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CEO Update | 27

CEO Update | 27

Senate Passes Bipartisan Opioid Legislation
The Senate on Thursday passed the SUPPORT for Patients and Communities Act, the opioid-response legislative package that the House passed last week.

Ninety-eight senators voted for the legislation, while Sen. Mike Lee (R-Utah) voted against it and Sen. Ted Cruz (R-Texas) did not vote.

As reported in CEO Update last week, the final legislation provides an optional benefit for states to pay IMDs for substance use disorder (SUD) treatment for patients between the ages of 21-64 for 30 days each year. In addition, patients with mental illness could be treated under this provision as long as they have at least one SUD, although the bill does not specify if SUD must be a primary or secondary condition. The provision is scheduled to take effect in October 2019 and end in September 2023. Congressional action is required to extend the measure beyond that four-year period.

The SUPPORT Act includes a maintenance-of-effort provision that would require states to maintain their current funding levels for both inpatient and outpatient services. In addition, a state would need to show the federal government that it has the full continuum of services, including early intervention, outpatient, intensive outpatient, partial hospitalization, and inpatient/residential transitions of care. All of these requirements are consistent with the recommendations NABH made in Pathways to Care: Treating Opioid and Substance Use Disorder.

In addition, eligible IMDs would be required to follow “reliable, evidence-based practices” and offer at least two forms of medication assisted treatment, including one antagonist and one partial agonist.

Other NABH priorities are part of the agreement, including a provision that would consider opioid treatment programs as eligible providers under Medicare, as well as a measure that would allow the Centers for Medicare and Medicaid Services (CMS) to test behavioral healthcare information technology (BHIT). Hospitals, community mental health centers, and SUD providers would all be eligible to participate in the BHIT test.

The legislation will move to the White House for the president’s signature.

SAMHSA’s McCance-Katz Highlights Problem with Fentanyl Test Strips
The nation should resist the urge to adopt quick solutions for the opioid crisis and instead focus on strong prevention strategies, Assistant Secretary for Mental Health and Substance Use Elinore McCance-Katz, M.D., Ph.D. wrote in a blog post this week.

In For Beating the Opioid Crisis, America has Better Weapons than Fentanyl Test Strips, McCance-Katz described how some states and communities use fentanyl test strips and questioned if “encouraging people who use drugs to test them first for ‘safety’ is the answer.”

According to the Centers for Disease Control and Prevention, deaths due to synthetic opioids (other than methadone) and primarily driven by illicit fentanyl doubled between 2015 and 2016. Meanwhile, provisional data from 2017 indicate that 29,000 of the 49,000 opioid-related deaths involved fentanyl.

“As a physician who has spent most of my career treating opioid use disorder, I find a fundamental problem in the justification for using such strips,” McCance-Katz wrote. “The purpose of the test strip is for an individual who is about to use a drug to first test the drug to detect fentanyl’s presence. If fentanyl is detected, the idea is, either the individual will not use or will change the way he or she uses (e.g., will use the more potent drug at a slower rate to try to avoid overdose),” she added. “On the surface, given the trends in deaths, this seems like a valid step to take.”

The problem with this approach, McCance-Katz continued, is that it’s based on the premise that a drug user poised to use a drug is making rational choices, weighing pros and cons, and thinking logically about his or her drug use. “Based on my clinical experience,” she noted, “I know this could not be further from the truth.”

McCance-Katz concluded by saying the Substance Abuse and Mental Health Services Administration has released more than $2 billion to address the crisis and that additional resources are coming. She specified that those funds should be used to enhance prevention strategies, ensure that people gain access to medication-assisted treatment and psychosocial therapies, and provide needed community recovery supports.

Kennedy Forum Launches “Don’t Deny Me” Campaign on MHPAEA’s 10th Anniversary
Behavioral health advocacy organization the Kennedy Forum this week kicked off Don’t Deny Me, a national campaign designed to spur a consumer-driven movement that pressures elected officials, insurance commissioners, and attorneys general to enforce parity laws.

NABH is pleased to support Don’t Deny Me, which launched on Oct. 3, the 10-year anniversary of the Mental Health Parity and Addiction Equity Act. Please visit the website for a fact sheet, infographic, and shareable social media graphics.

CMS Administrator Verma Says Better Data Will Modernize Medicaid
As Medicaid program costs continue to grow, the federal government has failed to deliver a level of transparency and accountability for achieving positive outcomes that is commensurate with its investment, the head of the Centers for Medicare and Medicaid Services (CMS) announced in a blog post this week.

But that practice is beginning to change, wrote CMS Administrator Seema Verma, who noted that her agency has collaborated with states to improve how CMS collects and uses data to modernize the Medicaid and Children’s Health Insurance Program (CHIP).

“As one example, CMS has worked with stakeholders to identify two core sets of healthcare quality measures that can be used to assess the quality of healthcare provided to children and adults enrolled in Medicaid and CHIP,” Verma wrote. “These core sets are tools states can use to monitor and improve the quality of healthcare provided to Medicaid and CHIP enrollees.”

Verma added that states have worked with CMS in recent years to modernize how administrative data are collected by moving to the Transformed-MSIS from the Medicaid Statistical Information Systems (MSIS).

“T-MSIS modernizes and enhances the way states submit operational data about beneficiaries, providers, claims, and encounters,” Verma said. “It is the foundation of a national analytic data infrastructure to support programmatic and policy improvements and program integrity efforts and will help advance reporting on outcomes.”

RAND Corp. Study Analyzes Vaping and Cigarette Patterns Among Youth
Adolescents who use vaping products are more likely to smoke cigarettes and increase their use of both products over time, according to a new RAND Corp. study.

More than 2,000 youth in California completed three surveys during a three-year period for this study, which allowed researchers to model e-cigarette use from ages 16 to 20. The findings showed that the increased use of both e-cigarettes and cigarettes over time cannot be attributed to other risk factors, such as consuming alcohol or marijuana.

“Our work provides more evidence that young people who use e-cigarettes progress to smoking cigarettes in the future,” Michael Dunbar, a Rand behavioral scientist and the study’s lead author, said in an announcement. “This study also suggest that teens don’t substitute vaping products for cigarettes,” he added. “Instead, they go on to use both products more frequently as they get older.”

NIMH Calls for Abstracts for Global Mental Health Research Conference
The National Institute for Mental Health is seeking abstracts for the 10th anniversary of the Global Mental Health Research without Borders conference.

For the first time, researchers are invited to submit abstracts to present original and innovative global mental health research. The NIMH Center for Global Mental Health Research will co-host the event with Grand Challenges Canada from April 8-9, 2019 at the Natcher Center on the National Institutes of Health campus in Bethesda, Md.

The conference will focus on the following six research tracks: root causes of mental illness and key targets and times for intervention; preventing mental illness and delivering early interventions; improved treatment quality, value, and effectiveness; integrating mental health services into existing healthcare platforms (e.g., HIV/AIDS, primary care); implementing sustainable, evidence-based mental healthcare; and sustainable research capacity where it is underdeveloped.

Abstracts are due by Saturday, Dec. 1, 2018.

Registration Now Open for the NABH 2019 Annual Meeting!
Registration for the 2019 NABH Annual Meeting — Behavioral Healthcare: Improving Coordination, Collaboration, Integration — is now available on the Annual Meeting homepage. We look forward to seeing you at the Mandarin Oriental Washington, D.C. from March 18-20, 2019!

For questions or comments about CEO Update, please contact Jessica Zigmond.