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HHS Provides Exemptions for Buprenorphine Prescribers for Fewer Than 30 Patients

The U.S. Department of Health and Human Services (HHS) announced Tuesday 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 200 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.

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Behavioral Health Slides from MACPAC’s April 2021 Public Meeting

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NABH Highlights Residential Treatment as Critical Service for Youth in New White Paper

NABH is pleased to share with you 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. We urge you 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.

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

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Joint Letter to OSHA on Inpatient Psych Regulatory Actions

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CMS Proposes 2.1% Payment Increase to Per-Diem Base Rate for IPFs in FY 2022 

The Centers for Medicare & Medicaid Services (CMS) on April 7 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.

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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:

  1. A description of the NQTL, plan terms, and policies at issue;
  2. Identification of the MH/SUD and medical/surgical benefits to which the NQTL applies;
  3. The factors used in applying the NQTLs to MH/SUD benefits and medical or surgical benefits;
  4. The evidentiary standards used for these factors;
  5. 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
  6. 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:

  1. What information plans and issuers must make available to support their their comparative analyses demonstrating compliance with MHPAEA in their use of NQTLs;
  2. Examples illustrating when the federal agencies might determine that a comparative analysis of NQTLs is insufficiently specific and detailed;
  3. 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;
  4. 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;
  5. Whether state agencies and plan participants and beneficiaries may request to see a plan or issuer’s comparative analysis of its use of NQTLs;
  6. 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).
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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.

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Bipartisan Policy Center Report Seeks to Bring Mental Healthcare & Addiction Treatment into the 21st Century

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Healthcare Coalition Letter: Medicare Sequester Moratorium

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