============================= BEHAVIORAL HEALTH UPDATE A Monthly Report for Members of the American Hospital Association and the National Association for Behavioral Healthcare www.aha.org www.nabh.org January 2019    Updates:

1. CMS Reports Healthcare Spending Growth Slowed Last Year
2. HRSA Releases Behavioral Health Workforce Projections
3. CMS Features FAQ on Price Transparency Provision in IPPS
4. CMS Requests Feedback on Conflict of Interest at Accrediting Organizations
5. Behavioral Health IT Coalition Sends Letter to CMS
6. RAND Report Analyzes Heroin-Assisted Treatment and Supervised Drug Consumption Sites
7. AMA Study Examines Association Between Psychotic Experiences and Risk of Suicide
8. MACPAC Releases 2018 Edition of MACStats: Medicaid and CHIP Data Book
9. PwC Health Research Institute Previews Top Health Industry Issues for 2019
10. CDC’s NVSR Reports on Drugs Most Frequently Used in Overdoses: 2011-2016
11. PCORI Board Approves $12.7 million for Mental Health Research Study
12. U.S. Preventive Services Task Force Seeks Comments on Opioid Interventions
13. CMMI Posts Fact Sheet on Integrated Care for Kids and Maternal Opioid Misuse Models
14. Manatt, AMA & Pennsylvania Medical Society Release Report on Practices to End Opioid Crisis
15. CHCS and ACAP Release Report on Social Determinants of Health via Medicaid Managed Care
16. Associations Among Motor Activity, Sleep, Energy & Mood Could Suggest New Focus for Depression Treatment
17. NIDA Highlights Details for National Drug and Alcohol Facts Week
18. World Congress to Host Opioid Management Summit in February
19. Register Today for 2019 Annual Meetings

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