urgently needed,” the report concluded. “The response would benefit from additional research on which interventions are effective at mitigating these risks.”

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

CEO Update 139

Written by Emily Wilkins (NABH) on March 12, 2021. Posted in CEO Updates.

Historic $1.9 Trillion Covid Relief Bill Includes Billions for Behavioral Healthcare

President Biden on Thursday signed the American Rescue Plan, a $1.9 trillion stimulus package to help Americans and the U.S. economy rebuild amid the Covid-19 global pandemic that brought the world to a halt a year ago this week. The landmark legislation provides some $8.5 billion in new funding for the Provider Relief Fund, focused primarily on the nation’s rural providers. It also includes $125.8 billion for the Elementary and Secondary School Emergency Relief Fund, some of which may be used for mental health supports, such as implementing evidence-based services in schools. In a White House announcement on Inauguration Day, the Biden administration said “Districts must ensure that funds are used to not only reopen schools, but also to meet students’ academic, mental health and social, and emotional needs in response to Covid-19 (e.g. through extended learning time, tutoring, and counselors), wherever they are learning.” Meanwhile, the new law includes $3 billion for the Substance Abuse and Mental Health Services Administration (SAMHSA) community mental health and substance abuse prevention and treatment grants, and $420 million for Certified Community Behavioral Health Clinics. It also provides $80 million in pediatric mental healthcare access funding, and $50 million in grants—for which behavioral health organizations are eligible—to address local behavioral health needs, including addressing surge capacity for behavioral health, telehealth, and crisis intervention services. The law also provides $30 million for substance use disorder (SUD) harm-reduction programs and $20 million for youth suicide-prevention programs. Here are other essential behavioral healthcare provisions in the American Rescue Plan:

Provides for mandatory coverage of COVID-19 vaccines, administration, and treatment under Medicaid

Allows states to extend Medicaid eligibility to women for 12 months postpartum for five years

Offers a Medicaid enhanced match (95%) for states that newly expand Medicaid as authorized under the Affordable Care Act

Includes a 7-percent increase in Medicaid match for home and community-based services including mental health services

Provides a Medicaid enhanced federal match (85% for three years) for mobile crisis services

$100 million for Behavioral Health Workforce Education and Training grants to graduate and professional training programs

$40 million for behavioral healthcare providers to support mental health among their workforce

$20 million to CDC for an education and awareness campaign directed to health care professionals and first responders

$80 million for behavioral healthcare for first responders

NABH Joins Other Healthcare Organizations to Support Medicare Sequester Extension

NABH is one of nearly 50 healthcare organizations that has requested House and Senate leaders extend the Medicare sequester moratorium and prevent the projected 4-percent Medicare spending cut scheduled to begin next year. Signed into law in late December, The Consolidated Appropriations Act of 2021 provided a three-month extension—until March 31—of the Medicare sequester moratorium that the CARES Act enacted. Meanwhile, unless Congress acts, a sequestration order will be issued to reduce spending in fiscal year 2022 by $381 billion, including a reduction in Medicare spending by four percentage points, which is an estimated $36 billion for that year. “Such extreme cuts would have a long-lasting and devastating impact on health care providers and patients alike,” the groups wrote in a letter Friday to House Speaker Nancy Pelosi (D-Calif.), House Minority Leader Kevin McCarthy (R-Calif.), Senate Majority Leader Chuck Schumer (D-N.Y.) and Senate Minority Leader Mitch McConnell (R-Ky.).

Fauci Says He is “Very Much” Concerned About a Mental Health Pandemic in Covid-19 Aftermath

Anthony Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases, told Norah O’Donnell of the CBS Evening News this week he is “very much” concerned about a mental health pandemic in the wake of the Covid-19 public health emergency. “That’s the reason why I want to get the virological aspect of this pandemic behind us,” Fauci said, “because the long-term ravages of this pandemic are so multifaceted.” Fauci also expressed his concerns about the prolonged symptomatology for those who have had the Covid-19 virus, the pandemic’s long-lasting economic effects, and the amount of routine medical examinations that Americans were forced to forego during the pandemic’s shutdown.

SAMHSA Accepting Applications for MAT-Prescription Drug-Opioid Addiction Grants

SAMHSA is accepting applications for fiscal year 2021 Medication-Assisted Treatment-Prescription Drug and Opioid Addiction (MAT-PDOA) grants to expand and enhance access to MAT services for individuals with opioid use disorder who are seeking or receiving MAT. SAMHSA’s announcement said the agency plans to issue about 89-135 awards of up to $1 million per year for states and up to $525,000 per year for other domestic, public or not-for-profit organizations for up to five years. The deadline to apply is Tuesday, April 27. Click here to learn more and apply.

IPFQR Webinar Scheduled for Next Week

The Quality Reporting Center has scheduled a webinar for participants in the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program about navigating public reporting websites on Wednesday, March 17 at 2 p.m. ET. According to an announcement, the presentation will describe how the IPF community can access publicly reported IPFQR program data on the Medicare Care Compare and Provider Data Catalog websites. Click here to learn more and to register.

Upcoming Opioid Crisis Webinar to Feature SAMHSA Chief Medical Officer Neeraj Gandotra, M.D.

SAMHSA Chief Medical Officer Neeraj Gandotra, M.D. will lead a panel of experts in a webinar to explore how healthcare providers, government agencies, and not-for-profit organizations can work together to address the nation’s ongoing opioid crisis. Healthcare software company WellSky will present the webinar, which is intended to help registrants learn about effective care coordination, effective strategies to produce better outcomes, and how advocates are working to align patient data sharing with the Health Insurance Portability and Accountability Act. The webinar is scheduled for Thursday, March 25 at 1 p.m. Click here to register.

Register to Attend the 2021 Rx Drug Abuse & Heroin Summit

The annual Rx Drug Abuse and Heroin Summit, known as the largest annual conference that addresses America’s opioid and addiction crises, will be held virtually this year from April 5-8. The conference will present more than 75 sessions across nine educational tracks and will cover topics ranging from prevention and treatment to public safety and technology. NABH Director of Quality and Addiction Services Sarah Wattenberg will present with representatives from the Office of National Drug Control Policy, the U.S. Drug Enforcement Administration, and the Veterans Affairs Department in a session titled, “Federal and Private Sector Responses to Opioid Treatment Issues During the Covid-19 Pandemic.” For additional information, download the conference brochure, and click here to register.

Save the Date: NABH 2021 Annual Meeting

June 13-15, 2022

June 12-14, 2023

We look forward to seeing you again in Washington!

Fact of the Week

A recent Kaiser Family Foundation health tracking poll found that during the Covid-19 pandemic, adults in households with job loss or lower incomes reported higher rates of symptoms of mental illness than those without job or income loss: 53% versus 32%. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 138

Written by Emily Wilkins (NABH) on March 5, 2021. Posted in CEO Updates.

Murthy Vows to Focus on Pandemic’s Mental Health Effects if Confirmed as Surgeon General

U.S. surgeon general nominee Vivek Murthy, M.D. said this week he will focus on the mental health effects of the Covid-19 global pandemic if he is confirmed to the post. Murthy told CBS This Morning on Tuesday that the nation is facing a “deeply concerning” increase in mental illness during the pandemic, including among children. “We know a lot of what we need to do, we just aren’t doing it,” Murthy said in the interview. “We have, for example, programs that we could be investing in schools to help provide mental health counseling to kids to detect symptoms of mental illness,” he continued. “We can train more mental health providers.” Ultimately, Murthy said, the country needs to have a “very different conversation” about mental health. “If you are struggling with your mental health, that does not mean that you are broken,” Murthy said. “What it means is that you are a human being having a human experience—one that many of us have been going through during this pandemic and many will experience long after the pandemic is over.” Murthy served as America’s 19th surgeon general from December 2014 until April 2017.

Joint Commission Journal Publishes Report on Staff Emotional Support During Pandemic

The Joint Commission Journal on Quality and Patient Safety this week published a study that examined different interventions that Montefiore Medical Center (MMC) applied to treat psychological distress among staff during the pandemic. According to the November 2020 study, the health system’s Moses campus admitted two patients diagnosed with Covid-19 a year ago on March 11, 2020. At the time of the study’s writing, more than 6,000 patients were admitted to MMC (including 91% from the Bronx), and more than 2,200 patients and 21 staff died from the virus. “On March 15, 2020, psychiatry leadership collaborated with leadership from various sectors of MMC to establish the Staff Emotional Support (SES) Team,” the study noted. “Over 10 weeks during the initial phase of the pandemic, the SES Team created a variety of mental health services to meet the needs of as many staff as possible, understanding that individuals respond to traumatic experiences and to support services in diverse ways.” The study said MMC applied a host of interventions, including psychoeducational resources, a phone support line, staff support centers (SSCs), a clinical treatment program, team support sessions, and more. “We believe that SSCs were the most frequently used,” the report said, “because they were easily accessible places for respite, refreshment, and recharging and offered a basic forum of human connection not necessarily associated with the potential stigma of seeking formal support.”

IPFQR Webinar Scheduled for Wednesday, March 17

SAMHSA Accepting Applications for MAT-Prescription Drug-Opioid Addiction Grants

The Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting applications for fiscal year 2021 Medication-Assisted Treatment-Prescription Drug and Opioid Addiction (MAT-PDOA) grants to expand and enhance access to MAT services for individuals with opioid use disorder who are seeking or receiving MAT. SAMHSA’s announcement said the agency plans to issue about 89-135 awards of up to $1 million per year for states and up to $525,000 per year for other domestic, public or not-for-profit organizations for up to five years. The deadline to apply is Tuesday, April 27. Click here to learn more and apply.

Register to Attend the 2021 Rx Drug Abuse & Heroin Summit

The annual Rx Drug Abuse and Heroin Summit, known as the largest annual conference that addresses America’s opioid and addiction crises, will be held virtually this year from April 5-8. The conference will present more than 75 sessions across nine educational tracks and will cover topics ranging from prevention and treatment to public safety and technology. NABH Director of Quality and Addiction Services Sarah Wattenberg will present with representatives from the Office of National Drug Control Policy, the U.S. Drug Enforcement Agency, and the Veterans Affairs Department in a session titled, “Federal and Private Sector Responses to Opioid Treatment Issues During the COVID-19 Pandemic.” For additional information, download the conference brochure, and click here to register.

Register to Attend the 6^th Annual Population Health Payer Innovations for Medicare, Medicaid & Duals

The 6^th Annual Population Health Payer Innovations for Medicare, Medicaid, & Duals will host its conference virtually this year from May 18-19. Free for hospitals, the conference will address topics such as combatting the opioid crisis, using community paramedics, and partnering clinical and analytic teams to explore value-based insurance design (VBID) models of care. Health plans that focus on Medicaid, Medicare, and dual-eligible beneficiaries, along with providers, will share best practices and how to build and manage population health programs to ensure compliance, improve outcomes, and control costs. Click here to learn more and to register.

Save the Date: NABH 2021 Annual Meeting

June 13-15, 2022

June 12-14, 2023

We look forward to seeing you again in Washington!

Fact of the Week

A new study found that health literacy (HL) “strongly correlated” with two-week and total readmissions among adult patients with bipolar disorder and supported the feasibility of assessing HL further in this patient population. The findings could also be useful for patient education, discharge planning, and policymaking. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 137

Written by Emily Wilkins (NABH) on February 26, 2021. Posted in CEO Updates.

CDC Reports U.S. Suicide Rate Fell Before Covid-19 Global Pandemic

The Centers for Disease Control and Prevention (CDC) this week reported that after increasing for 13 years, the U.S. suicide rate dropped overall by 2% between 2018 and 2019, but it cautioned those figures do not account for the Covid-19 pandemic’s impact. A total of 47,511 deaths were attributed to suicide in 2019, with half involving guns, although that rate also fell, the Atlanta-based agency said. Suicide rates declined by 3.2% for women and 1.8% for men. Meanwhile, the decrease varied by state and race, falling overall in Idaho, Indiana, Massachusetts, North Carolina, and Virginia—and only among white people. People aged 85 and older had the highest suicide rate of any age group, and levels appeared lowest in large, central metropolitan areas. “As the United States continues to respond to the coronavirus disease 2019 (Covid-19) pandemic and its long-term impacts on isolation, stress, economic insecurity, and worsening mental health and wellness, prevention is more important than ever,” the CDC’s Morbidity and Mortality Weekly Report noted. “Past research indicates that suicide rates remain stable or decline during infrastructure disruption (e.g., natural disasters), only to rise afterwards as the longer-term sequalae unfold in persons, families, and communities.”

‘Unified Vision’ to Address Mental Health and SUD Gains Support from 35 More Organizations

Thirty-five additional organizations have offered their support to the Unified Vision, a seven-pillar roadmap to address the future of mental health and substance use disorders (SUD) in America that a coalition of mental health and SUD organizations announced in December. NABH is part of that coalition, which developed the Unified Vision to provide action items meant to encourage and establish policy, programs, and standards that prioritize mental health and substance use care. The Unified Vision also addresses the social and economic conditions that disproportionately affect people of color and people whose income levels are below the federal poverty level. Organizations that joined recently include the American Academy of Child and Adolescent Psychiatry, Anxiety and Depression Association of America, National Association of School Nurses, and Trust for America’s Health. “An early priority is to break down the silos that currently exist in the mental health and substance use care space, which are all too often barriers to systemic change,” Daniel H. Gillison, Jr. of the National Alliance on Mental Illness, said in an announcement this week about the new signatories. “Our leadership team and recent signatories collectively represent close to 40 independent organizations, willing to work together on one of the direst issues of our time.” NABH, National Council and NASMHPD Urge CDC to Include Persons with SMI and SUD in Phase 1c Vaccination Groups NABH, the National Council, and the National Association of State Mental Health Program Directors (NASMHPD) have urged the CDC to include individuals with serious mental illness (SMI) and SUD in the agency’s Phase 1c vaccination groups for Covid-19 due to the high mortality rates among these patients from the coronavirus. In a letter to CDC Acting Director Rochelle Walensky, M.D., the three organizations assert that by excluding individuals with serious behavioral health conditions from Phase 1c prioritizations, these persons face increased risk of severe illness from Covid-19. CDC should also take immediate steps to distribute available vaccines directly to outpatient and inpatient behavioral health providers, the letter noted. The three groups outlined some action steps, such as urging the CDC to partner with the Substance Abuse and Mental Health Services Administration (SAMHSA) to allocate directly a limited supply of Covid-19 vaccine to select community mental health centers and community behavioral health organizations and inpatient psychiatric hospitals, as well as outpatient and residential treatment providers.

NABH Signs MHLG Coalition Letter to Support the TREAT Act

As a member of the Mental Health Liaison Group, NABH this week signed a letter to the Senate Health, Education, Labor, and Pensions and House Energy & Commerce Committees supporting the recently introduced Temporary Reciprocity to Ensure Access to Treatment Act (TREAT). The legislation from Senators Chris Murphy (D-Conn.) and Roy Blunt (R-Mo.) and Reps. Bob Latta (R-Ohio) and Debbie Dingell (D-Mich.) would increase access to healthcare services during the Covid-19 public health emergency by allowing practitioners with licenses to provide services—including telehealth services—in all states for the duration of the public health emergency. “The TREAT Act aims to increase access to crucial health services during this time by temporarily permitting health professionals to practice across state lines,” the letter noted. “The bill stipulates that a provider who holds a valid license in any state (and is not barred in another state) can practice in accordance with applicable state law in every state during the national public health emergency and during a 180-day transition period after the declaration is lifted,” it added.

Children’s Healthcare Groups Launch Youth Mental Health Awareness Campaign

The Children’s Hospital Association and the American Academy of Pediatrics (AAP) this week urged Congress and the Biden administration to prioritize children’s mental, emotional, and behavioral health in proposals that address the effects of the Covid-19 pandemic. In a joint announcement, the two organizations emphasized that the pandemic has exacerbated a disturbing trend, as hospital admissions and emergency room visits for suicide attempts doubled at children’s hospitals between 2008 and 2015. Hospitalizations at U.S. children’s hospitals increased last summer amid the pandemic, which included a 20% increase in suicide attempts and more than 40% in disruptive behavior disorders. “Almost a year into the pandemic, what began as a public health emergency is turning in a mental health crisis among our nation’s children and adolescents,” Dr. Lee Beers, president of the AAP, said in a news release. “The duration of the pandemic, isolation from friends and family, effects of parental stress and economic hardship, and loss of loved ones are all taking their toll on children’s mental health,” he added. “Now is the time for us to step up and invest in a broad-scale, comprehensive approach to prevention, early intervention, and treatment.”

Register to Attend the 2021 Rx Drug Abuse & Heroin Summit

Register to Attend the 6^th Annual Population Health Payer Innovations for Medicaid, Medicare & Duals

The 6^th Annual Population Health Payer Innovations for Medicaid, Medicare & Duals will host its conference virtually this year from May 18-19. Free for hospitals, the conference will address topics such as combatting the opioid crisis, using community paramedics, and partnering clinical and analytic teams to explore value-based insurance design (VBID) models of care. Health plans that focus on Medicaid, Medicare, and dual-eligible beneficiaries, along with providers, will share best practices and how to build and manage population health programs to ensure compliance, improve outcomes, and control costs. Click here to learn more and to register.

Save the Date: NABH 2021 Annual Meeting

June 13-15, 2022

June 12-14, 2023

We look forward to seeing you again in Washington!

Fact of the Week

Non-prescribed fentanyl and methamphetamine increased 78% and 29%, respectively, according to a new study from Millennium Health. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 135

Written by Emily Wilkins (NABH) on February 12, 2021. Posted in CEO Updates.

House Reconciliation Package Includes Strong Support for Behavioral Healthcare

U.S. House committees this week began marking up the Covid-19 reconciliation package that largely reflects the Biden administration’s priorities and includes strong support for behavioral healthcare and a number of NABH priorities. House members expect quick passage on a party-line basis for the legislation, which includes significant funding for state and local governments. NABH will apprise members of the final bill’s provisions when they are available. As of this week, the reconciliation package:

Includes Substance Abuse and Mental Health Services Administration (SAMHSA) block grants funded at $3.5 billion, split equally between the Block Grants for Community Mental Health Services and the Block Grants for Prevention and Treatment of Substance Abuse. Taken in conjunction with the $4.25 billion in funding that SAMHSA received in December as part of the stimulus package, this represents the largest onetime federal investment in behavioral health in our nation’s history.

Addresses the so-called Medicaid Inmate Exclusion Policy (MIEP) by allowing for medical assistance under Medicaid for inmates during the 30-day period preceding their release. This provision would expire after five years.

Provides enhanced Medicaid support for bundled mobile crisis intervention. States would be permitted to provide bundled payments for mobile crisis services at an 85% FMAP rate. This provision would expire after five years.

Provides for mandatory coverage of Covid-19 vaccines, administration, and treatment under Medicaid.

Allows states to extend Medicaid eligibility to women for 12 months postpartum for five years.

Provides $100 million for Behavioral Health Workforce Education and Training (BHWET) grants through the Public Health Service.

Provides $80 million for behavioral healthcare training for health care professionals, paraprofessionals, and public safety officers in the form of grants through the U.S. Health Resources and Services Administration (HRSA).

Provides $30 million for community-based substance use disorder programs for harm-reduction services and the prevention and control of the spread of infectious diseases through SAMHSA.

Provides $20 million for youth suicide prevention activities.

After the House passes this latest Covid-19 relief package, the Senate is expected to consider it after the upper chamber completes former President Trump’s impeachment trial.

Foley & Lardner Survey Examines Telehealth Commercial Insurance Laws Across States

Forty-three states and Washington, D.C. maintain some sort of telehealth commercial payer statute, although the quality and efficacy of these laws varies considerably from state to state, a new telehealth survey from law firm Foley & Lardner shows. The 190-page report notes that the legal landscape has “significantly improved” since the firm’s 2019 report, which is intended as a guide to telehealth insurance laws and regulations for healthcare providers, lawmakers, entrepreneurs, telemedicine companies, and other industry stakeholders. According to the report, although telehealth coverage has expanded widely, the same cannot be said for reimbursement/payment parity. “Currently, 22 states maintain laws expressly addressing reimbursement of telehealth services (an increase from 16 states in 2019), and 14 of those offer true “payment parity” (an increase from 10 in 2019), meaning that providers outside those 14 states may find they receive lower payment for telehealth-based services compared to in-person services (i.e., same service code, but different reimbursement rates),” the report said. “States with payment parity laws are Arkansas, California, Delaware, Georgia, Hawaii, Kentucky, Minnesota, Missouri, New Mexico, Texas, Utah, Vermont, Virginia, and Washington.”

Kaiser Family Foundation Analysis Shows Covid-19 Pandemic’s Effects on Mental Health and SUD

A new issue brief from the Kaiser Family Foundation reports that about four in 10 U.S. adults have reported symptoms of anxiety or depressive disorder during the Covid-19 global pandemic, up from one in 10 adults who reported these symptoms from January to June 2019. Meanwhile, a Kaiser Family Foundation tracking poll from July 2020 found that many adults are reporting specific negative effects on their mental health and well-being, such as difficulty sleeping (36%) or eating (32%), increases in alcohol and consumption or substance use (12%), and worsening chronic conditions (12%) due to worry and stress about the coronavirus. The study also examines the effects of adults losing their jobs, communities of color, young adults, and essential workers.

Pandemic-Related Alcohol Abuse Leads to Hospitalizations for Liver Disease

Hospitals nationwide have reported dramatic increases in alcohol-related admissions for critical diseases such as alcoholic hepatitis and liver failure, according to a story published this week in the Los Angeles Times. The story reported that alcoholism-related liver disease was a growing problem even before the Covid-19 pandemic, with about 15 million people diagnosed with the condition nationwide and with hospitalizations doubling during the last decade. “But the pandemic has dramatically added to the toll,” the story noted. “Although national figures are not available, admissions for alcoholic liver disease at Keck Hospital of the University of Southern California were up 30% in 2020 compared with 2019, said Dr. Brian Lee, a transplant hepatologist who treats the condition in alcoholics.” Meanwhile, specialists affiliated with the University of Michigan, Northwestern University, Harvard University, and Mount Sinai Health System in New York City reported rates of admissions for alcoholic liver disease have risen by up to 50% since last March. Click here to read the full story.

CMS’ Medicaid Initiatives Can Help States Fund the New Crisis Stabilization Services for Callers to the 988 Hotline

In a recent interview with Crisis Talk, Kirsten Beronio, NABH’s director of policy and regulatory affairs, explains how the Centers for Medicare & Medicaid Services’ (CMS) Medicaid initiatives can help states fund crisis stabilization services for callers to 988, the new three-digit national hotline for behavioral health emergencies. “988 has the potential to be a game-changer,” said Beronio, a former senior policy advisor at CMS, “And if we talk about it as a behavioral health crisis line, then states and commercial payers are more likely to see it as offering concrete opportunities to make improvements on a broader set of behavioral health issues that they’ve been struggling to address.” Click here to read Kirsten’s interview.

Register Today for National Drug and Alcohol Facts Week: March 22-28, 2021

The National Institute on Drug Abuse (NIDA) urges providers to register and sponsor an event for National Drug and Alcohol Facts Week, which will be held from March 22-28 this year. The week-long observance highlights science-based facts on how drugs and alcohol affect the brain and body, and NIDA has created five steps for providers to host an event. Click here to register and learn more.

Save the Date: NABH 2021 Annual Meeting

June 13-15, 2022

June 12-14, 2023

We look forward to seeing you again in Washington!

Fact of the Week

A new study from researchers at the Yale School of Medicine’s Department of Psychiatry found that people with serious mental illness are significantly overrepresented in deaths by suicide, even compared with individuals with other psychiatric diagnoses. Despite making up around 4% of the population of the United States, people with serious mental illness accounted for more than twice (8.7%) of those deaths by suicide, according to the results published in Schizophrenia Research. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 134

Written by Emily Wilkins (NABH) on February 5, 2021. Posted in CEO Updates.

CMS Announces Special Enrollment Period in Marketplaces During Covid-19 Pandemic

The Centers for Medicare & Medicaid Services (CMS) has announced a special enrollment period (SEP) for consumers—including both individuals and families—in the 36 states that operate health insurance marketplaces through HealthCare.gov, citing the “unprecedented challenges” that the Covid-19 public health emergency has created. “Millions of Americans are facing uncertainty and millions of Americans are experiencing new health problems during the pandemic,” said the announcement, which aligns with an Executive Order from President Biden. “Due to the exceptional circumstances and rapidly changing Public Health Emergency impacting millions of people throughout the U.S. every day, many Americans remain uninsured or underinsured and still need affordable health coverage.” Beginning Feb. 15 and continuing through May 15, marketplaces using the HealthCare.gov platform will make an SEP available to all marketplace-eligible consumers who are submitting a new application or updating an existing one. Eligible consumers who enroll under this SEP will be able to select a plan with coverage that starts prospectively the first month after plan selection. Consumers will then have 30 days from the time they applied to choose a plan.

ONDCP Announces 100-Day Priorities

The White House Office of National Drug Control Policy (ONDCP) this week outlined its priorities for the first 100 days of the new Biden administration, including a focus to lift burdensome restrictions on medications for opioid use disorder. The announcement from Acting Director Regina LaBelle perhaps signals that the Biden administration might further consider regulations related to buprenorphine prescribing for physicians who treat fewer than 30 patients. On Jan. 21, the new administration pulled back a guidance changing the requirements for these physicians as part of the regulatory freeze on Trump administration policies issued in the previous 60-days. In addition, ONDCP’s strategic aims include enhancing evidence-based, harm-reduction efforts, a departure from the previous administration.

Joint Commission Releases Sentinel Event Alert: Pandemic Special Edition, Part 1

The Joint Commission this week released a Sentinel Event Alert that addresses concerns from healthcare workers and offers examples for providers to manage the current Covid-19 pandemic and respond to future challenges. “Covid-19 is highlighting the absolute indispensability of a dedicated and fearless healthcare workforce,” the article noted. “The need to better ensure the safety and health of workers has become the topic of a national conversation,” it continued. “As of Jan. 15, 2021, 3,176 healthcare workers have died from Covid-19, according to independent tracking from The Guardian and Kaiser Health News.” The seven-page article examines how to foster transparent communication, remove barriers to workers seeking mental health services, ensure patient safety, develop and evaluate a flexible workforce, and more. According to the Joint Commission, this is the first in a series of special edition Sentinel Event Alerts about the Covid-19 pandemic.

JAMA Psychiatry Examines Trends in ED Visits for Mental Health, Overdose, and Violence

A study of nearly 190 million emergency department (ED) visits found that ED visit rates for mental health conditions, suicide attempts, all drug and opioid overdoses, intimate partner violence, and child abuse and neglect were higher in mid-March 2020 through October 2020, compared with the same period in 2019. The findings published this week in JAMA Psychiatry suggest that seeking care in an ED shifts during a pandemic and underscores the need to integrate mental health, substance use, and violence screening and prevention services into response activities during public health crises.

University of Michigan’s Behavioral Health Workforce Research Center Releases Telehealth Study Findings

All healthcare providers who participated in a study of Michigan behavioral healthcare providers last summer indicated they would like to see telebehavioral health services continue after the Covid-19 pandemic ends. Between late July and mid-August 2020, a team at the University of Michigan’s Behavioral Health Workforce Research Center, a contractor for the Substance Abuse and Mental Health Services Administration, conducted a study that included in-depth interviews with 31 Michigan behavioral healthcare providers statewide who provide telebehavioral health services. The center released a report that summarizes the study’s findings and suggests future policy considerations. Two accompanying briefs from the University of Michigan’s Institute for Healthcare Policy & Innovation—which funded the project— highlight the report’s essential findings and policy considerations, including one focused on state policy implications and the other on federal policy implications. “In order to continue treating clients and keep them safe, and as a result of state and federal policy changes, providers rapidly expanded their use of telehealth,” the summary noted. “Policy changes at the state and federal level expanded telehealth authorization and reimbursement across insurers, allowed for services to be delivered via video or audio-only methods, and removed requirements for written consent for treatment, allowing verbal consent, among other changes,” the summary added. Sarah Wattenberg, NABH’s director of quality and addiction services, is a member of the University of Michigan’s Behavioral Health Workforce Research Center’s Advisory Group, which guides the center’s research work. Please contact Sarah if you have ideas for future research projects.

DOJ Accepting Applications for Substance Use-Related Programs

The U.S. Justice Department (DOJ) is accepting applications for two substance use-related programs: the Second Chance Act Pay for Success Initiative and the Residential Substance Abuse Treatment (RSAT) for State Prisoners Program. In the Second Chance Act Pay for Success Initiative, the DOJ is seeking applications for funding for state, local, and tribal governments to enhance or implement performance-based and outcomes-based contracts with reentry, permanent supportive housing, or recovery housing providers to reduce recidivism and address the substance use disorders impacting formerly incarcerated people. The DOJ is also seeking funding applications for the RSAT program, which helps state, local, and tribal efforts to break the cycle of drug addiction and violence by reducing the demand for, use, and trafficking of illegal drugs. Applications for both programs are due in March; click here to learn more about the Second Chance Act Pay for Success Initiative and here to learn about the RSAT for State Prisoners Program.

Justice Clearinghouse to Host Webinar on Successful Mental Health Diversion Programs: Feb. 9

The Justice Clearinghouse, an organization of more than 80,000 justice and public safety professionals, will host a webinar next week that will explore what successful mental health diversion should look like. John Snook, NABH’s new director of government relations and strategic initiatives, will serve as a presenter during the webinar, which is scheduled for Tuesday, Feb. 9 from 3 p.m. to 4:15 p.m. ET. Click here to learn about the other presenters and to register.

Save the Date: NABH 2021 Annual Meeting

June 13-15, 2022

June 12-14, 2023

We look forward to seeing you again in Washington!

Fact of the Week

The New York Times reports that 69% of U.S. mothers say they have experienced adverse health effects due to worry and stress during the pandemic, compared with 51% of U.S. fathers. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 133

Written by Emily Wilkins (NABH) on January 29, 2021. Posted in CEO Updates.

CMS Issues Memo to Clarify Expectations of Hospital Surveys During Pandemic

The Centers for Medicare & Medicaid Services (CMS) Center for Clinical Standards and Quality has issued a memo that clarifies expectations regarding hospital surveys during the ongoing Covid-19 global pandemic. According to the memo, surveys will be limited to “Immediate Danger” complaint allegations for the 30 days following the memo’s release on Jan. 20. The memo also said hospital recertification surveys would be suspended for the most part. Meanwhile, hospital enforcement actions for deficiencies that do not represent “Immediate Jeopardy” will have their termination date extended for at least 30 days. The memo is also posted on NABH’s Covid-19 resources webpage.

HHS Releases Call to Action to Implement the National Strategy for Suicide Prevention

HHS has released The Surgeon General’s Call to Action to Implement the National Suicide Prevention Strategy (National Strategy), a 92-page guide from Jerome Adams, M.D., M.P.H., the nation’s most recent U.S. surgeon general. First released in 2001, the National Strategy was updated in collaboration with the Action Alliance in 2012. It identifies 13 goals and 60 objectives that address every aspect of suicide prevention—from fostering healthy and empowered individuals, families, and communities to providing effective prevention programs and clinical care. The guide is categorized into the following six action areas: activating a broad-based public health response to suicide, addressing upstream factors that impact suicide, ensuring lethal means safety, supporting adoption of evidence-based care for suicide risk, enhancing crisis care and care transitions, and improving the quality, timeliness, and use of suicide-related data. Adams served as U.S. surgeon general from September 2017 until Jan. 20, 2021. This week President Biden appointed Rear Admiral Susan Orsega, M.S.N. as acting U.S. surgeon general pending Senate confirmation of Vivek Murthy, M.D., M.B.A, who served as U.S. surgeon general from 2014 through 2017 in the Obama administration. Orsega has served in the surgeon general’s office since March 2019. In a letter this week to the Biden administration, the Kennedy Forum, Mental Health America, and the National Alliance on Mental Illness urged policymakers to integrate the nation’s mental health and addiction response in the fight against Covid-19 and listed suicide prevention as one of the priorities.

Coalition Endorses Principles to Guide State and Local Spending of Opioid Litigation Settlement Funds

The faculty at the Johns Hopkins Bloomberg School of Public Health has coordinated a coalition of 31 professional and advocacy organizations that has released Principles for the Use of Funds from the Opioid Litigation, which provides five principles to help guide state and local spending of the forthcoming opioid litigation settlement funds. NABH was one of the organizations to endorse the principles. An announcement noted the guidelines are meant to avoid mistakes made in the 1988 tobacco litigation settlement and support efforts based on evidence to save lives. “As states, counties, and municipalities begin receiving funds from entities that exacerbated America’s opioid overdose crisis, it will be critical for decision makers to use that money wisely,” Paul Earley, M.D., president of the American Society of Addiction Medicine, said in the announcement. “To make the most of this opportunity, state and local leaders should invest in evidence-based approaches to prevent and treat addiction, promote racial equity, and save lives.” The five principles include spending money to save lives, using evidence to guide spending, investing in youth prevention, focusing on racial equity, and developing a fair and transparent process for deciding where to spend the funding.

Research Shows Schizophrenia Second to Age as Greatest Risk Factor for Covid-19 Death

A new study shows people with schizophrenia, a mental disorder that affects mood and perception of reality, are nearly three times as likely to die from the coronavirus than those without the psychiatric illness. Researchers at the New York University Grossman School of Medicine led the study, which found that schizophrenia is by far the biggest factor (2.7 times increased odds of dying) after age (being 75 and older increased the odds of dying 35.7 times). “Our findings illustrate that people with schizophrenia are extremely vulnerable to the effects of Covid-19, lead author Katlyn Nemani, M.D., said in a news release about the study. “With this newfound understanding, healthcare providers can better prioritize vaccine distribution, testing, and medical care for this group.” The study was published this week in JAMA Psychiatry.

Center for Connected Health Policy to Host Telehealth Policy Webinar Next Week

The Center for Connected Health Policy will host Telehealth & Medicaid: What’s Next? A Roadmap for Telehealth Beyond the Pandemic next Friday, Feb. 5, 2021 at 2 p.m. ET. The webinar will feature experts in a panel discussion about what the future looks like for telehealth policy in Medicaid. Attendees will hear from high-level administrators and policy staff from the Medicaid and CHIP Payment Advisory Commission (MACPAC), the Arizona Health Care Cost Containment System, the Colorado Department of Health Care Policy and Financing, and the Oregon Health Authority. Click here to learn more and to register.

Save the Date: NABH 2021 Annual Meeting

June 13-15, 2022

June 12-14, 2023

We look forward to seeing you again in Washington!

Fact of the Week

A new study reports 46% of health care workers say their mental health has worsened during the pandemic, while 38% say there’s been no change. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 132

Written by Emily Wilkins (NABH) on January 22, 2021. Posted in CEO Updates.

Coderre & LaBelle Named as Acting Heads of SAMHSA and ONDCP

Tom Coderre, former Region 1 administrator at the Substance Abuse and Mental Health Services Administration (SAMHSA), has been named SAMHSA’s acting assistant secretary for mental health and substance use, and Regina LaBelle, former chief of staff at the White House Office of National Drug Policy (ONDCP), has been named ONDCP’s acting director in the new Biden administration. Coderre served in the Rhode Island Senate from 1995 until 2003 and later as senior advisor to Rhode Island Gov. Gina Raimando. In his previous role as chief of staff at SAMHSA, he led the team that produced Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Coderre is the first person in recovery to lead SAMHSA, and his bio notes that he acknowledges the essential role of peer recovery support services to help people with mental health and substance use disorder (SUD) rebuild their lives. LaBelle is a distinguished scholar and program director of the addiction and public policy initiative at the O’Neill Institute for National and Global Health Law at Georgetown University and is on a leave of absence from that position. LaBelle worked as the chief of staff and senior policy advisor at ONDCP during the Obama administration and oversaw the agency’s efforts to address the nation’s opioid crisis.

White House Issues Regulatory Freeze Pending Review

The White House on Thursday notified the leaders of federal executive departments and agencies that the Biden administration is freezing the federal regulatory process pending review. A memorandum from Ron Klain, assistant to the president and chief of staff, outlined the steps that department and agency leaders are expected to take immediately. It begins with the instruction that—subject to exceptions from the Office of Management and Budget in emergency situations—they propose or issue no rule in any manner, including sending a rule to the Office of the Federal Register, until a department or agency head appointed or designated by President Biden reviews and approves the rule. The memo also includes details about rules that have been published in the Federal Register, and those that have been issued in any manner but have not yet taken effect.

Joint Commission Proposes New Standards for Preventing Workplace Violence

The Joint Commission (TJC) on Wednesday proposed new, revised standards for workplace violence prevention. The standards provide a framework for developing strong workplace violence prevention systems, defining workplace violence, and developing a leadership structure, policies, and procedures, reporting systems, post-incident strategies, training, and education to decrease workplace violence. TJC will accept comments on the proposed new standards until Tuesday, Feb. 16. Click here to read the standards and to submit comments.

CMS Releases T-MSIS-based Medicaid SUD Data Book

The Centers for Medicare & Medicaid Services (CMS) this week released its second publication of the Transformed Medicaid Statistical Information System (T-MSIS)-based Medicaid Substance Use Disorder (SUD) Data Book to help policymakers, researchers, and other stakeholders better understand where to focus drug prevention and treatment efforts. The data book includes 2018 data on Medicaid beneficiaries treated for SUD and the services they received by type, setting, delivery system, and progression of care. According to the data book’s findings, of the 55.9 Medicaid beneficiaries ages 12 and older with full or comprehensive benefits, 4.6 million, or 8%, were treated for a SUD in 2018. Meanwhile, nearly half of beneficiaries, or 46%, treated for SUD received emergency services, and 26% received at least one service in an outpatient or home- or community-based setting within 30 days of discharge.

NABH Welcomes New Committee Chairs

NABH is pleased to announce new leaders for some of the association’s standing committees and thanks its outgoing leaders for their service. Tom Kenny of Sequel Youth & Family Services succeeds Pat Connell of Boys Town Behavioral Health Division as the new chairman of NABH’s Youth Services Committee, and Joe Pritchard of Pinnacle Treatment Centers succeeds Jeff Hillis of AdCare Hospital as the new chairman of the association’s Addiction Treatment Commitment. NABH is also pleased to welcome Kim Sanderson of Acadia Healthcare as the chairwoman for the SUD Medication Treatment Subcommittee.

NABH Releases Issue Brief on Changes to Medicare Coverage for SUD

NABH this week sent members an NABH Issue Brief to provide more details about recent changes to Medicare coverage for SUD that were included in the 2021 Physician Fee Schedule (PFS) rule. The Issue Brief includes information about how the rule expanded the PFS bundled payments to include all SUDs, as well as details about nasal naloxone.

Center for Connected Health Policy to Host Telehealth Policy Webinar on Feb. 5

The Center for Connected Health Policy will host Telehealth & Medicaid: What’s Next? A Roadmap for Telehealth Beyond the Pandemic on Friday, Feb. 5, 2021 at 2 p.m. ET. The webinar will feature experts in a panel discussion about what the future looks like for telehealth policy in Medicaid. Attendees will hear from high-level administrators and policy staff from the Medicaid and CHIP Payment Advisory Commission (MACPAC), the Arizona Health Care Cost Containment System, the Colorado Department of Health Care Policy and Financing, and the Oregon Health Authority. Click here to learn more and to register.

Save the Date: NABH 2021 Annual Meeting

June 13-15, 2022

June 12-14, 2023

We look forward to seeing you again in Washington!

Fact of the Week

Compared with 2019, the proportion of mental health-related visits for children aged 5 to 11 years old and 12 to 17 years old increased about 24% and 31%, respectively. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 131

Written by Emily Wilkins (NABH) on January 15, 2021. Posted in CEO Updates.

HHS to Expand Access to MAT by Eliminating ‘X-Waiver’ for DEA-Registered Physicians

The U.S. Health and Human Services Department (HHS) on Thursday said it will publish new guidelines that will exempt office-based physicians from having to receive a DATA 2000 waiver, known as the X-waiver, in order to prescribe buprenorphine for opioid use disorder treatment for up to 30 patients. The guidance is effective immediately. Specifically, the new guidance permits physicians to prescribe buprenorphine for up to 30 patients without completing eight hours of training prior to prescribing buprenorphine. The training requirement has been cited as a barrier to more physicians prescribing the drug. The new guidance does not change the existing regulations for physician assistants, nurse practitioners, or other mid-level practitioners. This move is intended to address the surge in opioid deaths in the past year. After declining between 2017 and 2018 by 4.1%, the number of overdose deaths increased 18.2% from June 2019 to May 2020. During this period, overdose deaths increased more than 20% in 25 states and the District of Columbia, 10% to 19% in 11 states and New York City, and up to 9% in 10 states. The new guidance has been issued under regulatory flexibility that permits the administration to make exemptions from the regulatory requirements, as deemed necessary, in consultation with the Drug Enforcement Administration, the National Institute on Drug Abuse, and the U.S. Food and Drug Administration. A new issue brief from the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) found that increasing buprenorphine prescribing capacity of one patient per 100 residents increases prescribing by 3.8% and decreases the use of other opioid prescribing by 2.3%. The relationship holds true only for metropolitan areas.

Meena Vythilingam, M.D. Named Acting Assistant Secretary for Mental Health and Substance Use

Capt. Meena Vythilingam, M.D. of the United States Public Health Service is serving as the acting assistant secretary for mental health and substance use, succeeding Elinore McCance-Katz, M.D., Ph.D., who resigned last week. Vythilingam, a board-certified psychiatrist, is also the first director of the HHS Center for Health Innovation, and the senior advisor for mental health and opioids in HHS’ office of the assistant secretary for health. Before she completed her psychiatry residency and post-doctoral fellowship at the Yale University School of Medicine, Vythilingam completed a residency in psychological medicine at the National Institute of Mental Health and Neurosciences in Bangalore, India. The Substance Abuse and Mental Health Services Administration (SAMHSA) announcement did not indicate how long Vythilingam will serve in the position.

NABH Highlights Priorities in Letter to the Biden-Harris Transition Team

NABH this week sent a letter to the Biden-Harris transition team that outlines the biggest challenges for behavioral healthcare and recommendations on how to address those problems. The 12-page letter describes the heightened need for mental health and substance use disorder services in the United States, which the Covid-19 pandemic has exacerbated. “Elevated levels of mental health and substance use disorders are expected to linger long after the Covid-19 pandemic ends,” NABH President and CEO Shawn Coughlin wrote. “Large-scale disasters such as the current pandemic are known to have widespread and long-lasting detrimental effects on mental health and substance use. Moreover, studies of past disasters have shown the mental health distress and suicidality often do not peak until years after the disaster has ended.” The letter includes recommendations related to vaccines for behavioral healthcare providers, continued telehealth coverage for mental health and addiction treatment, flexibilities regarding Special Conditions of Participation, increased availability of behavioral healthcare for children and youth, and the 988 hotline.

NABH Issue Brief Provides Details on Expanded Telehealth Coverage

NABH this week sent an Issue Brief to members that highlights details of the extended Medicare coverage that the Centers for Medicare & Medicaid Services (CMS) authorized in its final 2021 Medicare Physician Fee Schedule rule that was published in the Federal Register last month. Click here to learn more.

RAND Corp. Releases Report on Transforming U.S. Mental Health System

RAND Corp. has released a report with analysis and recommendations in 15 areas where there is potential to help improve the lives of more than 60 million Americans living with mental illness. How to Transform the U.S. Mental Health System addresses the following three questions: 1) How can policy changes at all levels of government effect transformational change to improve the lives of Americans with mental illness? 2) What are the best practices and recent innovations in the mental health sector? and 3) What opportunities for change in the mental healthcare system are supported by the research literature? The report is divided into five chapters, and it focuses on topics areas such as integrating behavioral health expertise in general health settings, strengthening mental health parity regulation and enforcement, establishing evidence-based behavioral health treatments at their true cost, linking homeless individuals with mental illness to supportive housing, and more. NABH Director of Policy and Regulatory Affairs Kirsten Beronio served on the advisory panel for this report.

NIH-Supported Study Finds Team-Based Approach May Improve Buprenorphine Care

A recent pilot study concluded that a collaborative approach to treating opioid use disorder that relies heavily on community pharmacists “is feasible and may increase adherence and participant satisfaction,” according to research published in the journal Addiction. The study—which the National Institute on Drug Abuse, part of the National Institutes of Health, supported—studied the transfer of care of 71 participants using buprenorphine maintenance therapy for opioid use disorder from waivered physicians to trained community pharmacists. According to the study, about 90% of people in the United States live within five miles of a community pharmacy. Researchers from Duke University and their collaborators found that nearly 89% of participants remained in the study and 95.3% adhered to the daily medication regimen. “Participants, physicians, and pharmacists alike reported high rates of satisfaction with the program,” the journal article noted. The study’s authors concluded that the pilot shows “strong support” for advancing physician-pharmacist team-based approaches to leveraging community resources when it comes to expanding access to opioid use disorder treatment with buprenorphine.

SAMHSA Accepting Applications for Grants to Prevent Prescription Drug/Opioid Overdose-Related Deaths

SAMHSA’s Center for Substance Abuse Treatment is accepting applications for fiscal year 2021 grants to prevent prescription drug and opioid overdose-related deaths through Monday, March 1. The program is meant to reduce the number of prescription drug and opioid overdose-related deaths and adverse events among individuals aged 18 and older by training first responders and community members on preventing these deaths and on how to implement secondary prevention strategies, such as buying and distributing naloxone. SAMHSA said it has a total amount of about $11.4 million for this project and expects to grant 13 awards of up to $850,000 per year for up to five years. Click here to learn more.

Center for Connected Health Policy to Host Telehealth Policy Webinar on Feb. 5

The Center for Connected Health Policy will host Telehealth & Medicaid: What’s Next? A Roadmap for Telehealth Beyond the Pandemic on Friday, Feb. 5, 2021 at 2 p.m. ET. The webinar will feature experts in a panel discussion about what the future looks like for telehealth policy in Medicaid. Attendees will hear from high-level administrators and policy staff from the Medicaid and CHIP Payment Advisory Commission (MACPAC), the Arizona Health Care Cost Containment System, the Colorado Department of Health Care Policy and Financing, and the Oregon Health Authority. Click here to learn more and to register.

Save the Date: NABH 2021 Annual Meeting

June 13-15, 2022

June 12-14, 2023

We look forward to seeing you in Washington!

Fact of the Week

A Mental Health America survey between June-September 2020 found that 76% of healthcare workers reported exhaustion and burnout. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 130

Written by Emily Wilkins (NABH) on January 8, 2021. Posted in CEO Updates.

SAMHSA’s Elinore McCance-Katz Resigns Following Violence at U.S. Capitol

Elinore McCance-Katz, M.D., Ph.D. announced Thursday she is resigning as the nation’s assistant secretary for mental health and substance use, citing the riotous takeover of the U.S. Capitol on Jan. 6. According to her statement, McCance-Katz had intended to stay in her role at the Substance Abuse and Mental Health Services Administration (SAMHSA) until the change in administration later this month. Those plans changed after she returned from a visit to a residential treatment program in New York and saw events unfold Wednesday. “I believe that we are given certain life situations where we must make the difficult decisions and we get one chance to do it the right way,” McCance-Katz said in her statement. “Because I believe that the mental health of our people has suffered so greatly under the stresses of Covid-19, the social justice issues that have been so painful for so many, and now with the rending of our nation over questions raised about the presidential election, I cannot support language that results in incitement of violence and risks our very existence.” McCance-Katz adds her name to a list of other high-ranking officials who have distanced themselves from the Trump administration through their resignations this week, including Transportation Secretary Elaine Chao, Education Secretary Betsy DeVos, Deputy National Security Adviser Matthew Pottinger, and others.

CMS Issues Guidance on Medicaid Coverage for Opioid Use Disorder Treatment

The Centers for Medicare & Medicaid Services (CMS) released guidance in late December about new Medicaid coverage requirements to treat opioid use disorders (OUD). The guidance provides information to state Medicaid programs about a new mandatory Medicaid benefit added under the 2018 SUPPORT Act that requires these programs to cover all drugs and biologicals that the U.S. Food and Drug Administration has approved or licensed to treat OUD, including methadone. It also includes information about the medications and treatment services included in this new medication-assisted treatment (MAT) benefit and the locations where MAT can be provided. In addition, the guidance includes details about other Medicaid authorities to help states expand their opioid use disorder service continuum.

SAMHSA Report Addresses How to Manage Increased Need for Services During Pandemic

SAMHSA has released a 25-page report and plan on how to address the heightened need for mental and behavioral healthcare services resulting from the effects of the Covid-19 global pandemic. Saving Lives Through Increased Support for Mental and Behavioral Health Needs is a result of President Trump’s Executive Order of the same name on Oct. 5, 2020. The effort is meant to address preventing suicide, ending the nation’s opioid crisis, and improving mental and behavioral health in the United States. The Executive Order’s goal is to reduce the number of immediate life-threatening situations related to mental illness and substance use disorders, and it also outlines ways to alleviate these ongoing problems. Most of the report highlights “building on existing strengths,” such as prevention, crisis services, the work of current programs, and more, while the remainder of the report offers recommendations.

NABH Welcomes Jameson Norton as 2021 Board Chair and New Board Members

NABH is pleased to welcome Jameson K. Norton, M.B.A., F.A.C.H.E., who has served on the NABH Board of Trustees, as the association’s 2021 Board Chair, effective Jan. 1. Based in Nashville, Norton serves as the chief operating officer of Newport Healthcare, which treats individuals ages 12–27 who struggle with depression, anxiety, and/or trauma-related issues, along with co-occurring eating disorders and substance abuse. Formerly he served as president of Vanderbilt Psychiatric Hospital and Outpatient Services. Norton has served in the U.S. Marine Corps and earned a B.A. at the University of Virginia and M.B.A. at Vanderbilt University’s Owen Graduate School of Management. In addition, NABH welcomes board members Pat Connell, M.B.A., F.A.C.H.E., C.B.H.E., C.H.C., vice president of behavioral health, compliance and government relations at Boys Town Behavioral Health Division in Boys Town, Neb.; Dwight A. Lacy, M.B.A., group president of western operations at Franklin, Tenn.-based Acadia Healthcare, Inc.; and Susan L. Wright, M.B.A., director of behavioral health operations at BayCare Behavioral Health in Clearwater, Fla. The association also welcomes Teena Ahuja, vice president of behavioral health at Prime Healthcare in Ontario, Calif.; Joe Pritchard, CEO of Pinnacle Treatment Centers, Inc. in Mount Laurel, N.J.; and Patricia Rehmer, M.S.N., A.C.H.E., president, behavioral health network and senior vice president of Hartford HealthCare, who have joined as automatic board seat members.

John Snook to Join NABH as Director of Government Relations and Strategic Initiatives

John Snook will join the National Association for Behavioral Healthcare (NABH) as director of government relations and strategic initiatives on Jan. 18. John comes to NABH from the Treatment Advocacy Center, where he served as the mental health advocacy organization’s executive director since 2015. He also brings with him more than 15 years of advocacy and policy experience at the state and federal levels. The Treatment Advocacy Center’s influence has been far-reaching: more than half of the states have reformed their mental health laws due in large part to the Center’s advocacy efforts, and the group’s original research on issues such as criminalization of mental illness has rewritten the national narrative on severe mental illness treatment. During his tenure as executive director of the Treatment Advocacy Center, John secured more than $70 million in federal funding for assisted outpatient treatment programs across the country, guided advocacy efforts that led to bipartisan mental health reforms in the 21st Century Cures Act; directed the publication of 15 major research reports; and oversaw the passage of 44 new laws designed to improve access to treatment for people with severe mental illness. “John is well-respected in Washington for his strong commitment to improving behavioral healthcare access and services in the United States,” said NABH President and CEO Shawn Coughlin. “We are excited and fortunate to welcome him to NABH,” he added. “Our national membership and Washington-based team will benefit greatly from his knowledge, experience, and ideas.” John’s interest in mental health began when he was in law school and saw a loved one struggle with mental illness. He championed mental illness reform, working first with the West Virginia Supreme Court on mental health issues, and then as an advocate at the Treatment Advocacy Center. John earned a B.A. from Washington & Jefferson College and a J.D. from the George Mason School of Law.

Center for Connected Health Policy to Host Telehealth Policy Webinar on Feb. 5

The Center for Connected Health Policy will host Telehealth & Medicaid: What’s Next? A Roadmap for Telehealth Beyond the Pandemic on Friday, Feb. 5, 2021 at 2 p.m. ET. The webinar will feature experts in a panel discussion about what the future looks like for telehealth policy in Medicaid. Attendees will hear from high-level administrators and policy staff from the Medicaid and CHIP Payment Advisory Commission (MACPAC), the Arizona Health Care Cost Containment System, the Colorado Department of Health Care Policy and Financing, and the Oregon Health Authority. Click here to learn more and to register.

Save the Date: NABH 2021 Annual Meeting

June 13-15, 2022

June 12-14, 2023

We look forward to seeing you in Washington!

Fact of the Week

In a typical year, Native American youth die by suicide at nearly twice the rate of their white peers in the United States, according to a story in Kaiser Health News that cited the Centers for Disease Control and Prevention. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 129

Written by Emily Wilkins (NABH) on December 18, 2020. Posted in CEO Updates.

Congress Works to Complete Covid-19 Relief Bill as Federal Funding Deadline Nears

Federal lawmakers on Friday continued to work on a $900 billion Covid-19 funding relief bill to avert a government shutdown before federal funding expires at midnight. Congress has already agreed on a $1.4 trillion omnibus bill, the legislative vehicle for the $900 billion economic relief package that lawmakers still need to complete. NABH has learned the Covid-19 relief bill is likely to include about $700 million for the U.S. Health and Humans Services Department (HHS) to use for additional research and procurement and medical supply needs, such as personal protective equipment, and about $35 billion for the Provider Relief Fund. The bill is also likely to provide about $3.15 billion to the Substance Abuse and Mental Health Services Administration (SAMHSA) for the Substance Abuse Prevention and Treatment Block Grant, the Community Mental Health Services Block Grant, tribal programs, emergency relief, and peer recovery programs and suicide prevention efforts at the Centers for Disease Control and Prevention (CDC); about $1.3 billion to State Opioid Response Grants, and about $150 million to the Certified Community Behavioral Health Centers Program. Meanwhile, the bill’s addiction and mental health provisions would also expand access to medication-assisted treatment (MAT) through a limited extension of Centers for Medicare & Medicaid Services (CMS) and Drug Enforcement Administration (DEA) telehealth waivers. It would also eliminate the requirement that practitioners apply for a waiver through the DEA in order to prescribe buprenorphine for substance use disorder treatment to the end of the public health emergency or to Dec. 31, 2021, under the conditions of appropriate state oversight and a follow-up study on buprenorphine diversion. NABH staff is tracking congressional developments and will keep members apprised of the legislation’s effects on behavioral healthcare providers.

HHS Starts Distributing $24.5 Billion in Phase 3 Covid-19 Provider Relief Funding

HHS announced Dec. 16 that it has increased and started to distribute $24.5 billion in the Provider Relief Fund’s (PRF) third phase. The announcement from HHS said the department completed its review of Phase 3 applications from the PRF and will distribute the funding to more than 70,000 providers. HHS also said the sum is greater than the $20 billion that was planned originally, with $4.5 billion being used “to satisfy close to 90% of each applicant’s reported lost revenues and net change in expenses” that the coronavirus pandemic caused during the first half of 2020. Click here to view HHS’ first set of Phase 3 payments by state.

Mental Health and Addiction Organizations Urge HHS to Include Behavioral Healthcare Providers Among Covid-19 Vaccine Priority Groups

NABH is one of nearly 50 mental health and addiction treatment advocacy groups that sent a letter Friday to HHS Secretary Alex Azar urging him to direct the CDC to issue guidance advising states to include mental health and addiction treatment providers among the prioritized groups for receiving the Covid-19 vaccines. The letter notes this group includes the behavioral healthcare practitioners and staff that the U.S. Homeland Security Department deems as critical essential workers; recovery support providers; and patients in inpatient psychiatric and residential treatment and community-based treatment settings. “The Covid-19 pandemic is having a significant impact on the behavioral health of children and adolescents,” the letter said. “According to another recent CDC report, the proportion of children’s visits to emergency departments for mental health reasons increased dramatically starting in April 2020 and continuing through October of 2020.”

CEOs from 14 Mental Health Groups Release ‘Unified Vision’ to Address U.S. Mental Health Crisis

The chief executives of the country’s 14 leading mental health advocacy organizations and professional associations this week announced they have formed a unified coalition to engage federal and state officials nationwide to introduce a plan for accelerating effective mental health and substance use care as America manages the global Covid-19 pandemic. NABH President and CEO Shawn Coughlin represents the association in the coalition, which also includes the American Psychiatric Association, American Psychological Association, Massachusetts Association for Mental Health, Meadows Mental Health Policy Institute, Mental Health America, National Alliance for Mental Illness, National Council for Behavioral Health, One Mind, Peg’s Foundation, Steinberg Institute, Kennedy Forum, Treatment Advocacy Center, and Well Being Trust. “The lesson of the Covid pandemic is not simply about lack of preparedness,” Kennedy Forum founder and former U.S. Rep. Patrick Kennedy (D-R.I.) and Thomas Insel, M.D. wrote in a joint op-ed about the coalition in The Newark Star-Ledger. “It is also about our resourcefulness as a society to mobilize public-private partnerships that could develop treatments and vaccines at unprecedented speed and scale.” The coalition’s vision statement provides “pathways for success” across seven critical policy areas: early identification and prevention, especially for families and young people; rapid deployment of emergency crisis response and suicide prevention; leveling inequities in access to care; establishing integrated health and mental health care to ensure “whole-person” well-being; achieving parity in payment by health plans for mental health and substance-use coverage; assuring evidence-based standards of treatments and care; and, engaging a diverse mental health care workforce, peer support and community-based programs. Visit the Unified Vision homepage to learn more.

HHS-OIG Requests Recommendations for New or Updated Safe Harbor Provisions

HHS’ Office of Inspector General (OIG) this week requested proposals and recommendations to develop new, or to modify existing, safe harbor provisions under the Social Security Act’s federal anti-kickback statute. The statute applies criminal penalties for whoever knowingly—and willingly—offers, pays, solicits, or receives money to induce or reward the referral for, or purchase of, items and services that are reimbursed under any federal healthcare program. Because of the statute’s broad reach, there was concern that the statute included relatively harmless business arrangements. This has had an especially negative effect on implementing “contingency management/motivational incentive treatment” practices in which individuals receive small rewards for improving treatment outcomes. Contingency management is an evidence-based practice that the National Institute on Drug Abuse and the SAMHSA developed as a joint initiative in 2001. This treatment intervention is especially critical for individuals with stimulant use disorders, for which there are no effective treatment medications. According to the CDC, drug overdoses involving psychostimulants increased 33.3% between April 2019 and April 2020, the highest percentage increase of all categories of drugs involved in overdoses for that time period. Healthcare providers and others could comply with safe harbor conditions so that they are not subject to the federal anti-kickback statute. The OIG will accept comments on the proposed rule until Tuesday, Feb. 16, 2021. Click here to learn how to submit recommendations.

SAMHSA Announces Mental Health and SUD Grant Funding Opportunities

SAMHSA this week announced it is accepting applications for more than a dozen grant funding opportunities in behavioral healthcare. The programs cover topics related to mental health, recovery, suicide, traumatic stress for children, and more. Click here to read about the program opportunities and application deadlines. Center for Connected Health Policy to Host Telehealth Policy Webinar on Feb. 5 The Center for Connected Health Policy will host Telehealth & Medicaid: What’s Next? A Roadmap for Telehealth Beyond the Pandemic on Friday, Feb. 5, 2021 at 2 p.m. ET. The webinar will feature experts in a panel discussion about what the future looks like for telehealth policy in Medicaid. Attendees will hear from high-level administrators and policy staff from the Medicaid and CHIP Payment Advisory Commission (MACPAC), the Arizona Health Care Cost Containment System, the Colorado Department of Health Care Policy and Financing, and the Oregon Health Authority. Click here to learn more and to register.

Reminder: NABH 2021 Board Election Ballots Due Thursday, Dec. 31

NABH has e-mailed members NABH Board of Trustees candidate profiles and a ballot to elect new members to the 2021 Board. If you have not done so, please vote for the open Board Chair-Elect position and three available Board seats; sign the ballot (it is not valid without a signature); and return it to NABH. You can do this by scanning your completed ballot and e-mailing it nabh@nabh.org, or faxing it to 202-783-6041. NABH must receive all ballots no later than Thursday, Dec. 31, 2020. New Board members and the Board Chair-elect will take office in January 2021.

Save the Date: NABH 2021 Annual Meeting

June 13-15, 2022

June 12-14, 2023

We look forward to seeing you in Washington next year! Fact of the Week A recent JAMA Psychiatry study examining the pandemic’s effects on mental health found that among Black residents, suicide deaths appeared to double the recent historical average from March 5, the date Maryland declared a state of emergency and shut down, until May 7, when the first public spaces reopened. While the researchers highlighted the study’s limitations, they concluded that “…policy interventions and targeted resource allocation may be warranted to mitigate disparities impacting Black individuals.”

Happy Holidays from NABH!

NABH will not publish CEO Update for the next two weeks and will resume on Friday, Jan. 8, 2021. The entire NABH team wishes you, your teams, and your families a very happy, healthy, and safe holiday season! For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 128

Written by Emily Wilkins (NABH) on December 11, 2020. Posted in CEO Updates.

HHS Updates Covid-19 Reporting Guidance for Hospitals, Labs, and Acute-Care Facilities

In guidance released this week, the U.S. Health and Human Services Department (HHS) said hospitals, hospital laboratories, and acute-care facilities will be required to include incidences of patients with influenza in their Covid-19 data reporting data as of Dec. 18. The new influenza fields were added as optional elements to the Covid-19 data reporting set in October and will be mandatory starting next week. In addition, the new reporting requirements include weekly reporting on inventory and use of Covid-19 therapeutic medications. Please note the relevant new provisions highlighted in this week’s guidance, which is also available on NABH’s Covid-19 resources webpage.

CMS Hospital Price Transparency Final Rule Presentation Now Available

The Centers for Medicare & Medicaid Services (CMS) has provided slides from the agency’s Dec. 8 webinar about the hospital price transparency final rule. Beginning Jan. 1, all U.S. hospitals will be required to provide transparent and accessible pricing information online about the items and services they provide. According to CMS, hospitals will be required to do this in two ways: first as a comprehensive, machine-readable file that notes all items and services, and second as a display of shoppable services in a consumer-friendly format. The webinar identified who must comply with the rule, defined hospital “standard charges,” and outlined what items and services must be included.

Biden Chooses Becerra, Murthy, and Walensky for Top Federal Healthcare Posts

President-elect Joseph Biden has selected California Attorney General Xavier Becerra as his nominee to lead HHS and internist Vivek Murthy, M.D. to reprise his earlier role as U.S. surgeon general. Becerra, who represented California in the U.S. House of Representatives from 1993 to 2017, was chairman of the House Democratic Caucus from 2013 to 2017 and served on the powerful House Ways and Means Committee. He earned both his bachelor and law degrees from Stanford. If confirmed, Becerra would be the first Latino to lead HHS. A fierce champion of the Patient Protection and Affordable Care Act, Becerra is leading 20 states and Washington, D.C. to protect the seminal 2010 healthcare law from being dismantled. Becerra would oversee the department at a critical time during the Covid-19 pandemic, as caseloads surge and a massive vaccination effort is set to launch soon. Murthy served as the nation’s 19th U.S. surgeon general during the Obama administration from December 2014 until January 2017. Murthy completed his internal medicine residency at Brigham and Women’s Hospital and Harvard Medical School, and also led and managed medical teams as a faculty member. Biden also named Rochelle Walensky, M.D., M.P.H., chief of infectious diseases at Massachusetts General Hospital, to lead the Centers for Disease Control and Prevention in Atlanta. Walensky also serves as professor of medicine at Harvard Medical School and is an expert on AIDS and HIV.

Well Being Trust and IHI Publish Resources to Help Providers and Communities Address Mental Health During Pandemic

Well Being Trust and the Institute for Healthcare Improvement (IHI) have released two resources to help healthcare providers, payors, and community partners implement strategies to help save lives from overdose and suicide, and care for front-line health workers during the Covid-19 pandemic. A Guide for Health Systems to Save Lives from “Deaths of Despair” and Improve Community Well-Being is a 37-page resource that explores the role of healthcare systems in improving health and well-being and proposes an approach that identifies who the population is, how to implement methods, and what interventions to use in communities. The shorter of the two resources, A Guide to Promoting Health Care Workforce Well Being During and After the Covid-19 Pandemic defines key concepts, such as “moral injury,” “psychological first-aid,” and “grief leadership,” and then offers applicable steps that healthcare organizations can take to build on existing support systems.

SAMHSA Releases Treatment Guide on Youth Suicide

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released Treatment for Suicidal Ideation, Self-harm, and Suicide Attempts Among Youth, a 57- page guide that provides interventions to treat suicidal ideation, self-harm, and suicide attempts among youth. Elinore McCance-Katz, M.D., Ph.D., assistant secretary for mental health and substance use, noted in a foreword that the guide is part of SAMHSA’s response to the 21^st Century Cures Act’s requirement to disseminate information on evidence-based practices and service delivery models. McCance-Katz also wrote that suicide is the second leading cause of death for youth in the United States. The suicide rate for youth aged 10 to 24 increased 56% to 10.6 per 100,000 people in 2017 from 6.8 per 100,000 people in 2007.

Reminder: NABH 2021 Board Election Ballots Due Thursday, Dec. 31

NABH this week e-mailed system members the NABH Board of Trustees candidate profiles and a ballot to elect new members to the 2021 Board. If you have not done so, please vote for the open Board Chair-Elect position and three available Board seats; sign the ballot (it is not valid without a signature); and return it to NABH. You can do this by scanning your completed ballot and e-mailing it nabh@nabh.org, or faxing it to 202-783-6041. NABH must receive all ballots no later than Thursday, Dec. 31, 2020. New Board members and the Board Chair-elect will take office in January 2021.

Save the Date: NABH 2021 Annual Meeting

June 13-15, 2022

June 12-14, 2023

We look forward to seeing you in Washington next year!

Fact of the Week

A new Morning Consult poll found that 36% of Americans reported their mental health has suffered during the Covid-19 global pandemic, while 19% said their physical health has worsened. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 127

Written by Emily Wilkins (NABH) on December 4, 2020. Posted in CEO Updates.

CDC Director Approves ACIP’s Covid-19 Vaccine Plan for Healthcare Workers, LTCFs

Centers for Disease Control and Prevention (CDC) Director Robert Redfield, M.D. on Thursday approved a CDC committee’s recommendation that healthcare personnel and long-term care facility (LTCF) residents be offered the Covid-19 vaccine in the vaccination program’s initial phase. The agency’s Advisory Committee on Immunization Practices (ACIP) Covid-19 Vaccines Work Group earlier this week outlined a phased allocation for the vaccines that highlighted the committee’s scientific and ethical considerations. The ethical principles include maximizing benefits, minimizing harm, promoting justice, and mitigating health inequities. ACIP members defined LTCF residents as “adults who reside in facilities that provide a variety of services, including medical and personal care, to persons who are unable to live independently,” and a footnote on slide 12 of the presentation includes psychiatric facilities in the LTCF definition. As part of this effort, NABH sent a letter to the National Governors Association that asked governors to prioritize behavioral healthcare providers in the first round of the Covid-19 vaccine distribution. In the letter, NABH President and CEO Shawn Coughlin emphasized that demand for mental health and addiction services has increased during the global pandemic, while challenges such as personal protective equipment shortages and reduced staff availability have placed additional burdens on behavioral healthcare providers. “It is critical that we preserve and even increase access to behavioral healthcare as a key component of the response to Covid-19,” Coughlin wrote. “Since the onset of the pandemic, our members have been intensely focused on implementing many new practices and protocols to address the increased demand for behavioral healthcare while preventing the spread of the coronavirus,” he added. “They have developed and implemented new screening and infection- control measures. Unfortunately, some of these measures, such as quarantine rooms, reduce their capacity to provide care.”

CMS Maintains Some Telehealth Provisions in 2021 Medicare Physician Fee Schedule

In the Calendar Year (CY) 2021 Medicare Physician Fee Schedule rule released this week, the Centers for Medicare & Medicaid Services (CMS) said it will maintain some of the telehealth service coverage it authorized during the Covid-19 pandemic, including telehealth coverage for group psychotherapy and psychological and neurological testing. CMS said it will decline to continue covering evaluation and management services via audio-only technology, and instead will provide coverage on an interim basis during CY 2021 for an extended, audio-only assessment service to determine whether an in-person visit is needed. This rule also finalized regulations to allow Medicare coverage of telehealth services provided to existing patients while at home, regardless of where they live for treatment of substance use disorders and co-occurring mental health conditions. The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) authorized this exception to the Medicare rules that do not generally cover telehealth services that originate from the patient’s home and limit coverage of telehealth to certain geographic areas.

CMS Includes PHP Payment Rates in 2021 OPPS Rule

CMS this week included payment rates for partial hospitalization programs (PHPs) in the CY 2021 Outpatient Prospective Payment System (OPPS) final rule the agency released on Dec. 3. In the rule, CMS made final its August proposal to use its existing methodology for calculating the CY 2021 geometric mean per diem cost using the most recent updated claims and cost data. Based on available data at that point, the proposed per diem rates were $243.94 for hospital-based PHPs and $121.62 for community mental health centers (CMHCs). Using the most recent updated claims and cost data as proposed, the final CY 2021 hospital-based PHP geometric mean per diem cost is $253.76 and the final CMHC geometric mean per diem cost is $136.14. CMS also finalized the proposed payment rate for Level 2 Health and Behavior Services (Ambulatory Payment Classification 5822) at $78.54, based on existing claims data.

CMS Announces RFA for the Value in OUD Treatment Initiative

CMS has announced a request for application (RFA) for a new initiative intended to increase access to opioid use disorder (OUD) treatment services to eligible Medicare fee-for-service beneficiaries and those dually eligible for Medicare and Medicaid. Funded through the SUPPORT Act, the Value in Opioid Use Disorder Treatment is a four-year demonstration that creates two new payments to participating providers: 1) a per-beneficiary, per-month, care-management fee, and 2) a performance-based incentive payment. The SUPPORT Act makes available $10 million each of the fiscal years 2021-2024 for demonstration payments. According to CMS, these payments will be made in addition to the OUD treatment services Medicare covers already. The demonstration is open to a range of participants, including opioid treatment programs, certified community behavioral health clinics, and community mental health centers. CMS will accept applications through Jan. 3, 2021, and selected participants are expected to implement the demonstration by April 1, 2021, at which time payments will begin. Click here to learn more and apply.

CMS to Host Hospital Price Transparency Webcast on Dec. 8

CMS will host a Hospital Price Transparency Webcast on Tuesday, Dec. 8 to provide a more detailed overview of the resources the agency outlined in an Open Door Forum late last month. Before Thanksgiving, CMS hosted a Rural Health Open Door Forum to highlight hospital price transparency resources to help providers prepare for complying with the agency’s Hospital Price Transparency Rule that takes effect on Jan. 1, 2021. Next week’s webcast will also provide a question-and-answer session after the presentation. Click here to register for the hourlong webcast, which will begin at 2 p.m. ET on Dec. 8.

The Commonwealth Fund Examines Covid-19’s Long-term Effects on Mental Health

U.S. policymakers should consider increasing the mental health provider workforce and investing in telehealth as the global pandemic’s mental health repercussions are likely to grow, according to a new report from The Commonwealth Fund. The report cites modeling estimates from the Well Being Trust that show the Covid-19 pandemic could lead to more than 75,000 additional deaths from alcohol and drug misuse and suicide. Meanwhile, the report notes that the pandemic’s effect on social determinants of health—such as employment, income levels, housing and food security—have “threatened basic survival,” and that nearly one-quarter of adults surveyed in early November reported they had not received needed care in the past four weeks. In addition to their mental health workforce and telehealth recommendations, researchers also suggested that states examine their respective insurance laws to ensure that mental health parity or equal treatment of mental health and substance use disorders is enforced, and enact plans to help children access the mental health resources they received previously in schools.

Learn about Prime Healthcare in Our NABH Member Profile!

In our latest Member Profile, NABH member Prime Healthcare shared some of the effective programs and resources the award-winning health system has developed and implemented during the pandemic. Click here to read Prime’s profile, and please contact Emily Wilkins at NABH if you would like to submit a profile about your organization.

Save the Date: NABH 2021 Annual Meeting

NABH is pleased to announce it will host its 2021 Annual Meeting from Wednesday, Oct. 6 – Friday, Oct. 8, 2021 at the Mandarin Oriental Washington, DC. The association re-scheduled for this later date in 2021 due to the ongoing Covid-19 pandemic. We hope you can join us! After 2021, NABH will host its subsequent Annual Meetings in June. Please save the date for these future NABH Annual Meetings:

June 13-15, 2022

June 12-14, 2023

Thank you for all you do to advance NABH’s mission and vision. We look forward to seeing you in Washington next year!

Fact of the Week

A study from the Centers for Disease Control and Prevention this summer found 15% of non-Hispanic Black adults had seriously considered suicide in the past 30 days, and 18.6% had started or increased their use of substances to cope with pandemic-related stress. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 124

Written by Emily Wilkins (NABH) on November 6, 2020. Posted in CEO Updates.

Former U.S. Rep. Jim Ramstad (R-Minn.), Addiction Recovery Champion, Dies at 74

Former U.S. Rep. Jim Ramstad (R-Minn.), a champion for addiction recovery, died Thursday at the age of 74. Ramstad, who had been ailing from Parkinson’s Disease, channeled his personal battle with addiction to become a strong advocate for recovery. He represented Minnesota’s third district in the U.S. House of Representatives for nine terms before he retired in 2009. The Minnesota Republican was the chief sponsor for the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, the bill that opened access to treatment for millions of Americans suffering from mental illness or chemical addiction. News outlets reporting Ramstad’s death described how the former congressman’s personal battle with alcoholism spurred him to help others battling addiction. The stories also mentioned Ramstad’s arrest for disorderly conduct while he served in the Minnesota state legislature, the event that caused him to give up drinking. “If I had not wound up in that jail cell, I would not have sought treatment,” Ramstad told The New York Times in 2006. Ramstad celebrated his 39^th year of sobriety at his death, according to news reports.

Federal Court Orders Class-Wide Remedies in Wit v. United Behavioral Health

NABH legal consultant and psychotherapist Meiram Bendat, Ph.D., J.D., sent the following summary to NABH this week regarding the remedies in the Wit v. United Behavioral Health case: In its 99-page ruling, the court explained the need for: (1) a 10-year injunction requiring UBH to exclusively apply medical necessity criteria developed by non-profit clinical specialty associations; (2) appointment of a special master; (3) training of UBH in the proper use of court-ordered medical necessity criteria; and (4) reprocessing of nearly 67,000 mental health and substance use disorder benefit claims denied during the class period. Today’s ruling stems from two consolidated class actions, Wit et al. v. United Behavioral Health. and Alexander et al. v. United Behavioral Health, brought by Psych-Appeal, Inc. and Zuckerman Spaeder LLP under the Employee Retirement Income Security Act of 1974 (“ERISA”) in 2014, certified in 2016, and tried in October 2017. While nearly 50,000 ERISA insureds will be eligible for class-wide relief in this case, non-ERISA insureds (such as governmental employees) adversely impacted by UBH’s defective guidelines must rely on state and federal regulators to intervene on their behalf. I trust that you recognize the significance of today’s ruling as much as we do. -Meiram Bendat, Ph.D., J.D., Founder and President, Psych Appeal

DEA Publishes Regulations to Implement the Controlled Substances Act and the Preventing Drug Diversion Act

The Drug Enforcement Administration (DEA) this week published regulations to implement amendments that the 2018 SUPPORT Act made to the Controlled Substances Act. The regulations became effective on Friday, Oct. 30 and appeared in the Federal Register on Nov. 2. The updated regulations:

Allow a practitioner to treat up to 100 patients if a practitioner meets additional credentialing requirements, or if the practitioner provides covered medications (MAT) in a qualified practice setting, and up to 275 patients if the practitioner meet specific additional requirements (42 CFR 8.610-8.655);
Permanently include nurse practitioner or physician assistant in the definition of ”qualifying other practitioner,” and temporarily expand the definition (until Oct. 1, 2023) to include a clinical nurse specialist, certified registered nurse anesthetist, or a certified nurse midwife who meets certain qualifications;
Provide an additional option for a physician to be considered a ”qualifying physician” if the physician graduates in good standing from an accredited school of allopathic medicine or osteopathic medicine in the United States five years prior to notifying HHS of his or her intention to dispense narcotic drugs for maintenance or detoxification treatment. This does not eliminate the SUPPORT Act’s eight-hour opioid training requirement; rather, it permits the training to be completed in medical school or residency, not just through post-residency continuing medical education; and
Permit pharmacies to deliver a controlled substance to a prescribing practitioner’s location for the purpose of administering the medication (through implantation or injection) to the patient or research subject, as previously permitted under a DEA exception. This permits administration directly in the provider’s office without requiring a trip to the pharmacy.

In separate rulemaking, the DEA proposed its intention to amend the Preventing Drug Diversion Act of 2018 related to the identifying and reporting of suspicious orders by DEA registrants. The proposal offers a two-option framework for reporting suspicious orders, establishes a centralized database for reporting, defines four terms: “due diligence,” “order,” “order received under suspicious circumstances,” and “suspicious order,” and requires registrants to design and operate privacy-law-compliant systems. The provisions are intended to clarify procedures for registrants and address a lack of uniformity in reporting suspicious orders. Comments are due by Monday, Jan. 4, 2021.

HHS Extends Compliance Deadline for Information Blocking and Health IT Certification

The U.S. Health and Human Services Department (HHS) recently released an interim final rule that gives healthcare providers and vendors an additional five months to comply with healthcare information blocking and interoperability regulations by April 5, 2021. In March, HHS’ Office of the National Coordinator for Health IT (ONC) released a 21^st Century Cures Act final rule that established exceptions to the Cures Act’s information blocking provision and adopted new health information technology (health IT) certification requirements to improve patients’ smartphone access to their health information at no cost through application programming interfaces. The new interim final rule extends dates in the information blocking provisions—including a November compliance deadline for providers—as well as dates for the Conditions and Maintenance of Certification provisions that require electronic health records platforms to be interoperable. This is the second time HHS has extended the compliance deadline due to the Covid-19 pandemic. “We are hearing that while there is strong support for advancing patient access and clinician coordination through the provisions in the final rule, stakeholders also must manage the needs being experienced during the current pandemic,” Don Rucker, M.D., national coordinator for health IT, said in an announcement. “To be clear, ONC is not removing the requirements advancing patient access to their health information that are outlined in the Cures Act final rule,” he continued. “Rather, we are providing additional time to allow everyone in the health care ecosystem to focus on Covid-19 response.” The rules require that various types of clinical notes be shared with patients, although the rules do not apply to “psychotherapy notes recorded in any medium by a healthcare provider who is a mental health professional documenting or analyzing the contents of a conversation during a private counseling session or a group, joint, or family counseling session and that are separate from the rest of the individual’s medical record,” according to a summary.

Reminder: DOL’s Rural Healthcare Workforce Training Grant Applications Due Nov. 13

The U.S. Labor Department’s Employment and Training Administration (ETA) will accept applications for its H-1B Rural Healthcare Grant Program until next Friday, Nov. 13. Earlier this fall, ETA announced $40 million in available grant funding for employment and training programs in healthcare occupations—including behavioral and mental healthcare—that serve rural populations. According to the announcement, employment and training programs through this funding can propose a wide range of models, including Registered Apprenticeship Programs and Industry-Recognized Apprenticeship Programs. Pre-apprenticeships are permitted only “as on-ramps” to apprenticeship programs proposed as a response to the funding notice and must lead to apprenticeships during the life of the grant. Click here to learn more about the training programs and here to learn how to apply for the funding.

Bipartisan Policy Center to Host Telehealth Webinar Next Week

Sen. Angus King (I-Maine), Maine healthcare providers, and Bipartisan Policy Center experts will lead a webinar about the future of telehealth next Friday, Nov. 13 at noon ET. The webinar will address the investments and changes that both policymakers and healthcare providers need to make to sustain access to quality healthcare through telehealth. Click here to learn more and to register.

NABH to Host Next Annual Meeting in October 2021

June 13-15, 2022
June 12-14, 2023

Thank you for all you do to advance NABH’s mission and vision. We look forward to seeing you in Washington next year! Fact of the Week Individuals with a serious mental illness have an average life expectancy 10 to 25 years lower than the rest of the population. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 121

Written by Emily Wilkins (NABH) on October 16, 2020. Posted in CEO Updates.

Presidential Executive Order Establishes Coronavirus Mental Health Working Group

The White House last week issued an executive order to create a Coronavirus Mental Health Working Group that is expected to develop a plan that addresses Covid-19’s mental health effects on Americans and calls for agencies to maximize support for behavioral healthcare treatment. President Trump’s Saving Lives Through Increased Support for Mental—and Behavioral-Health Needs executive order notes that the working group’s efforts will consider the mental and behavioral health conditions of the vulnerable populations that the pandemic has affected, including minorities, seniors, veterans, small business owners, children, individuals potentially affected by domestic violence or physical abuse, persons living with disabilities, and individuals with substance use disorder (SUD). “We know that the Covid-19 pandemic has created or exacerbated serious behavioral health challenges for many Americans, both adding new stresses and disrupting access to treatment,” U.S. Health and Human Services (HHS) Secretary Alex Azar said in a statement. “The president’s executive order is a welcome opportunity to increase efforts to address the mental health effects of the pandemic, which have already included hundreds of millions of dollars in grants and historic flexibilities to ensure Americans can continue to receive treatment for mental illness and substance use disorders.” Azar will co-chair the new working group with Brooke Rollins, acting director of the U.S. Domestic Policy Council.

U.S. Congress Joint Economic Committee Examines Covid-19’s Toll on Americans’ Mental Health

The United States Congress Joint Economic Committee has released a report that examines how Covid-19’s health and economic repercussions have led to “an unprecedented mental health crisis” in America. The 13-page report summarizes earlier surveys and studies that have found two-thirds of Americans fear that they or their loved ones will be exposed to the virus; more than 12 million Americans are unemployed, and, since February, more than 5 million have given up looking for work; and that nearly one-third of adult Americans are having trouble paying for typical household expenses. “There is yet no clear end in sight for the coronavirus pandemic, which will continue to have devastating effects on public health and on the economy,” the report said. “The Institute of Health Metrics and Evaluation projects more than 360,000 deaths by the end of 2020 under current circumstances, and upward of 430,000 if mandates continue to be eased,” it continued. “The Federal Reserve expects the unemployment rate to remain above pre-pandemic levels until at least the end of 2021. These intense stresses likely will have a growing and lasting impact on Americans’ mental health.

CMS Corrects Announcement to Say Providers Cannot Use PRF When Repaying Medicare Loans

The Centers for Medicare & Medicaid Services (CMS) corrected a misstatement in its Oct. 8 news release to say the nation’s healthcare providers and suppliers cannot use Provider Relief Funds (PRF) to repay Medicare loans the agency has made during the Covid-19 public health emergency. The correction first appeared in an FAQ on Oct. 9. CMS subsequently corrected its original release.

AAAP Releases Buprenorphine Provider Survey Report to Inform Policymakers

The American Academy of Addiction Psychiatry (AAAP) this week released the findings from a new survey that found 80% of X-waivered physicians, physician assistants, and nurse practitioners who treat patients with opioid use disorder (OUD) want telehealth options to continue after the Covid-19 public health emergency. The X-waiver permits office-based clinicians to prescribe Suboxone (buprenorphine/naloxone) for OUD patients. The AAAP led the project with help from other organizations, including the American Psychiatric Association, the American Society of Addiction Medicine, Boston Medical Center, Boston University, and the Yale Program in Addiction Medicine. According to the survey, 78% of respondents said the Covid pandemic has caused them to put on hold or reduce in-person visits. Meanwhile, 75% of physicians and other healthcare professionals said they have used virtual visits to help maintain medication to treat OUD, and 48% reported they used telehealth to initiate medication to help treat OUD. “During the pandemic, physicians and other health care professionals have adapted to quickly provide high-quality, evidence-based care, but this was only possible due to new flexibilities in telehealth rules,” the survey said.

National Addiction Treatment Week Begins Monday, Oct. 19

Monday kicks off National Addiction Treatment Week to build awareness that addiction is a disease, evidence-based treatment is available, and recovery is possible. The week is also meant to encourage people to enter the field of addiction treatment. The American Society of Addiction Medicine (ASAM) launched National Addiction Treatment Week three years ago with partner organizations. Partners include the National Institute on Drug Abuse, the American Medical Association, and the National Association of Addiction Treatment Providers. Click here for ASAM’s schedule of the week and toolkit. Separately, ASAM released an updated cannabis policy statement on Oct. 10.

Please Complete the 2020 NABH Annual Survey!

The 2020 NABH Annual Survey will close on Saturday, Oct. 31. NABH members should have received personalized links to the survey from consulting firm Dobson DaVanzo. If you have not received a link, please click here and follow the instructions to submit your survey today. Your feedback will help inform and improve NABH’s advocacy efforts. Thank you for your time!

Fact of the Week

The rate of domestic violence that women with serious mental illness experience throughout their adulthood was more than double than that of the general population: 69% versus 33%. Men with serious mental illness showed a similar trend when compared with the general population: 49% versus 17%, respectively. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 120

Written by Emily Wilkins (NABH) on October 9, 2020. Posted in CEO Updates.

CMS Gives Medicare Part A & B Providers One More Year to Repay AAP Loans

The Centers for Medicare & Medicaid Services (CMS) said Thursday it will give Medicare Part A and B providers and suppliers an additional year to repay loans the agency made to them during the Covid-19 public health emergency (PHE). CMS had advanced payments to Medicare Part A and B providers and suppliers through the Accelerated and Advance Payment (AAP) program to help cover costs as the PHE disrupted healthcare services this year. Initially CMS had required providers to start making repayments in August 2020. “CMS’ advanced payments were loans given to providers and suppliers to avoid having to close their doors and potentially causing a disruption in service for seniors,” CMS Administrator Seema Verma said in an announcement. “While we are seeing patients return to hospitals and doctors providing care we are not yet back to normal,” she added. According to the agency’s new terms, after that first year, CMS will automatically recoup 25% of Medicare payments otherwise owed to the provider or supplier for 11 months. After that period, CMS will increase the recoupment amount to 50% for another six months. CMS said it will send letters to providers who have any outstanding balances after the entire period—a total of 29 months— informing them that repayment will be subject to a 4% interest rate. Those letters will also include guidance on how to request an Extended Repayment Schedule (ERS) due to financial hardship. The agency’s announcement urged providers and suppliers to contact their Medicare Administrative Contractor for information about how to request an ERS. An ERS will allow a provider or supplier to repay these debts over the course of three to five years. CMS also said providers and suppliers may use Provider Relief Funds to repay these Medicare loans. CMS said it will communicate with each provider and supplier about the amount they owe and all applicable terms in the coming weeks.

New CMS Guidance Requires Psychiatric Hospitals to Report Covid-19 Data Weekly

CMS has released guidance that requires Medicare- and Medicaid-participating psychiatric hospitals to report Covid-19 data to the agency on a weekly basis. CMS published an interim final rule in early September that said hospitals would be required to submit Covid-19 data during the public health emergency in a frequent, standardized way that the U.S. Health and Human Services Department (HHS) secretary specified. This week’s awaited guidance makes it clear that the nation’s psychiatric hospitals—along with rehabilitation hospitals—need to report their data weekly, and not on a daily basis as other hospital types are required to do. NABH advocated for CMS to lessen the reporting frequency for psychiatric hospitals and is pleased with the change. The agency listed the required data in new guidance and also developed an infographic that highlights when the agency plans to alert hospitals about gaps in reporting and compliance. These materials are also available on NABH’s Covid-19 resources webpage.

HRSA Releases Provider Relief Fund Phase 3 Distribution Guide and Fact Sheet

HHS’ Health Resources and Services Administration (HRSA) has released a 12-page provider guide and separate fact sheet to help the nation’s healthcare providers navigate the third phase of the Provider Relief Fund (PRF) distribution during the Covid-19 pandemic. The guide includes specific details on eligibility requirements, application requirements, and reporting guidelines, while the fact sheet condenses the guide’s information and also provides links. HHS announced an additional $20 billion in additional funding last week and encouraged behavioral healthcare providers to apply. The department also developed a list of providers eligible for the funding, including addiction counseling centers, mental health counselors and psychiatrists. The Phase 3 Distribution application process opened this past Monday, Oct. 5, and the application deadline is Friday, Nov. 6. HRSA has scheduled an informational webinar to learn more about the Phase 3 Distribution process next Thursday, Oct. 15 at 3 p.m. ET. Click here to register. HHS has scheduled a webinar about the Phase 3 Distribution process specifically for behavioral healthcare providers and the associations that represent them for Friday, Oct. 16 at 3 p.m. ET. Click here to register.

NABH Submits Comments to CMS on 2021 Physician Fee Schedule Proposed Rule

NABH on Oct. 2 provided feedback to CMS on the telehealth services and substance use disorder (SUD) provisions in the agency’s 2021 physician fee schedule (PFS) proposed rule. In a letter to CMS Administrator Seema Verma, NABH said it supports the proposed rule’s provisions that would continue some of the expanded Medicare coverage of services provided via telehealth, including provisions to extend permanently Medicare coverage for group psychotherapy and psychological testing. The association also said it supports those provisions clarifying that clinical social workers and clinical psychologists and therapists can furnish online assessment and management services, virtual check-ins, and remote evaluations. “We urge you to continue covering evaluation and management services and behavioral health counseling as well as opioid/addiction treatment program counseling and periodic assessment services provided via audio-only technology, i.e., telephone,” the letter said. “Furthermore, we recommend continuing to pay for these services at the same or comparable rates as in-person care—as well as paying for administrative fees to help cover the costs of this technology.” NABH also provided comments on the Opioid Treatment Program (OTP) bundled payment regulations, emphasizing more equitable reimbursement for naloxone and community education for naloxone, as well as reduced limitations on the frequency of reimbursement to align with medical necessity determinations. In addition, NABH’s letter said the association supports continued coverage of periodic telehealth assessments beyond the PHE (including audio-only), and to be reimbursed every 60-90 days, consistent with many state requirements to perform such assessments. The association encouraged CMS to continue the simple, one-bundle structure that has been used successfully to date and reiterated NABH’s recommendation from last year that CMS provide a 17% adjustment to encourage the development of rural OTPs. And NABH underscored the importance of continuing to permit greater flexibility in take-home medications, as well identifying the need to permit reimbursement for OTPs who are under a Substance Abuse and Mental Health Services-provisional certification. Finally, NABH supported the agency’s proposal to expand the PFS bundled payments for Opioid Use Disorder to all SUDs.

U.S. Labor Department to Provide $40 Million in Rural Healthcare Workforce Training Grants

The U.S. Labor Department’s Employment and Training Administration has announced about $40 million in available grant funding for employment and training programs in healthcare occupations—including behavioral and mental healthcare—that serve rural populations. According to the announcement, employment and training programs through this funding can propose a wide range of models, including Registered Apprenticeship Programs and Industry-Recognized Apprenticeship Programs. Pre-apprenticeships are permitted only “as on-ramps” to apprenticeship programs proposed as a response to the funding notice and must lead to apprenticeships during the life of the grant. The deadline to apply is Friday, Nov. 13. Click here for additional information and how to apply.

U.S. Justice Department to Develop Guidelines to Manage Substance Withdrawal in Jail-based Settings

The U.S. Justice Department’s Bureau of Justice Assistance (BJA) and the National Institute of Corrections is seeking feedback to develop evidence-based, clinical guidelines and protocols that will help jail administrators, correctional officers, and jail-based clinicians identify and safely manage substance withdrawal in jail-based settings. According to an announcement, the guidelines will address a host of issues, including, but not limited to, rapid withdrawal from opioids, benzodiazepines, alcohol, methamphetamine, and cocaine individually or in combination, including specification of persons who exhibit withdrawal symptoms or report histories or information from other sources that indicate the necessity of immediate referral to medical facilities outside of the jail; screening for risk of suicide, specifically opioid withdrawal-potentiated suicides; and medication maintenance for entering detainees with prescriptions for opioid or antipsychotic medications. The BJA will select one applicant for a 10-month award to create a document that outlines the guidelines and protocols. Applications are due by Wednesday, Oct. 28. Click here for more information.

Joint Commission to Host Virtual Behavioral Health Care and Human Services Conference

The Joint Commission will host its Behavioral Health Care and Human Services conference in a virtual format on Friday, Oct. 28. This year, attendees will have the option to choose from two tracks: Track A, designed for organizations accredited under the Behavioral Health Care Accreditation Manual, and Track B, intended for those accredited under the Hospital Accreditation Manual and supplemented with the Behavioral Health Care Manual. Click here for more information and to register.

Today is the Deadline to Submit Recommendations for the 2021 NABH Board of Trustees

The deadline is today, Friday, Oct. 9, to submit nominees for NABH’s Board Chair-Elect and three NABH Board of Trustees seats that will become available in 2021. NABH’s Selection Committee is particularly interested in identifying senior managers who represent broad diversity within the NABH membership, including various levels of care, organizational structures, and size. If you have not done so yet, please download a nomination form to share your recommendations of individuals you would like to see included in the single-slate ballot for 2021. Please be sure to attached a curriculum vitae (CV) for each individual you recommend, which will help the Selection Committee in its deliberations. You are welcome to recommend yourself. Please send your completed form and all candidate CVs to NABH Director of Operations Maria Merlie. Thank you for your time!

Please Complete the 2020 NABH Annual Survey!

The 2020 NABH Annual Survey opened in late August and NABH members should have received personalized links to the survey from consulting firm Dobson DaVanzo. If you have not received a link, please click here and follow the instructions to submit your survey today. Your feedback will help inform and improve NABH’s advocacy efforts. The survey closes on Saturday, Oct. 31. Thank you for your time!

Fact of the Week

In the first half of 2019, just more than one in 10 adults (11%) reported symptoms consistent with a diagnosable anxiety or depressive disorder. By July 2020, during the Covid-19 pandemic, that number had increased to 40%. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 111

Written by Emily Wilkins (NABH) on July 31, 2020. Posted in CEO Updates.

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 includes psychiatric hospitals or other behavioral health facilities. The guidance also included challenges and potential solutions specific to behavioral health settings, such as group therapy sessions, cloth face coverings, alcohol-based hand sanitizer, and smoking.

HHS Joins Other Federal Agencies to Form Covid-19 Insights Partnership

HHS has joined the U.S. Veterans Affairs Department (VA) and the U.S. Energy Department to form the Covid-19 Insights Partnership to coordinate and share health data as well as expertise and research to fight against the coronavirus. “The volume and quality of the data HHS has on COVID-19 has advanced by leaps and bounds in recent months,” HHS Secretary Alex Azar said in an announcement about the partnership. “The Department of Energy’s world-class resources will help us derive new insights from the data we gather to help patients and protect our country.” The Covid-19 Insights Partnership’s research and analysis will focus on vaccine and therapeutic development and outcomes, virology, and other critical scientific topics to understand Covid-19 better. HHS and VA will provide additional updates and information on research projects as it becomes available.

MACPAC Responds to Covid-19 and Systemic Racism with New Resources

The Medicaid and CHIP Payment and Access Commission (MACPAC) has added a new section to its website and released a new issue brief to highlight the nation’s two public health crises: Covid-19 and systemic racism. An announcement from MACPAC noted that elevated rates of infection and mortality from Covid-19 are having a disproportionate effect on Black, Hispanic, and Native American communities. A new section of the commission’s website describes how Medicaid is using different legal authorities to respond to the deadly coronavirus, while a new issue brief highlights what MACPAC refers to as a “countercyclical role” responding to this current crisis as well as previous economic and public health emergencies.

Commonwealth Fund Releases Analysis on How States Can Address Mental Health

A new analysis from the Commonwealth Fund shows that 13.4% of adults 18 and older reported symptoms of serious psychological distress in April 2020, compared with 3.9% in April 2018. The findings also projected that deaths from suicide and alcohol or drug misuse could increase by an additional 75,000 before the U.S. economy recovers from Covid-19. In the report, researchers examine states’ mental health responses to Covid-19 by Medicaid and other insurers. The analysis also maps out effective strategies. “While no state has yet provided a comprehensive response, all have implemented measures to address the issue, providing a wealth of ideas and promising practices,” researchers K. Bryant Smalley and Jacob C. Warrant noted in the analysis released this week. “These strategies largely fall into five categories: telemental health, licensure and scope of practice, insurance changes, establishment of new services, and visibility and durability of efforts.”

Wit v. UnitedHealthcare Hearing Open to Public Via Webinar on Thursday, Aug. 6

Members of the public and press are welcome to join a webinar next week that will feature the remedies hearing in the Wit v. UnitedHealthcare case. Click here to follow the hearing via Zoom on Thursday, Aug. 6 at 12:30 p.m. ET/ 9:30 a.m. PT. For important information and guidance on technical preparation for the webinar, please click here.

Reminder: NABH Telehealth Survey Due Today, Friday, July 31

If you haven’t done so already, please fill out this survey about how expanded telehealth coverage during the Covid-19 pandemic has helped maintain and/or improve access to behavioral healthcare. This information will help us advocate for continued expanded telehealth coverage after the public health emergency ends. Please e-mail Kirsten Beronio, NABH’s director of policy and regulatory affairs, with any questions.

Fact of the Week

Three of the 20 most expensive conditions during hospital stays with an expected payer of Medicaid were related to mental and substance use disorders: schizophrenia spectrum and other psychotic disorders, depressive disorders, and alcohol-related disorders. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update: 106

Written by Emily Wilkins (NABH) on June 19, 2020. Posted in CEO Updates.

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 likely continue to debate additional funding for states through Medicaid and for providers. Without additional fiscal relief, states may be limited in their ability to support Medicaid providers and provider relief grants may not be adequate.”

News Report Shows 20% Increase in Drug Overdose Deaths in New Jersey

Drug overdose deaths in New Jersey have increased 20% this year during the Covid-19 pandemic, news outlet NJ.com reported this week. Citing data from NJ Cares, the state’s drug information dashboard, the story reported that 1,330 people in New Jersey died of suspected overdoses in the first five months of 2020, which is 225 more people than the number recorded in the same period last year. May’s figures were especially grim, the story said, when suspected deaths reach a high of 307—nearly 10 people per day. State Police Lt. Jason Piotrowski was quoted in an online town hall saying seven deaths a day has been typical and that he hopes last month’s number proves to be an anomaly.

CMS Chicago Stakeholders to Host Webinar on Covid-19 Relief Funds and Medicaid Next Week

The Centers for Medicare & Medicaid Services (CMS) Chicago Local Engagement and Administration will host a 30-minute webinar about CARES Act Provider Relief Fund distribution in Medicaid on Wednesday, June 24. The event is part of CMS Chicago’s weekly “Real Time” series on Wednesdays at 9 a.m. CT. Click here for more information and to register.

Fact of the Week

A June Health Affairs article reports fewer than half of U.S. mental health treatment facilities provide services for children with autism spectrum disorder (ASD). For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 101

Written by Emily Wilkins (NABH) on May 15, 2020. Posted in CEO Updates.

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 health and substance use training and technical assistance center at the Substance Abuse and Mental Health Services Administration (SAMHSA), and $50 million for the agency to award grants to states, tribes, and community-based entities to increase capacity for behavioral health services. In Medicaid, the bill would increase Federal Medical Assistance Percentage, or FMAP, payments to state Medicaid programs by a total of 14 percentage points from July 1, 2020 through June 30, 2021. And it would prevent the HHS secretary from finalizing the Medicaid Fiscal Accountability Regulation until the end of the Covid-19 public health emergency. The legislation also includes $175 billion for the public health and social services emergency fund, which breaks down to $100 billion in grants for hospitals and healthcare providers to be reimbursed for expenses or lost revenue resulting from the coronavirus, and $75 billion for Covid-19 testing and contact tracing. The House is expected to approve this bill, although its future is less certain in the Senate. NABH staff is watching the developments in this latest round of negotiations and its implications for behavioral healthcare providers.

Senate Passes Bill to Make National Suicide Prevention Hotline ‘9-8-8’

In a unanimous voice vote, the Senate this week passed the National Suicide Hotline Designation Act, a bill that would make the national suicide prevention hotline a three-digit number. Currently the national suicide prevention hotline is accessible through a 10-digit number, 800-273-8225 (TALK). This legislation would allow a person to dial 9-8-8 to access the hotline, although the current number would still work. The bill now moves to the House for consideration.

SAMHSA Covid-19 Emergency Response for Suicide Prevention Grant Applications Due May 22

SAMHSA this week said it is accepting applications for its Covid-19 Emergency Response for Suicide Prevention (Covid-19 ERSP) grants. The agency said it plans to issue 50 Covid-19 ERSP grants of up to $800,000 per year for 16 months for the program that is meant to support states and communities to prevent suicide and suicide attempts among adults 25 and older during the pandemic. SAMHSA’s announcement noted there are currently 57.8 million Americans living with mental and/or substance use disorders and suicide is the tenth leading cause of death in the United States. “The current national Covid-19 crisis will certainly contribute to the growth in the number of Americans needing urgent care to address mental health needs, including suicidality,” the announcement said. “Americans across the country will struggle with increases in depression, anxiety, trauma, grief, isolation, loss of employment, financial instability and other challenges, which can lead to suicide and suicide attempts.” SAMHSA will accept applications through next Friday, May 22. Click here to learn more.

Follow NABH on Twitter and LinkedIn During Mental Health Month

This Mental Health Month, please remember to follow NABH on Twitter @NABHBehavioral and on LinkedIn at the National Association for Behavioral Healthcare to learn what NABH members and other organizations are doing during the annual national observance.

Fact of the Week

Opioid use during pregnancy caused a 300% increase in neonatal abstinence syndrome (NAS) between 1999 and 2013. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 98

Written by Emily Wilkins (NABH) on April 17, 2020. Posted in CEO Updates.

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 during Covid-19 on Wednesday, April 22 featuring senior leaders from NABH member Sheppard Pratt Health System. Harsh Trivedi, M.D., M.B.A., an NABH board member and an AHA trustee, along with Sheppard Pratt’s chief medical officer, chief nursing officer, and chief strategy officer, will discuss how the system re-engineered care processes and developed new care protocols for agitated patients during the pandemic. The team will also discuss the system’s efforts to support staff and build resistance during the national emergency. The hourlong webinar will begin at 2 p.m. ET. Click here to register. O’Neill Institute Covid-19 and Addiction Policy Webinar Includes Pinnacle Treatment Centers CEO The O’Neil Institute for National and Global Health Law at Georgetown last week hosted a webinar on Covid-19 and addiction policy that featured Joe Pritchard, CEO of NABH member Pinnacle Treatment Centers and a member of NABH’s Addiction Treatment Committee. Panelists discussed the current state of access to treatment and harm reduction services for people with substance use disorders. Topics included recently waived federal regulations related to medications and telehealth, as well as the availability of harm reduction and recovery support services. Fact of the Week Between 1999 and 2018, suicide rates were lowest among females aged 10-14. The rate for this age group increased to 2.0 in 2018 from 0.5 in 1999. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 95

Written by Emily Wilkins (NABH) on March 27, 2020. Posted in CEO Updates.

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 members during the pandemic.

NABH and APA to Host Joint Webinar on Addressing Covid-19 in Multiple Settings

NABH and the American Psychiatric Association (APA) will host a joint webinar on Wednesday, April 1 that features experts working in inpatient, residential, and other non-ambulatory care settings who will discuss how they are assessing the current environment and developing new protocols to care for their patients during the Covid-19 pandemic. NABH Board members Frank Ghinassi, Ph.D., A.B.P.P., CEO at Rutgers University Behavioral Health Care, and Harsh Trivedi, M.D., M.B.A., president and CEO of Sheppard Pratt Health System, are among the presenters. The webinar will highlight types of services, key messages to share with team leaders, unique challenges for people with serious mental illness, how to handle group therapy, and more. It will include a live chat session for audience members to submit questions during the webinar. A recording will be available after the event. The hourlong webinar next week will begin at 2 p.m. ET. Click here to register.

Mental Health Liaison Group Urges Policymakers to Broaden Telehealth Services

NABH joined other members of the Mental Health Liaison Group (MHLG) in urging House and Senate leaders to temporarily lift telebehavioral health restrictions during the Covid-19 pandemic. “Given the orders from local, city, state, and national leaders for communities to shelter in place, the Centers for Medicare and Medicaid Services have broadened access to telehealth services and established payment parity under a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act,” the MHLG wrote in its March 25 letter to Senate Majority Leader Mitch McConnell (R-Ky.) and House Speaker Nancy Pelosi (D-Calif.) “We applaud this decision to expand telehealth coverage for Medicare beneficiaries and strongly urge states to follow suit,” it continued. “We request states to temporarily lift restrictions on telebehavioral health at all levels of care by telephone or video for individuals regardless of insurance plan and ensure payment parity until the conclusion of this national emergency.”

Kaiser Family Foundation Releases Medicaid Emergency Authority Tracker

The Kaiser Family Foundation this week released a Medicaid Emergency Authority Tracker that aggregates information on approved Medicaid emergency authorities to address the Covid-19 pandemic. The page noted that it currently includes details about section 1135 waivers and 1915 (c) waiver appendix K strategies and will later add other emergency authorities. NABH has posted the tracker on the Covid-19 resources page.

Fact of the Week

As a result of the Covid-19 pandemic, states may request blanket exceptions for all stable patients in an opioid treatment program to receive 28 days of take-home doses of the patient’s medication for opioid use disorder. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 93

Written by Emily Wilkins (NABH) on March 13, 2020. Posted in CEO Updates.

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-, state-, and national-level data files from the Hospital Compare archive. Slides will be available on the Quality Reporting Center website one day before the webinar. Click here to register.

HRSA Accepting Applications for Opioid Response Program in Rural Communities

The Health Resources and Services Administration (HRSA) is accepting applications for its Rural Communities Opioid Response Program (RCORP), which is intended to reduce the morbidity and mortality of SUD, including opioid use disorder, in high-risk communities. Eligible applicants include all domestic public or private, non-profit or for-profit entities, including faith-based and community-based organizations, tribes, and tribal organizations. Click here to learn more and apply. HRSA will accept applications through April 24.

Fact of the Week

In 2018, the states with the highest age-adjusted drug overdose death rates were West Virginia (51.5 per 100,000 standard population), Delaware (43.8), Maryland (37.2), Pennsylvania (36.1), Ohio (35.9), and New Hampshire (35.8). For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 89

Written by Emily Wilkins (NABH) on February 14, 2020. Posted in CEO Updates.

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 21^st 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 rule proposes to reduce the misuse of opioid medications in prescription drug plans. Currently, Part D plan sponsors are required to include Part D beneficiaries with a history of opioid-related overdose in DMPs. The rule would create a new exemption DMP category that includes individuals with sickle cell disease, those who receive hospice care, or those who live in long-term care facilities. CMS will accept public comments on the rule through Monday, April 6. NABH Supports FCC’s Suicide Hotline Implementation Act Proposed Rule and Nutrition CARE Act NABH this week joined other members of the Mental Health Liaison Group (MHLG) in sending a public comment letter to Federal Communications Commission Chairman (FCC) Ajit Pai about the FCC’s proposed rule for the Implementation of the National Suicide Hotline Improvement Act of 2018. “MHLG fully supports the FCC’s proposed rule plan to identify a three-digit number – 9-8-8 – to be designated for suicide and other mental health crises,” the MHLG wrote. “It is important that the designated number can be implemented quickly and with minimal confusion for the public,” it continued. “We implore the FCC and other policy leaders to make it a priority for the new 9-8-8 system to be nationally available and adequately resourced, so that all Americans have access to this crisis line.” NABH also recently signed onto a letter of support for the Nutrition Counseling Aiding Recovery for Eating Disorders (CARE) Act, which would provide medical nutrition therapy (dietitian services) for seniors and persons with disabilities who are affected by eating disorders under Medicare Part B. As the letter notes, eating disorders are serious mental illnesses that affect 30 million Americans in the course of their lifetime. These disorders have the second highest mortality rates of any psychiatric illness after opioid use disorder. NABH was one of 27 organizations that sent the letter to Senate Finance Committee Chairman Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Ore.) to urge the committee to advance S. 2907 for consideration. CMS to Host Medicare Learning Network Event on Availability of SUD Benefits CMS will host a Medicare Learning Network event next week to seek feedback from clinicians and associations that represent healthcare providers on what supplemental benefits they use to treat Medicare Advantage patients with substance use disorders (SUDs). The SUPPORT Act outlines strategies to address opioid misuse and requires CMS to evaluate the extent to which Medicare Advantage plans offer supplemental benefits to treat or prevent SUDs not otherwise covered under traditional Medicare, including how clinicians are impacted by the availability of supplemental benefits used to treat SUDs. A presentation will be available before the event, which CMS will host on Tuesday, Feb. 18 from 1:30 p.m. until 3 p.m. ET. Click here to learn more and to register. Join Us for Hill Day at the NABH 2020 Annual Meeting! NABH is pleased to present Hill Day 2020 at the association’s Annual Meeting in Washington, D.C. on Tuesday, March 17 from 1:30 to 5 p.m. ET. The NABH team will schedule Capitol Hill meetings and briefings for Annual Meeting attendees interested in Hill Day and will provide background materials and legislative priority documents to attendees before the Annual Meeting. To take advantage of this free opportunity, please indicate that you want to participate in Hill Day when you register for the Annual Meeting, or contact Julia E. Richardson, director of advocacy and senior counsel, at julia@nabh.org or 202.393.6700, ext. 103. Please visit NABH’s Annual Meeting homepage to view the meeting’s preliminary program and learn about the meeting’s speakers, exhibitors, and sponsors. We look forward to seeing you next month! Fact of the Week In 2018 an estimated 31.9 million Americans reported using an illicit drug in the past month. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 88

Written by Emily Wilkins (NABH) on February 7, 2020. Posted in CEO Updates.

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 barriers to integrating opioid use disorder (OUD) and infectious disease services and recommendations to overcome those challenges. The report notes that infectious diseases related to OUD today include human immunodeficiency virus (HIV) and hepatitis A, B, and C viruses, as well as bacterial fungal, and other infections. Barriers to integrating OUD and infectious disease prevention and treatment services include, but are not limited to, prior authorization policies, lack of data and integration sharing, inadequate workforce training, and a disconnect between the health and criminal justice systems. “Integrating medical services—such as co-locating services, sharing a common vision, and aligning processes—is a well-recognized strategy for the delivery of comprehensive healthcare,” the report noted. “When SUD treatment is moved from a stand-alone clinic to a general medical setting, the emphasis may expand to encompass harm reduction tactics and principles, including strategies for safer drug use, minimizing risk of overdose, and preventing transmission of infectious disease.” JAMA Study Examines Comparative Effectiveness of Different Treatment Pathways for OUD New research in JAMA Network Open shows treatment with buprenorphine or methadone was associated with reductions in overdose and serious opioid-related acute care use, but only a few individuals were treated with these medications. In the comparative effectiveness research study of 40,885 adults with OUD that compared six different treatment pathways, only treatment with buprenorphine or methadone was associated with reduced risk of overdose and serious opioid-related acute care use compared with not treatment during three and 12 months of follow-up. “These findings suggest that opportunities exist for health plans to reduce restrictions on use for medication for opioid use disorder (MOUD) and the need for treatment models that prioritize access to and retention of MOUD treatment,” the study concluded.

Trump Administration Releases Tool to Help Rural Leaders Build Drug-Free Communities

The Trump administration has released the Rural Action Guide: Building Stronger, Healthy, Drug-Free Rural Communities, a nearly 100-page document meant to help rural community leaders build an effective, local response to addiction. “The Rural Community Action Guide is an important tool to equip rural leaders with critical information from lessons learned on the frontlines of prevention, treatment, and recovery in rural America,” James Carroll, director of national drug control policy, wrote in the preface to the guide. “While no two rural communities are the same, there are promising practices gleaned from rural leaders in one town that can be replicated in another,” he added. “With this information, local leaders can then design a more effective strategy for deployment in their own community.” The guide is divided into five sections: face of addiction, impact of addiction on a rural community, prevention, treatment, and recovery. SAMHSA to Host IDSUDCC Meeting on Friday, Feb. 28

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced the Interdepartmental Substance Use Disorders Coordinating Committee (ISUDCC) will meet on Friday, Feb. 28 at 9:30 a.m. ET.

Held at SAMHSA’s headquarters in Rockville, Md., the meeting is open to the public and will focus on both federal and non-federal advances to address substance use disorders.

Click here for more information.

Political Analyst Nathan L. Gonzales to Address NABH 2020 Annual Meeting Attendees

NABH is pleased to welcome Nathan Gonzales, editor and publisher of Inside Elections with Nathan L. Gonzales, as the 2020 Annual Meeting Luncheon speaker.

Inside Elections with Nathan L. Gonzales provides non-partisan analysis of campaigns for Senate, House, governor and president. Mr. Gonzales can be seen regularly on CNN discussing the latest in politics, and the New York Times, the Washington Post, the Wall Street Journal, and USA Today have all sought him out for his expertise. Mr. Gonzales will speak on Tuesday, March 17 at noon during the Annual Meeting Luncheon. Please learn more about our Annual Meeting speakers and register for the 2020 Annual Meeting if you haven’t done so already. Also, be sure to reserve your room before the hotel cut-off date on Friday, Feb. 14. We look forward to seeing you in Washington!

Fact of the Week

Only a small portion of clinicians in SAMHSA’s buprenorphine practitioner locator ultimately offered initial appointments, implying the database is only marginally useful for patients. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 86

Written by Emily Wilkins (NABH) on January 17, 2020. Posted in CEO Updates.

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 because this legislation improves on the changes made in 2016 by removing the 15-day cap. Closing this coverage gap will allow patients and their treatment teams to decide on the appropriate length of stay.

NABH Welcomes NIMH Director Joshua Gordon, M.D., Ph.D. as Annual Meeting Speaker

NABH is pleased to welcome Joshua Gordon, M.D., Ph.D., director of the National Institute of Mental Health (NIMH) as an Annual Meeting keynote speaker on Tuesday, March 17 at 8:30 a.m. Gordon earned his M.D. and Ph.D. at the University of California, San Francisco, and completed his psychiatry resident and research fellowship at Columbia. He joined the Columbia faculty in 2004 as an assistant professor in the Department of Psychiatry, where he conducted research, taught residents, and maintained a general psychiatry practice. He has been director of the NIMH since September 2016. Please visit our Annual Meeting Speakers page to learn more. And please be sure to register for the Annual Meeting and reserve your hotel room if you haven’t done so yet. We look forward to seeing you in Washington!

Study Examines Relationship Between Community Care and Inpatient Services

Community care and inpatient psychiatric services are complements, not substitutes, in behavioral healthcare, according to a study published online in Psychiatric Services. Consequently, “Substantial resources should be allocated to services along a coordinated, balanced continuum of mental health care, where both psychiatric hospitals and community psychiatric services offer critical points of service,” author Isabel M. Perera wrote in the study. According to the findings, countries that provide high levels of psychiatric hospital services also tend to provide high levels of community-based care. Perera wrote that additional research is needed to examine this relationship and the mechanisms underlying it. “One hypothesis is that the hospital serves a coordinating role,” Perera wrote. “In the same way that general hospitals develop outpatient units, urgent care centers, and satellite clinics, so too do hospitals diversify their psychiatric services.”

Government Accountability Office Requests MedPAC Nominations

The Government Accountability Office (GAO) is requesting nominations for the Medicare Payment Advisory Commission, or MedPAC. GAO will accept letters of nomination and resumes until Friday, Feb. 14. NABH is pleased to help any NABH member who is interested in applying. Please contact Emily Wilkins, NABH’s administrative coordinator, if you have questions.

Save the Date: IPFQR Webinar Scheduled for Thursday, Jan. 30

CMS’ Quality Reporting Center will host a webinar for participants in the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program on Thursday, Jan. 30 at 2 p.m. ET. The presentation will review updates to the latest version of the IPFQR Program Manual and optional paper tools to equip inpatient psychiatric facilities with program requirements. Click here to register.

Save the Date: O’Neill Institute’s Addiction Policy & Practice Summer Program

The O’Neill Institute for National and Global Health Law and Georgetown University’s Graduate School of Arts and Sciences will host an Addiction Policy & Practice Summer Program from June 10-12, 2020 at Georgetown University. The program will bring together policymakers, advocates, journalists, and academics to examine different aspects of drug law and policy, and topics will range from adverse childhood experiences and substance use disorders to international development and supply-reduction strategies. A detailed agenda and registration information will be available in February.

Fact of the Week

Persons with psychiatric disorders were approximately 3 to 4 times more likely than their siblings without psychiatric disorders to be either subjected to violence or to perpetrate violence. For questions or comments about this CEO Update, please contact Jessica Zigmond

CEO Update 85

Written by Emily Wilkins (NABH) on January 10, 2020. Posted in CEO Updates.

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 applications for its Circles of Care grants, which would provide tribal and urban Indian communities with tools and resources to plan and design a holistic, evidence and community-based, coordinated system of care to support mental health for children, youth, and families in AI/AN communications. SAMHSA said it plans to issue 17 grants of up to $310,000 each year for up to three years. Grant applications for both programs are due by Monday, March 9. Click here for more information. Nearly 60% of Rural Americans Say Opioid Addiction is a ‘Serious Problem’ in Their Community Almost 60% of Americans living in rural areas said opioid addiction is a “serious problem” in their community, according to a JAMA study published this week. The study examined the views of U.S. rural adults on serious health and economic concerns and found that 57% of rural adults reported opioid or other drug addiction or abuse as a serious problem in their community, while 49% of rural adults said they personally know someone who has died of an opioid addiction. “These findings suggest that in today’s economically stretched rural United States, opioid or other drug addiction or abuse has emerged as an equal problem with economic concerns,” researchers from Harvard and the Robert Wood Johnson Foundation noted in the study’s conclusion. “One in three rural adults still have problems paying their medical bills even after the passage and implementation of the Patient Protection and Affordable Care Act.” View the 2020 Annual Meeting Preliminary Program and Register Today! The NABH 2020 Annual Meeting preliminary program is now available online. Please take a moment to view the program and register for the meeting. NABH will update the preliminary program periodically with session and speaker information, and all attendees will receive a final printed program at the Annual Meeting on Monday, March 16. Also please be sure to make your hotel reservation at the Mandarin Oriental Washington, DC. We look forward to seeing you in March! Final Call to Update Your NABH Membership Information! NABH is preparing the association’s 2020 Membership Directory. If you did not submit your updates by the Jan. 9 deadline, please contact Emily Wilkins, NABH’s administrative coordinator, at emily@nabh.org. Thank you for your cooperation! Fact of the Week Adults with mental health issues were 24% less likely overall to get screened for cancer compared with the general population. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CEO Update 84

Written by Emily Wilkins (NABH) on December 20, 2019. Posted in CEO Updates.

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 that time. To assure continuity of patient care, states must pay OTP claims for Medicaid state plan covered services for Medicaid enrolled providers while Medicare enrollments are being completed. The new guidance from CMS provides information to state Medicaid agencies about strategies for continuing to pay for OTP services, including continuing to pay for claims for a specified period, and advising OTPs to submit claims only after their Medicare enrollment has been approved. CMS recommends that states communicate with Medicaid managed care plans that cover OTP benefits, as well as with providers to advise them to enroll in Medicare.

Federal Survey Shows Adolescent Marijuana Vaping Surged in 2019

The latest Monitoring the Future survey showed that increases in adolescent marijuana vaping from 2018 to 2019 ranked among the largest single-year increases the survey has observed in the past 45 years among all outcomes measured. In 2019, the percentage of adolescents who had vaped in the last 12 months was 21% in 12^th grade, 19% in 10^th grade, and 7% in 8^th grade. Nicotine vaping also increased, as the survey showed 35% of 12^th graders reported vaping nicotine in the last 12 months, an increase of 5.6 points from 2018. Similarly, 31% of 10^th graders reported vaping nicotine in the last year, reflecting an increase of 6.1 percentage points from 2018. Also this week, SAMHSA released Substance Misuse Prevention for Young Adults, a guide to help healthcare providers, systems, and communities prevent substance misuse among young adults.

CMS Announces $50 Million in Funding to 10 States for Maternal Opioid Misuse Model

CMS on Thursday said 10 states will receive a total of $50 million over five years funding under the Maternal Opioid Misuse, or MOM, model to help pregnant and postpartum Medicaid beneficiaries with opioid use disorder. Colorado, Indiana, Louisiana, Maine, Maryland, Missouri, New Hampshire, Tennessee, Texas, and West Virginia were granted the awards, which they will use to transition into the model of care and then implement their plans. Click here to learn more.

New JAMA Study Shows Most Opioid Deaths Are Accidental; 4% Are Suicide

Accidental overdoses cause 90% of all U.S. opioid-related deaths while suicides account for 4% of all opioid-related deaths, according to a new study published in JAMA this week. In 2017, opioid-related deaths totaled about 47,500 and included 43,000 accidental deaths and 1,880 suicides. The cause of about 2,590 deaths could not be determined. Government researchers analyzed death certificates for people aged 15 and older, and the findings contrast with a 2018 article in the New England Journal of Medicine that estimated—based on emergency department data—that at least 20% to 30% of those deaths had been suicides. Understanding that most overdoses are accidental “puts the primary focus of care more squarely on the patient’s addiction,” although physicians should still evaluate their mental health, too, Dr. Mark Olfson, a psychiatrist at Columbia University and co-author of the study, told the Associated Press in a story about the analysis.

Please Update Your NABH Member Information Today!

NABH is preparing the association’s 2020 Membership Directory and asks all members to provide the most up-to-date information on their organizations. To help ensure we have the most accurate data on our members, please contact Emily Wilkins, NABH’s administrative coordinator, at emily@nabh.org for a personalized link to enter information about your organization’s facilities. The deadline to submit your information to NABH is Thursday, Jan. 9.

Register Today for the 2020 NABH Annual Meeting!

This week NABH sent members and Annual Meeting attendees the first in a series of weekly alerts about the 2020 Annual Meeting. Please visit NABH’s Annual Meeting homepage today to view the Schedule At-a-Glance, learn about our speakers, and to register for the meeting. Also please be sure to make your hotel reservation at the Mandarin Oriental Washington, DC from March 16-18, 2020. NABH will post the Annual Meeting’s online preliminary program in January. We look forward to seeing you in Washington!

Fact of the Week

Among U.S. 12^th graders, the prevalence of marijuana vaping increased 7.7 percentage points in 2019, reflecting the second largest increase in 12-month substance use ever recorded in this grade.

Happy Holidays from NABH!

NABH will not publish CEO Update for the next two weeks and will resume on Friday, Jan. 10. The entire NABH team wishes you and your families a very happy holiday season! For questions or comments about this CEO Update, please contact Jessica Zigmond.

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Written by Emily Wilkins (NABH) on November 22, 2019. Posted in CEO Updates.

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 NABH members have said for years: unfair managed care practices too often create barriers for patients to access the care they need. Earlier this year, NABH launched its Access to Care initiative to inform policymakers, the media, patient advocates, and the general public about two major challenges—unjust managed care practices and countless regulations—that prevent behavioral healthcare providers from providing a full range of services to patients.

CMS Announces Reorganization to Improve Regional Office Functions and Structure

The Centers for Medicare & Medicaid Services (CMS) this week announced a host of changes to its regional office structure as part of the agency’s earlier-announced Modernizing CMS Strategic Initiative. Among the changes is a plan to bring together staff, regardless of their location, who work on quality improvement and who survey facility quality and safety as a way to ensure consistency. Another program change will combine the regionally based Medicare operations work, the local oversight of the federally facilitated exchange plans, and external affairs into a single office that reports directly to the Office of the Administrator by creating the Office of Program Operations and Local Engagement, or OPLE. CMS also said it will position the Medicaid program to better serve stakeholders by creating centers of excellence. The announcement will be published in the Federal Register on Monday, Nov. 25.

SAMHSA to Host Webinar on National Agenda for Behavioral Health in Youth Next Week

The Substance Abuse and Mental Health Services Administration (SAMHSA) will host a webinar titled Fostering Healthy Mental, Emotional, and Behavioral Health in Children and Youth: A National Agenda next Tuesday, Nov. 26 at 6 p.m. ET. The webinar will provide an overview of the newly released National Academies of Sciences, Engineering, and Medicine’s consensus report on this topic and will feature contributors to the report. They will recommend how to leverage the research to create a national agenda where children and youth thrive. The previous report on this topic was released 10 years ago. Click here to learn more about the webinar and here to register.

SAMHSA Applications for Community Services Program Grant Due Dec. 23

SAMHSA is accepting applications for its Recovery Community Services Program to provide peer recovery support services through recovery community organizations to individuals with substance use disorders or co-occurring substance use and mental health disorders. The agency said it plans to issue six grants of up to $300,000 per year for up to five years. Applications are due by Monday, Dec. 23. Click here to learn more and to register.

Register Today for the 2020 NABH Annual Meeting!

Please visit NABH’s Annual Meeting homepage today to view the Schedule At-a-Glance, learn about our speakers, and to register for the meeting. Also please be sure to make your hotel reservation at the Mandarin Oriental Washington, DC from March 16-18, 2020. We look forward to seeing you next March!

Fact of the Week

In 2017, a child’s out-of-network office visit for behavioral healthcare was 10.1 times more likely than for an out-of-network primary care office visit, which was more than twice the disparity seen for adults.

Happy Thanksgiving from NABH!

NABH’s office will be closed next Thursday, Nov. 28 and Friday, Nov. 29 for Thanksgiving. CEO Update will resume on Friday, Dec. 6. The NABH staff wishes its members and their families a very happy Thanksgiving! For questions or comments about this CEO Update, please contact Jessica Zigmond.

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Written by Emily Wilkins (NABH) on November 15, 2019. Posted in CEO Updates.

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 Opioid Treatment Programs (OTPs). OTPs that enroll may begin billing January 2020. 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.

Senate Hearing on Alzheimer’s Awareness

NABH PAC Champions Senators Patrick Toomey (R-PA) and Debbie Stabenow (D-MI) will be holding a hearing next week on Alzheimer’s Disease. Witnesses for the hearing include Jason Karlawish, MD the Co-Director of the Penn Memory Center University of Pennsylvania; Janet Tomcavage, Chief Nursing Executive at Geisinger; Marc A. Cohen, Ph.D, Professor Research Director at the Center For Consumer Engagement In Health Innovation UMass Boston and Community Catalyst; and Lauren Kovach, and Alzheimer’s advocate from Brighton , MI.

Register Today for the 2020 NABH Annual Meeting!

Fact of the Week

The opioid crisis has contributed to the decline in U.S. overall life expectancy for 3 consecutive years; the first 3 year-on-year decline in U.S. life expectancy since the 1918 flu pandemic. For questions or comments about the Nov. 15 edition of CEO Update, please contact Scott Dziengelski.

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Written by Emily Wilkins (NABH) on November 8, 2019. Posted in CEO Updates.

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 for patients covered by private insurance, obtaining care from OON providers can come with a price,” the study noted. “Steeper cost-sharing payments, such as higher deductibles and higher coinsurance rates, are typically required for care from OON providers,” it continued. “Although the maximum annual out-of-pocket cost-sharing in private plans is capped under the Patient Protection and Affordable Care Act, this cap applies only to in-network healthcare.”

World Congress to Host Opioid Management Summit in February

SAMHSA is accepting applications for fiscal year 2020 Promoting Integration of Primary and Behavioral Healthcare (PIPHC) grants until Tuesday, Dec. 10. The program’s purpose is to promote full integration and collaboration in clinical practice between primary and behavioral healthcare, support integrated care models and improve the overall wellness and health of adults with serious mental illness or children with serious emotional disturbance, and promote and offer integrated care services related to screening, diagnosis, prevention, and treatment of mental and substance use disorders and co-occurring physical health conditions and chronic diseases.

Political Analyst Nathan Gonzales to Address Attendees at NABH Annual Meeting Luncheon

NABH is pleased to announce Nathan Gonzales, editor and publisher of Inside Elections with Nathan L. Gonzales—which provides non-partisan analysis of U.S. political campaigns—will serve as the 2020 Annual Meeting Luncheon speaker. Members can learn more about Mr. Gonzales and NABH’s other featured speakers—folk singer Judy Collins and neuroscientist and psychiatrist Tom Insel—in the Speakers section of our Annual Meeting homepage. Please visit NABH’s Annual Meeting homepage today to register for the meeting and make your hotel reservation at the Mandarin Oriental Washington, DC from March 16-18, 2020. We look forward to seeing you next March! Fact of the Week The journal Pediatrics reports that 20 percent of U.S. children live in counties without a child psychiatrist.

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Written by Emily Wilkins (NABH) on November 1, 2019. Posted in CEO Updates.

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 create their own records to process and pay the claim. Would these changes also apply to these types of records?” SAMHSA accepted all comments on the rule until last Friday, Oct. 25.

SAMHSA Announces Awards to Promote Behavioral Health in American Indian/Alaska Native Youth

SAMHSA has announced it will invest total funding of $9.2 million to promote mental and behavioral health among American Indian/Alaska Native (AI/AN) youth through the age of 24 years. SAMHSA said in an announcement that it expects up to 39 awards, funding programs up to $250,000 per year for five-year projects. Only federally recognized AI/AN tribes, tribal organizations, Urban Indian Organizations, or consortia of tribes or tribal organizations are eligible to apply.

Reminder: SAMHSA Grant Applications for Integrating Primary and Behavioral Healthcare Due Dec. 10

Register Today for the 2020 NABH Annual Meeting!

Please visit NABH’s Annual Meeting homepage today to view the Schedule At-a-Glance and to register for the meeting. Also please be sure to make your hotel reservation at the Mandarin Oriental Washington, DC from March 16-18, 2020. We look forward to seeing you next March! Fact of the Week Although the proportion of facilities with Assertive Community Treatment (ACT) that offer all the required core services has increased in recent years, such programs remain a minority, and the overall number of facilities with ACT has declined.

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Written by Administrator on October 25, 2019. Posted in CEO Updates.

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 (SUD). The resource describes relevant research; explores emerging and best practices; identifies knowledge gaps and implementation challenges; and offers resources.

SUD Increases Risk of Death from Heart Infection

Patients who suffer from infective endocarditis (IE) and struggle with SUD have a 240-percent increased risk of dying within 6 months to 5 years after valve surgery compared with other IE patients, according to a new study published online in The Annals of Thoracic Surgery. According to an announcement from the Society of Thoracic Surgeons (STS), IE is a life-threatening bacterial infection in the endocardium, the inner lining of the heart chambers and valves. Although this condition is often associated with heart defects or abnormal valves, the STS said it is also a “notorious complication after using unsanitary needles and syringes to inject drugs, as bacteria from the skin’s surface and injection equipment release directly into the bloodstream.” Despite medical advances, SUD-IE remains difficult to treat and has a high recurrence rate, the STS notes. The Centers for Disease Control and Prevention reports that people with SUD-IE are 10 times more likely than other patients with IE to require a second surgery or die months after leaving the hospital.

Behavioral Healthcare Providers Elected to National Academy of Medicine

Six behavioral healthcare providers were elected as new members to the National Academy of Medicine (NAM) this week. Election to the NAM is considered among the highest honors in the fields of health and medicine and recognizes individuals who have demonstrated both outstanding professional achievement and commitment to service. David Amaral, Ph.D., a distinguished professor in the department of psychiatry and behavioral sciences at the University of California, Davis; Colleen Barry, Ph.D., M.P.P., chair of health policy and management at the Johns Hopkins Bloomberg School of Public Health; Debra Elaine Houry, M.D., M.P.H., director of the National Center for Injury Control and Prevention at the Atlanta-based CDC; David Meyers, M.D., chief physician at the Agency for Healthcare Research and Quality in Baltimore; Scott Rauch, M.D., president and psychiatrist-in-chief at McLean Hospital and professor of psychiatry at Harvard Medical School; and Rachel Yehuda, Ph.D., professor and vice chair for veterans affairs for psychiatry and neuroscience at the Icahn School of Medicine at Mount Sinai in New York City were elected when the NAM announced the election of 90 regular members and 10 international members during its annual meeting on Oct. 21.

National Prescription Drug Take-Back Day is Oct. 26

The Drug Enforcement Agency under the U.S. Justice Department is sponsoring National Prescription Drug Take-Back Day on Saturday, Oct. 26. The day is meant to provide a safe, convenient, and responsible way of disposing prescription drugs, while also educating the public about the potential for medication abuse. Click here to learn more about the program and to identify drop-off sites.

IPFQR Program Webinar Scheduled for Oct. 31

The Quality Reporting Center will host a webinar for participants in the Inpatient Psychiatric Quality Reporting (IPFQR) Program next Thursday, Oct. 31 at 2 p.m. ET. The presentation—IPFQR Program FY 2020 Data Review is Thursday, Oct. 31 at 2 p.m. ET— will provide a review of the FY 2020 measure and non-measure data results. Click here to register and download the slides here from the Quality Reporting Center one day before the presentation.

SAMHSA Grant Applications for Integrating Primary and Behavioral Healthcare Due Dec. 10

SAMHSA has announced it is accepting applications for fiscal year 2020 Promoting Integration of Primary and Behavioral Healthcare (PIPHC) grants. The program’s purpose is to promote full integration and collaboration in clinical practice between primary and behavioral healthcare, support integrated care models and improve the overall wellness and health of adults with serious mental illness or children with serious emotional disturbance, and promote and offer integrated care services related to screening, diagnosis, prevention, and treatment of mental and substance use disorders and co-occurring physical health conditions and chronic diseases. Applications are due Tuesday, Dec. 10.

Judy Collins and Tom Insel to Serve as Keynote Speakers at NABH 2020 Annual Meeting

Grammy award-winning folk singer Judy Collins and neuroscientist Tom Insel, M.D., the former director of the National Institute Mental Health, will headline NABH’s 2020 Annual Meeting in Washington. Please visit NABH’s Annual Meeting homepage today to learn more and to register for the meeting. Also please be sure to make your hotel reservation at the Mandarin Oriental Washington, DC from March 16-18, 2020. We look forward to seeing you next March!

Fact of the Week

The last time a World Series was played in Washington, D.C. was 1933, the same year nine physicians established the National Association of Private Psychiatric Hospitals (NAPPH), the precursor to the National Association of Psychiatric Health Systems (NAPHS) and NABH. For questions or comments about CEO Update, please contact Jessica Zigmond.

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Written by Administrator on October 18, 2019. Posted in CEO Updates.

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 Omni Scottsdale Resort and Spa at Montelucia. Other sessions include Inside a Behavioral Healthcare M&A Transaction: Lessons for All Executives, and Roadmap to Growth: Key Legal Issues, and Solutions, in the Expansion of Your Treatment Center. Click here to register and use the code NABH to receive a $100 discount on your registration.

Register Today for the NABH 2020 Annual Meeting!

The schedule At-a-Glance for the 2020 NABH Annual Meeting—Expanding Access: Right Care. Right Setting. Right Time.— is now available online. Please visit NABH’s Annual Meeting homepage today to register for the Annual Meeting and also make your hotel reservation at the Mandarin Oriental Washington, DC from March 16-18, 2020. We look forward to seeing you next March!

Fact of the Week

Youth who received mobile crisis services had a significant reduction in odds of a subsequent behavioral health emergency department visit. For questions or comments about CEO Update, please contact Jessica Zigmond.

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Written by Administrator on October 11, 2019. Posted in CEO Updates.

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 with the highest rate of workplace violence. The current issue includes two papers that examine the consequences of exposure to violence based on in-person surveys of 500 adults in two violent Chicago neighborhoods. From those findings, the authors concluded that exposure to violence relates to being in a state of hypervigilance, which carries with it negative health consequences. “Exposure to violence increases the odds of hypervigilance, with exposure to police violence associated with an almost 10-percentage-point increase,” Weil noted, adding that a separate paper in the issue found that exposure to neighborhood violence increases social isolation and loneliness. The issue also includes a paper that explores the relationship between alcohol misuse and subsequent arrest for intimate partner violence.

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 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.

Register Today for the NABH 2020 Annual Meeting!

Registration has opened for the NABH 2020 Annual Meeting, Expanding Access: Right Care. Right Setting. Right Time. Please visit NABH’s Annual Meeting homepage today to register for the Annual Meeting and also make your hotel reservation at the Mandarin Oriental Washington, DC from March 16-18, 2020. We hope to see you next March!

Fact of the Week

A new study posted in Psychiatry Online shows any involvement between family members and inpatient staff was significantly associated with patients’ attending an outpatient appointment by seven days after discharge. For questions or comments about CEO Update, please contact Jessica Zigmond.

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Written by Administrator on October 4, 2019. Posted in CEO Updates.

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 the National Alliance on Mental Illness in this task force,” Mark Covall wrote in NABH’s letter. “We believe that together, CMS and these organizations can produce actionable steps to ensure Medicare beneficiaries continue to have the necessary and appropriate access to PHP services.”

NAMI Releases First Free Online Class for Parents of Children with Mental Illness

The National Alliance on Mental Illness (NAMI) has announced NAMI Basics OnDemand, a free, six-session education program for parents, caregivers, and other family who provide care for youth aged 22 or younger who are experiencing mental health symptoms. For the last 10 years, NAMI Affiliates have offered NAMI Basics in an in-person, group setting, serving about 20,000 participants in 43 states nationwide. This new resource meets an increasing demand for the program. “We know parents face barriers to attending an in-person class, especially when a child may be experiencing mental health challenges, but that’s when this information is needed the most,” NAMI Acting CEO Angela Kimball said in a news release. “We hope by providing this free, online course of NAMI Basics OnDemand, we’ll reach more people when and where it’s easiest for them to access this vital information,” she added. “We want parents to get the resources they need and to realize they are not alone.” The program’s six sessions focus on basic elements of coping with mental health conditions; brain biology and getting a diagnosis; communication skills and crisis preparation; treatment and connecting with others by sharing your story; navigating the mental health and education systems; and self-care and advocacy.

ASAM Seeks Public Comment on Clinical Practice Guideline

The American Society of Addiction Medicine is seeking both member and public comment on the draft of the society’s latest clinical practice guideline on alcohol withdrawal management in both inpatient and outpatient settings. Click here to learn about the methodology and for a copy of the draft guideline. The deadline to submit all comments is Monday, Oct. 7.

National Addiction Treatment Week is Oct. 21-27, 2019

The American Society of Addiction Medicine (ASAM) will host National Addiction Treatment Week from Oct. 21-27, 2019 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.

Register Today for the NABH 2020 Annual Meeting!

Fact of the Week

The aggregate production quote of oxycodone (APQ) in the United States—which the U.S. Drug Enforcement Agency (DEA) establishes annually—increased more than 400 percent between 2002 and 2013. It wasn’t until 2017 that DEA significantly reduced the APQ for oxycodone, by 25 percent. For questions or comments about CEO Update, please contact Jessica Zigmond.

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Written by Administrator on September 27, 2019. Posted in CEO Updates.

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 an increased CVD risk, while among women, that link was found only for depression, psychosis, and bipolar disorder. “Surprisingly, a PTSD (post-traumatic stress disorder) diagnosis in men was tied to a lower risk, but in women, PTSD was not linked to any difference in CVD risk,” the study said.

Methadone Barriers Remain Despite Evidence of Effectiveness to Treat OUD

Despite evidence proving its effectiveness, methadone—one of three medications the U.S. Food and Drug Administration (FDA) has approved to treat OUD—continues to be one of the most heavily regulated drugs in the country at a time when additional methadone treatment capacity is needed, according to new Health Affairs blog post. Citing statistics from the 2018 National Survey of Substance Abuse Treatment Services (a survey of substance use disorder treatment facilities), the blog noted that about 383,000 people were treated with methadone in the past year. Meanwhile, opioid treatment programs (OTPs) are unavailable or inaccessible in many communities, with 88.6 percent of large, rural counties lacking a sufficient number of these programs. The blog offers recommendations for increasing access to methadone, including regulating mobile methadone vans; urging states to promote using medication units, which are dosing sites affiliated with an existing OTP; and revising policies that unnecessarily restrict the number of OTPs and the services they offer.

Mental Health Awareness Week: Oct. 6-12, 2019

The National Alliance on Mental Illness (NAMI) will recognize Mental Health Awareness Week with the theme WhyCare? between Oct. 6-12. In an overview about its campaign, NAMI noted there are too many myths surrounding mental illness, and that “with these myths comes stigma, misunderstanding, and discrimination.” NAMI will work to dispel a myth a day on the following topics: prevalence of mental illness (Oct. 6), obsessive-compulsive disorder (Oct. 7), PTSD (Oct. 8), children and mental illness (Oct. 9), anxiety and depression (Oct. 10), borderline personality disorder (Oct. 11), and mental health treatment (Oct. 12). NAMI will also highlight National Day of Prayer for Mental Illness Recovery and Understanding on Oct. 8 and World Mental Health Day on Oct. 10. Visit WhyCare? for statistics and resources.

Save the Date for the NABH 2020 Annual Meeting!

Please join us for the NABH 2020 Annual Meeting at the Mandarin Oriental Washington, D.C. from March 16-18, 2020. NABH will send Save-the-Date cards early next week with additional information about the Annual Meeting. Online registration and hotel booking information also will be available the week of Sept. 30. We look forward to seeing you in Washington!

Fact of the Week

The availability of opioid treatment programs (OTPs) varies widely by state. For example, the 4.7 million people in Louisiana have access to 10 OTPs in their state, while the 3.6 million residents of Connecticut have access to 41 OTPs. For questions or comments about CEO Update, please contact Jessica Zigmond.

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Written by Administrator on September 20, 2019. Posted in CEO Updates.

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 week to support the Mental Health Professionals Workforce Shortage Loan Repayment Act of 2019, a bill intended to help build America’s mental and behavioral healthcare workforce. In a letter to Senators Kamala Harris (D-Calif.) and Cory Gardner (R-Colo.), the Mental Health Liaison Group cited statistics from a 2016 Health Resources and Services Administration report that projected the supply of personnel in selected behavioral and mental health fields to be 250,000 workers short of projected demand in 2025. Meanwhile, the National Institute of Mental Health has reported that nearly one in five adults in the United States experienced a mental or behavioral health problem in the last year alone, the letter noted. In addition to the Senate bill, there is a companion bill in the House of Representatives.

ASAM Seeks Public Comment on Clinical Practice Guideline

National Addiction Treatment Week is October 21-27, 2019

Save the Date for the NABH 2020 Annual Meeting!

Please save the date and plan to attend the NABH 2020 Annual Meeting at the Mandarin Oriental Washington, DC from March 16-18, 2020. NABH will send Save-the-Date cards with details in late September and will alert members when online registration and hotel reservations are available. We look forward to seeing you in Washington next March!

Fact of the Week

Those who abuse drugs are at an increased risk of infective endocarditis (IE), an infection of the heart. There has been a near doubling in prevalence of drug abuse-related IE from 2002 through 2016, as the condition increased alongside the nation’s opioid crisis. For questions or comments about CEO Update, please contact Jessica Zigmond.

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Written by Administrator on September 13, 2019. Posted in CEO Updates.

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 and local foundations and the business community;
Federal agencies should use their capabilities to promote healthy mental, emotional, and behavioral development and mitigate risks;
Federal agencies should support rapid development and dissemination of effective mental, emotional, and behavioral interventions for delivery to large populations; and
The U.S. Department of Health and Human Services should collaborate with states and local jurisdictions to conduct a comprehensive assessment of existing sources of data useful for tracking key population data on the mental, emotional, and behavioral health and development of children.

New Consumer Information on “Vaping Illnesses”

In response to the recent reports of respiratory illnesses following the use of vaping products, the U.S. Food and Drug Administration (FDA) has provided information to help protect consumers. The FDA is also in the process of investigating the issue more thoroughly and has encouraged the public to submit detailed reports of any unexpected tobacco- or e-cigarette-related issues to the FDA via the online Safety Reporting Portal.

Save the Date for the NABH 2020 Annual Meeting!

Fact of the Week

The percentage of Americans that “did not have health insurance at any point during the year” increased in 2018 to 8.5 percent (27.5 million people) from 7.9 percent (25.6 million people) in 2017. For questions or comments about CEO Update, please contact Jessica Zigmond.

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Written by Administrator on September 6, 2019. Posted in CEO Updates.

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 30^thAnniversary

This year marks the 30^th 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 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.

Save the Date for the NABH 2020 Annual Meeting!

New CEO Update Feature: Fact of the Week

Starting with this edition, NABH will provide a “Fact of the Week” as the last item in NABH’s weekly CEO Update. Some of these facts may be new, while others may have appeared as news items in previous editions of the CEO Update and are important enough to highlight. If you have an item to share with fellow NABH members, please contact Jessica Zigmond, NABH’s director of communications. This week’s fact: The risk of a suicide attempt doubles among the children of opioid users. For questions or comments about CEO Update, please contact Jessica Zigmond.

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Written by Administrator on August 23, 2019. Posted in CEO Updates.

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 may shift over time among former smokers,” the study said. “If people who stop smoking cigarettes substitute other forms of substance use, the overall health benefits of cigarette cessation may be decreased owing to the negative consequences of use of these drugs as well as consequent relapse to smoking cigarettes.”

HRSA Releases Dashboards on Health Professions Training Programs

The Health Resources and Services Administration (HRSA) this week released interactive dashboards that show aggregated performance data for HRSA-awarded health professions training grants from the academic year 2012-2013 to the present. These data are meant to provide insight into the distribution of HRSA’s healthcare providers who help and work in underserved communities. The dashboards offer information on training programs, demographics, health professional shortage areas, medically underserved areas, and more

HRSA Announces Funding Opportunity for Rural Health Network Development Program

HRSA said this week it expects to spend about $13 million on nearly 50 public or not-for-profit, private organizations to support integrated, rural healthcare networks. The agency’s Rural Health Network Development Program has previously funded networks that focused on coordinated care for patients, chronic disease management, telehealth, and behavioral health improvement. Details about the program and requirements for applications are available here, and the deadline is Nov. 25.

National Consortium of Telehealth Resource Centers Webinar to Focus on Mental Health

Speakers from the Telehealth Resource Centers and a rural federally qualified health center will present a webinar next week about how telehealth can help deliver mental and behavioral health services. Specifically, the presentation will explain how to integrate telemental/behavioral health into organizations and will provide stories from clinics that have done this successfully. The webinar is scheduled for Tuesday, Aug. 27 at 4 p.m. ET. Click here to register. For questions or comments about CEO Update, please contact Jessica Zigmond.

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Written by Administrator on August 16, 2019. Posted in CEO Updates.

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. He also highlighted what he called the “robust antidepressant effects” of the drug esketamine but called for more research into both medications. “The job is not done for TRD,” Gordon wrote. “Ketamine and esketamine work, but both have significant drawbacks. Many patients experience uncomfortable dissociate symptoms, hypertension, or other side effects for a few hours after administration,” he added. “Because of these symptoms, as well as the potential for abuse, both need to be administered in a doctor’s office.” Study Shows More Than One Tenth of Older Americans Are Binge Drinkers More than a tenth of older U.S. adults are estimated to be current binge drinkers and a large proportion of them have chronic diseases that are exacerbated by binge drinking, according to a new study published in the Journal of American Geriatrics Society. The study used data from the U.S. National Survey on Drug Use and Health (2017) and provides information on the prevalence of binge drinking in individuals 65 years and older. It found that between 2001 and 2013, there was a 22.4 percent increase in past-year alcohol use; a 65.2 percent increase in high-risk drinking; and a 106.7 percent increase in alcohol use disorder among adults aged 65 years and older. “Excessive alcohol use, including binge drinking, is a risk factor for a range of health problems, including injury,” the study concluded. “This is especially true for older adults due to physiological changes related to aging and increasing comorbidity,” it continued. “Binge drinking, even episodically or infrequently, may negatively affect comorbid conditions by exacerbating disease and complicating disease management.” IPFQR Program Webinar to Examine 2020 IPF PPS Final Rule on Aug. 28 The Quality Reporting Center will host a quality and education webinar for those who participate in the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program on Wednesday, Aug. 28 at 2 p.m. ET. Titled the IPFQR Program: FY 2020 IPF PPS Final Rule and APU Determination, the webinar will feature Jeffrey Buck, Ph.D., program leader and senior advisor for behavioral health at the Center for Clinical Standards and Quality at the Centers for Medicare and Medicaid Services (CMS); and Lauren Lowenstein, a program specialist at the Center for Clinical Standards and Quality. Webinar slides will be available to download from the Quality Reporting Center under “Upcoming Events” one day before the presentation. Click here to register. For questions or comments about CEO Update, please contact Jessica Zigmond.

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Written by Administrator on August 12, 2019. Posted in CEO Updates.

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 five place “a lot” of blame on mental illness for mass shootings, making it the No. 1 factor Republicans believe drive mass shootings. “This is a repeated message that is being put out there,” Bandy Lee, a Yale University psychiatrist and specialist in violence prevention programs, told the Morning Consult. “When a president says it, it has far-reaching cultural consequences.” NABH Recommends CMS Rewrite Special Conditions of Participation NABH on Thursday sent CMS a comment letter requesting the agency help reduce the administrative burden for providers. The letter is a response to CMS’ Request for Information (RFI) last month that seeks ideas on how to enhance 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. NABH’s comment letter focuses on the psychiatric hospital Conditions of Participation (CoP) and the 60 distinct compliance elements referred to as “B-tags”. “These rules are intended to serve the important goal of ensuring patient safety and high-quality care. However, some of these requirements are now outdated,” NABH President and CEO Mark Covall writes in the letter.” In addition, many surveyors apply these criteria indiscriminately in the field, exposing providers to unpredictable citations and requiring costly alterations in their procedures, equipment, and facilities.” NABH also submitted a copy of The High Cost of Compliance, the association’s report that assesses the regulatory burden on the nation’s inpatient psychiatric facilities. The report, which address the B-tags, ligature risk and the Emergency Medical Treatment and Labor Act, found that these three 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. Click here to read NABH’s letter to CMS. CDC Highlights How Naloxone Can Help End the Opioid Crisis in Vital Signs Report The Centers for Disease Control and Prevention said this week the overdose-reversing drug naloxone saves lives—but only if it’s readily available when an overdose happens. CDC researchers reported in the latest Vital Signs study that despite a huge increase in naloxone prescribing in recent years, far too little naloxone is being dispensed in many areas of the United States that need it most. “Moreover, too few doctors are prescribing naloxone to patients receiving high-dose opioids or opioids plus benzodiazepines or to those with a substance use disorder as recommended by CDC’s Guideline for Prescribing Opioids for Chronic Pain,” the Atlanta-based agency said in a news release. According to the study, the number of naloxone prescriptions dispensed doubled from 2017 to 2018, and only one naloxone prescription is dispensed for every 70 high-dose opioid prescriptions nationwide. Meanwhile, about 71 percent of Medicare prescriptions for naloxone required a copay, compared with 42 percent for commercial insurance. O’Neill Institute Reviews How States Support OUD Treatment Medication in Jails and Prisons A blog post from the O’Neill Institute for National and Global Health Law at Georgetown University Health Center this week explored recent state laws and appropriations on how different states are supporting opioid use disorder (OUD) treatment in their jails and prison systems. According to the blog, state legislators passed laws expanding access to treatment medications for OUD. In some states, legislators targeted their efforts to populations most at risk, including those who are incarcerated. “Upon leaving incarceration, an individual’s overdose risk skyrockets. Despite this, too few correctional institutions provide OUD treatment medications,” researchers Regina LaBelle (a 2019 NABH Annual meeting speaker) and Shelly Weizman, director and associate director, respectively, of the Addiction and Public Policy Initiative at Georgetown University Law Center, wrote. “In some cases, policymakers and jail administrators fear misuse of opioid treatment medications.” In Connecticut, Ohio, and Oklahoma, legislators have appropriated new funds to establish treatment programs using OUD medications for their incarcerated populations, while states such as Colorado and Maryland also passed legislation requiring county jails to phase in OUD medication treatment programs, LaBelle and Weizman noted. For questions or comments about CEO Update, please contact Jessica Zigmond.

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Written by Administrator on August 5, 2019. Posted in CEO Updates.

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

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

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

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

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

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Written by Administrator on July 26, 2019. Posted in CEO Updates.

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

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Written by Administrator on July 19, 2019. Posted in CEO Updates.

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

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Written by Administrator on July 12, 2019. Posted in CEO Updates.

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

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Written by Administrator on June 28, 2019. Posted in CEO Updates.

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

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Written by Administrator on June 21, 2019. Posted in CEO Updates.

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

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Written by Administrator on June 14, 2019. Posted in CEO Updates.

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

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Written by Administrator on May 31, 2019. Posted in CEO Updates.

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

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Written by Administrator on May 24, 2019. Posted in CEO Updates.

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

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Written by Administrator on May 17, 2019. Posted in CEO Updates.

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

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Written by Administrator on May 10, 2019. Posted in CEO Updates.

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 in GOP-controlled States Two states have made hypodermic needle exchanges legal this year while four other state legislatures are considering the move, Kaiser Health News reported this week. Georgia and Idaho, where Republicans control the House and Senate and the governor is a Republican, legalized needle exchange this year. Meanwhile, Arizona, Florida, Iowa, and Missouri have introduced bills to allow the practice. Research has shown the benefit of needle exchanges for years, the story noted, and lawmakers are now listening as the opioid crisis and infectious diseases have affected their communities. “The reality is maybe 10 or 15 years ago this wasn’t where Georgia was,” Republican state Rep. Houston Gaines, sponsor for Georgia’s needle-exchange law, said in the story. “But the medical and science community has shown that this works,” he added. “My hope is as Republicans, we can always be willing to embrace programs and ideas if they’re proven to work.” Opioid Addiction Drug Prescribed Mostly to Whites as Opioid Overdose Deaths Rose Among Blacks A new study in JAMA Psychiatry has found that white populations are almost 35 times as likely to have a buprenorphine-related visit than black Americans. This dominant use of the opioid-addiction drug happened at the same time opioid overdose deaths rose faster among blacks than whites. Poola Lagisetty, MD, an assistant professor of medicine at the University of Michigan Medical School and the study’s lead author, noted that most of the white patients either paid cash (40 percent) or relied on private insurance (35 percent) to fund their buprenorphine treatment. The statistic that only 25 percent of the visits were paid for through Medicaid or Medicare “does highlight that many of these visits could be very costly for persons of low income,” Lagisetty said in a joint story about the study from Kaiser Health News and National Public Radio. Longtime New York Times Healthcare Reporter Robert Pear Dies at 69 Robert Pear, a reporter for The New York Times since 1979, died Tuesday, May 7 following complications from a stroke. Pear, 69, worked out of the newspaper’s Washington bureau and wrote more than 6,700 articles for the Times during his career. He wrote many articles about behavioral healthcare and parity, giving visibility to these critical diseases. In his last published article on April 20, Pear wrote that while President Trump and congressional Republicans have said they are committed to protecting people with pre-existing medical conditions, many would have considerably less protection under their healthcare revisions. HRSA Accepting Applications for 2019 Graduate Psychology Education and Nurse Corps Programs The Health Resources and Services Administration (HRSA) is accepting applications for its Nurse Corps Scholarship Program (NCSP) through May 21. The NCSP awards funds to students enrolled in a diploma, associate, baccalaureate, or graduate degree nursing program accept applications for this program if those students commit to serving in high-need, underserved communities. Scholarship support covers tuition, required fees, other reasonable educational costs, and a monthly living stipend. HRSA will accept applications through May 21. Continue to Support Mental Health Month: Promote NABH’s Access to Care Initiative National Prevention Week kicks off on Sunday, May 12 to observe increasing awareness around mental health and substance use disorders. The week is part of Mental Health Month, which the United States has observed throughout May since 1949 to promote awareness about the importance of mental health as a part of overall health. This year, NABH asks its members to promote this important national observance by supporting the association’s Access to Care initiative. Launched in March, NABH’s Access to Care initiative focuses on two major challenges that too often prevent providers from offering patients a full range of behavioral healthcare services: unjust managed care contracts and countless regulations. Please visit our Access to Care page, where you can find resources to post and share with your followers, including our Access to Care video (which you can post directly to your organization’s website and share with others), our Access to Care resolution, our regulatory report, The High Cost of Compliance: Assessing the Regulatory Burden on Inpatient Psychiatric Facilities, and social media messages, including a LinkedIn article from NABH President and CEO Mark Covall. Thank you for your help and support! Learn About NewYork-Presbyterian in NABH’s Newest Member Profile! Please take a moment to learn about NABH member NewYork-Presbyterian’s Psychiatry Inpatient Access Center in our newest member profile! For questions or comments about CEO Update, please contact Jessica Zigmond.

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Written by Administrator on April 26, 2019. Posted in CEO Updates.

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

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Written by Administrator on April 22, 2019. Posted in CEO Updates.

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 high usage rate for telehealth, according to a new report from American Well, a privately held telemedicine company based in Boston. The report, Telehealth Index: 2019 Physician Survey, found that more than three-fourths of U.S. hospitals are currently using or implementing a telehealth program. And, as telehealth becomes a more common practice nationwide, physicians are more willing to use the technology. The findings showed that a total of 69 percent of physicians said they would be willing to use telehealth, up from 57 percent in 2015. Psychiatrists fared well for both telehealth willingness and usage, with the study reporting that “every psychiatrist that is interested in practicing telehealth uses the technology.” Shatterproof Releases Summary of Collaboration with NQF on SUD Treatment Programs National not-for-profit organization Shatterproof has released NQF Quality Innovation: Measuring Quality of Care in Substance Use Disorder (SUD) Treatment Programs, a detailed report of its collaboration with the National Quality Forum (NQF). The summary highlights the process of developing performance and outcomes measures that addiction treatment programs will use for public reporting. Specifically, the 73-page report describes how the NQF convened an expert panel to “pressure test” Shatterproof’s proposed measure set by gathering multi-stakeholder expert input on the measures, additional measure concepts, and guidance on Shatterproof’s proposed implementation of the measure set in its providing rating system pilot and future national expansion. Shatterproof also released a measurement set that will undergo feasibility testing in several states before the measures are made final. The testing will begin this August. HRSA Accepting Applications for 2019 Graduate Psychology Education and Nurse Corps Programs The Health Resources and Services Administration (HRSA) is accepting applications for its Graduate Psychology Education (GPE) program and its Nurse Corps Scholarship Program (NCSP) until May. HRSA’s GPE program trains doctoral health psychology students, interns, and post-doctoral residents to provide integrated, interdisciplinary, behavioral health and substance use prevention and treatment services in high-need and high-demand areas. The program also supports faculty development of health service psychology. According to HRSA, there is about $18 million in funding for about 40 awards, and it will accept applications through May 7. The NCSP awards funds to students enrolled in a diploma, associate, baccalaureate, or graduate degree nursing program accept applications for this program if those students commit to serving in high-need, underserved communities. Scholarship support covers tuition, required feeds, other reasonable educational costs, and a monthly living stipend. HRSA will accept applications through May 21. IPF PEPPER Review Webinar Scheduled for April 24 A webinar to review the Inpatient Psychiatric Facility (IPF) PEPPER (version Q4FY18)—released on Friday, April 5—will be held on Wednesday, April 24 at 3 p.m. ET. For questions or comments about CEO Update, please contact Jessica Zigmond.

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Written by Administrator on April 12, 2019. Posted in CEO Updates.

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

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Written by Administrator on April 5, 2019. Posted in CEO Updates.

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

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Written by Administrator on March 29, 2019. Posted in CEO Updates.

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

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Written by Administrator on March 22, 2019. Posted in CEO Updates.

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

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Written by Administrator on March 15, 2019. Posted in CEO Updates.

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

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Written by Administrator on March 8, 2019. Posted in CEO Updates.

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

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Written by Administrator on March 1, 2019. Posted in CEO Updates.

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.” Click here to learn more about the VA’s Recreation Therapy Service. JAMA Article Studies Geographical Distribution of Opioid-Related Mortality Nationwide Opioid-related mortality—driven by the use of synthetic opioids—has increased rapidly in all of the nation’s eastern states, according to a new study in JAMA. In an analysis of more than 350,000 U.S. residents who died from opioid-related causes, the age-standardized mortality rate from opioids increased more than two-fold every two years in 24 eastern states, reflecting an expansion from lower-income, rural states, the study found. Researchers examined deaths that involved any opioid, heroin, synthetic opioids, and natural and semisynthetic opioids. “Our findings indicate that policies focused on reducing opioid-related deaths may need to prioritize synthetic opioids and rapidly expanding epidemics in northeastern states,” researchers noted in the study, “and consider the potential for synthetic opioid epidemics outside of the heroin supply.” AAP Examines Nonmedical Prescription Opioid Use in Parents and Adolescents Parent-based interventions targeted toward adolescent, nonmedical prescription opioid use should address parental nonmedical prescription opioid use and smoking, and promote positive parenting, the American Academy of Pediatrics (AAP) reported this week in the journal Pediatrics. According to the AAP, this study is the first to examine intergenerational patterns of nonmedical prescription opioid use. Data came from 35,000 parent-child dyads with an adolescent between the ages of 12 and 17 between 2004 and 2012 from the National Surveys on Drug Use and Health. Scientists found that associations between parental and adolescent nonmedical prescription opioid use did not differ by adolescent sex or race and/or ethnicity. However, parental lifetime smoking, low monitoring, and parent-adolescent conflict were “uniquely associated with adolescent nonmedical prescription opioid use, as were adolescent smoking, marijuana use, depression, delinquency, and perceived schoolmates’ drug use.” Register Today for the 2019 NABH Annual Meeting! The 2019 NABH Annual Meeting is two weeks away! Please register today if you haven’t done so yet. For complete Annual Meeting details, including preliminary program and speaker information, please visit NABH’s Annual Meeting homepage. For questions or comments about CEO Update, please contact Jessica Zigmond.

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Written by Administrator on February 22, 2019. Posted in CEO Updates.

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

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Written by Administrator on February 15, 2019. Posted in CEO Updates.

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

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Written by Administrator on February 1, 2019. Posted in CEO Updates.

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

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Written by Administrator on January 25, 2019. Posted in CEO Updates.

Message from the President and CEO We are pleased to present a new and improved design for CEO Update, your weekly summary of industry and association news! This electronic newsletter serves the same purpose, and we hope you like the updated format. You will also see a new design in our other NABH communication pieces that we send our members via e-mail. At our recent staff retreat, our team discussed what information we share with our members; how we present that information; and how we want to share that information in the future. We decided to keep what works and add some new forms of communication in 2019. In addition to your weekly CEO Update, you will receive the following communication pieces throughout the year: NABH Alert: This message will contain urgent news briefs. NABH Inside Scoop: This message is meant to share inside information about what our team is hearing on Capitol Hill, at the regulatory agencies and accrediting bodies, and within the industry. NABH Issue Brief: This message will include all major points of an issue with some analysis. NABH Analysis: The message is the longest form of communication we will share and is meant for in-depth summaries of bills and regulations. We hope these resources will help you in your work as you advance NABH’s mission. As always, we welcome your feedback! —Mark Covall, NABH President and CEO Davos 2019 Spotlights Mental Health The World Economic Forum in Davos, Switzerland this week highlighted mental health as a growing global challenge that is both a health issue and an economic one. According to one London-based report of the annual conference in the Swiss alps, mental health is especially a challenge in low- and middle-income countries where numbers are rising but services lag behind. The story cited the World Health Organization’s estimates that more than three quarters of people with mental disorders in those countries receive no treatment. Meanwhile, mental health is responsible for 13 percent of the global burden of disease, and the World Economic Forum estimates it will cost the global economy $16 trillion by 2030 in lost productivity and healthcare costs. Even so, countries spend an average of less than 2 percent of their health budgets on mental health, the story noted. And less than 1 percent of global health aid—about $132 million a year—was directed to mental health between 1995 and 2015. Bipartisan Policy Center Releases Report on Integrating Clinical and Mental Health NABH’s top advocacy priorities were included in Integrating Clinical and Mental Health: Challenges and Opportunities, a 46-page report from the Bipartisan Policy Center this week that examines the barriers to integrating clinical and mental health services and identifies potential policy solutions to achieve integration. According to the report, nearly 45 million American adults suffered some form of mental illness in 2016, and at least 25 states experienced at least a 30-percent increase in suicide rates between 2014 and 2016. Meanwhile, 20.1 million Americans experienced a substance use disorder (SUD) and 8.2 million experienced both a mental illness and SUD in that same year. NABH is pleased that the Bipartisan Policy Center recommendations include repealing the Institutions for Mental Diseases (IMD) exclusion in Medicaid; eliminating the 190-day lifetime limit; and providing resources for behavioral health IT. The report is organized by the following topic areas: use of grant programs in treating mental illness and the transition to integrated care; insurance coverage barriers and policy options; workforce barriers and policy options; and federal administrative barriers and policy options. NABH and Six Other Hospital Associations Present HIT Interoperability Agenda NABH was one of seven national hospital associations this week that urged public and private stakeholders to support a six-point agenda that would help the United States achieve the secure exchange of patient health information. NABH joined America’s Essential Hospitals, the American Hospital Association, the Association of American Medical Colleges, Catholic Health Association of the United States, Children’s Hospital Association and Federation of American Hospitals in presenting the health information technology (HIT) agenda to “support optimal individual health, healthcare, and value.” Included in the report Sharing Data, Sharing Lives, the agenda identifies six pathways to exchange patient health information securely: security and privacy; efficient, usable solutions; cost-effective, enhanced infrastructure; standards that work; connecting beyond electronic health records; and shared best practices. An infographic accompanied the Sharing Data, Sharing Lives report that the seven organizations released on Jan. 22. CMS Seeks Public Comment on the Follow-Up After Psychiatric Hospitalization Measure The Centers for Medicare and Medicaid Services’ (CMS) Health Services Advisory Group (HSAG) is seeking comments from healthcare professionals and stakeholder organizations on the new Follow-Up After Psychiatric Hospitalization quality measure. After the measure is made final, it may be proposed to be included in the Inpatient Psychiatric Facility Quality Reporting program. The public comment period opens today, Friday, January 25, 2019, and will remain open through Wednesday, February 13, 2019 at noon ET. Click here for more information and here to submit comments. Please contact HSAG at PQM@hsag.com if you have trouble submitting comments. Thank you to Our 2019 NABH Annual Meeting Exhibitors and Sponsors! NABH thanks all of the companies that will serve as exhibitors or sponsors at the 2019 NABH Annual Meeting in March. Please take a moment to view our Exhibitors & Sponsors on our Annual Meeting homepage, where you can click on each organization to learn more. Also, please remember to visit with our exhibitors and sponsors during the Annual Meeting from March 18-20 at the Mandarin Oriental Washington, DC. And if you haven’t done so yet, please take a moment to read our updated preliminary program; register for the Annual Meeting; and reserve your hotel room! The hotel cut-off date is Monday, Feb. 11. We look forward to seeing you in Washington! For questions or comments about CEO Update, please contact Jessica Zigmond.

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Written by Administrator on January 11, 2019. Posted in CEO Updates.

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

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Written by Administrator on January 4, 2019. Posted in CEO Updates.

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

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Written by Administrator on December 21, 2018. Posted in CEO Updates.

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

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Written by Administrator on December 14, 2018. Posted in CEO Updates.

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

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Written by Administrator on November 16, 2018. Posted in CEO Updates.

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

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Written by Administrator on November 9, 2018. Posted in CEO Updates.

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

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Written by Administrator on November 2, 2018. Posted in CEO Updates.

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

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Written by Administrator on October 26, 2018. Posted in CEO Updates.

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

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Written by Administrator on October 19, 2018. Posted in CEO Updates.

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

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Written by Administrator on October 12, 2018. Posted in CEO Updates.

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 10^th Anniversary of Mental Health Parity and Addiction Equity Act The Senate this week passed a resolution that recognizes the 10^th anniversary of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act’s enactment. Introduced by Sens. Bill Cassidy, M.D. (R-La.) and Amy Klobuchar (D-Minn.), the resolution also honors the late Sens. Paul Wellstone (D-Minn.) and Pete Domenici (R-N.M.), who fought for access to mental health treatment and whose names are on the bill that became law on Oct. 3, 2008. Wellstone died in a plane crash in October 2002 and Domenici died in September 2017 following complications from abdominal surgery. “Senators Wellstone and Domenici worked to ensure access to mental health treatment,” Cassidy said in a news release. “Passing the Mental Health Reform Act of 2016 continued this bipartisan effort to remove stigma surrounding mental illness and increase access to treatment.” SAMHSA Introduces Early Serious Mental Illness Treatment Locator The Substance Abuse and Mental Health Services Administration (SAMHSA) this week launched its Early Serious Mental Illness Treatment Locator to help connect people experiencing a first onset of serious mental illness to effective care. According to SAMHSA, programs that treat serious mental illness—including first episode psychosis programs—are becoming more available. In two years, the number has increased to more than 270 programs in 49 states from a few programs in 17 states. The locator is a confidential and anonymous source of information for persons and their family members who are seeking treatment in the United States and U.S. territories for a recent onset of serious mental illness, such as psychosis, schizophrenia, bi-polar disorder, and other conditions. CDC Highlights Emergency Preparedness and Children for World Mental Health Day The Centers for Disease Control and Prevention (CDC) earlier this week published a blog post about the Atlanta-based agency’s experiences to help inform mental health interventions and improve outcomes for children after public health emergencies and disasters. The post focused on World Mental Health Day’s theme this year—”Young People and Mental Health in a Changing World”—and shared the lessons the CDC learned from the 2017 hurricane season. “Mental stress from a disaster can be harder on children,” the authors wrote. “Children are more vulnerable in emergencies because of their physical, developmental, behavioral, and emotional differences from adults,” they said, adding that children may also have difficulty or may not be able to communicate their symptoms or feelings. Click here to learn more. SAMHSA Releases Disaster Distress Hotline Reminder for Hurricane Michael Survivors The Substance Abuse and Mental Health Services Administration (SAMHSA) posted information regarding immediate crisis counseling for those affected by Hurricane Michael. SAMHSA’s Helpline, 1-800-985-5990, is available 24 hours a day, seven days a week, for anyone who needs counseling after a natural or human-made tragedy. NABH thanks its members in the region who have provided and will continue to provide care for those who need it. Register Today for the NABH 2019 Annual Meeting! Please visit NABH’s Annual Meeting homepage today to register and reserve your hotel room for the 2019 NABH Annual Meeting — Behavioral Healthcare: Improving Coordination, Collaboration, Integration. We look forward to seeing you at the Mandarin Oriental Washington, D.C. from March 18-20, 2019! For questions or comments about CEO Update, please contact Jessica Zigmond.

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Written by Administrator on October 5, 2018. Posted in CEO Updates.

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

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Written by Administrator on September 28, 2018. Posted in CEO Updates.

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

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Written by Administrator on September 21, 2018. Posted in CEO Updates.

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

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Written by Administrator on September 14, 2018. Posted in CEO Updates.

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

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Written by Administrator on September 7, 2018. Posted in CEO Updates.

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

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Written by Administrator on August 31, 2018. Posted in CEO Updates.

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

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Written by Administrator on August 24, 2018. Posted in CEO Updates.

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

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Written by Administrator on August 17, 2018. Posted in CEO Updates.

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

CEO Update | 19

Written by Administrator on August 10, 2018. Posted in CEO Updates.

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

CEO Update | 18

Written by Administrator on August 3, 2018. Posted in CEO Updates.

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

CEO Update | 17

Written by Administrator on July 27, 2018. Posted in CEO Updates.

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

CEO Update | 16

Written by Maria on July 20, 2018. Posted in CEO Updates.

NABH Sends Comments to HHS about Family First Prevention Services Act 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. In the letter, NABH emphasized that FFPSA creates a separate system of care for foster children in which judges and administrators—not clinicians—are left to make treatment decisions. The association urged ACF to work with stakeholders to create programs and services that can be tailored to every child’s needs and circumstances. Specifically, NABH recommended that ACF clarify the definition of Qualified Residential Treatment Program (QRTP); specify assessor credentials; provide options under court review; and allow for flexibility in providing services and including families in treatment. Click here to read the letter. SAMHSA Developing Mental Health Workforce Initiative The Substance Abuse and Mental Health Services Administration (SAMHSA) is developing a mental health workforce initiative that could be in place by late September, Assistant Secretary for Mental Health and Substance Use Elinore McCance-Katz, M.D., Ph.D., told federal lawmakers Thursday in a congressional hearing about implementing the 21st Century Cures Act. According to a hearing summary, McCance-Katz said the program would set up specialized training programs targeted toward mental health and substance use disorders that focus on local needs. She also said SAMHSA has partnered with the U.S. Department of Agriculture to address needs in rural areas, and added that her agency is working on additional guidance for states on telehealth to better serve rural populations. Click here to read McCance-Katz’s written testimony from the hearing. Azar Names CMMI Director Boehler to Lead Value-based Agenda HHS Secretary Alex Azar has named Centers for Medicare and Medicaid Innovation Director Adam Boehler as a senior adviser for value-based transformation and innovation at HHS. In this role, Boehler—who was appointed CMMI director in April—will lead the department’s broader value-based care agenda. Politico reported this week that Azar’s selection completes his team of officials responsible for overseeing HHS’ main policy priorities. The others are Assistant Secretary for Health Brett Giroir as the top official to oversee the opioid crisis; Dan Best as senior adviser on drug pricing; and James Parker as senior adviser on health reform. Opioid-related Deaths in the United States Increased by 345 percent from 2001-2016 The number of opioid-related deaths rose by a staggering 345 percent between 2001 and 2016, according to a new JAMA study that used data from the Centers for Disease Control and Prevention. Researchers used a method in which they examined cross sections at different points to investigate deaths from opioid-related causes in the United States between Jan. 2, 2001 and Dec. 31, 2016. They concluded that while opioid prescribing and overdose are leading public health problems in North America, the precise public health burden has not been quantified. The study showed that the burden was particularly high among adults aged 24 to 35 years old, and that 20 percent of deaths in this age group involved opioids in 2016. “Furthermore, the aging population of people with opioid use disorder requires attention, as the burden of opioid overdose among adults aged 55 to 64 years is growing at a concerning rate,” the researchers noted. “These trends highlight a need for tailored programs and policies that focus on both appropriate prescribing and harm reduction in these demographics.” Study Shows “Warm Handoffs” Do Not Improve Attendance at Behavioral Health Intake Appointments Boston Medical Center researchers have found that “warm handoffs”—in which primary care clinicians introduce patients to behavioral health professionals—are not associated with better attendance at behavioral health intake appointments. Rather, the most significant predictor of attendance at an initial intake was the time from referral until appointment, the researchers concluded in their study published in the Annals of Family Medicine. Meanwhile, the authors call for a prospective study that compares different types of warm handoffs with standard referrals to determine if warm handoffs improve attendance at initial intake appointments, as well as which features are most beneficial. Partial Hospitalization Program PEPPER Available A release of the Partial Hospitalization Program (PHP) Program for Evaluating Payment Patterns Electronic Report, or PEPPER, with statistics through December 2017 is now available. Freestanding PHPs can find their PEPPER through the PEPPER Resources Portal. Also, the TMF Health Quality Institute will host a webinar training session about the PHP PEPPER on Thursday, August 2 from 2 p.m. to 3 p.m. ET. For more information, visit the PHP Training and Resources page, and access the PHP PEPPER User’s Guide before the webinar. SAMHSA to Host Webinar on Supervising Peer Workers Next Week SAMHSA will host a webinar about supervising peer workers on Thursday, July 26 from 2 p.m. to 3 p.m. ET. The webinar’s presenters will outline the principles of supervising peer workers; share administrative, educational, and supportive supervisory practices; and discuss their own experiences supervising peer workers in different settings. Click here to register for the webinar. In addition, SAMHSA has announced a series of webcasts that include discussions from experts in the field of addiction treatment, research, and policy on overcoming stigma and ending discrimination; why addiction is a disease; and reducing discriminatory practices in clinical settings. SAMHSA developed the webcasts together with Massachusetts General Hospital’s Recovery Research Institute.

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

CEO Update | 15

Written by Maria on July 13, 2018. Posted in CEO Updates.

Number 15 July 13, 2018 Justice Department Announces Regulations to Address Opioid Crisis 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. The rule establishes that DEA will consider the extent to which a drug is diverted for abuse when the agency sets its annual opioid production limits. This means that if DEA officials believe a particular opioid or a particular company’s opioids are being diverted for misuse, the agency can reduce the amount that can be produced in a given year. Click here for more information. NIMH-Supported Study Examines EHR Model to Predict Suicide Attempts and Suicide Deaths The National Institute of Mental Health this week highlighted a study published earlier online in the American Journal of Psychiatry in which researchers at the Kaiser Permanente Washington Health Research Institute sought a better way to predict suicide attempts and suicide deaths in the 90 days after a mental health diagnosis. The model used data from electronic health records (EHRs) from seven health systems, including the Henry Fords Health System in Detroit, the HealthPartners Institute in Minneapolis, and the Kaiser Permanente regions of California, Colorado, Hawaii, Oregon and Washington. “By leveraging existing electronic health record data and advancements in statistical modeling, it is possible to significantly improve the prediction of death by suicide and suicide attempts over conventional self-report methods,” said Michael Freed, Ph.D., chief of the Services Research and Clinical Epidemiology Branch in NIMH’s Division of Services and Intervention Research. “Valid and reliable suicide risk prediction models hold tremendous promise to reduce death by suicide, especially when integrated with evidence-supported approaches to suicide prevention.” New Research Highlights Increasing Medications to Treat Opioid Addictions A recent study in the Annals of Internal Medicine has heightened interest in using medications to treat opioid addictions. “Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: A cohort study” (Annals of Internal Medicine, June 19, 2018) found that for the year after a nonfatal overdose:

Methadone reduced overdose deaths by 59 percent
Buprenorphine reduced overdose deaths by 38 percent
Fewer than one-third of all patients received a medication for opioid use disorder in the year following a nonfatal overdose
Naltrexone showed a one-month average retention rate, compared to five months for methadone and four months for buprenorphine.

Following the study, the July 5th issue of The New England Journal of Medicine published three articles about strategies that promote using medications in primary care settings to treat opioid use disorders. These include: “Primary care and the opioid crisis”: Authors Wakeman and Barnett dispel stigma and certain myths about buprenorphine prescribing that make primary care physicians reluctant to prescribe ‘bupe,” including perceptions that bupe treatment is more dangerous, substitutes one addiction for another, more onerous than other treatments, and that reducing the prescribing of opioids will put an end to the overdose epidemic. The authors also debunk as myth that detoxification treatment is effective. Defined as short-term, abstinence-based residential treatment, the article states that research demonstrates this model is ineffective and may increase opioid overdoses by reducing tolerance and increasing the risk of death. “Improving the quality of buprenorphine treatment”: Authors Saloner, Stoller, and Alexander suggest that primary care-based buprenorphine prescribing provides a unique opportunity for true integration of addiction and medical care, including coordination across care to detect the use of opioids and benzodiazepines. The authors recommend collaboration between specialty and primary care to increase the number of bupe providers; increase the duration of bupe treatment; use quality outcome measures to evaluate population-wide outcomes across levels of care; and improve reimbursement methodologies and extend bundled payments and shared savings arrangements to specialty addiction providers. “Methadone in primary care—one small step for congress, one giant leap for addiction treatment”: Authors Samet, Botticelli, and Walley propose that it’s time for the U.S. to permit methadone to be administered in the primary care setting, as is done in Canada, Great Britain, and Australia. Permitting administration by buprenorphine prescribers would not only fill geographical gaps caused by zoning issues, but also allow all three opioid medications to be offered in one place. Justification for this approach is found in a risk-benefit analysis in evaluating potential safety issues against 2017 research that shows a reduction in all-cause mortality for those treated with methadone or buprenorphine. HRSA Applications for SUD and Mental Health Services Funding Due Monday, July 16 Applications for federal money to support Health Services and Resources Administration (HRSA)-funded health centers by implementing and advancing evidence-based strategies to expand access to integrated substance use disorder and mental health services are due on Monday, July 16. According to HHS, there is about $350 million available for these awards, which will be announced in September. Click here to learn more and apply for funding. Webinar Presentation on IPFQR Program FY 2019 Requirements Now Available The Quality Reporting Center has posted slides from a webinar this week that summarizes the Fiscal Year (FY) 209 Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program requirements and includes tips to submit data successful. Click here to view the presentation. SAMHSA to Award Opioid-Related Funding Awards The Substance Abuse and Mental Health Services Administration (SAMHSA) will award 59 grants to state governments for prevention, treatment and recovery efforts for opioid use disorder (OUD). Grantees of the program will use data to identify gaps in availability of treatment by geographic, demographic and service-level terms, and use evidence-based implementation strategies “to identify which system design models will most rapidly and adequately address the gaps in their systems of care.” The application deadline is August 13. Click here for more information. SAMHSA will also award 263 grants to supplement current activities for federally recognized American Indian/Alaska Native tribes or tribal organizations to increase access to culturally appropriate and evidence-based treatment of OUDs. The deadline is August. 20. SAMHSA will host three webinars on this topic in the coming weeks. Click here to learn more. For questions or comments about CEO Update, please contact Jessica Zigmond.

CEO Update | 14

Written by Administrator on June 29, 2018. Posted in CEO Updates.

NABH Launches Redesigned Website We are pleased to announce NABH has launched a redesigned website at www.nabh.org! The website’s updated design will make it easier for NABH members to access their member benefits, resources and industry news. At the same time, the redesigned site will show policymakers, advocates, and members of the media how the association is working to improve behavioral healthcare services in the United States—and how these stakeholders can engage in that effort. As you navigate the new site, please note the following features:

Watch our video Behavioral Healthcare is Everyone’s Concern and access it from a slide on the homepage.
Navigate news and resources by category in seven tabs at the top of the homepage: Home, About NABH, NABH Resources, News & Insights, Be An Advocate, Policy Issues, and Annual Meeting.
Click on an interactive Impact Map of the United States for key information about NABH member locations in every congressional district throughout the country.
Learn what NABH members are doing nationwide in our Member Profile section.
Get to know the association’s leadership in the Board of Trustees & Staff page.
Follow the Annual Meeting Countdown on the homepage for a reminder about the association’s signature event every March.

We hope you like the redesigned website, and that you visit often! As always, we welcome your feedback. If you have comments, please e-mail NABH. Senate Appropriations Committee Approves HHS Funding for 2019 The Senate Committee on Appropriations this week passed the FY 2019 Labor, Health and Human Services, and Education (Labor-HHS) Appropriations Act, which provides $3.7 billion to address the opioid crisis and $3.4 billion for mental health treatment, prevention, and research. According to a summary, the opioid funding is targeted toward improving treatment and prevention efforts; finding alternative pain medications; workforce needs; and behavioral health. Funding to address the opioid crisis has increased by $3.5 billion—or about 1,300 percent—since fiscal year 2015. Click here to learn more about the funding levels. House-Passed Opioid Package Moves to Senate The House late last week passed H.R. 6: SUPPORT for Patients and Communities Act, a massive bill to address the nation’s opioid crisis. The legislation combined 58 individually approved House-passed bills, including many NABH-supported proposals—such as the IMD CARE Act and the Overdose Prevention and Patient Safety Act— in one package. House members passed the measure in an overwhelmingly bipartisan vote of 396-14, and the legislation now moves to the Senate for its consideration. Senate Majority Leader Mitch McConnell (R-Ky.) has indicated the Senate will consider opioid legislation later this summer or in the fall. In the upper chamber, the Senate Health, Education, Labor & Pensions (HELP) Committee approved a bipartisan package of proposals in the Opioid Crisis Response Act, which includes provisions that mirror those in the House’s opioid package. NABH Sends Comments on FY 2019 Proposed IPF PPS Rule to CMS Earlier this week NABH sent comments to the Centers for Medicare and Medicaid Services (CMS) about the agency’s proposed rule to update Medicare payment policies and rates for the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) in FY 2019. The rule proposed eliminating eight quality measures, many of which NABH has advocated for removing previously. With help from the NABH Quality Committee, NABH commented on several provisions for next year and focused primarily on two issues: 1) adopting a policy that would permit CMS to remove measures from the IPFQR set if the costs associated with a measure outweigh the benefit of its continued use in the program; and 2) encouraging CMS to keep the measure related to hours of seclusion and restraint. NABH Commends Policymakers for Introducing Bill to Boost Behavioral Healthcare Workforce NABH has sent letters to policymakers in the House and Senate who introduced respective versions of the Opioid Workforce Act of 2018 to expand and improve addiction medicine, addiction psychiatry, or pain management residency positions to address America’s opioid crisis. “A major driver of this increase in deaths is an inadequate number of professionals and paraprofessionals who are trained in substance use and addictions,” NABH President and CEO Mark Covall wrote in letters to Rep. Joseph Crowley (D-N.Y.) and Sen. Bill Nelson (D-Fla.). “Federal estimates project a workforce deficit of up to 250,000 workers by the year 2025,” Covall continued. “The Opioid Workforce Act of 2018 will add 1,000 residency positions in addiction medicine, addiction psychiatry, or pain management.” IPFQR Program FY 2018 Data Submission Period Begins July 1 The Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program Fiscal Year (FY) 2018 data submission period is scheduled to begin on Sunday, July 1, 2018, and end on Wednesday, August 15, 2018, at 11:59:59 p.m. Pacific Daylight Time (PDT). The opportunity to correct or otherwise modify your data ends on the data submission deadline of Wednesday, August 15, 2018, at 11:59:59 p.m. PDT. Refer to the IPFQR Program Manual, version 3.1, for more information about the IPFQR Program requirements described in this email. The manual is available at:

QualityNet: Inpatient Psychiatric Facilities > Resources
Quality Reporting Center: Inpatient > IPFQR Program > Resources and Tools

Also, please note that the IPFQR Program Resources and Tools page on the Quality Reporting Center website now includes the IPFQR checklists for submission, review, and verification of FY 2019 data and administrative requirements. The checklists will be available on the QualityNet website’s IPFQR Program Resources page at a later date. These checklists are meant to help inpatient psychiatric facilities (IPFs) meet the August 15, 2018 data submission deadline. They provide guidance on submitting data via the QualityNet Secure Portal and checking the IPF Participation Report for the completion of IPFQR Program administrative requirements via the QualityNet Secure Portal. Shatterproof Receives Funding to Identify Ways to Improve Coverage for Addiction Treatment The Leonard Davis Institute of Health Economics recently awarded funding to Shatterproof so the advocacy organization can identify strategies for insurance carriers to improve coverage for evidence-based addiction treatment, including the use of medications for opioid use disorder. The strategies will be based on the Shatterproof National Principles of Care. SAMHSA to Award Opioid-Related Funding Awards The Substance Abuse and Mental Health Services Administration (SAMHSA) will award 59 grants to state governments for prevention, treatment and recovery efforts for opioid use disorder (OUD). Grantees of the program will use data to identify gaps in availability of treatment by geographic, demographic and service-level terms, and use evidence-based implementation strategies “to identify which system design models will most rapidly and adequately address the gaps in their systems of care.” The application deadline is August 13. Click here for more information. SAMHSA will also award 263 grants to supplement current activities for federally recognized American Indian/Alaska Native tribes or tribal organizations to increase access to culturally appropriate and evidence-based treatment of OUDs. The deadline is August. 20. Click here for more information. We will not publish CEO Update on Friday, July 6 and will resume on Friday, July 13. For questions or comments about CEO Update, please contact Jessica Zigmond.

CEO Update | 13

Written by Administrator on June 22, 2018. Posted in CEO Updates.

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

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Written by Administrator on June 15, 2018. Posted in CEO Updates.

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

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Written by Administrator on June 8, 2018. Posted in CEO Updates.

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

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Written by Administrator on June 1, 2018. Posted in CEO Updates.

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

NABH Rebrand: The association rebranded to the National Association for Behavioral Healthcare from the former National Association of Psychiatric Health Systems (NAPHS) on March 19. If you were unable to attend the 2018 NABH Annual Meeting, please be sure to watch our brief video that we showed to kick off the meeting. Learn more about our rebranding, social media channels, and exciting changes ahead during this call.
Mental Health Month Recap: The country has recognized May as Mental Health Month since 1949. Learn how NABH commemorated Mental Health Month in 2018 with its first paid social media campaign, which focused on repealing the Institutions for Mental Diseases (IMD) exclusion in Medicaid.
Federal Policy Update: Congress continues to pay close attention to the nation’s deadly opioid crisis. Learn how the NABH team has worked with committees in both chambers of Congress to address this issue. Also learn about some important regulatory updates related to the inpatient psychiatric facility prospective payment system (IPF PPS).

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

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Written by Administrator on May 25, 2018. Posted in CEO Updates.

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

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Written by Administrator on May 11, 2018. Posted in CEO Updates.

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

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Written by Administrator on May 4, 2018. Posted in CEO Updates.

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