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CEO Update 156

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.

Register here.

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 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.

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.