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
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.
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.
