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CEO Update | 42

CEO Update | 42

NABH Alerts Governors about CMS Opportunity to Address Mental Health and SUD
NABH and Mental Health America (MHA) this week sent a letter to the nation’s 50 governors about a new opportunity from the Centers for Medicare and Medicaid Services (CMS) for states to address mental health and substance use disorder (SUD).

As part of the 21st Century Cures Act, CMS will allow states to implement 1115 (i) Medicaid demonstrations to offer additional inpatient mental health services, bypassing the Institutions for Mental Diseases (IMD) exclusion of coverage for inpatient mental health services for facilities with more than 16 beds in the Medicaid statute.

In particular, CMS has indicated the agency is interested in reviewing demonstration proposals that achieve the following goals: reduced utilization and lengths of stay in emergency departments among Medicaid beneficiaries with SMI or SED while awaiting mental health treatment in specialized settings; reduced preventable readmissions to acute care hospitals and residential settings; improved availability of crisis stabilization services, including services made available through call centers and mobile crisis units, intensive outpatient services, as well as services provided during acute short-term stays in residential crisis stabilization programs, psychiatric hospitals, and residential treatment settings throughout the state; improved access to community-based services to address the chronic mental healthcare needs of beneficiaries with SMI or SED including through increased integration of primary and behavioral healthcare; and improved care coordination, especially continuity of care in the community following episodes of acute care in hospitals and residential treatment facilities.

NABH will submit comments on the proposed regulations.

ONDCP Releases National Drug Control Strategy
The Office of National Drug Control Policy (ONDCP) late this week released its National Drug Control Strategy, a 23-page report meant to guide the federal government’s efforts on saving lives and working toward a drug-free nation.

The report maps out three areas of effort that include reducing the size of the drug-using population by preventing initiates to illicit drug use through education and evidence-based prevention programs; reducing barriers to treatment services so that access to long-term recovery is available for those suffering from SUD; and significantly reducing the availability of these drugs in the United States through law enforcement and cooperation with international partners to lessen the negative effects of drug trafficking that affect the safety of citizens and communities.

“Providing treatment services leading to long-term recovery for those suffering from substance use disorder, often using medication-assisted treatment (MAT) combined with therapy, moves people out of the active user population and on the path to recovery,” the report noted, underscoring an NABH priority.

Regarding metrics to evaluate the strategy, the report emphasized the importance of effects, and not only performance.

“While a performance measure represents the specific characteristic or aspect of the program or policy used to gauge successful performance of a specific task, effectiveness represents the aggregate progress, of multiple agencies contributing to achieving tangible improvement through their programs, initiatives, and policies,” the report noted. “Doing so requires linking actions taken on the front end of the global supply chain to reduce the availability of illicit drugs in the United States with measurable effects on the health and safety of our communities.”

Veterans Affairs Announces Proposed Access Standards to Take Effect in June
The Veterans Affairs (VA) department this week announced its proposed access standards for community care and urgent care provisions under last year’s MISSION Act that will take effect in June 2019.

As part of the law, the VA has proposed a 30-minute average driving standard for primary care, mental healthcare, and non-institutional extended care services. The department also proposed appointment wait-time standards of 20 days for primary care, mental healthcare, and non-institutional extended care services, and 28 days for specialty care from the date of request, with certain exceptions.

“VA’s current patchwork of seven separate community care programs is a bureaucratic maze that’s hard to navigate for veterans, their families, and VA employees,” VA Secretary Robert Wilkie said in a statement. “Our new access standards will form the basis of a federal regulation that will consolidate VA’s community care efforts into a single, simple-to-use program that puts veterans at the center of their VA healthcare decisions.

Bloomberg Law Story Reports Earlier Mental Healthcare Treatment Can Save Employers Money
Earlier treatment for mental health can lead to better outcomes for employers when it comes to lowering healthcare costs, Bloomberg Law reported in a story on Feb. 1.

The article cites an October 2018 report from Catalyst, a not-for-profit organization that represents about 30 employers, that said mental illness costs about $193 billion in lost earnings and productivity each year.

Meanwhile, mental health problems can be hard to identify in medical claims, the story noted.

“Behavioral health doesn’t show up under its own category,” Lee Lewis, a vice president in the Dallas office of risk management first Arthur J. Gallagher & Co., told Bloomberg Law. “Instead, it shows up under other categories, like emergency room claims for problems—think chest pain—that are really anxiety attacks.”

The story was published days after Kaiser Family Foundation President and CEO Drew Altman noted in a column that employers were the primary source of health insurance for 156 million non-elderly Americans in 2017, making employer-provided insurance by far the single largest form of coverage in the United States.

JAMA Study Shows Some Traumatic Brain Injury Patients at Greater Risk for PTSD
After a traumatic brain injury (TBI), some patients—based on their education, race/ethnicity, history of mental health problems, and cause of injury—were at a substantially higher risk for post traumatic stress disorder (PTSD) and/or major depressive disorder (MDD), according to a new study in JAMA.

In a cohort study of 1,155 patients with a TBI and 230 patients with orthopedic injuries not involving the head, patients with TBI were more likely to report PTSD and/or major depressive symptoms three to six months after their injury, the data showed.

Among those patients with TBI, a number of pre-injury (for example, before mental health problems) and injury-related characteristics were associated with an increased risk of mental health problems. Click here for the study.

JAMA Study Examines Neonatal Abstinence Syndrome, Economic Conditions and Services
Babies born after they have been exposed to opioids before birth are more likely to be delivered in regions of the United States with high rates of long-term unemployment and lower levels of mental health services, according to new findings from researchers at Vanderbilt University Medical Center and the RAND Corporation.

Published this week in JAMA, the study examined more than 6.3 million births in a diverse group of eight states and found that rural counties with long-term unemployment had significantly higher rates of babies born with neonatal abstinence syndrome (a term used to describe a group of problems a baby experiences when withdrawing from exposure to narcotics) when compared with urban counties with lower unemployment rates.

Meanwhile, counties with shortages of mental healthcare providers also had higher levels of neonatal abstinence syndrome when compared with other counties.

To learn more, read the study and view an infographic about the findings.

AHRQ Study Shows Opioid Crisis May Have a Greater Effect on Women, Especially in Rural Areas
The nation’s opioid crisis might be having a greater effect on women, especially those who live in rural areas where the healthcare infrastructure is limited, according to a new report from the Agency for Healthcare Research and Quality (AHRQ).

Compared with men, the data showed, women are more likely to be prescribed painkillers; are likely to be prescribed higher doses; and likely to become dependent on them more quickly.

Meanwhile, the percentage of opioid-related stays with a co-occurring pregnancy/childbirth increased with rurality of patient residence location to 10.1 percent in micropolitan, “non-core” areas from 6.8 percent in large, metropolitan areas.

The full report examines opioid use and hospitalization trends for demographic subdivisions among women including age, race, public and private health insurance, and metropolitan-rural geography.

CDC Reports Opioid Prescribing is Higher in Rural Areas
Primary care providers’ opioid-prescribing rates were significantly higher in nonmetropolitan counties than metropolitan counties, according a recent analysis from the Centers for Disease Control and Prevention (CDC).

The CDC reports that drug overdose is the leading cause of unintentional injury-associated death in the United States. Among 70,237 fatal drug overdoses in 2017, the Atlanta-based agency reported, prescription opioids were involved in 17,029, or about 24 percent of those cases. And in that same year, 14 rural counties were among the 15 counties with the highest opioid-prescribing rates.

This recent analysis examined how prescribing practices varied among six urban-rural classification categories of counties, before and after the CDC released Guideline for Prescribing Opioids for Chronic Pain in March 2016.

“Patients in noncore (the most rural) counties had an 87 percent higher chance of receiving an opioid prescription compared with persons in large central metropolitan counties during the study period,” the report said.

Register for The Joint Commission’s Behavioral Healthcare Conference in October
The Joint Commission’s Behavioral Healthcare Conference in late October will feature topics such as measurement-based care and suicide-risk assessment to eating disorder recovery.

The two-day conference will be held Oct. 23-24, 2019 at the Crowne Plaza O’Hare and is open to psychologists, social workers, nurses, counselors, administrators, and professionals who specialize in quality improvement and risk management. Click here to register.

Participate in the 2019 NABH Annual Survey
Consulting firm Dobson DaVanzo & Associates will conduct NABH’s 2019 Annual Survey and will e-mail NABH members a personalized link to the survey during the week of Monday, Feb. 4.

Please be sure to participate in the survey and share it with others in your organization. Your participation is essential in helping NABH report accurately on the U.S. behavioral healthcare field today. The e-mail message will include detailed instructions.

Thank you for your cooperation!

2019 NABH Annual Meeting Hotel Cut-Off Date is Approaching!
The hotel cut-off date for the 2019 NABH Annual Meeting is Monday, February 11, 2019.

Please be sure to reserve your hotel room today at the Mandarin Oriental Washington, DC. And please be sure to register for the Annual Meeting if you have not done so yet.

For complete Annual Meeting details—including the preliminary program and speaker information— please visit NABH’s Annual Meeting homepage. We look forward to seeing you in Washington!

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