CEO Update 219
House Passes Multitrillion-Dollar Budget Bill
The House on Tuesday narrowly passed its multitrillion-dollar budget resolution in a near party-line vote of 217-215, a key step toward advancing President Trump’s sweeping domestic policy agenda.
The Senate passed a competing plan last week, and the Republicans in the two chambers must now reconcile the significant differences between the two fiscal blueprints. Congressional leaders also must deal with a more immediate issue: the March 14 government shutdown deadline before moving to the next steps of reconciliation.
For its part, the Senate is looking to avert deep cuts to Medicaid, while the House is relying on those cuts for significant cost-shifting. Senate Republicans have insisted they will not support a final measure that extends Trump’s 2017 tax cuts only temporarily, which would require making significant changes to the House blueprint.
The House budget tasks the Energy & Commerce Committee, which has jurisdiction over Medicaid, to find $880 billion in funding cuts during the next decade. Advocates including NABH, hospitals, and patient groups have expressed concern to Congress that this will lead to deep cuts to the Medicaid program. A faction of the GOP conference – moderate Republicans, many of whom represent swing districts – also have qualms about the scale of the Medicaid cut the budget plan suggests. House leaders have indicated Medicaid savings would come from cutting “waste, fraud, and abuse;” however, many lawmakers remain skeptical that such large savings can be reached without affecting their constituents.
The most difficult part of the reconciliation process now begins. House and Senate leaders want to send a reconciliation package to President Trump by early May, although many expect the timeline to extend until Fall. It remains uncertain whether the House and Senate will hold a formal conference committee, or if the two chambers will engage in informal negotiations with Trump administration officials to reach a compromise.
NABH is contacting congressional offices to emphasize that behavioral health conditions such as major depressive disorder, schizophrenia, and opioid use disorder are highly prevalent among Medicaid beneficiaries. Decreasing provider payments, restricting benefits, and limiting eligibility – including new work requirements – could affect millions of Americans living with severe mental illness, putting vital mental health services and care at risk and leading to devastating consequences for individuals and families already struggling to access the support they need.
FDA Discontinues the Clozapine REMS Program
The Food and Drug Administration (FDA) on Monday announced it will discontinue the risk evaluation and mitigation strategies (REMS) program for clozapine, an antipsychotic medication indicated for treatment-resistant schizophrenia and recurrent suicidal behavior among people with schizophrenia or schizoaffective disorder.
This REMS program was intended to reduce the risk of severe neutropenia, which clozapine can induce by lowering the number of neutrophils— a type of white blood cell involved in the immune response to infections. The REMS program required clinicians to conduct blood tests before initiating patients on clozapine and then every week, other week, or month, depending on how long the patient had been treated with clozapine and their neutrophil count. Clinicians then reported neutrophil counts to a centralized database that pharmacists checked before dispensing.
Given the significant undertreatment of schizophrenia, effectiveness of clozapine, and feedback FDA received on the burdens of the REMS program, the agency determined that “although the risk of severe neutropenia with clozapine still exists… the REMS program for clozapine is no longer necessary to ensure the benefits of the medicine outweigh that risk.”
White House Executive Order on Pricing Transparency
President Trump signed an executive order on Tuesday intended to make healthcare pricing more transparent by directing federal agencies to enforce an order he signed during his first term as president.
The order instructs the Health and Human Services, Labor, and Treasury Departments to develop a framework within 90 days to enforce Trump’s June 2019 executive order forcing health insurers and hospitals to disclose healthcare cost details.
ICYMI: NABH Releases Quality Resources on Patient and Staff Health & Safety
NABH recently developed two quality-related resources to help members learn from their peers and inform policymakers, regulators, and the media about the innovative ways our members are working to protect their patients and staff.
Inpatient Psychiatric Hospitals and Units Implement Effective Violence-Prevention Measures highlights in bullet-list form how inpatient psychiatric hospital providers apply significant prevention protocols beyond existing workplace safety measures that state and federal laws require. Often inpatient psychiatric hospitals employ additional methods that protect staff who treat a range of patients treated in their hospitals, especially those who are admitted because of their violent behaviors.
Meanwhile, in The Right Place at the Right Time: Behavioral Healthcare Solutions to ED Boarding, NABH shares the methods and best practices that association members Avera Behavioral Health Services in South Dakota, Mass General Brigham (an integrated health system that includes NABH member McLean Hospital) in Massachusetts, Rutgers University Behavioral Health Care in New Jersey, and Sharp Mesa Vista in California have developed and implemented successful solutions to the persistent problem of “boarding,” the practice of holding patients with behavioral health conditions in a hospital’s Emergency Department (ED) after admission because no inpatient beds are available.
NABH has posted these factsheets in the Resources section of our homepage and will promote both on LinkedIn at the National Association for Behavioral Healthcare and @NABHBehavioral. Please share these tools with your teams and others who would find the information useful!
The association thanks members of the NABH Quality Committee for their ideas and their help developing these resources.
ICYMI: Please Read and Share NABH’s 2025 Advocacy Priorities!
NABH recently released its 2025 Advocacy Priorities, which we urge you to read and share with your Government Relations teams and others.
Leading NABH’s 2025 Advocacy Priorities are parity, workforce, behavioral healthcare information technology, America’s ongoing addiction crisis, and the Institutions for Mental Diseases (IMD) exclusion.
NABH will continue to promote the 2025 Advocacy Priorities @NABHBehavioral and at the National Association for Behavioral Healthcare on LinkedIn. Please follow us on these platforms and help us promote your priorities!
2025 NABH Annual Meeting Registration Opening Soon!
Please plan to join your peers and the NABH team at the Salamander Washington, DC from May 12-14 for this year’s NABH Annual Meeting: Behavioral Health is Everyone’s Concern: Constant Care, Changing Times.
Our thanks to this year’s Annual Meeting Program Committee, which approved this year’s theme. NABH Board Member Patricia Toole, M.A.S. from Hackensack Meridian Health Carrier Clinic chairs the Program Committee, which also includes NABH members Mary-Catherine Bohan, M.S.W. from Rutgers University Behavioral Health Care and Rhonda Ashley-Dixon, M.A. from Vanderbilt Psychiatric Hospital and Clinics.
Annual Meeting registration and a link to hotel reservations at the Salamander will open soon. We look forward to seeing you in Washington!
Fact of the Week
In a recent study of young adults, lifetime history of heavy cannabis use was associated with lower brain activation during a working memory task, according to a recent article in JAMA Network Open.
For questions or comments about this CEO Update, please contact Jessica Zigmond.