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SAMHSA Updates Confidentiality of Patient Records in Final Rule

The Substance Abuse and Mental Health Services Administration (SAMHSA) on Monday issued a final rule to update the Confidentiality of Substance Use Disorder Patient Records known as 42 CFR part 2 (or “part 2”) regulations, further aligning the regulations with other healthcare delivery rules.

Key changes include:

  • Part 2 programs may share information verbally with a non-part 2 provider without subjecting the non-part 2 record to the requirements of part 2, as long as the non-part 2 provider segregates specific substance use disorder (SUD) records.
  • Patients may consent to disclosures without naming a specific individual to receive this information; the update provides instructions for disclosures to exchanges and research institutions and provides guidance on disclosures related to care coordination and case management.
  • Non-part 2 providers are not required to redact information in their medical records and may redisclose information if the patient has signed a written consent, or if the disclosure is otherwise permitted under the regulations.
  • Written consents expressly allow sharing information with 18 types of payment and healthcare operations, including for care coordination and case management.
  • Non-opioid treatment providers have access to central registries if they have a treatment relationship to the patient.
  • Opioid treatment programs have new permissions to disclose information to prescription drug monitoring programs.
  • During medical emergencies, information may be shared among part 2 programs or other SUD treatment providers during state or federally declared natural and major disasters.
  • Disclosures for conducting scientific research may be made to non-Health Insurance Portability and Accountability Act (HIPAA) covered entities and those who are not subject to the Common Rule.
  • Permits federal, state, and local agencies to conduct audits and evaluations.
  • Extends to 12 months the period of placement of undercover agents or informants, which may be further authorized by a new court order.

These changes do not include provisions that recently became law in the Coronavirus Aid, Relief and Economic Security Act (CARES Act). CARES Act provisions are effective March 27, 2021.

This rule is expected to be published in the Federal Register this Wednesday, July 15, and will become effective within 30 days of its publication.

For questions about this rule, please contact Sarah Wattenberg, NABH’s director of quality and addiction services, at sarah@nabh.org.

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NABH Letter: Elementary and Secondary Emergency Relief Fund

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HHS Announces Relief Funding for Medicaid & CHIP Providers, Safety Net Hospitals

HHS said Tuesday it expects to distribute about $15 billion through the department’s Health Resources and Services Administration (HRSA) to eligible providers who participate in state Medicaid and CHIP programs and have not received a payment from the Provider Relief Fund General Distribution.

HRSA will also distribute about $10 billion from the Provider Relief Fund to the nation’s safety-net hospitals, which is expected to happen this week.

HHS said it will launch an enhanced Provider Relief Fund Payment Portal on Wednesday that is intended to allow eligible Medicaid and CHIP providers to report their annual patient revenue, which will be used as a factor for HHS to determine their Provider Relief Fund payment.

According to an announcement, the payment to each provider will be at least 2% of reported gross revenue from patient care. HHS said it will determine the final amount that each provider receives after data is submitted, including information about the number of Medicaid patients providers serve.

To be eligible for this funding, healthcare providers must not have received payments from the $50 billion Provider Relief Fund General Distribution and either have directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for healthcare-related services between January 1, 2018, to May 31, 2020.

On Monday, HHS contacted all hospitals, asking them to update information on their COVID-19 positive-inpatient admissions for the period January 1, 2020, through June 10, 2020. This information will be used to determine a second round of funding to hospitals in COVID-19 hotspots to ensure they are equitably supported in the battle against this pandemic. To determine their eligibility for funding under this $10 billion distribution, hospitals must submit their information by June 15, 2020 at 9:00 PM ET.

HHS said close to 1 million healthcare providers may be eligible for these patients. Click here for more information about eligibility and the application process.

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Covid-19 Task Force Letter to Congress

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NABH-The Kennedy Forum Op-Ed

In January, the Centers for Disease Control and Prevention announced some hopeful news when it reported a slight uptick in U.S. life expectancy following years of decline largely due to historic rates of overdoses and suicides.

Sadly, COVID-19 has the potential to reverse serious progress made in addressing our nation’s mental health and addiction crises — particularly around overdose rates — unless policymakers mitigate the pandemic’s serious effects on behavioral health in the next stimulus package.

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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 will be published in the Federal Register on Tuesday, April 14.

According to the proposed rule, CMS will adopt the Office of Management and Budget (OMB) 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.

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HHS Announces $30 Billion in Covid-19 Relief Funding for Providers

HHS announced on Friday it is distributing $30 billion immediately to healthcare providers fighting the deadly Covid-19 pandemic. The funding is the first portion of the $100 billion allotted to hospitals and other providers as part of the Coronavirus Preparedness and Response Supplemental Appropriations (CARES) Act that President Trump signed on March 27.

The funding will arrive via direct deposit to eligible providers starting on Friday, April 10. HHS’ announcement said the money is in the form of payments, not loans, so the money will not need to be repaid.

Eligible healthcare providers include all facilities and providers that received Medicare fee-for-service reimbursements in 2019. According to HHS, payments to practices that are part of larger medical groups will be sent to the group’s central billing office. Click here to learn how HHS will determine the payments and what eligible providers need to do.

To receive funding, providers must agree not to seek to collect out-of-pocket payments from a Covid-19 patient that are greater than what the patient would have otherwise been required to pay if an in-network provider had provided care, HHS said.

HHS has created a public website that shows all Covid-19 grant and cooperative agreement awards, which features a U.S. map detailing the amounts awarded by states, graphics highlighting the numbers of awards, amounts awarded by agency, and more.

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Critical Behavioral Healthcare Recommendations During Covid-19

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MHLG Letter to HHS and CMS on Medicare Telehealth

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