You're not alone. Confidential help is available for free. 1-800-662-HELP (4357)

CEO Update | 32

CEO Update | 32

What the 2018 Midterm Elections Could Mean for Behavioral Healthcare
An incoming Democratic majority in the U.S. House of Representatives and an expanded Medicaid program will have implications for the nation’s healthcare system in general and behavioral healthcare in particular, although what those changes are remains to be seen.

Although some races are still too close to call, Democrats regained majority control of the House for the first time since 2010 and Republicans slightly expanded their majority in the Senate after Tuesday’s highly anticipated midterm elections. Healthcare—particularly the issue of protections for pre-existing conditions—played an important role in this year’s elections, and the implications for behavioral healthcare are beginning to take shape.

Voters in Idaho, Nebraska, and Utah passed ballot initiatives requiring their states to expand Medicaid, while voters in Maine and Kansas elected new governors who support Medicaid expansion—and whose respective state legislatures are expected to follow suit. Consequently, about 500,000 Americans are expected to obtain coverage, according to estimates. Medicaid expansions have produced the broadest expansion of behavioral healthcare services in decades.

Meanwhile, the split control of Congress will likely prevent some of the more controversial and potentially negative legislative proposals that could affect the behavioral healthcare industry. These include efforts to repeal and replace the Patient Protection and Affordable care Act (ACA); turn Medicaid into a block grant program; and move the Medicare program toward a premium support model.

NABH Champions fared very well in this election cycle, with only a handful of NABH Champions retiring or losing their bids for re-election. NABH staff is awaiting the results of several races and will update our Champion targets as additional races are settled.

NABH Champion Rep. Frank Pallone (D-N.J.) is expected to serve as chairman of the influential House Energy and Commerce (E&C) Committee. Rep. Pallone has indicated that the priority issues for the next Congress should include protecting the ACA and addressing high prescription drug costs. He has also indicated interest in NABH-supported efforts to address the opioid epidemic and enact privacy protections and reforms. NABH Champion Rep. Anna Eshoo (D-Calif.) is expected to serve as chairman of the E&C Health Subcommittee. The California congresswoman has actively supported expanding telehealth services, an initiative NABH supports.

NABH Champion Richard Neal (D-Mass.) is expected to lead the House Ways and Means (W&M) Committee as its chairman. Rep. Neal has indicated there is more to be done to address the nation’s opioid crisis, namely improving funding for many of the programs authorized in this year’s legislation.  This is a priority for the new chairman and a possible area for bipartisan compromise in the new Congress.

Rep. Lloyd Doggett (D-Texas) is rumored to be interested in leading the W&M Health Subcommittee. In the past, Rep. Doggett has supported legislation to allow the Medicare program to negotiate drug prices.

In the Senate, there will be few changes to key committees as Republicans maintain the majority. Sen. Orrin Hatch’s (R-Utah) retirement means the Senate Finance Committee will have a new chairman, reports indicate that NABH Champion Sen. Chuck Grassley (R-Iowa) is considering the post. Grassley’s healthcare interests in the past have included a focus on high drug prices and transparency in payments from pharmaceutical and device companies to physicians. If Grassley does not assume the role, another NABH Champion —Sen. Michael Crapo (R-Idaho) — is reportedly another possibility. Finally, NABH Champion Sen. Lamar Alexander (R-TN) will remain as chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee.
CMS Proposed Rule Could Help Telehealth Providers
The Centers for Medicare and Medicaid (CMS) late this week proposed a rule that could help telehealth providers get approved for Medicaid and Children’s Health Insurance Program (CHIP) managed care.

In the rule, CMS noted that states have alerted the agency to concerns about the appropriateness of applying time and distance standards uniformly.

“In some situations, time and distance may not be the most effective type of standard for determining network adequacy and some states have found that time and distance analysis produces results that do not accurately reflect provider availability,” the rule said. “For example, a state that has a heavy reliance on telehealth in certain areas of the state may find that a provider to enrollee ratio is more useful in measuring meaningful access, as the enrollee could be well beyond a normal time and distance standard but can still easily access many different providers on a virtual basis,” it continued. “A 2017 Brookings/Schaefer Center report notes that in some clinical areas, telemedicine could make proximity measures obsolete, or counterproductive.”

Consequently, the agency said it proposes deleting requirements for states to set time and distance standards and “adding a more flexible requirement.”

The agency will accept public comments on the rule for the next 60 days.
The American Psychiatric Association Will Host Parity Briefing on Nov. 13
The American Psychiatric Association (APA) will host a briefing next week about enforcing mental health parity as an essential tool in fighting opioid addiction and preventing suicide.

Moderated by APA President-elect Bruce J. Schwartz, M.D., the briefing next Tuesday from noon to 1:30 p.m. ET will feature Mike Hogan from Case Western Reserve University, who will discuss parity and suicide; and Kevin Roy, the chief policy officer at Shatterproof, and Tim Clement, M.P.H., APA’s regional field director, who will discuss parity and opioids.

For those who will be in D.C. and can attend, the event will take place in the Senate Visitor Center room 210 of the U.S. Capitol. Please RSVP to
2019 NABH Membership Directory Ad Deadline Extended to Friday, Nov. 16th!
NABH has extended the deadline to submit an ad for the 2019 NABH Membership Directoryto next Friday, Nov. 16.

Each year NABH updates and publishes the NABH Membership Directory to help both consumers and providers find and access behavioral health services nationwide. Published in late fall 2018, the directory lists NABH member organizations geographically, alphabetically and by system/facility.The directory is widely distributed to state hospital associations, National Alliance on Mental Illness state affiliates, and NABH members. Now is the opportunity to highlight your organization’s specialized services through an ad in the 2019 edition. Download an advertising rate card or email

Register Today for the 2019 NABH Annual Meeting
Please visit NABH’s Annual Meeting homepage today to register and reserve your hotel room for the 2019 NABH Annual Meeting — Behavioral Healthcare: Improving Coordination, Collaboration, Integration. 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.