Category: Member Content

Please Visit Our New Website!

NABH is pleased to announce our new website is now live!  
 
NABH has designed our updated site to help members, policymakers, journalists, patient advocates, and the general public learn about our association and the resources we provide in a way that is easier to navigate so you find what you’re looking for quickly and efficiently.

We have also updated our member password, which is required for member-only resources, such as our letters to congressional offices and regulatory agencies, as well as previous editions of CEO Update (all of which can be found by clicking on the “News” tab). NABH members should refer to the NABH Alert they received on Thursday, Oct. 31 for the new member password.

Please e-mail nabh@nabh.org with any questions or feedback you may have about the new site.

As always, thank you for all you do each day to support and advance NABH’s mission and vision!

Deadline for Inpatient Psychiatric Hospital All-Inclusive Reporting Survey is Due Today, Nov. 1

As follow-up to its FY 2025 IPF PPS final rule, the Centers for Medicare & Medicaid Services (CMS) on Oct. 17 issued online guidance explaining the temporary flexibilities for hospitals transitioning from all-inclusive cost reporting to traditional reporting that includes ancillary costs and charges, such as those for lab and drug items. This shift requires IPF hospitals to change their charge structure to include ancillary costs and charges, for cost reports beginning on or after Oct. 1, 2024.  
 
The new guidance provides a new and temporary option for IPFs that will require extra time to implement the new billing structure needed to capture and report ancillary costs and charges. Specifically, the CMS guidance applies to providers that are unable to complete the transition to ancillary reporting for the full 12 months of cost reporting periods beginning between Oct. 1, 2024 – May 31, 2025. Such hospitals may ask their Medicare Administrative Contractor (MAC) to use an alternate cost reporting methodology on a temporary basis.
 
If the MAC approves the request, a provider may report estimated ancillary charges using a six-step process to extrapolate ancillary costs and charges from at least a portion of the cost reporting cycle to the full cycle.
 
For NABH members who operate inpatient psychiatric hospitals: please review this multi-step process carefully in the online guidance and email any concerns or feedback with this process to NABH at nabh@nabh.org.
 
NABH continues to communicate with CMS representatives about this complex transition. To help with our advocacy efforts, please complete this survey on your estimated timing of compliance with ancillary reporting by Friday, Nov. 1. 
 
The survey findings will be used only in the aggregate during our advocacy to extend CMS’ announced flexibilities to also address hospitals that will be delayed beyond June 1, 2025, due to fixed variables such as affordability, supply chain and vendor delays, a shortage of available personnel with training on relevant information technology protocols, and other factors.

Your survey response will help NABH tell this story and advocate for additional flexibility following May 2025. As always, thank you for your time and cooperation!

Register Today for NABH’s Webinar on Using Publicly Available Data in Health Plan Negotiations

Please join NABH for a webinar on Thursday, Nov. 14, 2024 to learn about using hospital data effectively in your negotiations with health plans.

The webinar will feature Erica K. Fox, M.B.A., vice president of business development and managed care contracting at Perimeter Healthcare. A member of NABH’s Managed Care Committee, Fox will review the use of publicly available data from hospitals, such as payer-specific negotiated rates and standard charges for all payers and plans, to negotiate contracts with health plans. 
 
Fox has more than 25 years of senior leadership experience in the behavioral health sector. Prior to her current role, she served as the business development director at Peachford Hospital, a Universal Health Services facility. Fox earned her undergraduate degree from Michigan State University, where she received a dual degree in Communications and Spanish. She later earned a master’s degree in healthcare administration from Loyola University Chicago.   

Register here for this hourlong webinar that will begin at 1 p.m. on Nov. 14. 

Manatt to Host Webinar About State Medicaid Innovations to Addressing America’s Behavioral Health Crisis

Research firm Manatt will host a webinar with state leaders to address topics such as 1115 demonstrations, strategies to combine Medicaid with other sources of funding, and what policies states are implementing to address the nation’s behavioral health crisis.
 
The hourlong webinar will start at 3 p.m. ET on Thursday, Nov. 21. Click here to register. 

Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.   
 
We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.
 
Policymakers have expressed particular interest in our aggregate estimate on days of uncompensated charity care, as well as the length of delayed health plan responses to prior-authorization requests.
 
To support this advocacy push, we strongly encourage all NABH members to submit data to the portal. Please contact NABH Associate Manager for Congressional Affair Emily Wilkins with questions about the data metrics that we are collecting and/or the data-submission process.

Fact of the Week

A Centers for Disease Control and Prevention analysis of a nationally representative sample of U.S. adults found that in 2023, an estimated 15.5 million, or about 6.0%, had a current attention-deficit/hyperactivity disorder (ADHD) diagnosis. The study found that about one half of adults with current ADHD have ever used telehealth for ADHD services. “As policies are currently developed and evaluated related to ADHD clinical care for adults, access to prescription stimulant medications, and flexibilities related to telehealth, these results can guide clinical care and regulatory decision-making,” the study noted.
 
For questions or comments about this CEO Update, please contact Jessica Zigmond.

2025 NABH Board Nominations Are Due Monday, Oct. 21!

NABH’s Selection Committee needs your help as it considers possible nominees to serve on the NABH Board of Trustees in 2025.
 
Please help us identify potential candidates for: 

• Board Chair-Elect
• Two Board Seats

The Selection Committee is particularly interested in identifying senior managers who represent the broad diversity within the NABH membership, including various levels of care, organizational structures, and size.    
 
Please download a nomination form to share your recommendations of individuals you would like to see included in the single slate for 2025. Please attach a curriculum vitae (CV) for each person you recommend. This will help the Selection Committee in its deliberations. You are welcome to suggest yourself. 

Please return this form and candidates’ CVs by Monday, Oct. 21, 2024 to maria@nabh.org.

Thank you for your time.

NABH Thanks Sheppard Pratt for Hosting a Successful Unit Committee Leadership Forum!

NABH member Sheppard Pratt graciously welcomed the NABH Behavioral Health Services within General Healthcare Systems Committee (Unit Committee) to Baltimore last week for the Unit Committee’s annual leadership forum.

The Committee enjoyed two days of hospital tours, presentations, and networking. Attendees toured two Sheppard Pratt facilities—the state-of-the-art Baltimore/Washington campus and the historic Towson campus. While networking with peers was a highlight, seeing the Aurora Borealis over Baltimore’s Inner Harbor during the group’s dinner cruise was a stand-out memory!

The tour of the Baltimore/Washington campus, featuring extra space for future growth, highlighted the staff and CannonDesign’s patient-friendly design, with its focus on natural materials, abundant light, and integration with the wetlands surrounding the hospital.

After a delicious and nutritious lunch catered by the same chef that cooks for patients, attendees learned from the CannonDesign team about the wide array of customized unit spaces the firm has created nationwide, as well as about the facility-design trends of the future, including an aging population, earlier clinical intervention, home-based care, integration with primary care, and the growth of outpatient care.

Sheppard Pratt Solutions Vice President and COO Stephen Merz led a discussion about Crisis Care and psychiatric urgent care, a unique, patient-centered intake model, and his work with local governments for funding and implementation.

Finally, leaders shared keys to effective dyadic relationships based on trust and respect, along with the blending of professional skills and styles.

The group concluded the second day on the Towson campus. Geisinger Health and Main Line Health leaders discussed best practices for managing recovery centers in acute care systems. Michael Abbatiello, operations executive at Sheppard Pratt, led a discussion about major pain points for members of the committee. The meeting closed with the designers of the Yale Patient Experience tool, referred to by CMS as the “PIX,” which will be used in CY 2025 for voluntary reporting, with mandatory reporting to follow. Attendees also had the opportunity to visit Sheppard Pratt’s museum, Institute for Advanced Diagnostics, and Psychiatric Urgent Care department.

NABH thanks the entire Sheppard Pratt team for its planning and gracious hospitality and all who attended this year’s Leadership Forum!

NABH Thanks Director of Quality and Addiction Services Sarah Wattenberg!

NABH and its Washington-based team thanks Sarah Wattenberg, the association’s director of quality and addiction services since 2018, for her excellent work and dedication to improving policies, regulations, and protocols that help open access to quality care for people with substance use disorders.
 
Sarah is retiring from the behavioral healthcare field and her last day at NABH is today, Friday, Oct. 18. Sarah’s industrious career includes positions at HHS at both the Substance Abuse and Mental Health Services Administration and the Assistant Secretary for Health, where she worked on critical issues of the day, including privacy, electronic health records, performance measures, the Affordable Care Act, opioids, marijuana, college drinking, financing, and workforce.  
 
In a farewell letter to colleagues, Sarah noted that this quote from former HHS Secretary Hubert Humphrey – inscribed in a plaque on a wall at HHS – refreshed her commitment to public service every day: “The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy, and the handicapped.”  
 
We all thank Sarah and wish her many years of continued success and happiness in her retirement!

CMS Provides Temporary Flexibilities to All-Inclusive Cost Reporters

Following ongoing communication with NABH, the Centers for Medicare & Medicaid Services (CMS) posted online official guidance for inpatient psychiatric facilities (IPF) that, based on the agency’s fiscal year 2025 final rule, must phase out “all-inclusive” reporting for cost reports beginning on or after Oct. 1, 2024. This shift requires IPF hospitals to change their charge structure to include ancillary costs and charges, such as those for lab and drug items.
 
Under a new and temporary option for this subset of IPFs, CMS will provide flexibility for those IPFs that will require extra time to implement reporting of ancillary costs and charges. Specifically, the CMS guidance applies to providers that are unable to complete the transition to ancillary reporting for the full 12 months of cost reporting periods beginning between Oct. 1, 2024 – May 31, 2025. Such hospitals may ask their Medicare Administrative Contractor (MAC) to use an alternate cost reporting methodology on a temporary basis. 
 
If the MAC approves the request, a provider may report estimated ancillary charges using a six-step process to extrapolate ancillary costs and charges from at least a portion of the cost reporting cycle to the full cycle. 
 
Please carefully review this multi-step process in the online guidance, which NABH helped develop, and share with NABH any concerns or feedback with this process to nabh@nabh.org.

NABH continues to communicate with CMS representatives about this complex transition. As part of this advocacy, please complete the related survey that NABH will send to members on Monday, Oct. 21. The survey will ask all of NABH’s all-inclusive members to estimate the timing of their sites’ compliance with ancillary reporting.

This communication will focus on member sites that will not be able to implement the necessary changes to their charges structure by May 31, 2025, the date targeted in CMS’ guidance. NABH will emphasize the fixed variables that will prevent some sites from achieving full reporting capability by this date, including affordability, supply chain and vendor delays, a shortage of available personnel with training on relevant information technology protocols, and other factors.
As always, thank you for your cooperation!

Reps. Tonko and Turner Seek Feedback on Effects of ‘Mainstreaming Addiction Treatment Act’

Hospitals, insurance plans, pharmacies, pharmacists, and providers were the recipients of inquiries from Reps. Paul D. Tonko (D-N.Y.) and Mike Turner (R-Ohio) to help the lawmakers better understand the impact of the Mainstreaming Addiction Treatment Act, (MAT) a 2023 law that removed the DATA Waiver 2000 as a way to increase the number of medical professionals prescribing buprenorphine for individuals with opioid use disorder. 
 
The goal is to expand providers from 130,000 to 1.8 million.  

“For the millions of Americans battling substance use disorder, having access to proven, affordable treatment can mean the difference between life and death,” Tonko said in a statement. 

“Passing the MAT Act into law last Congress was a crucial step forward in our country’s battle against opioid addiction and substance use disorder,” Turner added.

Tonko also introduced the BUPE for Recovery Act, legislation that would require the Drug Enforcement Administration administrator to temporarily exempt buprenorphine from the Suspicious Orders Report System, or SORS, for the remainder of the opioid public health emergency.

The congressmen sent 38 letters to healthcare providers nationwide, including to UnitedHealth Group, The Cigna Group, Kaiser Permanente, Elevance Health, Centene Corporation, Blue Cross and Blue Shield, CVS Health/Aetna, Molina Healthcare, Health Care Services Corporation, Highmark Health, Humana, and others. See the full list here.

Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.   
 
We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.
 
Policymakers have expressed particular interest in our aggregate estimate on days of uncompensated charity care, as well as the length of delayed health plan responses to prior-authorization requests.
 
To support this advocacy push, we strongly encourage all NABH members to submit data to the portal. Please contact NABH Associate Manager for Congressional Affair Emily Wilkins with questions about the data metrics that we are collecting and/or the data-submission process.

Fact of the Week

A large, multicenter cohort study found that prescription of GLP1R in adolescents with obesity was associated with decreased risk for suicidal ideation, according to an article in JAMA Pediatrics.
 
NABH will host its Fall 2024 Board of Trustees Meeting in Nashville next Friday, Oct. 25 and will not publish CEO Update. CEO will resume on Friday, Nov. 1.
 
For questions or comments about this CEO Update, please contact Jessica Zigmond.

Reminder: NABH’s Second AI Survey Deadline is Due Monday!

NABH continues to explore how our members use Artificial Intelligence (AI), and our AI survey earlier this year identified Care Quality, Business Operations, and Workforce Solutions as our members’ priority areas.

As follow-up to our first survey, we ask you to complete this brief follow-up survey  to help us delve deeper into members’ AI practices, which will help refine our advocacy efforts on this important issue.

Please complete the survey by this coming Monday, Oct. 7.

HHS and Industry Leaders to Form Joint Task Force on AI & Cybersecurity

HHS, industry leaders, and the Health Sector Coordinating Council Cybersecurity Working Group will soon launch a joint task force to examine the cybersecurity implications of AI, the news publication Inside Health Policy (IHP) reported recently.

According to the story, Micky Tripathi, Ph.D., who leads HHS’ health information technology office, confirmed to IHP that staff from HHS’ Deputy Secretary’s Office and Administration for Strategic Preparedness and Response are engaged in the task force on AI and cybersecurity.
Greg Garcia, executive director of the Health Sector Coordinating Council Cybersecurity Working Group, told IHP that it’s uncertain whether the task force will produce a white paper, list of best practices, or some other resource. The task force is expected to discuss the implications of AI with different healthcare sectors in the next six to 12 months, the story reported.

In related news, Politico reported today, Friday, Oct. 4 that HHS Deputy Secretary Andrea Palm said she expects to release a new AI strategy in January to comply with President Joe Biden’s executive order on AI practices. Palm also discussed how she intends to manage the more than 150 ways AI is used at the agency and what worries her most about the technology.

OIG Report Says Medicare & Medicaid Enrollees in High-Need Areas May Lack Access to Medications for OUD

HHS’ Office of Inspector General (OIG) recently published a report that found while the Centers for Medicaid & Medicaid Services (CMS) has taken several steps in recent years to increase medications for opioid use disorder (MOUD) access, many Medicare and Medicaid enrollees do not receive MOUD.

According to the report, hundreds of counties lack office-based buprenorphine providers and opioid treatment programs; in counties that have appropriate providers, they often do not treat Medicare or Medicaid enrollees.

Meanwhile, the OIG found that the lack of providers might be due to Medicare Advantage prior-authorization requirements, low Medicaid reimbursement rates, and inadequate public information about MOUD provider locations.

The OIG recommends that CMS geographically target efforts to increase providers treating Medicare and Medicaid enrollees in high-need counties; work with states to assess whether Medicaid reimbursement rates are sufficient to recruit and retain enough providers; and work with the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop and maintain a list of active office-based buprenorphine providers.

National Academy of Medicine to Focus on Mental Health and SUD in Upcoming Annual Meeting

The National Academy of Medicine (NAM) will host a symposium titled “Bridging Science, Practice, and Policy to Advance Mental Health” on Monday, Oct. 21.

That session will feature panel discussions on the social drivers that affect mental health and substance use, emerging science and innovative therapies, and equitable access to mental healthcare.

The two-day event – which will be held both virtually and in person at the National Academy of Sciences Building in Washington, D.C. – will include Interest Group sessions on the meeting’s first day, Sunday, Oct. 20. Those sessions will bring together NAM members from a variety of disciplines to engage and convene on the most current topics affecting science, medicine, technology, and health.

Click here to learn about registration and additional meeting details.

Register for Our November Webinar on Using Publicly Available Data in Health Plan Negotiations

Please join NABH for a webinar on Thursday, Nov. 14, 2024 to learn about using hospital data effectively in your negotiations with health plans.

The webinar will feature Erica K. Fox, M.B.A., vice president of business development and managed care contracting at Perimeter Healthcare. A member of NABH’s Managed Care Committee, Fox will review the use of publicly available data from hospitals, such as payer-specific negotiated rates and standard charges for all payers and plans, to negotiate contracts with health plans.

Fox has more than 25 years of senior leadership experience in the behavioral health sector. Prior to her current role, she served as the business development director at Peachford Hospital, a Universal Health Services facility. Fox earned her undergraduate degree from Michigan State University, where she received a dual degree in Communications and Spanish. She later earned a master’s degree in healthcare administration from Loyola University Chicago.

Register here for this hourlong webinar that will begin at 1 p.m. on Nov. 14.

Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Policymakers have expressed particular interest in our aggregate estimate on days of uncompensated charity care, as well as the length of delayed health plan responses to prior-authorization requests.

To support this advocacy push, we strongly encourage all NABH members to submit data to the portal. Please contact NABH Associate Manager for Congressional Affair Emily Wilkins with questions about the data metrics that we are collecting and/or the data-submission process.

Fact of the Week

Fewer than half (43.8%) of 1,028 U.S. jails surveyed nationwide provided any medication for opioid use disorder, and only 12.8% made these available to anyone with the disorder, according to a National Institute on Drug Abuse-supported study published in JAMA Network Open.

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

Please Submit Your Updated Member Information Today, Friday Sept. 27!

NABH is developing its online-only 2024 Membership Directory, an essential member benefit that helps the association in its advocacy efforts.

Last month NABH e-mailed system members a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use that link to our membership-update tool and verify your system’s information.

The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all of your system’s facilities so that we have a better picture of our membership.

We extended the deadline for members to submit changes to today, Friday, Sept. 27. If you need assistance, please contact Maria Merlie maria@nabh.org or 202-393-6700, ext. 104.

As always, thank you for your time and for all you do to advance NABH’s Mission and Vision!

FDA Approves First New Schizophrenia Drug in Decades

The U.S. Food and Drug Administration (FDA) on Thursday approved Cobenfy (xanomeline and trospium chloride) capsules for oral use to treat schizophrenia in adults. According to the FDA, it is the first antipsychotic drug approved to treat schizophrenia that targets cholinergic receptors as opposed to dopamine receptors that has long been the standard of care.

“Schizophrenia is a leading cause of disability worldwide. It is a severe, chronic mental illness that is often damaging to a person’s quality of life,” Tiffany Farchione, M.D., director of the Division of Psychiatry, Office of Neuroscience in the FDA’s Center for Drug Evaluation and Research, said in the agency’s announcement. “This drug takes the first new approach to schizophrenia treatment in decades. This approval offers a new alternative to the antipsychotic medications people with schizophrenia have previously been prescribed.”

House and Senate Clear Short-term Spending Bill, Delaying Funding Fights to December

The House and Senate on Wednesday night approved a bill to avert a government shutdown, pushing numerous tough spending fights past the November elections to the end of the year.

The legislation leaves federal agencies with static budgets through Dec. 20 and will now move to the White House for President Biden’s signature before the Sept. 30 shutdown deadline.

The three-month stopgap legislation sets the stage for another shutdown showdown in December, during the congressional “lame-duck” period, when lawmakers will have to piece together a spending bill to keep the government funded past the new deadline.

House Speaker Mike Johnson (R-La.) has vowed that the House will not approve a sprawling omnibus bill to avert a December shutdown, although he acknowledged that will be a difficult goal to achieve as the House has passed only five of 12 spending bills, while the Senate Appropriations Committee reached bipartisan agreements on 11 of the 12 appropriations bills—none of which made it to the Senate floor.

The two chambers are currently nearly $90 billion apart on overall discretionary spending, and that was before the Biden administration identified a $12 billion veterans’ healthcare shortfall. The success of a year-end spending bill and any additional year-end legislative priorities will also hinge on the November elections and which party wins control of the House, Senate, and White House.

Update: FY 2025 IPF PPS Rule’s Provision on All-Inclusive Reporting

After the Centers for Medicare & Medicaid Services (CMS) released its FY 2025 IPF PPS final rule, NABH has communicated with CMS staff to discuss the rule’s provisions related to all-inclusive reporting on cost reports.

Under the rule, inpatient psychiatric hospitals that are not tribally or federally owned must bridge from all-inclusive reporting to include ancillary charges – especially laboratory and pharmacy charges – on cost reports, including for claims from private payers. This shift is to be implemented by the cost reporting period beginning on or after Oct. 1, 2024.

As the final rule lacked full details on the agency’s expectations and protocols for how providers and their Medicare administrative contractors (MAC) should implement this change, NABH has recommended to CMS a bridging methodology that recognizes that every all-inclusive hospital will not be in full compliance with this shift for their entire next cost-reporting period. CMS understands this reality and this week the agency reported it has several forms of guidance in process, including instructions for both providers and MACs.

NABH is waiting for CMS’ final position on the matter; however, it appears the agency will grant some flexibility to hospitals facing challenges implementing a new charges reporting system. NABH will keep members posted as soon as we learn more about such flexibilities.

Sens. Wyden and Warner Introduce Bill to Enforce Minimum Healthcare Cybersecurity Standards

Senate Finance Committee Chairman Ron Wyden (D-Ore.) and Senate Intelligence Committee Chairman Mark Warner (D-Va.) on Thursday unveiled legislation that would require HHS to enforce minimum cybersecurity standards in the healthcare sector.

According to the bill’s sponsors, the legislation is in response to a surge in cybersecurity attacks that threatened patients’ privacy and lives as well as healthcare providers’ bottom lines. In 2023, 725 data breaches that affected more than 120 million Americans were reported. HHS has not conducted a cybersecurity audit since 2017 and has not issued updated regulations under the HIPAA Security Rule since 2013.

If adopted, the legislation would modify HIPAA requirements by mandating HHS adopt minimum cybersecurity standards for HIPAA-covered entities such as providers, insurers, and their business associates within two years. HHS would also be required to update those standards every two years. Meanwhile, covered entities and business associates would have to conduct a security risk analysis, craft plans to resolve cyber incidents, and conduct stress tests.
The legislation would create fines for violators, rising from $500 for violators with no “knowledge” and up to $250,000 for violators with “willful neglect” that don’t make corrections. HHS may consider an entity’s size, history of compliance, and “good faith efforts to comply” with the requirements.

It would also offer $800 million for two years for 2,000 rural and urban safety net hospitals to prepare, as well as $500 million to encourage hospitals to adopt enhanced practices. The bill would also cement HHS’ authority to provide accelerated and advanced Medicare payments in the event of a cyberattack, such as the one that happened in the wake of the Change Healthcare cyberattack.

The outcome of the legislation is unknown at this point. Sens. Wyden and Warner would like to get the legislation into an end-of-year legislative package; however, Republican members have not expressed support for the legislation and the bill’s unknown cost could potentially be a barrier.

Click here for a one-page summary of the bill; here for a section-by-section summary; and here for the full legislative text.

Please Tell Us More About Your AI Use!

NABH continues to explore how our members use Artificial Intelligence (AI). Our AI survey earlier this year identified Care Quality, Business Operations, and Workforce Solutions as our members’ priority areas.

As follow-up to our first survey, we ask you to complete this brief follow-up survey to help us delve deeper into members’ AI practices, which will help refine our advocacy efforts on this important issue.

Please complete our survey by Monday, Oct. 7.

Register for Our November Webinar on Using Publicly Available Data in Health Plan Negotiations

Please join NABH for a webinar on Thursday, Nov. 14, 2024 to learn about using hospital data effectively in your negotiations with health plans.

The webinar will feature Erica K. Fox, M.B.A., vice president of business development and managed care contracting at Perimeter Healthcare. A member of NABH’s Managed Care Committee, Fox will review the use of publicly available data from hospitals, such as payer-specific negotiated rates and standard charges for all payers and plans, to negotiate contracts with health plans.

Fox has more than 25 years of senior leadership experience in the behavioral health sector. Prior to her current role, she served as the business development director at Peachford Hospital, a Universal Health Services facility. Fox earned her undergraduate degree from Michigan State University, where she received a dual degree in Communications and Spanish. She later earned a master’s degree in healthcare administration from Loyola University Chicago.

Register here for this hourlong webinar that will begin at 1 p.m. on Nov. 14.

Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.

We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Policymakers have expressed particular interest in our aggregate estimate on days of uncompensated charity care, as well as the length of delayed health plan responses to prior-authorization requests.

To support this advocacy push, we strongly encourage all NABH members to submit data to the portal. Please contact NABH Associate Manager for Congressional Affair Emily Wilkins with questions about the data metrics that we are collecting and/or the data-submission process.

Fact of the Week

National surveys from the Centers for Disease Control and Prevention show an unprecedented decline in drug deaths of roughly 10.6%. Nabarun Dasgupta, Ph.D., M.P.H., a researcher at the University of North Carolina and an expert on street drugs, said he expects the data will show an even larger decline in drug deaths when federal surveys are updated to reflect improvements being seen at the state level, especially in the eastern United States. “In the states that have the most rapid data collection systems, we’re seeing declines of twenty percent, thirty percent,” Dasgupta told NPR.

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

Deadline Extended: Please Submit Updated Member Information by Friday, Sept. 27!

NABH is developing its online-only 2024 Membership Directory, an essential member benefit that helps the association in its advocacy efforts.

Last month NABH e-mailed system members a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use that link to our membership-update tool and verify your system’s information.

The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all of your system’s facilities so that we have a better picture of our membership.

We have extended the deadline for members to submit changes to Friday, Sept. 27. If you need assistance, please contact Maria Merlie maria@nabh.org at 202-393-6700, ext. 104.

As always, thank you for your time and for all you do to advance NABH’s Mission and Vision!

House Advances Telehealth and Social Media Reform Bills

On Wednesday, Sept.18, the House Energy & Commerce Committee passed several bills related to telehealth and social media access, as Congress attempts to complete pending business before the November election.

In a unanimous vote, lawmakers advanced an amended version of H.R. 7623, the bipartisan Telehealth Modernization Actby Reps. Buddy Carter (R-Ga.) and Lisa Blunt Rochester (D-Del.) which would extend pandemic era Medicare telehealth rules for two years and applies flexibilities to federally qualified health centers and rural clinics. The existing rules are scheduled to expire at year’s end. The Congressional Budget Office gave the two-year telehealth extension an estimated cost of about $4 billion. The bill is offset using pharmacy benefit manager reforms. The legislation, which offers payment parity between virtual and in-person care, must be reconciled with similar legislation in the House Ways & Means Committee and must pass both legislative chambers.

The Committee also passed several bills concerning children and social media. H.R. 7891, the Kids Online Safety Act – sponsored by Reps. Bilirakis (Fla.), Castor (Fla.), and Schrier (Wash.), tasks social media platforms with removing or mitigating design features that promote suicide, eating disorders, substance use or sexual exploitation. H.R.7890, the Children and Teens’ Online Privacy Protection Act, by Reps. Castor (Fla.)  and Rep. Walberg (Mich.), bans targeted advertising aimed at minors. Neither the Kids Online Safety Act nor the Children and Teens Online Privacy Protection Actrequire warning labels but are the first step toward regulating the platforms, which have largely been immune to legal scrutiny. Last week, a bipartisan group of 39 state attorney generals backed that recommendation and called on Speaker Johnson, Senate Majority Leader Schumer and Senate Minority Leader McConnell to pass legislation requiring social media companies to post warnings that their sites endanger kids’ mental health.

The Senate previously passed the Kids Online Safety Act by a 91-3 vote in July, but the measure advanced in Energy & Commerce is significantly different, eliciting some opposition by members on both sides of the aisle.  The committee debate suggests Republican leaders might demand further changes to allow for a vote for this bill on the House Floor. If the House were to pass it, representatives and senators will meet to form a compromise version of the bill, then vote again to pass that version.

Also on Wednesday, the House of Representatives passed H.R. 7858, the Telehealth Enhancement for Mental Health (TELEMH) Act of 2025, by Rep. James (Mich.) which amends title XVIII of the Social Security Act to establish a Medicare incident to modifier for mental health services furnished through telehealth. This bill is a positive development as it would allow supervised “non-physician practitioners” (PAs, NPs, etc.) to bill for telehealth services. Supporters say it would ensure virtual care is used efficiently and with integrity. The bill must now pass the Senate.

Updated Date!: Join NABH for November Webinar on Using Publicly Available Data in Health Plan Negotiations

Please join NABH for a webinar to learn about using hospital data effectively in your negotiations with health plans on Thursday, Nov. 14, 2024.

The webinar will feature Erica K. Fox, M.B.A., vice president of business development and managed care contracting at Perimeter Healthcare. A member of NABH’s Managed Care Committee, Fox will review the use of publicly available data from hospitals, such as payer-specific negotiated rates and standard charges for all payers and plans, to negotiate contracts with health plans.

Fox has more than 25 years of senior leadership experience in the behavioral health sector. Prior to her current role, she served as the business development director at Peachford Hospital, a Universal Health Services facility. Fox earned her undergraduate degree from Michigan State University, where she received a dual degree in Communications and Spanish. She later earned a master’s degree in healthcare administration from Loyola University Chicago.

Register here for this hourlong webinar now occurring on Thursday, Nov. 14 starting at 1 p.m. ET. We hope you join us!

SAMHSA Publishes Compendium: Connected and Strong

A newly published SAMHSA Compendium highlights ten papers aimed at enhancing and unifying behavioral health crisis services. This compilation of resources pinpoint recommendations and present strategies to improve connection within behavioral healthcare.

Focus areas discussed within the papers include but are not limited to the integration of peer support, improving access through the utilization of technology, as well as expanding the crisis response workforce. You can find the complete list of the papers included in the compendium here.

Please Submit Data to NABH’s Denial-of-Care Portal

We urge all NABH members to join those already submitting data to our Denial-of-Care Portal.
We are beginning to use aggregated portal data to illustrate and compare prior authorization practices for commercial, Medicare Advantage, and Medicaid managed care denials.

Policymakers have expressed particular interest in our aggregate estimate on days of uncompensated charity care, as well as the length of delayed health plan responses to prior-authorization requests.

To support this advocacy push, we strongly encourage all NABH members to submit data to the portal. Please contact NABH Associate Manager of Congressional Affairs Emily Wilkins with questions about the data metrics that we are collecting and/or the data-submission process.

Fact of the Week

Despite a 13% decline in adolescents experiencing major depressive episodes between 2021 and 2023, a SAMHSA reportfound that 40% of young people between the ages of 12 and 17 with major depressive episodes did not receive mental health treatment.

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

DOL Official Timothy Hauser to Headline NABH Annual Meeting Day #2

NABH is pleased to announce Timothy D. Hauser, deputy assistant secretary for program operations at the U.S. Labor Department’s (DOL) Employee Benefits Security Administration (EBSA), will kick off our Annual Meeting’s second day on Tuesday, May 14 at 10 a.m. Hauser, who serves as EBSA’s chief operating officer, will discuss parity and be prepared to answer questions from attendees. Hauser joined DOL in 1991 as a trial attorney for the Plan Benefits Security Division (PBSD), where he represented the department in federal district court and appellate litigation. From November 2000 until November 2013, Hauser was the associate solicitor of the division. As the head of PBSD, Hauser was responsible for all of DOL’s legal work under ERISA. Before joining DOL, Hauser worked as a trial attorney for six years at Legal Aid of Western Missouri. He graduated from Harvard Law School in 1985 and earned his undergraduate degree at the University of Illinois. You can learn more about this year’s speakers and view our preliminary program on NABH’s Annual Meeting homepage. And please be sure to register for the Annual Meeting if you haven’t yet.   We look forward to seeing you in Washington!

Remember to Register for Hill Day 2024!

Please register for Hill Day 2024 on Tuesday, May 14 and urge members of your team to join you!   Hill Day is an excellent opportunity to meet one-on-one with legislators to discuss the issues that matter most to behavioral healthcare providers.   After you register for the NABH Annual Meeting, the NABH Congressional Affairs team will match you with legislators who represent you or your facility footprint. Closer to the day of the meeting, we will send you a meeting schedule, materials, and talking points to guide your conversations with Members of Congress and their staff. Please indicate in your Annual Meeting registration form that you are interested in Hill Day and be sure to include all the states where your system has a footprint. If you have an existing relationship with a legislator, please let us know!

SAMHSA’s Recent Grant Funding Opportunities Limit Financial Incentives for Contingency Management

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week released funding opportunity notices for State Opioid Response and Tribal Opioid Response grants that limit financial incentives for contingency management to $75 per budget period. While the grants require implementing evidence-based practices, the funding limitation is contrary to what is known to be an evidence-based incentive amount that produces behavior change. This amount is inconsistent with what the Contingency Management Policy and Practice Group (CMPG) – known formerly as the Motivational Incentive Policy Group and of which NABH is a member – has advised the federal government. “This is a squandered opportunity to implement a highly effective treatment for stimulant use disorder, which is fueling almost half of our nation’s overdoses,” said NABH Director of Quality and Addiction Services Sarah Wattenberg, who serves as NABH’s CMPG representative. “If we can’t get a handle on stimulant use, we won’t see the overdose rate go down,” Wattenberg said before she cautioned providers against using $75 for incentives because they haven’t proven effective. The grant applications are due July 1, 2024.

Reminder: Please Complete Federal BHIT Data Standards Survey by May 12

Advocating for parity in behavioral health information technology (BHIT) is one of NABH’s top advocacy priorities. That’s why we strongly urge our members’ information technology, medical record documentation, and coding leaders to complete a federal survey by May 12 that will help create standardized behavioral health data elements. NABH alerted members about the survey from SAMHSA and the Office of the National Coordinator for Health Information Technology (ONC) in CEO Update earlier this year. Part of SAMHSA and ONC’s joint BHIT initiative, the survey presents more than 150 potential data elements for consideration, including many clinical elements, as well as provides a platform for survey respondents to submit alternative elements for evaluation. Ultimately, HHS expects to incorporate the final data metrics into the Center for Medicare and Medicaid Innovation’s eight-year project with eight states to develop alternative payment models and quality measures to advance integrated BH and physical healthcare services, including a Medicare per-member-per-month risk-adjusted payment, and a complementary Medicaid payment model and statewide IT approach. To participate in the survey, respondents must first create a user account using the log in feature in the top right of the USCDI+ Platform page. See the USCDI+ User Guides for help creating an account, navigating datasets, and submitting new data elements or comments. Learn more from this federal resource page, or e-mail USCDI.Plus@hhs.gov for further assistance.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

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:

1. 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.

1. 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.

Fact of the Week

The American Psychological Association recently released a report that calls on social media companies to take responsibility to help protect youth mental health.   For questions or comments about this CEO Update, please contact Jessica Zigmond.

Please Help Us Welcome Deputy National Coordinator for Health IT Steven Posnack on May 13!

NABH is pleased to welcome Deputy National Coordinator for Health Information Technology Steven Posnack, M.S., M.H.S., as our first 2024 Annual Meeting presenter on Monday, May 13 at 2:45 p.m. ET in the Salamander hotel’s Grand Ballroom. Posnack advises the national coordinator, executes the Office of the National Coordinator for Health Information Technology’s (ONC) mission, and represents ONC’s interests at a national and international level. Together with the national coordinator, Posnack also oversees ONC’s federal coordination, regulatory policy, public-private initiatives, and the overall implementation of statutory authorities and requirements, including those from the 21st Century Cures Act and HITECH Act. He will discuss behavioral health information technology at our Annual Meeting. Also, please join us for Monday’s workforce panel on Monday, May 13 at 4 p.m. This year’s panel of NABH members and workforce consultants will highlight NABH member best practices to recruit and retain talent as well as how to establish partnerships and “grow your own” programs to address your workforce needs. Please click here to learn about our panelists and other Annual Meeting speakers. And be sure to register for the meeting, reserve your hotel room, and view our preliminary program if you haven’t yet.   We look forward to seeing you in Washington!

Biden Administration Releases First National Strategy for Suicide Prevention

The Biden administration this week released the 2024 National Strategy for Suicide Prevention and accompanying federal action plan to combat America’s deadly mental health and overdose crises. The National Strategy was the result of a combined effort among the Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and Prevention, the National Action Alliance for Suicide Prevention, and more than 20 agencies across 10 federal departments. The National Strategy maps out recommendations for addressing gaps and meeting the needs of at-risk populations, while the federal action plan identifies 200 discrete actions to be initiated and evaluated over the next three years. Actions include identifying ways to address substance use and suicide risk together in the clinical setting; funding a mobile crisis locator for use by 988 crisis centers; increasing support for survivors of suicide loss and others whose lives have been affected by suicide; and evaluating promising community-based suicide prevention strategies. The Biden administration said it will monitor and evaluate these strategies regularly to determine progress and success, and to further identify barriers to successful suicide prevention.

CMS Releases Final Rule on Medicare Managed Care Transparency and Accountability

NABH is pleased with the Centers for Medicare & Medicaid Services’ (CMS) final rule on transparency and accountability for Medicaid managed care plans that the agency released this week. Nearly a year after issuing its proposed rule – and facing firm opposition from healthcare insurance stakeholders – CMS released a rule with provisions that NABH strongly supports, including maximum appointment wait time standards aligned with commercial insurance, including a 10-day wait time standard for outpatient mental health and substance use disorder services. The rule also requires independent annual secret shopper surveys that assess appointment timeliness standards and provider director accuracy. And in an important move toward price transparency, health plans will be required to share their actual expenditures and revenues for state-directed payments and to report any identified or recovered overpayments to states within 30 days. Given the rule’s complex rollout schedule, CMS issued a detailed chart showing the staggered implementation plan for the rule, with effective dates ranging from immediate implementation to four years after its release. Additional information is available in the agency’s fact sheet.

NABH Comments to CMS About Agency’s Accrediting Organization Oversight Rule

NABH recently sent a comment letter to CMS about a proposed rule intended to improve and make more consistent the agency’s oversight of accrediting organizations (AO). NABH supports the rule’s overall direction, which is to improve the accountability and transparency of AO survey and accreditation activities. Of the nine AOs this rule would affect, The Joint Commission is the one of most interest to NABH members. “NABH appreciates that the proposed rule recognizes the current disparity of survey findings among The Joint Commission (and other AOs) and state survey agencies,” NABH wrote in our letter. “Such disparities raise red flags about the misaligned criteria, as well as the reliability of relevant surveyor training programs and preparedness of individual surveyors,” the letter continued. “Current inadequacies have resulted in inconsistent, and therefore at least partially inaccurate, survey findings. This entire process warrants closer examination by CMS of the overall scope and details of these inconsistencies – and the public sharing of related findings with stakeholders.”

NABH Opposes FTC’s Final Rule Banning Non-Compete Agreements

NABH staunchly opposes this week’s final rule banning noncompetes from the Federal Trade Commission (FTC) that the agency said it expects will generate new businesses, raise worker wages, and boost innovation. The FTC estimates that the final rule will lead to new business formation growing by 2.7% per year, resulting in more than 8,500 additional new businesses created each year. The FTC also expects the final will result in higher earnings for workers, with estimated earnings increasing for the average worker by an additional $524 per year; as well as lower healthcare costs by up to $194 billion over the next decade. The U.S. Chamber of Commerce and other business groups filed suit to stop the FTC from banning noncompetes, arguing the FTC doesn’t have the authority to prohibit companies from limiting their employees’ ability to work for competitors.   NABH weighed in on the proposed rule a year ago and acknowledged the FTC’s other efforts to address issues of genuine, unequal bargaining power between certain employers and certain types of workers. However, we opposed the proposed rule for several reasons. “First, the rule proposes an overly simplified, one-size-fits-all approach for all employees across all industries,” NABH said in our March 2023 comment letter. “From a behavioral healthcare perspective, the proposed rule would profoundly alter the healthcare labor market – particularly for physicians and senior hospital executives – by instantly invalidating millions of dollars of existing contracts,” the letter continued. “The rule would affect the full array of NABH members’ employees, including those who are highly trained and lower skilled; as well as both highly compensated and lower-wage employees.”

The Joint Commission Announces New Telehealth Accreditation Program

The Joint Commission this week announced its new Telehealth Accreditation Program for eligible hospitals, ambulatory, and behavioral healthcare organizations. Effective July 1, 2024, the program’s requirements contain many of the standards similar to other Joint Commission accreditation programs, such as requirements for information management, leadership, medication management, patient identification, documentation, and credentialing and privileging. Some requirements specific to the new telehealth program include:

• Streamlined emergency management requirements to address providing care and clinical support remotely rather than in a physical building.
• New standards for telehealth provider education and patient education about the use of telehealth platforms and devices.
• New standards chapter focused on equipment, devices, and connectivity.

The Joint Commission’s announcement noted telehealth use increased by 154% during the COVID-19 pandemic’s early years before stabilizing and presently remaining at levels 38 times higher than they were in 2019.

NABH Telehealth Survey is Due Tuesday, April 30

NABH is eager to learn how your system uses telehealth services in its operations. Please remember to complete this brief survey by Tuesday, April 30, 2024.    Your responses will help guide our advocacy efforts. We also urge you to share this survey with IT colleagues who have insight into how your facilities use telehealth to support your patients. Please email NABH Executive Vice President for Government Relations and Public Policy Rochelle Archuleta if you have questions.

Reminder: The National Academies to Explore Mental Health Services for Anxiety & Mood Disorders in Women

The National Academies Forum on Mental Health and Substance Use Disorder will host a hybrid public workshop in Washington, D.C. and via webcast to explore mental health care services related to anxiety and mood disorders in women on April 29 and 30. Sponsored by the Health Resources and Services Administration, the workshop will examine currently available evidence to identify, define, and prepare strategies for the provision of essential healthcare services related to anxiety and mood disorders in women across the life course. Presentations will also describe health disparities, healthcare finances, and policies related to the quality and access of mental healthcare services available for women.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

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:

1. 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.

1. 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.

Fact of the Week

Researchers have created an AI model that can identify accurately women at risk of child-birth related PTSD, Science Daily reports. The study notes early intervention is critical to prevent progression of a disorder that could carry serious health consequences for as many as 8 million women a year globally.   For questions or comments about this CEO Update, please contact Jessica Zigmond.

RTI Study Shows Pervasive Disparities in Access to In-Network Behavioral Healthcare 

A report this week from not-for-profit research institute RTI International adds to mounting research showing a lack of access to affordable mental health and substance use disorder treatment in the United States continues. NABH helped sponsor the study, Behavioral Health Parity—Pervasive Disparities in Access to In-Network Care Continue, which found that patients went out-of-network 3.5 times more often to see a behavioral health clinician than a medical/surgical clinician, 8.9 times more often to see a psychiatrist, 10.6 times more often to see a psychologist, 6.2 times more often for acute behavioral inpatient care, and 19.9 times more often for sub-acute behavioral inpatient care. “It’s upsetting, though not surprising, that RTI researchers found what we’ve seen for too long: patients who need critical behavioral healthcare services are forced to seek that care out-of-network much more than they do for medical-surgical services because of inadequate insurer networks. This comes at higher personal costs to these patients,” NABH President and CEO Shawn Coughlin said in a statement. “Worsening the problem, behavioral healthcare providers are reimbursed at much lower rates than their peers in medical/surgical facilities. The Mental Health Parity and Addiction Equity Act passed more than 15 years ago,” he continued. “It’s time lawmakers and regulators ensure this critical law is implemented fairly and fully nationwide.” The study also found that in-network office visit reimbursement, which health plans use to encourage provider in-network participation, was higher for medical/surgical clinicians than office visits with behavioral clinicians: 22% higher on average; 48% higher at the 75th percentile; and 70% higher at the 95th percentile. Notably, physician assistants were reimbursed for office visits at an average amount 19% higher than psychiatrists and 23% higher than psychologists.

In Case You Missed It: Watch Our Foundation’s Talent-Recruitment, Part II Webinar

The NABH Education and Research Foundation hosted the second in its two-part webinar series about talent recruitment and retention on Thursday, April 18. NABH Board Chair Frank Ghinassi, Ph.D., A.B.P.P., president and CEO of Rutgers University Behavioral Health Care, and senior vice president of the Behavioral Health and Addictions Service Line at RWJBarnabas Health, co-led the webinar with workforce consultants Beth Kuhn of Stonegate Strategies and John Pallasch of One Workforce Solutions. The presenters discussed long-term solutions to recruiting and retaining talent through partnerships; how skills-based hiring is a more effective approach to talent management; and what funding sources are available to help NABH members in their workforce-related efforts.   If you missed it, please click here for the webinar’s recording, here for the presentation slides, and here for the poll question results. And be sure to join us for our Annual Meeting Workforce Panel on Monday, May 13 from 4 – 5 p.m. ET in the Salamander Washington DC’s Grand Ballroom. NABH Education and Research Foundation Vice President Jim Shaheen, CEO of New Season, will moderate the panel, which will include this week’s webinar presenters Kuhn and Pallasch, as well Jason Brooks, senior vice president of Human Resources at New Season, and Rhonda Ashley-Dixon, vice president of strategic partnership and engagement at Vanderbilt Behavioral Health.

Please Meet Our Exhibitors and Sponsors at the 2024 NABH Annual Meeting Next Month!

NABH appreciates the generous support of our exhibitors and sponsors, whose valuable products and services help NABH members deliver quality behavioral healthcare every day to those who need it. Please make time to visit our exhibitors and sponsors at the Annual Meeting from May 13-15 at the Salamander Washington, DC. Before then, you can view a list of our exhibitors and sponsors on our Annual Meeting homepage. Also, please register for the Annual Meeting, reserve your hotel room, and view our preliminary program, if you haven’t done so yet. We look forward to seeing you in Washington!

FTC Brings Case Against Monument to Enforce Health Data Privacy Protections

The Federal Trade Commission for the first time took enforcement action through the Opioid Addiction Recovery Fraud Prevention Act (OARFPA) to stop telehealth company Monument from disclosing health data to advertising platforms by bringing a case against the company, which treats patients with alcohol addiction virtually, Inside Health Policy reports.  The story also noted that Monument’s data-sharing practices also violated section 5 of the FTC Act, resulting in a proposed ban on data sharing with third parties and a $2.5 million civil penalty, FTC says. Enacted in 2018, OARFPA authorizes FTC to seek civil penalties for unfair or deceptive acts or practices related to substance use disorder treatment services or products.

Center for Health Strategies Examines Medicaid Options to Cover Incarcerated Youth

The Center for Health Care Strategies, together with the Annie E. Casey Foundation, has developed a policy cheat sheet outlining requirements that will expand Medicaid options to cover services for incarcerated youth starting in 2025.   Several provisions under the Consolidated Appropriations Act of 2023 will expand Medicaid services to youth who are incarcerated, of which nearly two-thirds have a diagnosable mental health or substance use disorder, according to the Medicaid Payment and CHIP Access Commission, or MACPAC. The fact sheet outlines the new requirements, opportunities for Medicaid to collaborate with the corrections sector, and next step for Medicaid agencies before the provisions take effect.

Reminder: The National Academies to Explore Mental Health Services for Anxiety & Mood Disorders in Women

The National Academies Forum on Mental Health and Substance Use Disorder will host a hybrid public workshop in Washington, D.C. and via webcast to explore mental health care services related to anxiety and mood disorders in women on April 29 and 30. Sponsored by the Health Resources and Services Administration, the workshop will examine currently available evidence to identify, define, and prepare strategies for the provision of essential healthcare services related to anxiety and mood disorders in women across the life course. Presentations will also describe health disparities, healthcare finances, and policies related to the quality and access of mental healthcare services available for women.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

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:

1. 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.

1. 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.

Fact of the Week

Among U.S. college athletes, suicide is now the second leading cause of death after accidents—and  rates have doubled to 15.3% from 7.6% in the past 20 years, according to a study published in the British Journal of Sports Medicine. CNN analyzed the report’s findings in a recent article. For questions or comments about this CEO Update, please contact Jessica Zigmond.

NABH Remembers Unit Committee Member Anthony Santucci, M.S.

NABH remembers with grateful appreciation Anthony Santucci, M.S., 50, of BayCare Behavioral Health, who died unexpectedly on March 25. Anthony served as BayCare’s director of nursing for 13 years and was an active and energetic member of NABH’s Behavioral Health Services within General Healthcare Systems Committee – known as the Unit Committee – for many years. Born and raised in South Jersey, Anthony earned his nursing degree at Wesley College in Delaware and continued his education at Jacksonville and Walden Universities, ultimately earning a Master of Science degree in nursing in 2016. Anthony was also a 2020 graduate of the Tampa Bay Chamber’s Leadership Tampa, an intensive executive leadership program, and was a devoted member of the Tampa Bay behavioral health community for more than 25 years. Anthony is survived by Jaclyn Santucci, his wife of 20 years, and their daughter Josephine Cecilia. Anthony will be missed by all who knew him. In lieu of flowers, donations can be made in Anthony’s memory to Feeding Tampa Bay or to the Pinellas County Hunter Association, a horseback riding association, via Zelle at 123pcha@gmail.com.

Register Today for Part II of Our Foundation’s Talent-Recruitment Webinar Series on April 18

Please join us and register today for the NABH Education and Research Foundation’s second webinar about recruiting and retaining talent next Thursday, April 18 from 2 p.m. – 3 p.m. ET. NABH Board Chair Frank Ghinassi, Ph.D., A.B.P.P. president and CEO, Rutgers University Behavioral Health Care and senior vice president, Behavioral Health and Addictions Service Line, RWJBarnabas Health, will co-lead this free, interactive webinar with workforce consultants Beth Kuhn of Stonegate Strategies and John Pallasch of One Workforce Solutions. Kuhn has more than 30 years of workforce experience and served previously as commissioner of the Kentucky Department of Workforce Investment and as Vermont’s director of workforce development. Pallasch has spent more than 20 years influencing organizational personnel, efficiency, and productivity in the public and private sectors and served previously as the assistant secretary for employment and training at the U.S. Labor Department. Together they will discuss establishing and developing partnerships to “grow your own” within your systems; explore funding opportunities to help support your workforce efforts; and urge you to focus more on skill sets and less on job responsibilities among your staff. Please share the registration link with your Human Resources, Operations, and Workforce Engagement teams!

The 2024 NABH Annual Meeting Hotel Cutoff Date is Now Sunday, April 28

The Salamander Washington, DC has extended its cutoff date for NABH 2024 Annual Meeting room reservations through Sunday, April 28. Please reserve your hotel room today and be sure to register for our Annual Meeting (May 13-15), if you have not done so yet. We look forward to seeing you in Washington!

House and Senate Committees Examine Behavioral Healthcare Policies in Hearings

House and Senate Committees returned from the Easter recess and reviewed several pending behavioral healthcare policies this week. In a hearing on Wednesday, April 10, the House Energy & Commerce Committee Health Subcommittee explored ways to support patients’ access to telehealth as lawmakers determine how best to extend digital health flexibilities in effect through Dec. 31. Lawmakers will need to decide whether to pursue a temporary or permanent extension of pandemic-era telehealth policies. Extending telehealth coverage beyond 2024 is expected to be costly, and if implemented in a budget neutral manner, would reduce funds available for other Medicare programs. Committee members said best practices on digital billing codes, policies that prevent overuse of telehealth services and limit fraud, and CMS’ ability to capture and report telehealth data are integral pieces for them to determine whether telehealth provisions will be extended permanently by year’s end. Lawmakers also expressed concerns that changes to virtual care policy will not hinder access to in-person care. Wednesday’s hearing announcement included a list of 15 telehealth bills that would extend or make permanent telehealth provisions. Two bills specific to behavioral healthcare include H.R. 3432, Rep. Doris Matsui’s (D-Calif.) Telemental Health Care Access Act, which eliminates certain restrictions relating to Medicare coverage of mental health services that are provided through telehealth; and H.R. 7858, the Telehealth Enhancement for Mental Health Act of 2024 from Reps. John James (R-Mich.), Don Davis (D-N.C), and David Schweikert (R-Ariz.), which would establish a Medicare “incident to” modifier for tele-mental health services. Lawmakers remain divided over whether to extend audio-only telehealth. Representatives who serve rural and underserved communities say audio-only telehealth may be the only way their constituents can experience virtual care. The ultimate collection of provisions – either temporary or permanent – will likely be included in a larger healthcare package expected to be taken up in a lame-duck session. The Senate Finance Health Subcommittee convened a roundtable to discuss opportunities to improve substance use disorder (SUD) treatments within federal health programs. Witnesses described how measures such as treatment prior authorization, low physician reimbursement rates, and inadequate funding perpetuate treatment barriers for individuals living with SUD. Both Democrats and Republican lawmakers expressed support for increasing access to care through peer support specialists, increased reimbursement rates, comprehensive care, and certified community behavioral health clinics (CCBHCs). Additional discussion items included the importance of a continuum of care and opportunities to reduce SUD stigma. One panelist highlighted increasing the availability of methadone treatment options, and several senators reiterated support for S. 644, the Modernization Opioid Treatment Access Act. Committee leaders indicated they will hold an official hearing about increasing access to SUD treatment in the future.

The National Academies to Explore Mental Health Services for Anxiety & Mood Disorders in Women

The National Academies Forum on Mental Health and Substance Use Disorder will host a hybrid public workshop in Washington, D.C. and via webcast to explore mental health care services related to anxiety and mood disorders in women on April 29 and 30. Sponsored by the Health Resources and Services Administration, the workshop will examine currently available evidence to identify, define, and prepare strategies for essential healthcare services related to anxiety and mood disorders in women across the life course. Presentations will also describe health disparities, healthcare finances, and policies related to the quality and access of mental healthcare services available for women.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

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:

1. 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.

1. 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.

Fact of the Week

A new JAMA study shows probabilities of parents having anxiety-related visits (10.6% versus 7.0%), depression-related visits (8.4% versus 6.1%), and any mental health-related visits (18.1% versus 13.3%) were higher in families of children with cancer versus  children without cancer. The authors said the findings underline the importance of multi-level interventions – such as providing MH screening, counseling, and timely support and ensuring comprehensive insurance coverage and paid medical leave – to better meet the mental-health needs of these parents. For questions or comments about this CEO Update, please contact Jessica Zigmond.

Please Join Us for Our Annual Meeting Workforce Panel on Tuesday, May 14!

Building on last year’s success, the NABH Education and Research Foundation will host a panel discussion featuring NABH members and workforce consultants during the 2024 Annual Meeting on Monday, May 13 from 4 p.m. – 5 p.m. ET. This year’s panel will focus on NABH member best workforce practices, workforce development boards, apprenticeships, fellowships, and other “grow your own” programs. It will feature the following panelists: Jason Brooks, Senior Vice President of Human Resources, New Season Rhonda Ashley-Dixon, Vice President, Strategic Partnerships & Engagement, Vanderbilt Behavioral Health Beth Kuhn, Principal, Stonegate Strategies and former Commissioner, Kentucky Department of Workforce Investment John Pallasch, Founder and CEO, One Workforce Solutions and former U.S. Assistant Secretary for Employment and Training, U.S. Labor Department The Foundation urges NABH members to attend the session and engage with panelists during the question-and-answer period. Also, please remember to register for the Annual Meeting and reserve your hotel room if you haven’t done so yet. We look forward to seeing you in Washington!

Learn About Long-term Solutions in the Fight for Talent!

Please join us for the NABH Education and Research Foundation’s second in its two-part webinar series about recruiting and retaining talent on Thursday, April 18 from 2 p.m. – 3 p.m.   NABH Board Chair Frank Ghinassi, Ph.D., A.B.P.P., who serves as president and CEO of Rutgers University Behavioral Health Care and senior vice president of the Behavioral Health and Addictions Service Line at RWJBarnabas Health, will co-lead this interactive webinar with workforce consultants Beth Kuhn of Stonegate Strategies and John Pallasch of One Workforce Solutions. Kuhn has more than 30 years of workforce experience and served previously as commissioner of the Kentucky Department of Workforce Investment and as Vermont’s director of workforce development. Pallasch has spent more than 20 years influencing organizational personnel, efficiency, and productivity in the public and private sectors and served previously as the assistant secretary for employment and training at the U.S. Labor Department.   Together they will present practical approaches to attracting and keeping top talent, such as developing partnerships and offering apprenticeship programs. Participants will come away with some applicable next steps to employ in their own systems to set the foundation for long-term solutions. Please click here to register and be sure to alert your members of your Human Resources, Operations, and Workforce Engagement teams to attend!

NABH Comments to Federal Agencies About Proposed BHIT Data Standards

NABH on March 29 submitted comments to the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of the National Coordinator for Health Information Technology (ONC) on their joint effort to create official data standards for behavioral health information technology (IT). In addition to the association sending a comment letter, NABH members concurrently responded to the related online survey about potential behavioral health data items. As we know, behavioral healthcare providers were not eligible recipients of the HITECH Act of 2009 funding, and, as such, most IT vendors did not develop viable BHIT systems or tools at that time or since. More than 15 years after HITECH became law, our country needs a federal investment in BHIT to help our field align with the IT capacity of the rest of the continuum of healthcare providers. Our comments emphasized that a significant portion of our membership lacks an IT system compliant with the ONC standards set in 2015. As a result, many in our field face reduced efficiency and more administrative burden. We also noted that on the policy front, the ongoing use of outdated IT reduces the field’s ability to engage in recent policy initiatives that require modern interoperability. NABH recommended that the new behavioral health language include data metrics for behavioral health populations that tend to be overlooked by behavioral health IT system modules, such as for patients experiencing suicidality or the potential of harm to self or others; substance use disorder patients; patients in intensive outpatient programs or partial hospitalization programs; and adolescent and youth populations. Our letter also recommended social determinants of health to include in the new standards. In addition, we urged the initiative to consider data terms related to the emerging use of artificial intelligence within behavioral healthcare settings. Because this is a top priority of NABH, we urged SAMHSA and ONC to work closely with providers and other stakeholders on this long-awaited investment. This collaboration is of highest importance because it is expected that the data standards that emerge from this project will be used in future standards for BH electronic medical records.

NABH Weighs in On Physical Holds for Children and Youth in Joint Commission Letter

In a letter to The Joint Commission (TJC) this week, NABH noted that The Joint Commission’s proposal to modify standards on the use of physical holds for children and youth would affect NABH-member group homes, foster care, non-hospital residential treatment programs, and perhaps others – many of which are accredited by the Council on Accreditation. The Joint Commission’s proposed change would combine the current physical holding standards for children and youth with existing standards for restraints and seclusions for all individuals served. Because the brief proposal lacks a clear rationale, NABH’s letter outlined several key elements that stakeholders need before responding to the proposal. Specifically, we asked for a comprehensive policy justification and evidence, impact estimate, and explanation of any link between this proposal and efforts to combat workplace violence. NABH also requested a meeting with The Joint Commission to learn more about the proposal.

Reminder: U.S. Labor Department Seeks Information in Parity Enforcement Survey

The U.S. Labor Department is conducting an 11-question survey to better understand stakeholder views about the department’s federal parity law oversight and enforcement efforts. In particular, the survey focuses on compliance enforcement for non-quantitative treatment limitations, which include prior authorization protocols, network adequacy standards, and timeliness requirements. Click here to complete the survey, which opened on Wednesday, March 27 and closes on Wednesday, April 10.

Reminder: Please Submit Data to NABH’s Denial-of-Care Portal

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:

1. 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.

1. 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.

Fact of the Week

A new telehealth study focused on patients with Alcohol Use Disorder showed some groups were less likely to receive any video telehealth than telephone visits, suggesting that multiple treatment modalities should remain available to ensure treatment access. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CMS Proposes IPF PPS Reforms and FY 2025 Increase of 2.6%

The Centers for Medicare & Medicaid Services (CMS) on Thursday proposed a net update of 2.6 percentage points for fiscal year (FY) 2025 payment levels relative to FY 2024 levels for hospitals and units reimbursed under the inpatient psychiatric facility prospective payment system (IPF PPS). The update moderately varies by provider types, with a 2.2% increase for urban, freestanding for-profit providers, and a 2.4% increase for urban, freestanding not-for-profit hospitals, as well as for urban, for-profit and not-for-profit units. The IPF PPS rule also proposed budget-neutral adjustments to the Medicare severity diagnosis related groupd (DRG), which are payment categories that reflect a patient’s principal diagnosis, selected comorbidities, patient age, and the variable per diem adjustments. The proposed changes also include:

• Maintaining the current 17 DRGs.
• In response to the growing volume of these cases, CMS proposes to make these two current DRGs eligible for payment add-ons: DRGs 917 (Poisoning and toxic effects of drugs w MCC) and 918 (Poisoning and toxic effects of drugs w/out MCC). See Table 4 in the rule for more details.
• Replacing DRGs 080 (Nontraumatic stupor & coma w MCC) and 081 (Nontraumatic stupor & coma w/o MCC) with DRGs 947 (Signs and Symptoms w MCC) and 948 (Signs and Symptoms w/out MCC), because volume in these current DRGs have decreased significantly and CMS said the proposed replacement DRGs are a more appropriate fit. See Table 3 in the rule for more details.

Regarding comorbidity payment add-ons, in an overall budget-neutral manner, CMS proposes multiple changes to these payment adjustment rates, as outlined in Table 8 in the rule. To maintain this payment system’s 2.0% outlier pool, CMS proposed to increase the fixed dollar loss threshold to $35,590 from $33,470, which will result in fewer cases qualifying for outlier payments. The rule also proposes to increase payments for electroconvulsive therapy to $660.30 in FY 2025 from the current rate of $385.58. Due to these adjustments, the base per diem was reduced to $874.93 from $895.63 (a 2.3% reduction) to ensure that overall payments remained budget neutral.  And our analysis will further explain this reduction and its overall financial impact to the industry. In addition, under the congressional mandate from the Consolidated Appropriations Act, 2023, the rule includes two requests for information (RFI) on potential future IPF PPS reforms. For the first RFI, CMS revisits and builds upon its 2022 technical report by flagging several potential future reforms to the current adjustments for rural IPFs, teaching IPFs, and “safety-net” IPFs. The second RFI in the rule proposes to develop a standardized IPF patient assessment instrument, which will be designed to implement in 2028. Please see the agency’s fact sheet for additional information about the proposed rule. Public comments are due by Tuesday, May 28. Also, please join NABH via Zoom on Tuesday, April 16 from 2 p.m. – 3 p.m. ET, when we’ll discuss the rule in greater detail, as well as priority issues that NABH will address in the association’s official comment letter.

View the NABH 2024 Annual Meeting Preliminary Program!

Earlier this week NABH shared its 2024 Annual Meeting preliminary program with members and meeting registrants. Unless noted otherwise, meeting sessions are open to all Annual Meeting attendees. Please remember to register for the Annual Meeting and reserve your hotel room today if you haven’t done so yet. We look forward to seeing you in Washington!

Deadline to Advertise in the 2024 NABH Exhibitor and Sponsor Guide is Today, March 29!

NABH will distribute the 2024 NABH Exhibitor and Sponsor Guide to all registrants at the 2024 NABH Annual Meeting from May 13-15 at the Salamander Washington, DC. Be sure your organization is included in it!   All ads are due today, Friday, March 29, 2024. Please click here for details about advertising options, requirements, payment, and more. The association also will send the guide to all NABH members after the meeting and post it on the NABH Annual Meeting webpage.

Register for Part II of Our Foundation’s Talent-Recruitment Webinar Series!

Please join us on Thursday, April 18 at 2 p.m. ET for Part II of the NABH Education and Research Foundation’s talent-recruitment webinar series, which will explore long-term solutions. NABH Board Chair Frank Ghinassi, Ph.D., A.B.P.P. president and CEO, Rutgers University Behavioral Health Care and senior vice president, Behavioral Health and Addictions Service Line, RWJBarnabas Health, will lead the April webinar along with Kuhn and workforce consultant John Pallasch of One Workforce Solutions. Pallasch served previously as the assistant secretary for employment and training at the U.S. Labor Department. This interactive webinar will explore how to develop partnerships for apprenticeships and other “grow your own” programs.   Please click here to register.

ICYMI: Watch Part I of Our Foundation’s Talent-Recruitment Webinar Series!

On March 26, our foundation hosted Part I of its two-part, talent-recruitment webinar series, which focused on short-term solutions. If you missed it, please click here for the webinar’s recording, here for the presentation slides, and here for the poll question results.

U.S. Labor Department Seeks Information in Parity Enforcement Survey

The U.S. Labor Department is conducting an 11-question survey to better understand stakeholder views about the department’s federal parity law oversight and enforcement efforts. In particular, the survey focuses on compliance enforcement for non-quantitative treatment limitations, which include prior authorization protocols, network adequacy standards, and timeliness requirements. Click here to complete the survey, which opened on Wednesday, March 27 and closes on Wednesday, April 10.

Reminder: Please Submit Data to NABH’ Denial-of-Care Portal

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:

1. 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.

1. 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.

Fact of the Week

Perinatal mood and anxiety disorder (PMAD) diagnoses among privately insured people nationwide increased by 93.3% from 2008 to 2020, growing faster in 2015–20 than in 2008–14, according to a new study published in Health Affairs. For questions or comments about this CEO Update, please contact Jessica Zigmond.

Congress Moves to Approve Final Spending Bill Before Government Shutdown Deadline

Congressional appropriators on Thursday unveiled legislative text for the final spending package for fiscal year 2024. The House will vote first on this six-bill “minibus,” which contains the appropriations bills for Labor-HHS-Education, Defense, Financial Services and General Government, Homeland Security, State-Foreign Operations, and Legislative Branch during a Friday session. The Senate is moving quickly to review the package before the federal funding deadline expires at midnight. Absent this “time agreement,” a brief weekend shutdown could be possible while the bill works its way to the president’s desk. Negotiations between House and Senate leadership broke down on another skinny health package. This deal would have included additional funding for community health centers, PBM reforms and price transparency provisions, as well as extensions for the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPA) and the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment Act (SUPPORT). Lawmakers may consider these provisions during the congressional lame duck session after the elections. In the bill, HHS is set to receive an increase of $955 million above the current funding level to more than $117 billion. Behavioral healthcare funding includes more than $4.6 billion to support substance use prevention and treatment efforts to address the rising toll of opioid overdoses; $2 billion for the Substance Use Prevention, Treatment, and Recovery Services Block Grant; $1.575 billion for State Opioid Response grants; $145 million for the Rural Communities Opioid Response Program; and $1 billion for the Mental Health Block Grant. The bill also provides $153 million for the Behavioral Health Workforce Education and Training Program to support community-based clinical training and strengthen the mental health workforce through repayment of education loans for individuals working in either a Mental Health Professional Shortage Area or where the overdose death rate exceeds the national average. The package allocates $42 million to the Health Resources and Services Administration (HRSA) for the Office of the Advancement of Telehealth (OAT) for expenses, grants, contracts and “cooperative agreements for the advancement of telehealth activities; $1 million to connect rural veterans to health care facilities; and $20.9 million for rural hospitals to adopt health information technology.   The bill also provides an $18 million increase for the 988 Suicide Prevention Lifeline, building on the nearly $400 million increase in fiscal year 2023. The proposed boost comes after GOP leaders on the House Energy and Commerce Committee requested that the Government Accountability Office audit the Substance Abuse and Mental Health Services Administration’s (SAMHSA) oversight of funds to the lifeline, saying more than half of designated funding has gone unused.

Register Today for Next Week’s NABH Education and Research Foundation Workforce Webinar

There’s still time to register for the NABH Education and Research Foundation’s workforce webinar on Tuesday, March 26 from 2 p.m. – 3 p.m. ET. Next week’s webinar is the first in a two-part series that explores talent recruitment and retention. Foundation Vice President Jim Shaheen, CEO of New Season/Colonial Management Group, LP, Foundation Secretary Mary Pawlikowski, president at Vanderbilt Psychiatric Hospital and Clinics, and workforce consultant Beth Kuhn of Stonegate Strategies will lead participants in an interactive discussion to share their talent-recruitment and retention challenges, as well as their best, short-term strategies to address those problems. These practices include re-organizing recruitment teams to align with operations, developing alumni outreach initiatives, streamlining an organization’s onboarding process, conducting stay interviews, and more. Please join us and click here to register for Part I on March 26 at 2 p.m. ET! The second webinar in this series will examine longer-term solutions to recruiting talent – such as Registered Apprenticeship Programs, education and certification opportunities, fellowships, and more – on Thursday, April 18 at 2 p.m. ET. NABH Board Chair Frank Ghinassi, Ph.D., A.B.P.P. president and CEO, Rutgers University Behavioral Health Care and senior vice president, Behavioral Health and Addictions Service Line, RWJBarnabas Health, will lead the April webinar along with Kuhn and workforce consultant John Pallasch of One Workforce Solutions. Pallasch served previously as the assistant secretary for employment and training at the U.S. Labor Department.   Please join us and click here to register for Part II on April 18!

HHS Needs Your Feedback to Help Develop a Behavioral Healthcare Data Set

Through next Friday, March 29, HHS’ Office of the National Coordinator (ONC) – the federal agency that standardizes information technology requirements for healthcare providers – is collecting information about specific data elements to include in a new behavioral healthcare data set. NABH encourages you to help with this important project. The task is a joint effort between ONC and the Substance Abuse and Mental Health Services Administration (SAMHSA) to create the draft United States Core Data for Interoperability (USCDI) + BH to address core data and interoperability for behavioral health needs beyond the scope of the USCDI. In December 2023, ONC launched a new USCDI+ platform to support the organization, linking of domains, and functionality to solicit and receive feedback for all USCDI+ domains. HHS’ goal with this activity is to confirm the data points needed to improve and advance care continuity for patients who see behavioral healthcare providers and other healthcare providers. Survey respondents will identify the specific data metrics from among 187 options – such as the patient’s address, insurance information, clinical data points, and more – that HHS should collect, as well as items that HHS should not collect. Your expertise will help develop an eventual government-endorsed data set for the behavioral healthcare field and also influence a separate HHS effort to develop a future behavioral health information technology system.   Behavioral Health Information Technology, or BHIT, is one of NABH’s top advocacy priorities, so we strongly urge you and your teams’ health IT experts to complete ONC’s survey by no later than Friday, March 29. Meanwhile, NABH is working with its committees to prepare an association comment letter to ONC. Please contact Sarah Wattenberg with any questions.

White House Announces Challenge to Save Lives from Overdose

The Biden administration has announced The White House Challenge to Save Lives from Overdose, a nationwide call to action to stakeholders from all sectors to save lives by increasing training about and access to life-saving opioid overdose reversal medications. The White House urges organizations, philanthropists, local governments, and businesses large and small to participate in a variety of ways, such as training 100% of an organization’s employees on how and when to use an opioid reversal medication; ensure an opioid overdose reversal medication is in every first aid kit in worksites and schools; and purchase and distribute opioid overdose reversal medications to a certain number of employees. Click here to learn more about the challenge.

2024 Annual Meeting Hotel Reservation Cutoff Date is Approaching!

Please reserve your hotel room today at the Salamander Washington, DC for the 2024 NABH Annual Meeting from May 13-15, 2024! The Salamander, Washington DC’s reservation cutoff date is Sunday, April 14. And please remember to register for this year’s Annual Meeting, The Future of Behavioral Healthcare, if you haven’t done so yet. The Annual Meeting’s preliminary program will be available soon. We look forward to seeing you in Washington!

Advertise in the 2024 NABH Exhibitor and Sponsor Guide!

NABH will distribute the 2024 NABH Exhibitor and Sponsor Guide to all registrants at the 2024 NABH Annual Meeting from May 13-15 at the Salamander Washington, DC. Be sure your organization is included in it!   All ads are due by next Friday, March 29, 2024. Please click here for details about advertising options, requirements, payment, and more. The association also will send the guide to all NABH members after the meeting and post it on the NABH Annual Meeting webpage.

Reminder: Please Submit Data to NABH’ Denial-of-Care Portal

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:

1. 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.

1. 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.

In Case You Missed It: NABH’s 2024 Advocacy Priorities

NABH has released its 2024 Advocacy Priorities, which we urge you to read and share with your Government Relations teams. Topping NABH’s priorities this year are parity, workforce, behavioral healthcare information technology, America’s ongoing addiction crisis, and the Institutions for Mental Diseases (IMD) exclusion.

Fact of the Week

A recent JAMA study reported Delta 8-THC use prevalence is appreciable among U.S. adolescents and is higher in states without marijuana legalization or existing Delta 8-THC regulations. The study noted that prioritizing surveillance, policy, and public health efforts addressing adolescent Delta 8-THC use may be warranted.   For questions or comments about this CEO Update, please contact Jessica Zigmond.

HHS Needs Your Feedback to Help Develop a Behavioral Healthcare Data Set

Through March 29, HHS’ Office of the National Coordinator (ONC) – the federal agency that standardizes information technology requirements for healthcare providers – is collecting information about specific data elements to include in a new behavioral healthcare data set. NABH encourages you to help with this important project. The task is a joint effort between ONC and the Substance Abuse and Mental Health Services Administration (SAMHSA) to create the draft United States Core Data for Interoperability (USCDI) + BH to address core data and interoperability for behavioral health needs beyond the scope of the USCDI. In December 2023, ONC launched a new USCDI+ platform to support the organization, linking of domains, and functionality to solicit and receive feedback for all USCDI+ domains. HHS’ goal with this activity is to confirm the data points needed to improve and advance care continuity for patients who see behavioral healthcare providers and other healthcare providers. Survey respondents will identify the specific data metrics from among 187 options – such as the patient’s address, insurance information, clinical data points, and more – that HHS should collect, as well as items that HHS should not collect. Your expertise will help develop an eventual government-endorsed data set for the behavioral healthcare field and also influence a separate HHS effort to develop a future behavioral health information technology system.   Behavioral Health Information Technology, or BHIT, is one of NABH’s top advocacy priorities, so we strongly urge you and your teams’ health IT experts to complete ONC’s survey by no later than Friday, March 29. Meanwhile, NABH is working with its committees to prepare an association comment letter to ONC. Please contact Rochelle Archuleta with any questions.

Register Today for the NABH Education and Research Foundation’s Talent-Recruitment Webinars

The NABH Education and Research Foundation will host a two-part webinar series about talent recruitment featuring NABH members and workforce experts in March and April. Part I –Talent Recruitment: Exploring Short-Term Solutions – on Tuesday, March 26 will feature Foundation Vice President Jim Shaheen, CEO of New Season/Colonial Management Group, LP; Foundation Secretary Mary Pawlikowski, president at Vanderbilt Psychiatric Hospital and Clinics; and workforce consultant Beth Kuhn of Stonegate Strategies. In this hourlong webinar, presenters will lead participants in an interactive discussion to share and discuss their talent-recruitment and retention challenges, as well as their best, short-term strategies to address those problems. These practices include re-organizing recruitment teams to align with operations, developing alumni outreach initiatives, streamlining an organization’s onboarding process, conducting stay interviews, and more. Please join us and click here to register for Part I on March 26 at 2 p.m. ET! The second webinar in this series will examine longer-term solutions to recruiting talent – such as Registered Apprenticeship Programs, education and certification opportunities, fellowships, and more – on Thursday, April 18 at 2 p.m. ET. NABH Board Chair Frank Ghinassi, Ph.D., A.B.P.P. president and CEO, Rutgers University Behavioral Health Care and senior vice president, Behavioral Health and Addictions Service Line, RWJBarnabas Health, will lead the April webinar along with Kuhn and workforce consultant John Pallasch of One Workforce Solutions. Pallasch served previously as the assistant secretary for employment and training at the U.S. Labor Department.   Please join us and click here to register for Part II on April 18!

President Biden’s Fiscal 2025 Budget Proposal Aims to Transform Behavioral Healthcare

President Biden this week unveiled his fiscal year (FY) 2025 budget proposal, which would provide considerable funding to achieve the Biden administration’s goal of transforming behavioral healthcare in America. Each year, the president’s budget proposal is most significant for sending a message about the administration’s priorities. President Biden’s FY 2025 proposal provides $1 billion to advance BHIT adoption and interoperability among providers. It also provides a combined total of $216 million for mental health programs, including $200 million from the Bipartisan Safer Communities Act, a 900% increase in program funding since 2021. The funds will help to increase the number of school-based counselors, psychologists, social workers, and other mental health professionals in K-12 schools. NABH is also pleased to see the president’s budget proposal seeks to strengthen parity by requiring all commercial market health plans to cover mental health and substance use disorder benefits; ensuring that plans have an adequate network of behavioral health providers; and improving the U.S. Labor Department’s (DOL) ability to enforce the law. The budget includes $275 million over 10 years to increase the DOL’s capacity to ensure that large group market health plans and issuers comply with mental health and substance use disorder requirements, and to act against plans and issuers that do not comply. The budget’s other behavioral healthcare provisions include: investing in strengthening the behavioral healthcare workforce, including integration into primary care settings; increasing funding for the Children’s Mental Health Initiative by $50 million; increasing funding for the State Opioid Response grant program, investing in a new technical assistance center to strengthen health providers’ understanding and treatment of substance use and women’s mental health; expanding the 988 Suicide and Crisis Lifeline, and more.

SAMHSA to Host Webinar Next Week on Assisted Outpatient Treatment Program for Individuals with Serious Mental Illness

SAMHSA will host a virtual webinar for prospective applicants interested in applying for the fiscal year 2024 Assisted Outpatient Treatment Program for Individuals with Serious Mental Illness (AOT). The webinar will provide an overview of SAMHSA’s late-February AOT funding opportunity and application requirements. Registration is not required for the webinar on Wednesday, March 20 from 2:30 – 4 p.m. ET.

Register Today for the 2024 NABH Annual Meeting

Please remember to register for the 2024 NABH Annual Meeting, The Future of Behavioral Healthcare and reserve your hotel room at the Salamander Washington, DC from May 13-15, 2024.   This year’s meeting will examine and discuss critical issues that behavioral healthcare providers manage today and will continue to address tomorrow, including access to care, parity, technology, workforce, the political environment, and more. We look forward to seeing you in Washington!

Join Us for Hill Day 2024

Please remember to sign up for Hill Day 2024 on Tuesday, May 14, the second day of this year’s Annual Meeting. Hill Day is an excellent opportunity to meet one-on-one with legislators to discuss the issues that matter most to behavioral healthcare providers. After you register for the NABH Annual Meeting, the NABH Congressional Affairs team will match you with legislators who represent you or your facility footprint. Closer to the day of the meeting, we will send you a meeting schedule, materials, and talking points to guide your conversations with Members of Congress and their staff. Please indicate in your Annual Meeting registration form that you are interested in Hill Day, and be sure to include all the states where your system has a footprint. If you have an existing relationship with a legislator, please let us know!

Reminder: Please Submit Data to NABH’ Denial-of-Care Portal

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:

1. 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.

1. 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.

In Case You Missed It: NABH’s 2024 Advocacy Priorities

NABH released its 2024 Advocacy Priorities, which we urge you to read and share with your Government Relations teams. Topping NABH’s priorities this year are parity, workforce, behavioral healthcare information technology, America’s ongoing addiction crisis, and the Institutions for Mental Diseases (IMD) exclusion.

Fact of the Week

In 2021 and 2022, people ages 75 and older had the highest suicide rate among all age groups, largely driven by males, according to the Centers for Disease Control and Prevention and noted in a recent Health Affairs article. For questions or comments about this CEO Update, please contact Jessica Zigmond.

NABH Supported Behavioral Healthcare Riders in Funding Package Passes House and Awaits Senate Passage

House and Senate Leadership agreed to a six-bill spending package with a March 9 deadline that contains a narrow list of health measures, including several important NABH priorities. The agreement set up a Wednesday vote in the House, which passed the legislation 339-85 and sent the package to the Senate. The Senate is expected to consider and pass the legislation today or early tomorrow morning to avoid a partial government shutdown. Following passage of the initial package, lawmakers will have roughly three additional weeks to fund HHS as part of the second funding package which has a March 22 deadline. The limited health care riders include NABH priority provisions to permanently require state Medicaid plans to cover medication-assisted treatment and to create a permanent state Medicaid option allowing treatment of substance use disorder at institutions. Other behavioral health provisions include establishing Certified Community Behavioral Health Clinic services as an optional Medicaid benefit, requiring HHS to issue guidance on how states can improve integrating behavioral health with primary care, and a provision to make treatments more streamlined for justice-involved Medicaid beneficiaries — states must suspend rather than terminate coverage for incarcerated enrollees. The skinny health care package also includes funding to eliminate the statutorily required payment reductions intended to offset hospitals’ uncompensated care costs through Dec. 31, 2024. Notably excluded from the healthcare package is the Modernizing Opioid Treatment Access Act (MOTAA), which NABH and coalition partners advocated extensively to stop. Other healthcare provisions excluded include an extension of now-expired pandemic provisions allowing employers to offer telehealth as a separate benefit, highly-debated items related to prescription drugs and hospitals, such as pharmacy benefit manager (PBM) reforms, hospital price transparency measures, or any site neutral payment policies for hospitals. There is the potential that some healthcare provisions could move with the March 22 funding package or in a year-end health package following the November elections. Should another healthcare package emerge, NABH will continue to advocate for remaining SUPPORT Act provision priorities and to prevent any effort to include MOTAA.

HHS Announces Steps to Assist Providers After Change Healthcare Cyberattack

HHS on Thursday announced what the Centers for Medicare & Medicaid Services (CMS) is doing to help healthcare providers continue to serve patients following the late-February cyberattack on Change Healthcare, a unit of UnitedHealth Group (UHG). The HHS announcement also said the department is in regular contact with UHG leadership, state partners, and with numerous external stakeholders to better understand the nature of the impacts and to ensure the effectiveness of UHG’s response. “HHS has made clear its expectation that UHG does everything in its power to ensure continuity of operations for all health care providers impacted and HHS appreciates UHG’s continuous efforts to do so,” said in its statement. “HHS is also leading interagency coordination of the Federal government’s related activities, including working closely with the Federal Bureau of Investigations (FBI), the Cybersecurity and Infrastructure Security Agency (CISA), the White House, and other agencies to provide credible, actionable threat intelligence to industry wherever possible.” Click here to read about the steps CMS is taking to assist providers. And please contact NABH if your system has been affected by the cyberattack and/or if you have questions for NABH.

SAMHSA Announces $36.9 Million in Behavioral Healthcare Grant Funding

The Substance Abuse and Mental Health Services (SAMHSA) recently announced $36.9 million in grant program funding to support behavioral healthcare services nationwide. The funding covers a variety of areas, including $10 million for screening, brief intervention, and referral to treatment; more than $6 million to support first responders and others with training, administering, and distributing naloxone and other Food and Drug Administration (FDA)-approved opioid overdose reversal medications or devices; and more than $5 million to help expand and ensure that students in health professional receive SUD education early in their academic careers and have a basic knowledge of strategies to identify and treat addiction and support recovery after they graduate. Click here to read about the other funding opportunities.

Register for the NABH Education and Research Foundation’s Talent Recruitment Webinars

The NABH Education and Research Foundation will host a two-part webinar series about talent recruitment featuring NABH members and workforce experts in March and April. Part I –Talent Recruitment: Exploring Short-Term Solutions – will be held Tuesday, March 26, 2024 at 2 p.m. ET. Foundation Vice President Jim Shaheen, CEO of New Season/Colonial Management Group, LP, and Foundation Secretary Mary Pawlikowski, president at Vanderbilt Psychiatric Hospital and Clinics, will join workforce consultant Beth Kuhn of Stonegate Strategies for this interactive webinar to help NABH members learn about and share their best, short-term solutions to recruiting talent. Kuhn has more than 30 years of workforce experience and has served in both Democratic and Republican administrations, including in her roles as commissioner of the Kentucky Department of Workforce Investment and as Vermont’s director of workforce development. She has also served as chief engagement officer at the Kentucky Cabinet of Health and Family Services. The second webinar in this series will examine longer-term solutions to recruiting talent – such as Registered Apprenticeship Programs, education and certification opportunities, fellowships, and more – on Thursday, April 18 at 2 p.m. ET. NABH Board Chair Frank Ghinassi, Ph.D., A.B.P.P. president and CEO, Rutgers University Behavioral Health Care and senior vice president, Behavioral Health and Addictions Service Line, RWJBarnabas Health, will lead the April webinar with Kuhn and workforce consultant John Pallasch of One Workforce Solutions. Pallasch served previously as the assistant secretary for employment and training at the U.S. Labor Department. Please join us and click here to register for Part 1 on March 26 and here to register for Part 2 on April 18!

Alcohol Deaths Jump During Pandemic

A new CDC study found that more than 178,300 people died from excessive alcohol use during 2020 and 2021 in the U.S., a 29% increase from 2016 and 2017, and that the number of people who died per year increased by more than 40,000 within six years. Female deaths had a 35% spike compared to 27% for males.  The report suggests that increases may have been caused by changes in alcohol policies during the COVID-19 pandemic in which many states permitted alcohol carryout and delivery to homes for off-premises consumption.

SAMHSA to Hold Briefing on CFR Amendments

Join a virtual stakeholder briefing on Thursday, March 14, 3-4 pm ET, unveiling recent amendments to 42 CFR part 8 of the Code of Federal Regulations (CFR) governing opioid treatment program (OTP) certification and treatment standards. Published on Feb. 2, 2024, these revisions aim to enhance care access through reduced barriers, flexible treatment, and telehealth integration. This event will include a presentation from Dr. Yngvild Olsen, director of SAMHSA’s Center for Substance Abuse Treatment (CSAT), others, and followed by a Q&A and discussion. Register for this breifing here.

Register Today for the 2024 NABH Annual Meeting!

Please remember to register for the 2024 NABH Annual Meeting, The Future of Behavioral Healthcare and reserve your hotel room at the Salamander Washington, DC from May 13-15, 2024.   This year’s meeting will examine and discuss critical issues that behavioral healthcare providers manage today and will continue to address tomorrow, including access to care, parity, technology, workforce, the political environment, and more. We look forward to seeing you in Washington!

Reminder: Please Submit Data to NABH’ Denial-of-Care Portal

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:

1. 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.

1. 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.

In Case You Missed It: NABH’s 2024 Advocacy Priorities

Last week NABH released its 2024 Advocacy Priorities, which we urge you to read and share with your Government Relations teams. Topping NABH’s priorities this year are parity, workforce, behavioral healthcare information technology, America’s ongoing addiction crisis, and the Institutions for Mental Diseases (IMD) exclusion.

Fact of the Week

Research from the Treatment Advocacy Center (TAC) reports that bed availability within state psychiatric hospitals reached a low of 10.8 beds per population of 100,000 in 2023. TAC’s report attributed this trend to a variety of circumstances, including the COVID-19 pandemic and the increasing, disproportionate number of beds filled by individuals from the criminal legal system.   For questions or comments about this CEO Update, please contact Jessica Zigmond.

Now Available: NABH 2024 Advocacy Priorities!

NABH is pleased to share its 2024 Advocacy Priorities, which we urge you to read and share with your Government Relations teams. Topping NABH’s priorities this year are parity, workforce, behavioral healthcare information technology, America’s ongoing addiction crisis, and the Institutions for Mental Diseases (IMD) exclusion. “NABH’s 2024 advocacy priorities reflect the organization’s mission to advance responsive, accountable, and clinically effective prevention, treatment, and care for children, adolescents, adults, and older adults with mental health (MH) and substance use disorders (SUD),” the advocacy priorities document notes. “2024 is a critically important year as the country continues to face intense access challenges for both MH and SUD patients. Demand for our services across all age groups nationwide has never been higher.

NABH Education and Research Foundation to Host Webinar Series on Talent Recruitment

The NABH Education and Research Foundation will host a two-part webinar series about talent recruitment featuring NABH members and workforce experts in March and April. Part I –Talent Recruitment: Exploring Short-Term Solutions – will be held Tuesday, March 26, 2024 at 2 p.m. ET. Foundation Vice President Jim Shaheen, CEO of New Season/Colonial Management Group, LP, and Foundation Secretary Mary Pawlikowski, president at Vanderbilt Psychiatric Hospital and Clinics, will join workforce consultant Beth Kuhn of Stonegate Strategies for this interactive webinar to help NABH members learn about and share their best, short-term solutions to recruiting talent. Kuhn has more than 30 years of workforce experience and has served in both Democratic and Republican administrations, including in her roles as commissioner of the Kentucky Department of Workforce Investment and as Vermont’s director of workforce development. She has also served as chief engagement officer at the Kentucky Cabinet of Health and Family Services. The second webinar in this series will examine longer-term solutions to recruiting talent – such as Registered Apprenticeship Programs, education and certification opportunities, fellowships, and more – on Thursday, April 18 at 2 p.m. ET. NABH Board Chair Frank Ghinassi, Ph.D., A.B.P.P. president and CEO, Rutgers University Behavioral Health Care and senior vice president, Behavioral Health and Addictions Service Line, RWJBarnabas Health, will lead the April webinar with Kuhn and workforce consultant John Pallasch of One Workforce Solutions. Pallasch served previously as the assistant secretary for employment and training at the U.S. Labor Department. Please join us and click here to register for Part 1 on March 26 and here to register for Part 2 on April 18!

Lawmakers Avert Government Shutdown; Healthcare Funding Package Slated for Late March

Federal lawmakers this week averted a partial government shutdown after the Senate on Thursday approved a two-step Continuing Resolution that clears the path for policymakers to conclude appropriations work and prepare for a healthcare funding package scheduled for March 22. The House and Senate moved quickly to pass a stopgap funding bill ready for President Biden’s signature this weekend, buying more time to finalize half a dozen spending bills that congressional leaders must pass by the new March 8 deadline. The vote will set up a first tranche of full-year spending bills, which include the Agriculture, Commerce-Justice-Science, Energy-Water, Interior-Environment, Military Construction-VA and Transportation-Housing and Urban Development measures. Enacting these bills would fund those agencies through Sept. 30. Congress will consider a second batch of bills as they face a new deadline of March 22 to avoid a partial government shutdown. That package includes the Defense, Financial Services, Legislative Branch, Homeland Security, Labor-HHS-Education and State-Foreign Operations measures. A final deal on the Labor-HHS bill could include a stripped-down healthcare package with a handful of priorities, including a NABH priority: an IMD provision that would make the state plan amendment option permanent. Other healthcare priorities expected in the bill include a partial fix to Medicare physician pay cuts, extended funding for community health centers, and delayed disproportionate share hospital cuts. Other long-debated health policy measures – including pharmacy benefit manger reforms, site-neutral hospital policies, transparency reforms, and some SUPPORT Act provision reauthorizations – are likely to be set aside until the lame-duck session after November’s elections. MOTAA proponents will likely continue to advocate for including this measure – which NABH will continue to oppose – in a November funding package.

SAMHSA to Host Webinar on Models to Reduce Frequent Service Utilization for Individuals with MH and SUD

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) GAINS Center will host the webinar Implementing Complex Care Models to Reduce Frequent Service Utilization Among Individuals Experiencing Mental and Substance Use Disorders later this month. As SAMHSA noted in its announcement, people with complex healthcare needs, including mental and substance use disorders, can sometimes fall through service gaps and cycle among emergency, criminal justice, and hospital systems. Their complex needs require a person-centered approach to care and linkages to support treatment retention and recovery. Learn more in this webinar on Thursday, March 21 starting at 1:30 p.m. ET. Click here to register.

Now Open: 2024 NABH Annual Meeting Registration

Registration is now open for the 2024 NABH Annual Meeting, The Future of Behavioral Healthcare. Please join us at the Salamander Washington, DC from May 13-15, 2024 for this year’s Annual Meeting to examine and discuss critical issues that behavioral healthcare providers manage today and will continue to address tomorrow, including access to care, parity, technology, workforce, the political environment, and more. Click here to register for the meeting and reserve your hotel room. We look forward to seeing you in Washington!

Join Us for Hill Day 2024!

Please remember to sign up for Hill Day 2024 on Tuesday, May 14, the second day of this year’s Annual Meeting. Hill Day is an excellent opportunity to meet one-on-one with legislators to discuss the issues that matter most to behavioral healthcare providers. After you register for the NABH Annual Meeting, the NABH Congressional Affairs team will match you with legislators who represent you or your facility footprint. Closer to the day of the meeting, we will send you a meeting schedule, materials, and talking points to guide your conversations with Members of Congress and their staff. Please indicate in your Annual Meeting registration form that you are interested in Hill Day, and be sure to include all the states where your system has a footprint. If you have an existing relationship with a legislator, please let us know!

Reminder: Please Submit Data to NABH’ Denial-of-Care Portal

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:

1. 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.

1. 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.

Fact of the Week

In areas with some racial or ethnic diversity, there is a large decline in the geographic availability of buprenorphine prescribers and prescription fills, according to a new study from the University of Pittsburgh. “In areas that are less than 95% white, for example, there’s a 45 to 50% drop (in access),” said Coleman Drake in a U.S. News and World Report article. Drake is an assistant professor of health policy and management at Pitt Public Health in Pittsburgh and the study’s lead author.   For questions or comments about this CEO Update, please contact Jessica Zigmond.

DOL Includes Mental Health in $200 Million Grant Announcement for Registered Apprenticeships

The U.S. Labor Department this week announced nearly $200 million in grants to support public-private partnerships that expand, diversify, and strengthen Registered Apprenticeships and included mental health occupations under the “care economy” sector that is eligible to apply. The funding opportunity includes $95 million of competitive grants through the second round of the Apprenticeship Building America Grant Program and $100 million in the second round of State Apprenticeship Expansion Formula Grants. The Apprenticeship Building America Grant Program aims to leverage Registered Apprenticeships as a workforce solution while assuring that people from underrepresented and underserved communities can access high-quality training and pre-apprenticeships that lead directly to enrolling in a Registered Apprenticeship program. In addition to the care economy, sectors include information technology/cybersecurity, K-12 teacher occupations, clean energy, hospitality, public sector, and supply chain sector (logistics, warehousing, transportation, manufacturing). Click here to learn about the second round of the Apprenticeship Building America Grant Program and here to learn about the State Apprenticeship Expansion Formula grants. The NABH Education and Research Foundation will host a webinar this spring to help members learn more about Registered Apprenticeships and will provide details soon.

U.S. Supreme Court Rejects UBH Request to Hear Claim Denial Case

In a win for behavioral healthcare providers, the U.S. Supreme Court this week rejected a request for appeal from United Behavioral Health (UBH) to hear a behavioral health claim denial case. The initial case centered on how health plans under the Employee Retirement Income Security Act (ERISA) handle clinician insights in the denial-appeal process and how those decisions should be communicated to members. UBH sought to challenge a prior court’s rule pertaining to whether the health plan gave the plaintiff – a patient who ultimately died by suicide – a full and fair review during the denial-appeals process. The Supreme Court’s rejection this week upholds the 10^th U.S. Circuit Court of Appeals’ May 2023 ruling, which noted: “United argues its actions were not arbitrary and capricious because it met certain ERISA regulatory requirements. It points to regulations which discuss requirements for engagement with medical opinions in ERISA disability plans,” and continued: “We recognize the textual difference in the ERISA disability and ERISA medical regulations pointed out by United but disagree that the dialogue absolves United from its duty to engage in meaningful dialogue that includes a full and fair review of the insured’s claim.”

National Academies Report Urges Developing Standards to Limit Potential Social Media Harms on Adolescent Mental Health

A recent report from the National Academies of Sciences, Engineering, and Medicine (NASEM) recommends developing new industry standards to limit the potential harms of social media on adolescent mental health while bolstering its possible benefits. The report notes that during the past 15 years, an increase in young people’s smartphone usage has coincided with a decline in mental health, a damaging  association that U.S. Surgeon General Vivek Murthy, M.D., M.B.A, warned against in a May 2023 advisory. Click here to read the JAMA article about the NASEM report.

HHS & DOJ to Host Webinar on Tech-facilitated Abuse in Teen Relationships Next Week

In conjunction with February’s Teen Dating Violence Awareness Month, HHS and the U.S. Justice Department (DOJ) will host a webinar on Feb. 28 to help participants learn about the use of technology in teen dating and its related impacts on behavioral health. HHS’ Office of Family Violence Prevention and Services and Substance Abuse and Mental Health Services Administration, along with DOJ’s Office on Violence Against Women, will lead the 75-minute event, which will also examine non-consensual image-sharing and practices to address these challenges at the community level. Click here to register for the webinar, which will begin at 3 p.m. ET next Wednesday.

Now Open: 2024 NABH Annual Meeting Registration

Registration is now open for the 2024 NABH Annual Meeting, The Future of Behavioral Healthcare. Please join us at the Salamander Washington, DC from May 13-15, 2024 for this year’s Annual Meeting to examine and discuss critical issues that behavioral healthcare providers manage today and will continue to address tomorrow, including access to care, parity, technology, workforce, the political environment, and more. Click here to register for the meeting and reserve your hotel room. We look forward to seeing you in Washington!

Reminder: Please Submit Data to NABH’ Denial-of-Care Portal

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:

1. 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.

1. 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.

Fact of the Week

A recent report from union group National Nurses United showed 81.6% of nurses polled said they had experienced workplace violence in at least one form. Respondents reported the three most common types of violence were being verbally threatened (67.8%), physically threatened (38.7%), and being pinched or scratched (37.3%).   For questions or comments about this CEO Update, please contact Jessica Zigmond.

NABH Remembers Youth Services Committee Member Mike Lyons, M.S.

NABH remembers with grateful appreciation Mike Lyons, M.S., 54, who died unexpectedly of a brain aneurysm on Sunday, Feb. 11. Mike served as vice president of specialty education for Universal Health Services’ (UHS) Behavioral Health Division, where he was responsible for implementing UHS’ Best in Class Academic Accountability System throughout the organization’s network of academic programs in acute, partial hospitalization, residential, and day-school settings. Mike also championed education legislation at the state and federal levels to make certain that children and adolescents with mental illness receive an equitable and quality educational experience. At the association, Mike was an influential and supportive member of the Youth Services Committee, where his fellow members and NABH team respected him highly for his insights, thoughtful comments, and devotion to helping kids learn. As an example, last year Mike sent his regrets for missing the 2023 Annual Meeting and Youth Services Committee meeting so he could attend the high school graduation ceremony at one of UHS’ facilities. Mike will be missed by all who knew him. There will be a celebration of Mike’s life at The Casa Bella Club House, 6005 Anello Drive, Melbourne, Florida 32940 from 2 – 5 p.m. on Saturday, Feb. 17. In lieu of flowers, donations can be made to Camp Marist, 22 Abel Boulevard, Effingham, New Hampshire, 03882. Under the leadership of the Marist Brothers for more than 70 years, Camp Marist is based in New Hampshire’s White Mountain Lakes region and is a place where children learn about character, leadership, and community.

NABH Sends MOTAA Opposition Letter to Congressional Leaders

This week NABH sent a letter to House and Senate leaders outlining the association’s strong opposition to the Modernizing Opioid Treatment Access Act (MOTAA). “The Modernizing Opioid Treatment Access Act (MOTAA) [H.R. 1359 / S. 644] would permit addiction physicians outside OTPs to prescribe methadone that would be dispensed through pharmacies,” NABH wrote in its letter. “This legislation has not been vetted appropriately with stakeholders, the House has not held a hearing to examine it, and the Senate has given it only a cursory review,” the letter continued. “The bill’s goal is to provide greater access to methadone; however, patient safety concerns with such an untested approach warrants further review and attention before further congressional consideration.” NABH cautioned that MOTAA would significantly introduce more danger of overdose given the safety profile of methadone (versus buprenorphine, for example). Instead, NABH wrote that implementing the Substance Abuse and Mental Health Services Administration’s (SAMHSA) regulations released on Feb. 2 would be a more effective approach to providing greater access. “They will allow greater access to individuals of all ages, provide greater convenience for patients, bolster the workforce, ease expansion to broader settings of care (medication units and mobile units), and more,” NABH wrote. “The regulations also recognize that methadone has a more dangerous pharmacological profile than other medications for OUD.”

CMS Clarifies Parameters on Using AI in Coverage Decisions for MA Plans

In a recent memo, the Centers for Medicare & Medicaid Services (CMS) clarified that Medicare Advantage (MA) plans cannot use artificial intelligence (AI) and algorithms to deny prior authorization requests but may use the technology to assist in coverage decisions. This clarification – published in the memo as frequently asked questions (FAQ) – is based on the agency’s April 2023 rule, which took effect on Jan. 1, 2024. In the FAQ, the agency responds to concerns about inappropriate coverage denials based on algorithms. “An algorithm or software tool can be used to assist MA plans in making coverage determinations, but it is the responsibility of the MA organization to ensure that the algorithm or artificial intelligence complies with all applicable rules for how coverage determinations by MA organizations are made,” the agency noted in its FAQ. This scrutiny aligns with recent lawsuits against UnitedHealth Group, Humana, and Cigna’s MA plans, as well as a 2022 HHS Office of the Inspector General report about the erroneous algorithm coverage decisions.

Kaiser Family Foundation to Examine Prior Authorization in Webinar Next Week

The Kaiser Family Foundation (KFF) will host a webinar on Feb. 22 featuring a panel of four experts who will explore why insurers use prior authorization, its effect on patients and providers, and how new regulations may change current practices. Larry Levitt, KFF’s executive vice president for health policy, will moderate the 45-minute discussion that will include Troyen Brennan, M.D., adjunct professor of health policy and management at the Harvard T.H. Chan School of Public Health and former CVS Care executive; Fumiko Chino, M.D., radiation oncologist at Memorial Sloan Kettering Cancer Center; Anna Schwamlein Howard, principal, policy development at the American Cancer Society Action Network; and Kaye Pestaina, KFF’s vice president and director of the Program on Patient and Consumer Protection.   Click here to register for the webinar, which is scheduled for Thursday, Feb. 22 at noon ET.

SAMHSA Releases Resource on Medicaid Coverage of Medications for Alcohol and Opioid Use Disorders

SAMHSA has released a report that provides an update on the present state of coverage, availability of, and access to medications within state Medicaid plans for treating ongoing alcohol use disorder (AUD) and opioid use disorder (OUD) and reversing an opioid overdose. The new resource also includes examples of efforts to increase access to medications for treating SUD. SAMHSA also developed an hourlong webinar and slides in conjunction with the report.

SAMHSA Announces New SUD-Related Funding Opportunities

SAMHSA this week released two separate notices of funding opportunities focused on SUD. In the first funding notice, SAMHSA will distribute up to 10 awards totaling $9.95 million to implement the screening, brief intervention, and referral to treatment public health model for children, adolescents, and/or adults in primary care and community health settings, HMOs, PPOs, health plans, federally qualified health centers, children’s hospitals, and more with a focus on screening for underage drinking, opioid use, and other substance use. The other funding notice will distribute up to 18 awards totaling $5.4 million to expand and assure that graduate-level healthcare students receive SUD education early in their academic careers and prepare them to identify and treat UD in mainstream healthcare after they graduate.

Now Open: 2024 NABH Annual Meeting Registration

Registration is now open for the 2024 NABH Annual Meeting, The Future of Behavioral Healthcare. Please join us at the Salamander Washington, DC from May 13-15, 2024 for this year’s Annual Meeting to examine and discuss critical issues that behavioral healthcare providers manage today and will continue to address tomorrow, including access to care, parity, technology, workforce, the political environment, and more. Click here to register for the meeting and reserve your hotel room. We look forward to seeing you in Washington!

Join Us for Hill Day 2024!

Please remember to sign up for Hill Day 2024 on Tuesday, May 14, the second day of this year’s Annual Meeting. Hill Day is an excellent opportunity to meet one-on-one with legislators to discuss the issues that matter most to behavioral healthcare providers. After you register for the NABH Annual Meeting, the NABH Congressional Affairs team will match you with legislators who represent you or your facility footprint. Closer to the day of the meeting, we will send you a meeting schedule, materials, and talking points to guide your conversations with Members of Congress and their staff. Please indicate in your Annual Meeting registration form that you are interested in Hill Day, and be sure to include all the states where your system has a footprint. If you have an existing relationship with a legislator, please let us know!

Reminder: Please Submit Data to NABH’ Denial-of-Care Portal

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:

1. 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.

1. 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.

Fact of the Week

Behavioral healthcare jobs made three of the top seven and five of the top 20 jobs in Indeed’s Best Jobs of 2024, which focused on jobs w/ a minimum salary of $75,000 and w/ at least 10% of postings that included remote or hybrid work.   For questions or comments about this CEO Update, please contact Jessica Zigmond.

Now Open: 2024 NABH Annual Meeting Registration!

Registration is now open for the 2024 NABH Annual Meeting, The Future of Behavioral Healthcare. Please join us at the Salamander Washington, DC from May 13-15, 2024 for this year’s Annual Meeting to examine and discuss critical issues that behavioral healthcare providers manage today and will continue to address tomorrow, including access to care, parity, technology, workforce, the political environment, and more. Click here to register for the meeting and reserve your hotel room. We look forward to seeing you in Washington!

SAMHSA and ONC Launch Behavioral Health Information Technology Initiative

HHS’ Substance Abuse and Mental Health Services Administration (SAMHSA) and Office of the National Coordinator for Health Information Technology (ONC) this week announced they will invest more than $20 million of SAMHSA funds in the next three years to advance health information technology (IT) in behavioral healthcare and practice settings. The announcement acknowledged that behavioral healthcare providers lag behind other providers in health IT adoption in part because they are ineligible to participate in health IT incentive programs that the Centers for Medicare & Medicaid Services (CMS) provide. An ONC analysis of American Hospital Association survey data from 2019 and 2021 found that 86% of non-federal, general acute care hospitals had adopted a 2015-edition certified electronic health record (EHR), while only 67% of psychiatric hospitals had adopted the same certified EHR. Meanwhile, ONC analysis of SAMHSA survey data from 2020 show psychiatric hospitals lag even further behind in adoption of interoperability and patient engagement functions. To address these challenges, the Behavioral Health Information Technology (BHIT) Initiative will identify and pilot a set of behavioral health-specific data elements with SAMHSA’s Substance Use Prevention, Treatment, and Recovery Services Block Grant and Community Mental Health Services Block Grant grantees and Community Mental Health Services Block Grant grantees. The data elements will be coordinated via a new USCDI+ domain for behavioral health to improve the effectiveness and reduce the costs of data capture, use, and exchange for behavioral health providers. This year ONC, SAMHSA, and other federal partners will begin to identify data elements for the USCDI+ project as part of the broader BHIT Initiative. This collaborative approach will incorporate input on behavioral health priorities from a variety of individuals and entities including clinicians, grantees, states, and advocates. Then SAMHSA and ONC will coordinate with technology developers and participating providers on how to best include USCDI+ behavioral health data elements in health IT and pilot their use.

HHS Finalizes ‘42 CFR Part 2’ Rule to Better Align with HIPAA Standards

HHS on Thursday released its final Confidentiality of Substance Use Disorder (SUD) Patient Records rule to implement the Coronavirus Aid, Relief, and Economic Security Act (CARES) amendments to the federal substance use confidentiality rule – commonly known as 42 CFR part 2, or Part 2. Consistent with NABH recommendations, the new rules further align Part 2’s requirements with the Health Insurance Portability and Accountability Act’s (HIPAA) rules and the Health Information Technology for Economic and Clinical Health Act (HITECH). Although opponents to these changes argued they were unnecessary, HHS nonetheless adopted these modifications to align with HIPAA, a rule that has historically had fewer privacy protections than part 2. The new rule permits patients to provide one-time consent for the disclosure of treatment records; permits an accounting of disclosures; strengthens prohibitions against disclosure of records in civil, criminal, or legislative proceedings, and provides HHS with enforcement authority, including financial penalties. Importantly, the rule creates a new definition for SUD clinicians’ notes that is analogous to the protections HIPAA provides for psychotherapy notes. The rule will become effective 60 days after publication and compliance is not required until 2026. Meanwhile, HHS’ Office for Civil Rights plans to finalize changes to the HIPAA Notice of Privacy Practices (NPP) to address uses and disclosures of protected health information that is also protected by Part 2 along with other changes to the NPP requirements, in an upcoming final rule modifying the HIPAA privacy. In addition, HHS plans to implement in separate rulemaking the CARES Act antidiscrimination provisions that prohibit the use of patients’ Part 2 records against them.

CMS Releases Updated State Medicaid & CHIP Telehealth Toolkit

CMS this week released an updated State Medicaid & Children’s Health Insurance Program (CHIP) Telehealth Toolkit, a series of resources that include telehealth policies and information about telehealth platforms, billing best practices, strategies to deliver accessible and culturally competent care via telehealth, and more. The resources provide states with statutory and regulatory infrastructure issues to consider as they evaluate the need to expand their telehealth capabilities and coverage policies, including coverage and reimbursement policies, providers, and practitioners eligible to provider telehealth, technology requirements, considerations for specific populations, and state examples and strategies.

Prevent Suicide New Jersey to Host Safety Planning Intervention Workshop on Feb. 28

Prevent Suicide New Jersey, a partnership among state departments, professional and community organizations, schools, and families, will host a free workshop on Feb. 28 about the Stanley Brown Safety Planning Intervention (SPI), a collaborative, clinical intervention that results in a prioritized written list of warning signs, coping strategies, and resources for suicidal individuals. The virtual workshop will teach participants the six steps to create a safety plan: 1) recognizing warning signs; 2) identifying internal coping strategies; 3) identifying other people or social settings for distraction; 4) identifying individuals to ask for help; 5) identifying professionals and agencies for help; and 6) making the environment safe. The New Jersey Chapter, American Academy of Pediatrics (NJAAP), ABFT International Training Institute, LLC, and the U.S. Journal of Training are co-sponsoring the training, and the webinar is open to certified licensed community behavioral health clinicians, school-based behavioral health providers, and interested community members. Click here to register.

Reminder: Please Submit Data to NABH’ Denial-of-Care Portal

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:

1. 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.

1. 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.

Fact of the Week

Researchers at the University of Texas at Austin, the University of Texas at Dallas, and the University of Miami have identified a molecule that reduces hypersensitivity in trials in mice by binding to a protein they have shown is involved in neuropathic pain, according to a study published in Science Daily. The new compound, dubbed FEM-1689, does not engage opioid receptors in the body, making it a possible alternative to existing pain medications linked to addiction.   For questions or comments about this CEO Update, please contact Jessica Zigmond.

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:

1. 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.

1. 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.

CMS $50 Million in Grants for School-Based Health Services, Particularly for Mental Health

The Centers for Medicare & Medicaid Services (CMS) this week announced $50 million in state grant funding to connect millions more children to critical healthcare services, especially mental health, in schools. The funding comes through the Bipartisan Safer Communities Act and will provide 20 states up to $2.5 million each in funding that can help states implement, enhance, and expand school-based health services through Medicaid and the Children’s Health Insurance Program, or CHIP. “This funding will be transformational for states at any stage in developing school-based health services programs, which represent one of CMS’ most powerful tools for expanding access to care for our children,” CMS Administrator Chiquita Brooks-LaSure said in an announcement about the funding. “Medicaid and CHIP cover over 39 million children. This targeted support is one way CMS can help kids get the health care they need by meeting them where they are — in school.” CMS said it anticipates a total of 20 grant awards, with a minimum of 10 awards to states that have yet to cover school-based health services for all children covered under Medicaid or CHIP. In addition, the agency said up to 10 grants are intended for states that have taken initial steps to expand school-based health services, with the hope that these grants will enhance or refine their existing programs. Applications for grant funding are due by March 25 and funding is expected by this summer. Click here for more information.

National Academy for State Health Policy Updates State Opioid Settlement Tracker

The National Academy for State Health Policy (NASHP) this month updated its tracker to show how states are implementing administrative structures to disburse an expected $50 billion awarded to states and localities from opioid-related lawsuits, which includes $26 billion awarded to 46 states as part of the National Opioid Settlement. These structures include strategies for engaging a wide variety of stakeholders on priorities for reducing opioid-related deaths and investing in SUD prevention, treatment, and recovery infrastructure. NASHP released an issue brief about its tracker in December 2022 to show funding allocated to each state through the National Opioid Settlement, as well as laws, agreements, and processes that states have established for allocating the funds.

Now Available: NABH Education and Research Foundation Webinar Resources and Interview

Thank you to all who joined or watched our foundation’s webinar, Redesigning the Present and Future Behavioral Healthcare Workforce, on Tuesday, Jan. 23. NABH regrets that we were unable to hear from NABH Education and Research Foundation President and co-presenter Don Parker soon after the webinar began due to a power outage in Parker’s service area. Below is an exchange between Parker and co-presenter Beth Kuhn, principal at workforce consultancy Stonegate Strategies, in a post-webinar interview. BK: Don, what can you tell us about the top workforce challenges you experienced at Hackensack Meridian Health System? DP: At the start of the COVID-19 pandemic, the Hackensack Merdian Health System asked the system’s Behavioral Health Care Transformation Services to develop a post-pandemic strategy recognizing that we would have two major problems to deal with: a rapidly increasing demand for behavioral healthcare, given all of the fear, loss, isolation and uncertainty our citizens were experiencing, and an unpredictable reaction from our staff who had the same fears but just multiplied given the nature of their jobs in health care. Although we slowed our feared staff exodus, similar to every other hospital in America, it increased and has led to shortages across the professions. As we now face both supply (under staffing of all levels of professionals) and demand (unprecedented demand for behavioral health from every age cohort) our HMH team has turned its focus to improving retention and attracting new recruits to bolster our veterans. BK: Your system has been especially focused on building partnerships to support your talent supply efforts.  What can you tell us about your approach? DP: Knowing we would face a shortage of psychiatrists, HMH initiated 64 psychiatry resident slots and 16 fellowships (heavily weighted to children). Our first class graduated last year and began to fill our ranks.  For the many residents and fellows we recruited to stay at HMH, we engaged them in an “Earn While You Learn” program for their final year. They received what would be equal to a signing bonus in monthly increments for the year. It provided great recruitment and retention. Our health system created two new nursing school partnerships with all the nurses rotating through the HMH psychiatry locations. The exposure has proven to be highly beneficial to our nursing recruitment. On the Mental Health Technician front, we have initiated several programs in partnership with the Local Workforce Investment Boards and the Community Colleges. I have had more than a 30-year history of working closely with WIBs. I also served as chairman of the WIB in my county in New Jersey for several years. I have been a Board Member of the Community College in my County for 17 years and personally started my education in a Junior College. BK: One webinar participant asked for information on what “resiliency investments” look like. It seems to me that you have some answers within your overall retention strategy. DP: Our administrative staff were deeply concerned that we would experience an exodus of our staff due to the sheer everyday extreme stress they were experiencing. During the pandemic HMH engaged in multiple staff support strategies, from shortened schedules, on the spot individual and group counseling, integrative medicine delivered remotely or on the spot, as well every morale booster we could engage in. In addition, as a retention strategy, HMH has shifted to a Strength-based motivational system (our version of Strength-based therapy). We expect that the focus on creating a mindset as a Survivor as opposed to being a victim of the pandemic will have a major impact on improving retention. BK: Apprenticeship seems to hold a lot of potential, both in bringing more professionals into your system and in prompting workforce redesign.  Tell us about HMH apprenticeship efforts. DP: Our post-pandemic initiatives have featured two collaborations with Middlesex Community College in New Jersey and the WIB Board. In Fall 2023, we worked with Middlesex to develop and deliver a certification as a Mental Health Technician. While not specifically designated as an apprenticeship, it served the purpose, as the academics, designed in collaboration with the HMH staff, were delivered to the college, with the on-the-job at HMH Psychiatric Hospitals. HMH has engaged in designing a second MHT Certification with a specialization in Integrative medicine. Each of our four psychiatric inpatient hospitals at HMH provide a daily curriculum filled with options for patients to engage in relaxation exercises, music therapy, yoga, Qigong, exercise programs, and a substantial exposure to art therapy. We expect this initiative will expand our recruitment pool to all the integrative medicine providers who practice in the community and can blend their practices with a job that offers steady income and benefits.

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:

1. 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.

1. 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

Semaglutide, a highly popular medication that the U.S. Food and Drug Administration has approved to treat obesity and manage type 2 diabetes, was associated with a 49% to 73% lower risk of first-time or recurring suicidal ideations compared with other medications for controlling obesity and type 2 diabetes that work via different mechanisms, according to a recent NIH-funded study.   For questions or comments about this CEO Update, please contact Jessica Zigmond.

NABH Education and Research Foundation to Kick Off Webinar Series Next Week

The NABH Education and Research Foundation is pleased to host its first webinar, Redesigning the Present and Future of Behavioral Healthcare, on Tuesday, Jan. 23, 2024 from 2 p.m. – 3 p.m. ET. Foundation President Donald Parker, who serves as president of Behavioral Health Care Transformation Services for Hackensack Meridian Health, will co-lead the webinar with workforce consultant Beth Kuhn of Stonegate Strategies. Kuhn has more than 30 years of workforce experience – with special interest and expertise in behavioral healthcare workforce development – and has served in both Democratic and Republican administrations, including in her roles as commissioner of the Kentucky Department of Workforce Investment and as director of workforce development at the Vermont Department of Labor. Kuhn’s accomplishments include creating the Strategic Initiative for Transformation Employment, or SITE, a statewide model designed to bridge the gap between recovery and workforce participation for individuals active in their recovery from substance use issues. During this interactive webinar, participants are encouraged to ask questions of Kuhn and Parker, who will provide an overview of existing behavioral healthcare workforce challenges; explain why America’s current workforce structure doesn’t meet present or future workforce needs; suggest redesign strategies, present examples of current successes; and offer ideas about how to leverage current options to help providers develop a more robust workforce system. Please join us and click here to register for this free webinar!

Congress Clears Stop Gap Funding Extension, Delaying Potential Healthcare Package

Staving off a government shutdown, House and Senate lawmakers passed legislation this week to extend the federal government’s current funding deadlines into March. The House passed the bill in 314-108 vote hours after the Senate passed the measure 77-18. The legislation extends funding for agencies under four appropriations bills that were scheduled to expire today, Jan. 19 – Agriculture, Rural Development, Food and Drug Administration, and related agencies; Energy and Water Development; Military Construction, Veterans Affairs, and related agencies; and Transportation, Housing and Urban Development, and related agencies – until March 1. Funding covered under the remaining eight bills that were scheduled to expire Feb. 2 have been extended through March 8. Lawmakers have indicated they expect this is the final stopgap spending measure needed for fiscal year 2024. Several non-controversial healthcare provisions were included in the March 8 stopgap measure, such as providing continued funding for community health centers, teaching health centers and the National Health Service Corps; funding special diabetes programs; averting steep cuts to hospitals that have a high volume of uninsured and Medicaid patients; and providing continued funding for the Sexual Risk Avoidance Education Program, which aims to limit teen pregnancy and domestic violence. The bill did not address several expired health programs, including the SUPPORT Act reauthorization; the global HIV/AIDS program, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR); the Pandemic and All-Hazards Preparedness Act; and heath price transparency legislation. Lawmakers are expected to include those programs in a potential March deal, if Congress doesn’t have to punt again with another spending patch. NABH continues to advocate for SUPPORT Act reauthorization and to stop the Modernizing Opioid Treatment Access Act (MOTAA) as part of a broader healthcare package. Health policy leaders in the House and Senate remain in negotiations on a final package.

CMS Increases Prior Authorization Timeliness and Transparency in Final Rule

The Centers for Medicare & Medicaid Services (CMS) this week finalized a rule that takes concrete steps to shorten the prior authorization process, which physicians and providers use to request health plan coverage for medical treatments and services that a physician has prescribed for a patient. In part, this rule responds to recent government audits that found that many government-contracted health plans were denying coverage inappropriately for services that actually were covered. The rule mostly takes effect for managed contracts in 2026 and beyond for insurers who contract with Medicare, Medicaid, and the Children’s Health Insurance Program, but not private insurance. Specifically, health plans will be required to make prior authorization coverage decisions within seven days and 72 hours for urgent requests. The rule also requires health plans to provide a specific reason for denying a prior-authorization request, which will help facilitate the correction of fixable claims as well as denial appeals. These payers also will be required to report their clinical and/or policy basis publicly for prior-authorization denials. Finally, to further reduce administrative burden, payers will now be required to conduct prior authorizations using a common electronic interface for transactions and data exchange, using Health Level 7 and other applications. Overall, CMS estimates that the final rule will reduce federal healthcare expenditures by approximately $15 billion over 10 years. Click here to learn more in the agency’s fact sheet.

CMS Announces Model to Test Approaches for Advancing Integration in Behavioral Health

CMS on Thursday introduced its Innovation in Behavioral Health (IBH) model to improve the care quality and outcomes for adults with Medicare and Medicaid who have mental health conditions and/or substance use disorder (SUD) by connecting them with the physical, behavioral, and social supports they need. The CMS Innovation Center will test the new IBH model, under which community-based behavioral healthcare practices will form interprofessional care teams composed of behavioral and physical health providers, as well as community-based supports. This new model supports President Biden’s mental health strategy and implements an action item in the HHS Roadmap for Behavioral Health Integration.   “The Biden-Harris administration will continue to explore innovative ways to help people with mental health conditions and/or substance use disorder,” HHS Secretary Xavier Becerra said in an announcement. “Put simply, mental health is health—and by expanding access to the high-quality care that people need, we are changing lives.” CMS’ announcement said through the interprofessional care teams, people will experience an integration of services that will bridge the gaps between physical and behavioral health. The model enables a “no wrong door” approach, meaning that regardless of how patients enter care, they will have access to all available services. Through this practice, IBH also aims to reduce overall program expenditures. The model will launch in Fall 2024, and CMS said it expects it to operate for eight years in up to eight states. CMS will release a notice of funding opportunity for the model in Spring 2024. Click here to learn more.

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:

1. 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.

1. 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 SAMHSA’s Food and Mood Project aims to promote emotional wellness and reduce the impact of mental health and substance use conditions among the nation’s K-12 population by implementing strategies that address the intersection among behavioral health, food/nutrition security, and cultural food diversity.   For questions or comments about this CEO Update, please contact Jessica Zigmond.

Congress Returns to Urgent Funding Deadlines and Full 2024 Agenda

Congress returned to Washington this week facing two deadlines to fund all federal government operations as it works to clear some policy priorities – including a healthcare package with the SUPPORT Act’s reauthorization – ahead of the 2024 campaign season. In early January, House Speaker Mike Johnson (R-La.) and Senate Majority Leader Chuck Schumer (D-N.Y.) agreed to topline funding figures, allowing congressional appropriations leaders to begin the process of negotiating each of the spending allocations for all 12 spending bills. Congress has until Jan. 19 before the first government funding deadline for the U.S. Agriculture, Energy, Housing and Urban Development, Transportation, and Veterans Affairs Departments. All other departments, including HHS, are funded through Feb. 2. There is a growing likelihood that Congress will have to pass a short-term continuing resolution (CR) to allow lawmakers to agree on funding, although conservative House members are strongly opposed to that action and threaten to derail progress. Congressional leaders have indicated a healthcare package will likely be included in the first funding bill, due to the urgency in addressing several expired health programs and funding provisions for physician payments. This package will include several healthcare bills the House and Senate have passed.   NABH continues to advocate strongly for the SUPPORT Act’s reauthorization with new provisions and opposes the Modernizing Opioid Treatment Access Act (MOTAA), which only the Senate HELP Committee has passed and the House has not considered. MOTAA proponents are strongly advocating for this bill to be included in the final package, and NABH and coalition partners are working with both congressional chambers to prevent this effort. This advocacy includes working with members of the Senate HELP Committee who oppose MOTAA to continue raising concerns with their Senate leadership; contacting members who serve on the Senate Judiciary Committee; contacting other senators who share concerns with law enforcement officials about implementing this legislation; as well as contacting members of the House Energy and Commerce Committee and House Judiciary Committee. House Energy & Commerce Republicans remain strongly opposed to including MOTAA in any legislative package. NABH continues to emphasize to Members of Congress that there is no consensus on MOTAA and these policies need more vetting. Other health policies that lawmakers might fold into a larger legislative package include addressing expired telehealth regulations, Medicare’s physician pay cut, transparency measures, reporting requirements for insurers, hospitals and pharmacy benefit managers, and site-neutral payment provisions. In addition, funds for graduate medical education, community health centers, and special diabetes programs sunset on Jan. 19, and certain Medicaid disproportionate share hospital cuts are delayed until that date. NABH will continue to support provisions important to our members and fight to prevent bad policies from becoming law. Please see next week’s edition of CEO Update for the latest information.  

NABH Education and Research Foundation to Host Workforce Webinar on Jan. 23

Please join us for the NABH Research and Education Foundation’s first webinar, Redesigning the Present and Future of Behavioral Healthcare, on Tuesday, Jan. 23, 2024 from 2 p.m. – 3 p.m. ET. Foundation President Donald Parker, who serves as president of Behavioral Health Care Transformation Services for Hackensack Meridian Health, will co-lead the webinar with workforce consultant Beth Kuhn of Stonegate Strategies. Kuhn has more than 30 years of workforce experience – with special interest and expertise in behavioral healthcare workforce development – and has served in both Democratic and Republican administrations, including in her roles as commissioner of the Kentucky Department of Workforce Investment and as Vermont’s director of workforce development. Kuhn’s accomplishments include creating the Strategic Initiative for Transformation Employment, or SITE, a statewide model designed to bridge the gap between recovery and workforce participation for individuals active in their recovery from substance use issues. During this interactive webinar, participants are encouraged to ask questions of Parker and Kuhn, who will provide an overview of existing behavioral healthcare workforce challenges; explain why America’s current workforce structure doesn’t meet present or future workforce needs; suggest redesign strategies, present examples of current successes; and offer ideas about how to leverage current options to help providers develop a more robust workforce system. Please click here to register for this free webinar and share the link with members of your teams!

CMS Administrator Brooks-LaSure to Outline Agency’s 2024 Priorities in Stakeholder Call

The Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure will host a stakeholder call to discuss the agency’s 2023 accomplishments, 2024 priorities, and CMS Strategic Plan on Tuesday, Jan. 23. CMS Principal Administrator and Chief Operating Officer Jon Blum and other members of the CMS leadership team will also serve as presenters during the hourlong call, which will begin at 1 p.m. ET. Click here to register.

CMS Releases State Plan Summaries for American Rescue Plan of 2021

CMS has released state spending plan summaries for a section of the American Rescue Plan of 2021 (ARP) that provides information about the amount of money spent on activities to enhance, expand, or strengthen community-based services. NABH members might find the report useful because it includes information about state spending on efforts related to workforce, technology, education, behavioral healthcare support for youth, housing and homelessness, and more. Click here for the full report and to read your state’s summary.

Save the Date for the NABH 2024 Annual Meeting!

Registration will open soon for the NABH 2024 Annual Meeting, The Future of Behavioral Healthcare, at the Salamander Washington, DC from May 13-15, 2024. Please plan to join us!  

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:

1. 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.

1. 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.

Fact of the Week

About 52,000 Medicare enrollees experienced an opioid overdose in 2022; however, only 18% of Medicare patients with opioid use disorder received medication-assisted treatment, according to a report from the HHS Office of the Inspector General. For questions or comments about this CEO Update, please contact Jessica Zigmond.

NABH Welcomes Frank Ghinassi, Ph.D. as 2024 Board Chair

NABH is pleased to welcome Rutgers University Behavioral Health Care (UBHC) President and CEO Frank Ghinassi, Ph.D. as chair of the NABH Board of Trustees for 2024. A longstanding NABH member, Frank has served the association in many capacities, including as board treasurer, Quality Committee chair, and Annual Meeting program chair. As UBHC’s CEO, Frank is responsible for a statewide system of academically based mental health and addiction services across New Jersey; managing an annual operating budget of $320 million and 2,200 staff and faculty. UBHC, one of the largest providers of behavioral and addictions healthcare in the country, offers a wide range of clinical services across all diagnosis, and across the lifespan, including inpatient units, partial hospitalization programs, intensive outpatient programming, case management, traditional outpatient treatment, correctional health care, a Certified Community Behavioral Health Center, peer operated helplines for service members, veterans, mothers of children with special needs, law enforcement officers and child protection workers, a statewide suicide prevention hotline and a clinical research and training institute, as well as an array of specialty and peer support services. Frank also serves as professor at Rutgers Graduate School of Applied and Professional Psychology; an adjunct professor of psychiatry at Rutgers Robert Wood Johnson Medical School; an adjunct associate professor of psychiatry at the University of Pittsburgh School of Medicine; and a core faculty member at Rutgers Global Health Institute. The association’s Washington-based team is eager to work with Frank this year and appreciates his vision and leadership. NABH is also grateful to Sheppard Pratt President and CEO Harsh Trivedi, M.D., M.B.A. for his service as the association’s 2023 board chair and all he has done to promote NABH, its priorities, and its mission. Thank you, Harsh!

NABH Letter to CMS Cites Concerns about Medicare Advantage Plans that Block Access to Care

NABH this week sent a letter to the Centers for Medicare & Medicaid Services (CMS) expressing concerns about Medicare Advantage (MA) plans that either block or delay access to behavioral healthcare services. The association’s letter endorsed and also made recommendations related to the rule’s positive provisions, such as incentivizing MA coverage for additional behavioral healthcare practitioners and inclusion in a health plans’ provider networks; annually analyzing the health equity level of MA plans relative to underserved populations; and laying the groundwork for increased data collection on MA coverage decisions, appeals and decision rationales. NABH’s letter also urged CMS to modify its existing proposal to improve the appeals process for MA enrollees in certain settings to include behavioral healthcare settings, which the letter describes in detail.

Sen. John Fetterman Discusses His Battle with Depression on NBC’s ‘Meet the Press’

In an exclusive interview with NBC News’ “Meet the Press” on Dec. 31, Sen. John Fetterman (D-Pa.) spoke candidly about his experience with clinical depression and how he is grateful for receiving treatment. The first-term senator was discharged March 31 from Walter Reed National Medical Center, where he had received treatment for clinical depression. Fetterman checked himself in for treatment on Feb. 15 last year following a battle with depression that worsened during his recovery from a stroke he suffered in May 2022. “The line [is] ‘I’m living my best life,’ and I really am, because I just am so grateful,” Fetterman told journalist Kristen Welker. “And I’m always talking about mental health because I want everybody that can hear that is that help works, and you should get help. And please, don’t suffer any longer, because you deserve to be better. And I’m so grateful to do that, and I’m paying it forward by talking about it.” Click here to watch Fetterman’s interview.

NABH Education and Research Foundation to Host Workforce Webinar on Jan. 23

The NABH Education and Research Foundation is pleased to host its first webinar, Redesigning the Present and Future of Behavioral Healthcare, on Tuesday, Jan. 23, 2024 from 2 p.m. – 3 p.m. ET. NABH Education and Research Foundation President Donald Parker, who serves as president of Behavioral Health Care Transformation Services for Hackensack Meridian Health, will co-lead the webinar with workforce consultant Beth Kuhn of Stonegate Strategies. Kuhn has more than 30 years of workforce experience – with special interest and expertise in behavioral healthcare workforce development – and has served in both Democratic and Republican administrations, including in her roles as commissioner of the Kentucky Department of Workforce Investment and as Vermont’s director of workforce development. Kuhn’s accomplishments include creating the Strategic Initiative for Transformation Employment, or SITE, a statewide model designed to bridge the gap between recovery and workforce participation for individuals active in their recovery from substance use issues. Throughout this interactive webinar, participants are encouraged to ask questions of Parker and Kuhn, who will provide an overview of existing behavioral healthcare workforce challenges; explain why America’s current workforce structure doesn’t meet present or future workforce needs; suggest redesign strategies, present examples of current successes; and offer ideas about how to leverage current options to help providers develop a more robust workforce system. The Foundation will also ask attendees poll questions during the hourlong webinar to gauge member interest in future workforce events and resources. Please join us and click here to register for this free webinar!

National Academies to Host Webinar on Behavioral Healthcare Provider Experience with Public Insurance Programs Next Week

The National Academies’ Committee on Strategies to Improve Access to Behavioral Health Care Services through Medicare and Medicaid will host a virtual webinar that discusses behavioral healthcare provider experiences with public insurance programs on Wednesday, Jan. 10. This webinar will examine the experiences of behavioral healthcare providers who accept Medicare, Medicaid, and Marketplace insurance and discuss what can be done to increase access to behavioral healthcare services for this patient population. Click here to register for the two-hour webinar, which starts at 2 p.m. ET next Wednesday.

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:

1. 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.

1. 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 mark your calendars and plan to join us at the Salamander Washington, DC from May 13-15, 2024 for this year’s NABH Annual Meeting!

Fact of the Week

A new study in Psychiatry Research suggests ethnoracial inequities in patient assignment to buildings that differed in clinical and physical conditions. Examining data from more than 18,000 unique patients during a period of six years, researchers said the findings serve as a call to action for hospital systems to examine the ways in which structural racism impact clinical care.   For questions or comments about this CEO Update, please contact Jessica Zigmond.

NABH Education and Research Foundation to Host Workforce Webinar in January

The NABH Education and Research Foundation is pleased to host its first webinar, Redesigning the Present and Future of Behavioral Healthcare, on Tuesday, Jan. 23, 2024 from 2 p.m. – 3 p.m. ET. Foundation President Donald Parker, who serves as president of Behavioral Health Care Transformation Services for Hackensack Meridian Health, will co-lead the webinar with workforce consultant Beth Kuhn of Stonegate Strategies. Kuhn has more than 30 years of workforce experience – with special interest and expertise in behavioral healthcare workforce development – and has served in both Democratic and Republican administrations, including in her roles as commissioner of the Kentucky Department of Workforce Investment and as Vermont’s director of workforce development. Kuhn’s accomplishments include creating the Strategic Initiative for Transformation Employment, or SITE, a statewide model designed to bridge the gap between recovery and workforce participation for individuals active in their recovery from substance use issues. During this interactive webinar, participants are encouraged to ask questions of Parker and Kuhn, who will provide an overview of existing behavioral healthcare workforce challenges; explain why America’s current workforce structure doesn’t meet present or future workforce needs; suggest redesign strategies, present examples of current successes; and offer ideas about how to leverage current options to help providers develop a more robust workforce system. Please join us and click here to register for this free webinar!

NABH 2024 Board Election Ballots Due Friday, Dec. 29!

NABH has e-mailed system members NABH Board of Trustees candidate profiles and a ballot to elect new members to the 2024 Board. If you have not done so, please vote for the open Board Chair-Elect position and four available Board seats; sign the ballot (it is not valid without a signature); and return it to NABH. You can do this by scanning your completed ballot and e-mailing it nabh@nabh.org or maria@nabh.org. NABH must receive all ballots no later than Friday, Dec. 29, 2023. New Board members and the Board Chair-elect will take office in January 2024.

SAMHSA Releases Advisory on Implementing Low-Barrier Care to Expand Access and Improve Outcomes for Individuals with SUD

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released an advisory that outlines recommendations to implement low barrier models of care to significantly expand access to lifesaving treatment for individuals with substance use disorders (SUD). Despite evidence showing the effectiveness of SUD treatment, fewer than 10% of individuals who need care receive it. Barriers such as lack of treatment availability, strict program requirements, stigma, and discrimination. The advisory emphasizes the importance of low barrier care in overcoming substantial gaps in access to SUD treatment and engaging more people in care.

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:

1. 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.

1. 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 mark your calendars and plan to join us at the Salamander Washington, DC from May 13-15, 2024 for next year’s NABH Annual Meeting!

Fact of the Week

The Centers for Disease Control and Prevention reports that while the provisional number of suicides in 2022 (49,449) was 3% higher than in 2021 (48,183), suicide rates for people in age groups 10–14, 15–24, and 25–34 declined 18%, 9%, and 2%, respectively, from 2021 to 2022.

Happy Holidays from NABH!

NABH will not publish CEO Update next week and will resume on Friday, Jan. 5, 2024. The entire NABH team wishes you, your families, and your teams a very happy, healthy, and safe holiday season!   For questions or comments about this CEO Update, please contact Jessica Zigmond.

House & Senate Advance Key Behavioral Healthcare Legislation to Consider in the New Year

The House and Senate advanced several behavioral healthcare-related bills this week that NABH either supports and opposes and Congress is expected to consider early in the New Year.   The Senate Health, Education, Labor and Pensions (HELP) Committee marked up several pieces of legislation, including reauthorization of the SUPPORT Act and S. 644, the Modernizing Opioid Treatment Access Act (MOTAA). The Committee approved its version of the SUPPORT Act reauthorization bill 19-1. This bill would reauthorize programs to improve the prevention, treatment, and recovery of substance use disorders (SUD), including supporting training for first responders and programs that support youth and mental health. The legislation also directs the U.S. Health and Human Services Department (HHS) and the Drug Enforcement Agency (DEA) to establish a special registration program permitting physicians to prescribe controlled substances through telemedicine, among other provisions. The Modernizing Opioid Treatment Access Act, S. 644 was reported favorably as amended by a roll call vote of 16-5 with Ranking Member Sen. Bill Cassidy, M.D. (R-La.) supporting the legislation. Sens. Susan Collins (R-Maine), Rob Marshall (R-Kan.), Tommy Tuberville (R-Ala.), Markwayne Mullin (R-Okla.), and Ted Budd (R-NC) voted against the bill. NABH opposed the bill, which would expand access to methadone by permitting take-home prescribing of the drug through pharmacies.   On Wednesday the House passed both the Lower Costs, More Transparency Act (H.R. 5378), and the H.R.4531, the Support for Patients and Communities Reauthorization (SUPPORT) Act of 2023.  H.R. 5378 contains provisions to promote more transparency within various sectors of the healthcare industry; delay certain disproportionate share payment cuts; and extend funding for community health centers, the National Health Service Corp, and teaching health centers that operate graduate medical education (GME) programs. The bill also increases reporting requirements for insurers, hospitals and pharmacy benefit managers, and changes Medicare payment policy so that drugs administered in a hospital outpatient department are reimbursed at the same rate as they are in a physician’s office, a policy known as site-neutral payments.   Meanwhile, House Energy and Commerce Subcommittee on Health Chair Brett Guthrie (R-Ky.) and Rep. Anne Kuster (D-N.H.) led H.R.4531, the Support for Patients and Communities Reauthorization (SUPPORT) Act of 2023, which the House passed in a 386-37 vote. The bill includes several important NABH priorities, including permanently lifting Medicaid’s IMD Exclusion, which restricts access to care for rehab and institutional care services; ensuring Medicaid beneficiaries have access to Medication Assisted Treatment; reauthorizing resources for residential SUD treatment for pregnant and postpartum women; and monitoring prescribing of antipsychotic medications. The House Energy and Commerce Committee passed H.R. 4531 in a 49-0 vote this past July. These healthcare bills, in addition to the Senate Finance Committee’s previously passed Better Mental Health Care, Lower-Cost Drugs and Extenders Act, which included language from S. 3098, the Securing Advances and a Variety of Evidence-Based (SAVE) Institutions for Mental Diseases (IMD) Options Act which would make the state plan amendment option permanent, will be rolled into one healthcare package for Congress to consider in the New Year. Other healthcare issues include addressing scheduled cuts to the Medicare Physician Fee Schedule (MPFS), reform and transparency for pharmacy benefit managers (PBM) and Medicare Advantage (MA) plans, and other bipartisan policies to address drug shortages, antimicrobial resistance, and workforce needs. Congress has two early deadlines in 2024 to move the healthcare package across the finish line — Jan. 19 and Feb. 2, the latter of which includes the deadline for Labor-HHS-Education funding bill. NABH and allied partners will be working to stop MOTAA and include our policy priorities in this final package.

HHS Takes Step to Regulate AI in Health Data, Technology, and Interoperability Final Rule

HHS this week unveiled the department’s data-related priorities for the next two years in a rule that includes information about data sharing across the government and the private sector and using artificial intelligence (AI) to boost medical innovation and improve health outcomes. HHS’ Office of the National Coordinator (ONC) for Health Information Technology finalized its Health Data, Technology, and Interoperability rule, which establishes the first transparency requirements for AI and other predictive algorithms that are part of certified health information technology. ONC reports that it certifies health IT that supports care delivered by more than 96% of hospitals and 78% of office-based physicians nationwide. The final rule also implements the 21^st Century Cures Act’s requirement to adopt a Condition of Certification (the “Insights Condition”) for developers of certified health IT to report certain metrics as part of their participation in the Certification Program. These metrics will give more insight into how certified health IT is used in support of care delivery. Click here to learn when ONC will host information sessions about the rule in January and February.

CMS Releases Guidance on Dually Eligible Beneficiaries Receiving Medicare Part B Marriage and Family Therapist, Mental Health Counselor, and Intensive Outpatient Services

The Centers for Medicare & Medicaid Services (CMS) on Thursday released Guidance to State Medicaid Agencies on Dually Eligible Beneficiaries Receiving Medicare Part B Marriage and Family Therapist Services, Mental Health Counselor Services, and Intensive Outpatient Services, an informational bulletin with changes that take effect on Jan. 1, 2024.   Beginning in the New Year, Medicare will become the primary payer for dually eligible beneficiaries receiving these services from Medicare-enrolled practitioners or providers. According to CMS, typically state Medicaid agencies may not pay claims if it is likely that a third party (such as Medicare) is liable for the claim, as Medicaid is generally the payer of last resort. For dually eligible beneficiaries, Medicare is generally liable for claims for Medicare-covered services, including MFT services, MHC services, and IOP services furnished on or after Jan. 1, 2024, and therefore state Medicaid agencies are required to cost-avoid claims for such services, or seek reimbursement from the practitioner or provider. Currently, MFTs and MHCs provide services that can be covered as an optional state plan benefit such as services of other licensed practitioners under the Medicaid state plan. IOP services are generally covered through the optional rehabilitative services benefit under the Medicaid state plan.

AMCHP and ASTHO Release Guidance on Public Health Approaches to Perinatal Substance Use

The Association of Maternal & Child Health Programs (AMCHP) and the Association of State and Territorial Health Officials (ASTHO) have released a special issue of the Maternal and Child Health Journal focused on public health approaches to perinatal substance use. This December 2023 special issue features 21 open-access articles with the latest research, programs, and policy initiatives related to perinatal substance use that highlight approaches to preventing and mitigating the harmful effects of perinatal substance use and improving maternal and child health. AMCHP and ASTHO will host a virtual forum about the special issue on Tuesday, Dec. 19 at 12:30 p.m. ET. Click here to learn more and register.

NABH 2024 Board Election Ballots Due Friday, Dec. 29!

NABH has e-mailed system members NABH Board of Trustees candidate profiles and a ballot to elect new members to the 2024 Board. If you have not done so, please vote for the open Board Chair-Elect position and four available Board seats; sign the ballot (it is not valid without a signature); and return it to NABH. You can do this by scanning your completed ballot and e-mailing it nabh@nabh.org or maria@nabh.org. NABH must receive all ballots no later than Friday, Dec. 29, 2023. New Board members and the Board Chair-elect will take office in January 2024.

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:

1. 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.

1. 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 mark your calendars and plan to join us at the Salamander Washington, DC from May 13-15, 2024 for next year’s NABH Annual Meeting!

Fact of the Week

Overdoses in the United States involving methadone were 48% higher in 2020 than in 2019, according to a study of overdose deaths during the COVID-19 pandemic published in Forensic Science International.   For questions or comments about this CEO Update, please contact Jessica Zigmond.

Senate HELP Committee to Mark Up SUPPORT Act Reauthorization Bill Next Week

The Senate Health, Education, Labor, and Pensions (HELP) Committee is slated to mark up the Substance-Use Disorder Prevention that Promotes Opioid Recovery and Treatment Act’s (SUPPORT Act) reauthorization bill along with other legislation – including the Modernizing Opioid Treatment Access Act (MOTAA) – on Tuesday, Dec. 12. The SUPPORT Act expired on Sept. 30, and Congress has long been expected to reauthorize the opioid treatment and prevention programs that the 2018 law created. NABH sent a Government Relations Network alert asking members to contact Senate HELP Committee members and urge them to apply an all-hands-on-deck approach to America’s mental health and addiction crises by reauthorizing the SUPPORT Act’s expired provisions. The association also asked NABH members to encourage HELP Committee members to oppose the MOTAA bill, which would threaten patient safety if methadone prescriptions were allowed outside opioid treatment programs. While the MOTAA bill was not incorporated into the underlying SUPPORT Act, lawmakers will consider it as stand-alone legislation and the committee may pass it. If this happens, NABH will work with partners to oppose the bill if it moves to the full Senate for a vote and also urge House lawmakers not to consider it. Also next week, the House is expected to pass its version of the SUPPORT Act, which includes several NABH priorities. The House Energy and Commerce Committee passed this bill with bipartisan support and did not consider the MOTAA bill in this legislation. Meanwhile, House and Senate conferees are negotiating a broader healthcare package for Congress to consider in early 2024. NABH will provide the latest information about these and other congressional actions next week and future editions of CEO Update.

ONDCP to Host Webinar on Medicaid 1115 Re-Entry Demonstration Opportunity on Dec. 12

The White House Office of National Drug Control Policy (ONDCP) will host a webinar on Tuesday, Dec. 12 to highlight the state of Washington’s work on the Medicaid Re-Entry Demonstration Opportunity that the Centers for Medicare and Medicaid Services (CMS) announced in April 2023. The opportunity allows states to cover a package of pre-release services, including medications for opioid use disorder and connection to substance use disorder care, for up to 90 days before an incarcerated individual’s release date. To date, 16 states have applied for the waiver and two states have been approved. Click here to register for the 90-minute webinar, which will begin at 2:30 p.m. ET on Tuesday.

National Academies to Host Webinar About Social Media and Adolescent Health on Dec. 13

The National Academies of Sciences, Engineering, and Medicine will host a webinar next week highlighting the conclusions and recommendations from the Academies’ ad hoc committee that drafted a report about social media’s effect on adolescents’ mental and physical health. Click here to learn more and register for the hourlong webinar, which will start at noon ET on Wednesday, Dec. 13.

CMS Provides Guidance to States on Mandatory Medicaid and CHIP Core Set Reporting Requirements

CMS sent a letter to state health officials that offered guidance about implementing the reporting requirements outlined in the Mandatory Medicaid and Children’s Health Insurance Program (CHIP) Core Set Reporting final rule that the agency released in August. The letter includes guidance about mandatory reporting regulations and adherence to reporting guidance; Core Set measures for which reporting is mandatory in 2024; the populations who must be included in reporting and the population exemption process; categories of stratified data that must be reported in or before 2025; measures subject to stratification in 2025; attribution rules; and the Child and Adult Core Set State Plan Amendment.

Reminder: Please Contribute Data to NABH’s Enhanced Denial-of-Care Portal

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:

1. 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.

1. 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 mark your calendars and plan to join us at the Salamander Washington, DC from May 13-15, 2024 for next year’s NABH Annual Meeting!

Fact of the Week

The first government-sanctioned overdose prevention centers (OPCs) opened in New York City in November 2021, drawing concerns that they might increase crime and disorder. A new study in JAMA that examined two OPCs and 17 syringe service programs found no significant increases in crimes recorded by the police or calls for emergency service.   For questions or comments about this CEO Update, please contact Jessica Zigmond.

Please Urge Your Senators to Reauthorize the SUPPORT Act and Oppose MOTAA

As Congress returned this week for its year-end push, NABH continues to advocate for federal lawmakers to reauthorize the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT) and oppose the Modernizing Opioid Treatment Access Act (MOTAA). The Senate Health, Education, Labor and Pensions (HELP) Committee has not announced a markup for these bills; however, lawmakers may act on them during the first or second week of December. As NABH outlined in a letter to Sen. Bill Cassidy, M.D. (R-La.) on Nov. 22, the association supports efforts to reauthorize the expired provisions of the SUPPORT Act. NABH wrote in the letter that the nation’s mental health crisis requires an all-hands-on-deck approach, and that it makes no sense to limit grantees based on a facility’s tax status when many individuals who need mental health and substance use disorder services are not able to access those services. Meanwhile, in a letter to the Senate HELP Committee this week, NABH expressed our firm opposition to the MOTAA bill, which would threaten patient safety if methadone prescription would be allowed outside Opioid Treatment Programs (OTPs). Our concern reflects the complexity of this patient population, which requires comprehensive and ongoing clinical oversight that would be difficult for busy pharmacies to provide. To assure patient safety, NABH supports additional research and data collection prior to altering current methadone prescribing protections provided by OTPs. Please help NABH’s advocacy efforts by contacting Senate HELP Committee members in your region and urge their support to reauthorize the SUPPORT Act and oppose MOTAA. Thank you for your support! Please contact NABH Director for Congressional Affairs Andy Dodson if you have questions.

HHS OIG Reports Low Misuse of Medicare Part D Buprenorphine

A new report from HHS’ Office of the Inspector General (OIG) found most Medicare Part D beneficiaries prescribed buprenorphine for opioid use disorder received recommended amounts in 2022, meaning there was likely little misuse of the drug. The findings are similar to a 2021 report’s results, which led the OIG to conclude in the new review that there continues to be little risk of buprenorphine misuse among Part D enrollees. Click here to read the full report.

Bipartisan Policy Center to Host Medicare Reform Webinar on Dec. 11

The Bipartisan Policy Center (BPC) will explore potential solutions to improve the beneficiary experience and ensure a fiscally responsible Medicare program, which nearly 20% of Americans rely on for healthcare coverage and is estimated to become insolvent by 2031. During the discussion, BPC will release federal policy recommendations meant to enhance Medicare benefits, increase competition, establish better program management, and improve financing. The hourlong event starts at 11:30 a.m. ET. Click here to register.

NIDA to Host ‘Monitoring the Future’ Survey Data Release Webinar on Dec. 13

The National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH) will host a webinar to discuss results from its annual Monitoring the Future (MTF) survey on Wednesday, Dec. 13. The MTF survey has measured drug and alcohol use and related attitudes among adolescent students nationwide since 1975. In it, a nationally representative sample of survey participants report their drug use behaviors across three time periods: lifetime, past year, and past month. NIDA funds the survey, which is conducted by the University of Michigan. This year, the hourlong briefing will feature Marsha Lopez, Ph.D., M.H.S., who serves as chief of the epidemiology research branch in NIDA’s Division of Epidemiology, Services and Prevention Research. The webinar will begin at 10 a.m. ET. Click here to register.

National Academies to Host Workshop that Examines Adult ADHD Diagnosis & Treatment

The National Academies’ Forum on Drug Discovery, Development and Translation and Forum on Neuroscience and Nervous System Disorders will host a workshop to explore the diagnosis and treatment of adults with Adult Attention-Deficit/Hyperactivity (ADHD) Disorder and the challenges and opportunities for drug development on Dec. 12 and 13. The workshop is intended to offer professionals who typically diagnose ADHD—such as physicians, psychologists, social workers, nurse practitioners, and other licensed counselors or therapists—as well as drug developers, researchers, and regulators, to discuss and support the public health goal of treating adults with ADHD safely and effectively. Supported partly through a grant from the Food and Drug Administration’s Center for Drug Evaluation and Research, the workshop will be presented on Tuesday, Dec. 12 from 8:30 a.m. – 5 p.m. ET and on Wednesday, Dec. 13 from 8:30 a.m. – 2 p.m. ET. Click here to register.

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:

1. 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.

1. 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 mark your calendars and plan to join us at the Salamander Washington, DC from May 13-15, 2024 for next year’s NABH Annual Meeting! Fact of the Week Drug overdose deaths rose noticeably between January to June 2018 and July to December 2021 among 10- to 44-year-old girls and women who were pregnant or pregnant within the previous 12 months, according to a new study by NIDA researchers at the NIH. For questions or comments about this CEO Update, please contact Jessica Zigmond.

SAMHSA Releases 2022 National Survey on Drug Use and Health

Among U.S. adults aged 18 or older in 2022, 23.1%, or 59.3 million people, had any mental illness in the past year while 48.7 million people aged 12 or older, or 17.3%, had a substance use disorder (SUD) in the past year, according to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2022 National Survey on Drug Use and Health (NSDUH). The annual report provides nationally representative data on the use of tobacco, alcohol, and drugs; SUDs; mental health issues; and receipt of substance use and mental health treatment among the civilian, noninstitutionalized population aged 12 or older in the United States. In addition, the 2022 Methodological Summary and Definitions report summarizes the information users need to properly interpret NSDUH estimates related to substance use and mental health. This report accompanies the annual detailed tables and provides information on overall methodology, key definitions for measures and terms used in 2022 NSDUH reports and tables, along with some analysis of these measures and of the survey as a whole.

NIH Study Examines How to Reduce Suicide Risk Among Young People in Hospital EDs

The National Institutes of Health (NIH) has released Emergency Department Safety Assessment and Follow-Up Evaluation 2 (ED-SAFE 2), a study that shows it’s possible to significantly reduce suicidal behaviors among young people at risk for suicide in emergency departments. ED-SAFE is a randomized clinical trial designed to improve suicide risk screening and detection in emergency department settings. The trial differs from similar studies because routine clinical staff—rather than researchers—deliver the suicide risk intervention, according to the NIH. This approach increases the likelihood that the suicide prevention strategies can be reliably implemented and sustained in the real world. ED-SAFE is also the largest practical clinical trial of suicide-related best practices in emergency departments.

National Academies Examines How to Support and Sustain the Current and Future Workforce to Care for People with Serious Illness

The National Academies Roundtable on Quality Care for People with Serious Illness has released a resource from its April 2023 public workshop that explored strategies and approaches to address major workforce challenges for those who care for people with serious illness. The workshop built on a 2019 Roundtable workshop, Building the Workforce We Need to Care for People with Serious Illness. Click here to access the free resource.

SAMHSA to Host Webinar on Certified Peer Specialist Career Outcomes Study

SAMHSA’s Office of Recovery will host a webinar later this month to discuss the results from the Certified Peer Specialist (CPS) Career Outcomes Study. Laysha Ostrow, Ph.D. will present some of the findings from the three-year study, including information about wages and financial wellbeing, workplace burnout, and CPS in rural areas. The webinar will start Monday, Nov. 27 at 1 p.m. ET. Click here to register.

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:

1. 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.

1. 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.

Fact of the Week

More Americans used illicit drugs in 2022 than in 2021, with illicit marijuana being the most common. Nearly 62 million people used illicit marijuana last year, up from 52.5 million in 2021, according to the 2022 National Survey on Drug Use and Health.

Save the Date for the NABH 2024 Annual Meeting!

Please mark your calendars and plan to join us at the Salamander Washington, DC from May 13-15, 2024 for next year’s NABH Annual Meeting!

Happy Thanksgiving!

The NABH staff wishes its members and their families a very happy, healthy, and safe Thanksgiving! NABH will not publish CEO Update next week and will resume on Friday, Dec. 1, 2023.   For questions or comments about this CEO Update, please contact Jessica Zigmond.

Senate Finance Committee Advances ‘Better Mental Health Care, Lower-Cost Drugs and Extenders Act’

The Senate Finance Committee on Wednesday advanced the bipartisan Better Mental Health Care, Lower-Cost Drugs and Extenders Act in a unanimous vote. The healthcare package partially mitigates Medicare payment cuts for physicians, extends certain expiring Medicare and Medicaid provisions, targets pharmacy benefit manager practices, and extends several substance use disorder (SUD) measures that expired on Oct. 1 as lawmakers missed the deadline to reauthorize the SUPPORT Act. Included in the legislation is language from S. 3098, the Securing Advances and a Variety of Evidence-Based (SAVE) Institutions for Mental Diseases (IMD) Options Act that Sens. John Thune (R-S.D.), Maggie Hassan (D-N.H.), and Marsha Blackburn (R-Tenn.) introduced to make the state plan amendment option permanent, a provision also included in the House Energy & Commerce Committee-passed SUPPORT Act Reauthorization bill. Some states, including South Dakota and Tennessee, opted into a state plan amendment option authorized under the SUPPORT Act that allows states to avoid the IMD Exclusion. Without renewal, states avoiding the payment exclusion will be forced to terminate payments to IMD facilities or cover such costs through state funds. Other provisions in the legislation include prohibiting states from terminating Medicaid coverage for incarcerated individuals and expanding access to mental health and SUD services for Medicaid-eligible individuals 30 days prior to their release from incarceration. The legislation also requires the Centers for Medicare & Medicaid Services (CMS) to collect and publish data from Medicare Advantage plans on the number of prior authorization requests, denials, and appeals for mental health and SUD services at the plan level, including the timelines of prior authorization decisions and justifications for denials. Senate Finance Committee leaders said the goal is to include the Better Mental Health Care, Lower-Cost Drugs and Extenders Act legislation into a broader healthcare package, a second Continuing Resolution (CR), or end-of-year omnibus funding package.

CMS Extends MA Coverage to Additional Behavioral Healthcare Practitioners

In a proposed rule released this week, CMS proposed several changes to increase access to behavioral healthcare services for Medicare Advantage (MA) enrollees. As required by law, CMS proposed to expand network adequacy standards for MA plans by adding a new category of specialists, “outpatient behavioral health” providers, as a required element of each network. Practitioners in this new category would include marriage and family therapists, mental health counselors, opioid treatment program providers, community mental health centers, addiction-medicine physicians, and other providers already providing traditional Medicare-covered addiction medicine and behavioral health counseling or therapy services. Also, CMS would extend the existing 10% compensation boost to this new category of practitioners for any MA network that has at least one provider group providing telehealth services. Comments on this rule are due to CMS by Jan. 25, 2024.

White House, ONDCP, Domestic Policy Council, and 12 Federal Agencies Release Recovery-Ready Workplace Toolkit

The White House, the Office of National Drug Control Policy, the Domestic Policy Council, and a dozen federal departments and independent agencies released their Recovery-Ready Workplace Toolkit: Guidance and Resources for Private and Public Sector Employers this week. The 140-page resource supports the fourth pillar of President Biden’s Unity Agenda for the Nation: beating the opioid and overdose epidemic. Specifically, the toolkit is designed to help businesses and other employers prevent and respond more effectively to substance misuse among employees, build their workforces through hiring of people in recovery, and develop a recovery-supportive workplace culture. It is also intended to serve as a resource to states, local governments, labor organizations, business groups, and non-profits considering launching multi-employer recovery-ready workforce initiatives at the local or state levels.

HHS Releases ‘Action for Adolescents: A Call to Action for Adolescent Health and Well-Being’

HHS recently released Action for Adolescents: A Call to Action for Adolescent Health and Well-Being, a new effort to promote collaboration and prompt action to improve the health and well-being of U.S. adolescents nationwide. Take Action for Adolescents is a research-based resource that outlines a vision, key principles, and eight goals, including: 1) Eliminate disparities to advance health equity, 2) Increase youth agency and youth engagement, 3) Ensure access to safe and supportive environments, 4) Increase coordination and collaboration within and across systems, 5) Expand access to health care and human services, 6) Strengthen training and support for caring adults, 7) Improve health information and health literacy, and 8) Support, translate, and disseminate research. The resource also includes a Take Action toolkit. In other HHS news related to the nation’s youth, HHS Secretary Xavier Becerra was recently named Chair of the U.S. Interagency Council on Homelessness and announced $6.1 million in new measures on affordable housing and support for runaway youth. Some of that funding will be used to enhance a variety of supportive services, including mental health services, on-site child care, financial literacy and coaching, GED preparation classes, transportation assistance, and early childhood and youth programs.

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:

1. 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.

1. 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.

Fact of the Week

For young people between the ages of 15 to 24, time spent in person with friends has reduced by nearly 70% during the last two decades to 40 minutes per day in 2020 from roughly 150 minutes per day in 2003 to 40 minutes per day in 2020, according to The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community.

Save the Date for the NABH 2024 Annual Meeting!

Please mark your calendars and plan to join us at the Salamander Washington, DC from May 13-15, 2024 for next year’s NABH Annual Meeting!

Many Thanks to All Veterans!

This Veterans Day Weekend, NABH thanks its members and their families who have served or are serving in the U.S. military. We appreciate your sacrifice and service.   For questions or comments about this CEO Update, please contact Jessica Zigmond.

White House Asks Congress for $1.55 Billion to Address Nation’s Fentanyl Crisis

The Biden administration this week requested $1.55 billion from Congress for HHS’ Substance Abuse and Mental Health Services Administration (SAMHSA) State Opioid Response grants to provide treatment, harm reduction, and recovery support services in all states and territories to combat the nation’s ongoing fentanyl crisis.   “Thanks to historic funding and bipartisan efforts, the rate of overdose deaths is slowing after a period of exponential increase, access to treatment is expanding, and historic amounts of fentanyl are being seized at our borders,” the White House said in a fact sheet about the Biden administration’s domestic spending requests to Congress. “But our work to beat the overdose epidemic is far from over and additional resources are needed to continue the Administration’s aggressive action to save lives.”

CDC: Healthcare Workers Report a Decrease in Odds of Burnout if They Trust Management

Healthcare workers continued to face a mental health crisis in 2022, although positive working conditions were associated with less burnout and better mental health, the Centers for Disease Control and Prevention (CDC) concluded in a Vital Signs report released this week. From 2018 to 2022, healthcare workers reported an increase of 1.2 days of poor mental health during the previous 30 days (to 4.5 days from 3.3 days), while the percentage who reported feeling burnout very often increased to 19% from 11.6%, the findings showed. However, the report found healthcare workers experienced a decrease in odds of burnout if they trusted management, had supervisor help, had enough time to complete work, and felt their workplace supported productivity. The report highlighted the CDC’s National Institute for Occupational Safety and Health (NIOSH), which has implemented efforts to promote the mental health and well-being of healthcare workers, including a national social marketing campaign, Impact Wellbeing, which emphasizes primary prevention strategies such as worker participation in decision-making, supportive supervision, and increasing psychological safety for help-seeking. “NIOSH has also developed burnout training for supervisors of public health workers and through its efforts has emphasized improving the work environment, rather than asking workers to be more resilient or fix problems themselves,” the report said.

SAMHSA Summary Report Shows Climate Change is a Social Determinant of Mental Health

A recent SAMHSA report concluded climate change is a social determinant of mental health; behavioral health systems should become “climate-informed;” and intergenerational trauma will be one of the layered effects of climate-related environmental change. The report summarized the findings from SAMHSA’s August 2022 request for information that sought feedback about potential agency actions regarding mental health and substance use wellbeing in the context of climate change and health equity. Respondents suggested SAMHSA should develop an agency-wide climate action plan to serve as a roadmap for change and integration of climate-informed behavioral health in SAMHSA research, programs, contracts, technical assistance, and reports. They also said SAMHSA should support increased resources and allowable costs that shift behavioral health systems toward public behavioral health strategies for mental health promotion, substance use prevention, community-level response, and community-based mental health resilience. “Respondents emphasized that a protective factor for healthcare workers is adequate training and preparation,” the report said. “Therefore, building out a climate-informed behavioral health system that provides resources to an increasingly diverse behavioral health workforce is protective to both the behavioral health workforce and the communities they serve,” it continued. “Timely and tailored interventions need to be designed in such a way that they can be altered over time to meet current and evolving needs.”

CMS Seeking Feedback to Improve Provider Resources

The Centers for Medicare and Medicaid Services (CMS) is conducting a study to help the agency improve user experience with Medicare program and billing resources. Responses are confidential, and the survey should take about 10 minutes to complete. Click here to take the survey, which is due Thursday, Nov. 9.

SAMHSA Releases 988 Lifeline Videos

SAMHSA has produced two new videos that promote the 988 Lifeline. Called “Impact of the 988 Lifeline” and “You Matter PSA,” the videos are included in SAMHSA’s 988 Partner Toolkit. In its announcement, SAMHSA noted that its 988 fact sheet, available in both English and Spanish, has been helpful in communicating about the 988 Lifeline’s services and successes.

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:

1. 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.

1. 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.

Reminder: The O’Neill Institute to Host Webinar on Recovery Housing Next Month

The O’Neill Institute’s Addiction and Public Policy Initiative will host a webinar next month about the current state of recovery housing and the opportunities for improving recovery housing in the United States. As the O’Neil Institute explains, social determinants, such as housing, and expanded access to medications for substance use disorder are part of effective, long-term solutions. National standards for recovery housing, along with protecting the rights of individuals under the law, are central to facilitating a needed societal shift and maximizing opportunities for people with substance use disorder. Recognizing the critical role that housing plays in improving outcomes for people with substance use disorder (SUD), SAMHSA recently issued Best Practices for Recovery Housing, and the U.S. Justice Department protects the rights of individuals with SUD afforded under the Fair Housing Act and the Americans with Disabilities Act.

Fact of the Week:

More than 1 million hospital emergency department visits are attributed annually to children and adolescents with a mental health disorder diagnosis, according to a new CDC study. For questions or comments about this CEO Update, please contact Jessica Zigmond.

Reminder: NABH Board Nominations Due Today, Friday, Oct. 20! 

NABH is seeking help from members as the NABH Selection Committee prepares to consider possible nominees to serve on the NABH Board of Trustees. Specifically, NABH requests that members help the association identify: ► Board Chair-Elect and      ► Four Board seats that will become available in 2024 The Selection Committee is particularly interested in identifying senior managers who represent the broad diversity within the NABH membership, including various levels of care, organizational structures, and size. Please download a nomination form to share your recommendations of individuals you would like to see included in the single slate for 2024. Please attach a curriculum vitae (CV) for each person you recommend. This will help the Selection Committee in its deliberations. You are welcome to suggest yourself. Please return this form (and candidates’ CVs) by today, Oct. 20, 2023, to maria@nabh.org.

Sens. Thune, Hassan, and Blackburn Introduce SAVE IMD Options Act

Sens. John Thun (R-S.D.), Maggie Hassan (D-N.H.), and Marsha Blackburn (R-Tenn.) on Thursday introduced the Securing Advances and a Variety of Evidence-Based (SAVE) Institutions for Mental Disease (IMD) Options Act. The bipartisan legislation would establish a permanent state plan option in Medicaid that allows states to provide patients between the ages of 21 and 64 with substance use disorder (SUD) treatment in an IMD. Current law does not allow federal Medicaid funds to be used for those patients at IMDs, which include hospitals, nursing facilities, or other institutions with more than 16 beds that provide care for mental health diseases, including SUD. NABH strongly supports the bill and is working with the lawmakers’ congressional staff to provide support. “Establishing a permanent state option in Medicaid for substance use disorder treatment provided in IMD will provide states with certainty and ensure individuals have access to this lifesaving treatment,” NABH President and CEO Shawn Coughlin said in a news release about the bill.

NABH Submits Parity Comments to HHS, DOL, and Treasury

NABH this week submitted comments to the U.S. Health and Human Services, Labor, and Treasury Departments on this year’s proposed parity rule and thanks all members who provided feedback. In its letter, NABH recognized the three departments for their collective determination to enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) that passed 15 years ago this month and has yet to be implemented fully and fairly nationwide. NABH’s letter also said the association especially supports the proposed rule’s requirement that each plan’s comparative analysis on parity compliance include substantive data on non-quantitative treatment limitations (NQTL), including network composition. These requirements will do much to enforce both the letter and spirit of the MHPAEA, NABH noted. The letter continued by categorizing NABH’s comments into the following sections: 1) parity in behavioral healthcare benefits, 2) NQTL comparative analysis requirements, 3) improving and expanding meaningful parity standards, and 4) network adequacy. “We appreciate that the rule addresses ambiguous definitions that contribute to the disparity between mental and physical healthcare,” the letter said in a section about clarifying meaningful coverage and scope of covered services. “Such ambiguity tends to yield overly flexible interpretations that generally favor health plans over patients. In particular, the proposed, more specific definitions for ‘meaningful coverage’ and ‘scope of covered services’ will bring valuable clarity and consistency to coverage determinations,” it continued. “Of notable benefit, we strongly support the proposed requirement for plans that provide behavioral healthcare benefits in any classification of care, to do so in all classifications of care. Similarly, we urge the departments to add to the final rule a definition of ‘meaningful’ as it applies to scope of covered MH and SUD benefits in each classification.”

Fewer Medicare Advantage Plans Earned a 5-Star Rating for 2024

In its 2024 Star Ratings released last week, the Centers for Medicare & Medicaid Services (CMS) gave 31 Medicare Advantage (MA) contracts a five-star rating, a notable drop from the 57 contracts that earned the top rating in 2023. An MA contract must earn at least a four-star rating to receive a quality bonus payment from CMS. MA open enrollment for 2024 kicked off on Oct. 15 using new MA requirements that CMS finalized in April and will take effect on Jan. 1, 2024. The 40 quality metrics that apply to MA plans with a drug benefit in 2024 will include new restrictions on deceptive marketing, multiple prior authorization improvements, and affordable drug pricing, with the latter required by law. CMS is in the process of remaking the star-rating system to remove incentives that inadvertently permitted lower quality and unnecessary spending. This effort includes applying more stringent criteria for star-rating quality metrics, which are expected to result in fewer insurers securing high ratings and greater financial benefits for insurers focused on treating disadvantaged populations. CMS’ effort also includes changes from the 2024 MA final rule, which strives to improve coverage, ensure timely access to care, and advance parity between MA and traditional fee-for-service coverage.

The National Academies Seeks Experts to Participate in Workshop to Explore Data-Collection Efforts for People Who Use Drugs

The National Academies is seeking suggestions for experts to participate in a White House Office of National Drug Control Policy-sponsored workshop to explore data-collection efforts, evidence gaps, and research needs on harm-reduction services for people who use drugs (PWUD). Specifically, the workshop will examine harm-reduction services that aim to prevent overdose and infectious disease transmission; enhance the health, safety, and wellbeing of PWUD; and offer low-threshold options for accessing SUD treatment. According to the National Academies, services include syringe services programs; providing fentanyl and xylazine test strips; distributing naloxone and other reversal medications; and facilitating connections to social services for PWUD in need of medical services, stable housing, food-assistance, or employment. Nominations are due next Wednesday, Oct. 25 to help the National Academies establish a 10-person, volunteer planning committee for the project. Click here to learn more and submit a nomination.

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:

1. 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.

1. 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.

Reminder: The O’Neill Institute to Host Webinar on Recovery Housing Next Month

The O’Neill Institute’s Addiction and Public Policy Initiative will host a webinar next month about the current state of recovery housing and the opportunities for improving recovery housing in the United States. As the O’Neil Institute explains, social determinants, such as housing, and expanded access to medications for substance use disorder are part of effective, long-term solutions. National standards for recovery housing, along with protecting the rights of individuals under the law, are central to facilitating a needed societal shift and maximizing opportunities for people with substance use disorder. Recognizing the critical role that housing plays in improving outcomes for people with substance use disorder (SUD), SAMHSA recently issued Best Practices for Recovery Housing, and the U.S. Justice Department protects the rights of individuals with SUD afforded under the Fair Housing Act and the Americans with Disabilities Act.

Fact of the Week:

New data from the Centers for Disease Control and Prevention show 1 out of 5 persons who died from drug overdoses in 2020 worked in construction or restaurants. For questions or comments about this CEO Update, please contact Jessica Zigmond.

FDA Creates Advisory Committee to Examine Digital Health Technologies

The U.S. Food and Drug Administration (FDA) this week announced it has created a Digital Health Advisory Committee to help the agency explore the scientific and technical issues related to digital health technologies (DHTs), such as artificial intelligence/machine learning (AI/ML), augmented reality, virtual reality, digital therapeutics, wearables, remote patient monitoring and software. The new committee will advise the FDA on issues related to DHTs and provide expertise to help the agency better understand benefits, risks, and clinical outcomes associated with use of DHTs. “As one of our strategic priorities, our goal is to advance health equity in part through expanding access by bringing prevention, wellness, and healthcare to all people where they live – at home, at work, in big cities and rural communities,” Jeff Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health, said in an announcement. “Digital health technologies are critical for achieving this transformation in care delivery,” he continued. “As digital health technologies advance, the FDA must capitalize on knowledge from inside and outside of the agency to help ensure we appropriately apply our regulatory authority in a way that protects patient health while continuing to support innovation.” FDA’s announcement said the committee should be fully operational in 2024.

SAMHSA Releases Mental Health Client-Level Data 2021 Annual Report

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week released Mental Health Client-Level Data (MH-CLD) 2021: Data on Clients Receiving Mental Health Treatment Services Through State Mental Health Agencies, the annual report that details the total number of clients receiving mental health treatment services in 2021 by demographics, national outcomes measures, and the top five mental health diagnoses for children (ages 0-17) and adults (ages 18 and older) by geographic distribution. SAMHSA uses the MH-CLD data to better understand publicly funded mental health treatment service systems. The data are also used to inform decisions about how SAMHSA’s uses its mental health block grant funds, and are used to help the agency learn about the technical assistance and support needs of mental health providers and the communities they serve.

CMS Administrator Brooks-LaSure to Host Stakeholder Update Next Week

CMS Administrator Chiquita Brooks-LaSure and her leadership team will provide a stakeholder and partner update about the agency’s recent accomplishments and efforts to advance the CMS Strategic Plan on Tuesday, Oct. 17. Click here to RSVP for the hourlong call, which starts at 1 p.m. ET.

Manatt Health to Host Webinar Next Week on Emerging Fraudulent Healthcare Schemes

Manatt Health will host a webinar next week to help providers and health plans navigate the emerging landscape of fraudulent healthcare schemes and provide practical answers to the legal questions that resulted from recent litigation and enforcement actions. The free webinar will feature panelists — all of whom have successfully defended litigants who have been forced to deal with inducement-based lawsuits in both federal and state courts – who will share an overview of the current litigation and policy landscape and offer insights into how providers and plans can protect themselves and their organizations. The webinar also will discuss the findings from internal investigations that have uncovered fraudulent activities and improper conduct impacting patients’ health and safety and providers’ and plans’ financial viability. Click here to register for the hourlong webinar on Tuesday, Oct. 17, which starts at 1 p.m. ET.

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:

1. 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.

1. 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.

Reminder: NABH Board Nominations Due Next Friday, Oct. 20! 

NABH is seeking help from members as the NABH Selection Committee prepares to consider possible nominees to serve on the NABH Board of Trustees. Specifically, NABH requests that members help the association identify: ► Board Chair-Elect and      ► Four Board seats that will become available in 2024 The Selection Committee is particularly interested in identifying senior managers who represent the broad diversity within the NABH membership, including various levels of care, organizational structures, and size. Please download a nomination form to share your recommendations of individuals you would like to see included in the single slate for 2024. Please attach a curriculum vitae (CV) for each person you recommend. This will help the Selection Committee in its deliberations. You are welcome to suggest yourself. Please return this form (and candidates’ CVs) by Friday, Oct. 20, 2023, to maria@nabh.org.

The O’Neill Institute to Host Webinar on Recovery Housing Next Month

The O’Neill Institute’s Addiction and Public Policy Initiative will host a webinar next month about the current state of recovery housing and the opportunities for improving recovery housing in the United States. As the O’Neil Institute explains, social determinants, such as housing, and expanded access to medications for substance use disorder are part of effective, long-term solutions. National standards for recovery housing, along with protecting the rights of individuals under the law, are central to facilitating a needed societal shift and maximizing opportunities for people with substance use disorder. Recognizing the critical role that housing plays in improving outcomes for people with substance use disorder (SUD), SAMHSA recently issued Best Practices for Recovery Housing, and the U.S. Justice Department protects the rights of individuals with SUD afforded under the Fair Housing Act and the Americans with Disabilities Act.

Fact of the Week:

Nearly 40% of primary care providers (PCPs) are screening patients for behavioral health conditions, according to a new report from The Advisory Board, which included survey responses from 300 PCPs. For questions or comments about this CEO Update, please contact Jessica Zigmond.

DEA Extends Pandemic Telemedicine Rules Through December 2024

The Drug Enforcement Administration (DEA) on Friday said it will extend its eased, COVID-19 pandemic rules for prescribing controlled substances via telemedicine through Dec. 31, 2024. This is DEA’s second extension of these rules; the agency first extended its pandemic-era, telehealth regulations in May 2023, which are set to expire on Nov. 11, 2023. DEA said in its notice that DEA and HHS continue to consider revisions to the agency’s March 2023 proposed rule and that DEA’s telemedicine listening sessions last month helped inform this latest extension. NABH reported on those listening sessions in CEO Update on Sept. 15.

FDA Issues Draft Guidance on Developing Treatment Drugs for Stimulant Use Disorders

The U.S. Food and Drug Administration (FDA) this week issued draft guidance for developing drugs to treat stimulant use disorders. Stimulant Use Disorders: Developing Drugs for Treatment addresses the FDA’s current recommendations regarding the overall development program and clinical trial designs for developing drugs to treat moderate-to-severe cocaine use disorder, methamphetamine use disorder, or prescription drug stimulant use disorder. The FDA will accept public comments about the guidance through Monday, Dec. 4. Click here for comment submission instructions.

CMS Seeks Feedback on Assessing Parity Compliance in Medicaid Managed Care, ABPs, & CHIP

The Centers for Medicare & Medicaid Services (CMS) is seeking public comments about a set of questions regarding processes to assess compliance with mental health parity ad addiction equity requirements for Medicaid managed care arrangements, Medicaid Alternative Benefit Plans (ABPs), and the Children’s Health Insurance Program. (CHIP). The questions for comment address a variety of topics, including model formats (e.g., templates) and key questions to consider that could make documenting compliance with parity requirements more efficient and effective; processes that states and managed care plans use to determine whether existing coverage policies are comparable for mental health and substance use disorders compared with medical and surgical benefits; how data should be collected; and more. CMS will accept public comments here through Monday, Dec. 4. NABH will submit comments.

CBO Estimates Federal Subsidies for Health Insurance to be $1.8 Trillion in 2023

In a new report, the Congressional Budget Office (CBO) estimates federal subsidies for health insurance in 2023 to be $1.8 trillion, or 7% of the nation’s Gross Domestic Product. Meanwhile, the CBO and the Joint Committee on Taxation (JCT) together project those net subsidies to grow substantially–reaching $3.3. trillion, or 8.3% of GDP, by 2033. The CBO said this is the first time the projections reflect the entire population instead of only the civilian, noninstitutionalized population younger than 65.

CMS Administrator Brooks-LaSure to Host Stakeholder Update on Oct. 17

CMS Administrator Chiquita Brooks-LaSure and her leadership team will provide a stakeholder and partner update about the agency’s recent accomplishments and efforts to advance the CMS Strategic Plan on Tuesday, Oct. 17. Click here to RSVP for the hourlong call, which starts at 1 p.m. ET.

NIMH Marks 75^th Anniversary with Podcast Series

The National Institute of Mental Health is honoring its 75^th anniversary with a podcast series that explores the stories behind influencers and innovators in mental health research and the lives of people with mental illness. The latest podcasts feature “Depression: The Case for Ketamine,” and “Understanding and Preventing Youth Suicide.” Click here to listen.

Please Nominate Members for the NABH Board of Trustees!

NABH is seeking help from members as the NABH Selection Committee prepares to consider possible nominees to serve on the NABH Board of Trustees. Specifically, NABH requests that members help the association identify: ► Board Chair-Elect and      ► Four Board seats that will become available in 2024 The Selection Committee is particularly interested in identifying senior managers who represent the broad diversity within the NABH membership, including various levels of care, organizational structures, and size. Please download a nomination form to share your recommendations of individuals you would like to see included in the single slate for 2024. Please attach a curriculum vitae (CV) for each person you recommend. This will help the Selection Committee in its deliberations. You are welcome to suggest yourself. Please return this form (and candidates’ CVs) by Friday, Oct. 20, 2023, to maria@nabh.org.

Fact of the Week:

People who work shift work are 22% more likely to develop depression than those who work a regular daytime schedule, according to a recent study published in JAMA Network Open. For questions or comments about this CEO Update, please contact Jessica Zigmond.

HHS Releases Contingency Plan as Federal Government Shutdown Looms

HHS this week released a government shutdown contingency plan if federal lawmakers don’t pass legislation by Saturday, Sept. 30 to extend government funding and maintain federal operations. If they don’t, critical federal services will end at 12:01 a.m. on Sunday. The ongoing government funding talks have put on hold consideration of all other bills that are set to expire after Sept. 30, including the SUPPORT Act reauthorization. NABH expects reauthorization to move through both chambers of Congress after lawmakers resolve the federal funding issue. Meanwhile, here are HHS’ plans for the agencies that affect NABH members: the Agency for Healthcare Research and Quality, Centers for Medicare & Medicaid Services, Health Resources and Services Administration, National Institutes of Health, and Substance Abuse and Mental Health Services Administration.

SAMHSA Announces $131.7 Million in Grants for Youth and Families  

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week said it awarded $131.7 million in grant programs to connect youth and families with behavioral healthcare services. The awards will fund a variety of programs and services, including cooperative agreements for school-based, trauma-informed support services for mental healthcare, expanding substance use treatment capacity in adult and family drug courts, preventing youth overdose, and more. Click here to read more about the awards.

Joint Commission Revises Terms to Reflect Current Terminology in Addiction Medicine

The Joint Commission said it has revised two terms for Behavioral Health Care and Human Services to reflect current terminology in the addiction medicine field. “Medication-assisted treatment” has been updated to “medications for substance use disorders,” and, if the requirement needs to be more specific, the term used is “medications for opioid use disorder” or “medications for alcohol use disorder.” Meanwhile, the Joint Commission removed “detoxification,” which is now referred to as “withdrawal,” “withdrawal management,” or “medically supervised withdrawal management.” “These revisions are editorial in nature and do not change any requirements,” the Joint Commission said in its announcement, adding that any questions should be directed to the organization’s Department of Standards and Survey Methods. The changes take effect on Jan. 1, 2024.

October is Youth Substance Use and Misuse Prevention Month

As National Recovery Month draws to a close, the nation now turns to Youth Substance Use Prevention Month and Substance Misuse Prevention Month for October. SAMHSA has created a Prevention Month toolkit with shareable social media graphics to help people promote the message of prevention for kids and family and developed other resources and events to help communities participate. In conjunction with Prevention Month, SAMHSA this week announced it awarded $42.6 million in grants to 17 states and 60 communities—located across 33 states—as a foundational investment for substance use prevention. Click here to learn more.

Please Nominate Members for the NABH Board of Trustees!

NABH is seeking help from members as the NABH Selection Committee prepares to consider possible nominees to serve on the NABH Board of Trustees. Specifically, NABH requests that members help the association identify: ► Board Chair-Elect and      ► Four Board seats that will become available in 2024 The Selection Committee is particularly interested in identifying senior managers who represent the broad diversity within the NABH membership, including various levels of care, organizational structures, and size. Please download a nomination form to share your recommendations of individuals you would like to see included in the single slate for 2024. Please attach a curriculum vitae (CV) for each person you recommend. This will help the Selection Committee in its deliberations. You are welcome to suggest yourself. Please return this form (and candidates’ CVs) by Friday, Oct. 20, 2023, to maria@nabh.org.

Fact of the Week:

Between 2014 and 2019, the national Hispanic population increased by 4.5%, or 5.2 million people. During the same period, the proportion of facilities that offered treatment in Spanish declined by 17.8%, or a loss of 1,163 Spanish-speaking mental health facilities, according to a study published in Psychiatric Services. Overall, 44 states saw a decline in the availability of services in Spanish, despite growth in Hispanic populations across all states.   For questions or comments about this CEO Update, please contact Jessica Zigmond.

White House Recovery Summit Seeks to Create a ‘Recovery-Ready Nation’

As part of Recovery Month, the White House this week held a Recovery Summit to celebrate people with substance use disorders (SUD) who are in treatment and to discuss ways that Americans can build a recovery-ready nation.   The Office of National Drug Control Policy Director Rahul Gupta, M.D., M.P.H. hosted the event, and one highlight included a panel of high school students who shared their personal recovery journeys. Assistant Secretary for Mental Health and Substance Use Disorders Miriam Delphin-Rittmon, Ph.D., who leads the Substance Abuse and Mental Health Services Administration (SAMHSA), moderated the panel, and Sen. Jeanne Shaheen (D-N.H.) and Rep. Paul Tonko (D-N.Y.) offered remarks. Sarah Wattenberg, director of quality and addiction services at NABH, represented the association at the summit. Click here to learn more.

SAMHSA Releases New Data on Recovery from SUD and Mental Health Problems Among Adults

About 70 million U.S. adults aged 18 and older perceived they ever had a substance use and/or mental health problem, according to a new report SAMHSA released this week. Using data from the 2021 National Survey on Drug Use and Health, the report also showed that for substance use specifically, 29 million adults perceived they ever had a substance use problem, and 20.9 million people (or 72.2%) considered themselves to be in recovery or to have recovered from their drug or alcohol use problem.   For mental health, of the 58.7 million adults who perceived they ever had a mental health problem, 38.8 million (or 66.5%) considered themselves to be in recovery or to have recovered from their mental health problem. Click here to read the report, Recovery from Substance Use and Mental Health Problems Among Adults in the United States.

2023 NABH Membership Directory Updates Are Due Wednesday, Sept. 27!

NABH has extended the deadline for system members to submit changes about their organizations for the 2023 NABH Directory to Wednesday, Sept. 27. NABH’s online-only 2023 Membership Directory is an essential member benefit that helps the association advance its advocacy efforts. Last month NABH sent system members a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use the link to verify your system’s information. The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all your system’s facilities to help provide NABH with an accurate picture of our membership. If you need assistance, please contact Maria Merlie maria@nabh.org or 202-393-6700, ext. 104.

Reminder: Deadline for Health Data Privacy Feedback to Senate HELP Committee is Next Week

Senate Health, Education, Labor, and Pensions (HELP) Committee Ranking Member Sen. Bill Cassidy, M.D. (R-La.) announced earlier this month he’s seeking information from stakeholders about ways to improve the privacy protections of health data in a way that safeguards sensitive information while balancing the need to support medical research. According to a Senate HELP Committee announcement, Cassidy, an NABH Champion, hopes to use the stakeholder feedback to identify solutions to modernize HIPAA and ensure that all health data are safeguarded properly.   The deadline to submit feedback is Thursday, Sept. 28. Click here to read Cassidy’s full request and here to submit comments.    

Reminder: CMS to Host Webinar on Person-Centered Approaches to Improving Behavioral Health Condition Management

CMS’ Medicare-Medicaid Coordination Office recently announced an upcoming webinar that will examine how traditional silos of care impede comprehensive approaches to care coordination and explore potential solutions to improve behavioral health condition management in persons with intellectual and developmental disabilities. Presenters include Andrea Witwer, Ph.D., associate clinical professor in psychiatry and behavioral health at Ohio State; family caregiver Patricia Nobbie, Ph.D.; and Olivia Ayers, LMCH, LPC, clinical director at Elevate Certified Community Behavioral Health Clinic in Iowa. The 90-minute webinar will be held on Wednesday, Sept. 27 starting at 2:30 p.m. ET. Click here to learn more and to register.

Fact of the Week:

Researchers at the not-for-profit research institute RTI International have found that approximately 3.7 million, or 1.8%, of U.S. adults ages 18 to 65, have a lifetime history of schizophrenia spectrum disorders— a figure two-to-three times higher than previous studies. The findings came from the Mental Health and Substance Use Disorder Prevalence Study, which SAMHSA funds.   For questions or comments about this CEO Update, please contact Jessica Zigmond.

NABH Comments on 2024 OPPS and Physician Payment Proposed Rules

This week NABH submitted a comment letter to the Center for Medicare & Medicaid Services (CMS) about the agency’s proposed rules pertaining to both the outpatient prospective payment system (OPPS) and physician fee schedule (PFS) for 2024. Outpatient PPS Proposed Rule. Among the rule’s multiple behavioral healthcare provisions, a key item was CMS’ proposed design and implementation of the congressionally mandated intensive outpatient program (IOP) as a new Medicare benefit in hospital outpatient departments, community mental health centers, federally qualified health centers, rural health clinics, and opioid treatment programs. NABH generally supports CMS’ proposed approach of basing many of the new IOP design features on the existing partial hospitalization program (PHP) framework because PHPs treat a similar mix of patients, although with a higher level of intensity. That said, NABH raised concerns regarding some of the proposed design features, including the need to align the new IOP patient eligibility criteria with the clinical characteristics of current IOP populations. Specifically, NABH urged CMS to remove these criteria: “adequate support system at home” and “risk of danger to self or others” as they would exclude a significant portion of the patient population for whom this benefit is intended.   NABH expressed additional concerns related to the implementation of IOP benefit by opioid treatment programs including that the physician-driven IOP certification and treatment planning requirements do not align with the scopes of practice of non-physician professionals nor with the ASAM requirements for IOP and other level of care assessments; that additional specialty care settings should be considered for IOP services; and that CMS develop a contingency management bundle for individuals with stimulant use disorder. Physician Fee Schedule Proposed Rule. NABH’s comments about the PFS rule respond to CMS’ proposed 2.0% increase for psychiatric service payments, relative to CY 2023 rates, which starkly contrasts to the proposed decrease for overall PFS payments of negative 3.3%. Our comments recommend increases for both overall and psychiatric services due to significant workforce and other pressures facing all healthcare providers. We also support the agency’s provision to set payments to 150% of facility-based payments for “psychotherapy for crisis” services that are furnished in a setting other than a physician’s office or mobile unit or home. In addition, we support CMS’ proposal to allow three new behavioral healthcare practitioners to bill under Medicare Part B: marriage and family therapists, mental health counselors (MHCs), and addiction counselors that meet Medicare criteria for MHCs. NABH also called for a 10 percentage-point increase in payments for these providers and the addition of psychiatric mental health nurse practitioners to this group. We also recommended that telehealth services offered by community health integration, social determinants of health, and principal illness navigation specialists be covered; that remote monitoring codes be developed for opioid treatment programs and office-based opioid treatment providers; and that progressively decreasing buprenorphine reimbursement rates be re-evaluated and increased.

Providers Share the Negative Impact of Returning to DEA’s Pre-Pandemic Telemedicine Rules

The Drug Enforcement Administration held a two-day listening session this week in response to almost 40,000 comments it received earlier in the year about its proposal to reimpose in-person visits for the prescribing of controlled substances, including buprenorphine.   DEA Administrator Anne Milgram announced that the agency would provide an additional comment period for telemedicine. This would likely require an extension of the telemedicine flexibilities offered during the COVID-19 pandemic. Testimony over the course of two days addressed how changes to pandemic-era telemedicine rules would impede care for individuals needing medication for attention-deficit/hyperactivity disorder and opioid use disorder, individuals in end-of-life care needing opioids for pain relief, individuals receiving gender-affirming care, and many others. The listening session requested recommendations on a “special registration” process that Congress requested many years ago.

National Academies Seeking Experts to Participate in Study to Develop National Prevention Infrastructure for Behavioral Health Disorders Blueprint

The National Academies of Sciences, Engineering, and Medicine is seeking suggestions for experts to participate in a study to develop a Blueprint for a National Prevention Infrastructure for Behavioral Health Disorders.   The study also will identify funding needs and strategies to support the infrastructure; identify gaps in policy research and health services research that may serve as barriers to implementing the program; and recommend state and federal policies to support the financing and infrastructure, including workforce development and data interoperability for promoting behavioral health. Click here to learn more about the scope of work for the ad hoc committee that will develop the blueprint and click here to submit recommendations of volunteer experts. The deadline to submit recommendations is Wednesday, Sept. 20.

SAMHSA Releases Resources to Help Communities Address Opioid Overdose Crisis

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week released two resources to help community practitioners end America’s opioid crisis. SAMHSA commissioned RTI International to develop—together with a SAMHSA technical expert panel— Engaging Community Coalitions to Decrease Opioid Overdose Deaths and Opioid-Overdose Reduction Continuum of Care Approach. The guides are based on insights and tools from the ongoing National Institutes of Health (NIH) HEALing Communities Study. NIH and SAMHSA launched that study in 2019 to test the effect of an integrated set of evidence-based practices across healthcare, behavioral health, justice, and other community-based settings.

Reminder: Sept. 28 Deadline for Health Data Privacy Feedback to Senate HELP Committee

Senate Health, Education, Labor, and Pensions (HELP) Committee Ranking Member Sen. Bill Cassidy, M.D. (R-La.) last week announced he’s seeking information from stakeholders about ways to improve the privacy protections of health data in a way that safeguards sensitive information while balancing the need to support medical research. According to a Senate HELP Committee announcement, Cassidy, an NABH Champion, hopes to use the stakeholder feedback to identify solutions to modernize HIPAA and ensure that all health data are safeguarded properly. The deadline to submit feedback is Thursday, Sept. 28. Click here to read Cassidy’s full request and here to submit comments.   

Reminder: CMS to Host Webinar on Person-Centered Approaches to Improving Behavioral Health Condition Management

CMS’ Medicare-Medicaid Coordination Office recently announced an upcoming webinar that will examine how traditional silos of care impede comprehensive approaches to care coordination and explore potential solutions to improve behavioral health condition management in persons with intellectual and developmental disabilities. Presenters include Andrea Witwer, Ph.D., associate clinical professor in psychiatry and behavioral health at Ohio State; family caregiver Patricia Nobbie, Ph.D.; and Olivia Ayers, LMCH, LPC, clinical director at Elevate Certified Community Behavioral Health Clinic in Iowa. The 90-minute webinar will be held on Wednesday, Sept. 27 starting at 2:30 p.m. ET. Click here to learn more and to register.

Deadline Extended! 2023 NABH Membership Directory Updates Are Due Sept. 27

NABH has extended the deadline for system members to submit changes about their organizations for the 2023 NABH Directory to Wednesday, Sept.27. NABH’s online-only 2023 Membership Directory is an essential member benefit that helps the association advance its advocacy efforts. Last month NABH sent system members a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use the link to verify your system’s information. The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all of your system’s facilities to help provide NABH with an accurate picture of our membership. If you need assistance, please contact Maria Merlie maria@nabh.org or 202-393-6700, ext. 104.

Reminder: Please Submit Your Managed Care Denials Data to Support NABH Advocacy

Thank you to all members who have submitted data to NABH’s denial-of-care portal! We are still seeking data from additional members to support advocacy on health plan denials and prior-authorization timeliness. If you are a new participant, please e-mail NABH Administrative Coordinator Emily Wilkins for support.

Fact of the Week:

Recent research found that, overall, people with mental health conditions seemed to have an elevated risk of heat-related death. This was even more severe for people with schizophrenia: a 200% increase compared with typical summers. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CMS Announces AHEAD Model to Improve Overall Health of State Population

The Centers for Medicare & Medicaid Services on Thursday unveiled its States Advancing All-Payer Health Equity Approaches and Development (AHEAD) model to better address chronic disease, behavioral health, and other medical conditions among state populations. CMS said the new approach is intended to help participating states be better equipped to promote health equity, increase access to primary care services, set healthcare expenditures on a more sustainable trajectory, and lower healthcare costs for patients.   AHEAD also includes specific payment models for participating hospitals and primary care practices as a tool to achieve the model’s goals. Through AHEAD, CMS said it aims to strengthen primary care, improve care coordination for people with Medicare and Medicaid, and increase screening and referrals to community resources such as housing and transportation to address social drivers of health. CMS will issue awards to up to eight states, and each selected state will have an opportunity to receive up to $12 million from CMS to support state implementation. The agency said states interested in participating in the model may apply during two different application periods and elect to participate in one of three cohorts with staggered start dates and performance years. CMS will release the Notice of Funding Opportunity, which includes the specific application requirements, in the late fall.

CMS Releases Request for Applications for New ‘Making Care Primary’ Model

CMS also announced it is now accepting applications for its recently introduced voluntary Making Care Primary, or MCP, model. Launching on July 1, 2024, the 10.5-year model will be tested in eight states – Colorado, North Carolina, New Jersey, New Mexico, New York, Minnesota, Massachusetts, and Washington – and is meant to give primary care clinicians the tools they need to form partnerships with healthcare specialists and leverage community-based connections to address patients’ needs. “This model will attempt to strengthen coordination between patients’ primary care clinicians, specialists, social service providers, and behavioral health clinicians, ultimately leading to chronic disease prevention, fewer emergency room visits, and better health outcomes,” CMS said in its announcement about accepting applications. CMS also said its new MCP care approach communicates the agency’s vision for three domains: care management, care integration, and community engagement. For the second domain of care integration, CMS said participants will strengthen their connections with specialty care clinicians while using “evidence based behavioral health screening and evaluation to improve patient care and coordination.” CMS will accept applications through Thursday, Nov. 30, 2023 by 11:59 p.m. ET. Click here for more details and eligibility requirements.

Cassidy Seeks Information to Improve Americans’ Health Data Privacy

Senate Health, Education, Labor, and Pensions (HELP) Committee Ranking Member Sen. Bill Cassidy, M.D. (R-La.) on Thursday announced he’s seeking information from stakeholders about ways to improve the privacy protections of health data in a way that safeguards sensitive information while balancing the need to support medical research. According to a Senate HELP Committee announcement, Cassidy, an NABH Champion, hopes to use the stakeholder feedback to identify solutions to modernize HIPAA and ensure that all health data are safeguarded properly. The deadline to submit feedback is Thursday, Sept. 28. Click here to read Cassidy’s full request and here to submit comments.       

CMS Announces Webinar on Person-Centered Approaches to Improving Behavioral Health Condition Management

CMS’ Medicare-Medicaid Coordination Office this week announced an upcoming webinar that will examine how traditional silos of care impede comprehensive approaches to care coordination and explore potential solutions to improve behavioral health condition management in persons with intellectual and developmental disabilities. Presenters include Andrea Witwer, Ph.D., associate clinical professor in psychiatry and behavioral health at Ohio State; family caregiver Patricia Nobbie, Ph.D.; and Olivia Ayers, LMCH, LPC, clinical director at Elevate Certified Community Behavioral Health Clinic in Iowa. The 90-minute webinar will be held on Wednesday, Sept. 27 starting at 2:30 p.m. ET. Click here to learn more and to register.

2023 NABH Membership Directory Update Deadline is Next Week!

The deadline for NABH system members to submit changes about their organizations for the 2023 NABH Directory is Wednesday, Sept. 13. NABH’s online-only 2023 Membership Directory is an essential member benefit that helps the association advance its advocacy efforts. Last month NABH sent system members a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use the link to verify your system’s information. The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all your system’s facilities to help provide NABH with an accurate picture of our membership. If you need assistance, please contact Maria Merlie maria@nabh.org or 202-393-6700, ext. 104.

Reminder: Please Submit Your Managed Care Denials Data to Support NABH Advocacy

Thank you to all members who have submitted data to NABH’s denial-of-care portal! We are still seeking data from additional members to support advocacy on health plan denials and prior-authorization timeliness. If you are a new participant, please e-mail NABH Administrative Coordinator Emily Wilkins for support. 

Fact of the Week:

Of people appointed to HHS between 2004 and 2020, about one-third (32%) left for positions in industry, according to a comprehensive Health Affairs study of the “revolving door” in healthcare regulation. Axios, Becker’s Hospital Review, and Fierce Healthcare were among the news outlets that reported on the findings, which raise questions about the potential conflict-of-interest risks between industry and the federal department that regulates it. For questions or comments about this CEO Update, please contact Jessica Zigmond.

Biden Highlights Parity in National Recovery Month Proclamation

Today kicks off National Recovery Month, a nationwide observance every September since 1989 to promote and support new evidence-based treatment and recovery practices, the nation’s recovery community, and the dedication of service providers and communities who make recovery in all its forms possible. In his proclamation on the annual observance, President Biden noted that drug overdoses last year took more than 100,000 American lives and that addressing the country’s substance use disorder (SUD) crisis is a core pillar of his Unity Agenda. “That work starts by fulfilling the promise of true parity for mental health and substance use disorder treatment for all Americans,” Biden said in the proclamation. “Mental health and substance use disorder care is healthcare.  It is essential to people’s well-being — to their ability to lead full and productive lives, to find joy and meaning, to take care of themselves and their loved ones, and to give back to their communities and our nation,” he continued. “It is about dignity. Health insurers should cover it the same way they would cover treatment for a broken bone or any other kind of health condition.  And since I took office, that is what we have been fighting to do.” Click here to access the Substance Abuse and Mental Health Services Administration (SAMHSA) National Recovery Month toolkit. And please remember to follow NABH @NABHBehavioral and on LinkedIn at the National Association for Behavioral Healthcare to read and share our social media posts about National Recovery Month.

Appellate Court Vacates Earlier Ruling in Wit v. UBH Case

A three-judge panel in the 9^th U.S. Circuit Court of Appeals last week vacated its prior holdings in the ongoing Wit v. United Behavioral Health (UBH) case for the second time and issued this opinion. NABH consultant Meiram Bendat, JD, Ph.D, founder and president of Psych Appeal, summarized the decision: “Essentially, the appellate court affirmed the trial court’s findings that UBH’s medical necessity guidelines were inconsistent with generally accepted standards of care (GASC), but also held that the trial court erred in holding that UBH’s plans required it to cover all services consistent with GASC,” Bendat wrote, adding, “The appellate court affirmed the trial court’s class certification order to allow the classes to pursue their breach of fiduciary duty claim. The trial court findings that UBH violated the laws of jurisdictions requiring the use of state-mandated criteria also remain undisturbed,” he continued. “The appellate court also walked away from its previous holdings that remand is not an available remedy under ERISA and that all absent class members must exhaust their administrative remedies prior to pursuing their claims in court.”   Bendat added that—absent another petition for review—the case will be sent back to the trial court, which will likely again clarify that it based UBH’s liability on UBH’s deviation from GASC in its medical necessity guidelines, which were intended to implement the GASC requirement in the plans. The trial court is also expected to answer several other questions the 9th Circuit posed. “In short, plaintiffs are now in a far better position than they were last year,” Bendat wrote. “Hopefully, folks can appreciate how important it is to have laws like SB 855, which require medical necessity to be made consistent with GASC and which don’t vest plan administrators with discretion to adopt self-serving clinical guidelines with which to deny claims.”

HRSA Announces More than $80 Million in Funding for Rural Communities to Combat Opioid Crisis

HHS’ Health Resources and Services Administration (HRSA) announced Thursday more than $80 million in awards to rural communities in 39 states to support key strategies that respond to the overdose risk from fentanyl and other opioids. HRSA funding will support interventions such as distributing the lifesaving overdose reversal drug naloxone to prevent overdose; creating and expanding treatment sites in rural areas to provide medications to treat opioid use disorder; expanding access to behavioral health care for young people in rural communities; and, caring for infants in rural areas who are at-risk for opioid exposure or experiencing symptoms related to opioid exposure. Click here to learn more and here to see the list of awardees.

SAMHSA Awards $57.6 Million to Connect Americans with Substance Use Recovery and Treatment Supports

As part of Overdose Awareness Week and the start of National Recovery Month, SAMHSA this week announced $57.6 million in seven grant programs to connect Americans who misuse substances to recovery and treatment supports. According to SAMHSA, the grant awards facilitate ongoing efforts throughout the nation in treatment, recovery support and harm reduction – three of the pillars of the HHS’ Overdose Prevention Strategy. Click here to read about the grant programs.

SAMHSA Releases Guide for Reentry from Criminal Justice Settings for People with Mental Health Conditions and SUD

SAMHSA has released Best Practices for Successful Reentry From Criminal Justice Settings for People Living With Mental Health Conditions and/or Substance Use Disorders, which examines the types of interventions that support successful reentry for adults with mental health conditions and/or substance use disorders who are leaving jail/prison. The 85-page guide includes an issue brief on the topic, current evidence on three interventions, guidance for identifying and implementing evidence-based practices to support reentry, and more.

Manatt to Examine Latest Wit v. UBH Ruling in Mental Health Parity Webinar 

Manatt litigation and benefits experts will discuss a host of parity issues in an upcoming webinar, including the latest federal report to Congress, action items for health plans and service providers, and the latest decision in the Wit v. UBH case.   Presenters will include Manatt partners Joe Laska and Harvey Rochman, as well as Jean Kim, special counsel, executive compensation and employee benefits. The hourlong webinar will take place Tuesday, Sept. 19 at 1 p.m. ET.   Click here to register.

Please Update Your Member Information for the 2023 NABH Membership Directory! 

NABH is developing its online-only 2023 Membership Directory, an essential member benefit that helps the association in its advocacy efforts. NABH has sent members a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use the link to verify your system’s information. The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all your system’s facilities so that we have a better picture of our membership. The deadline to submit your changes to NABH is Wednesday, Sept. 13. If you need assistance, please contact Maria Merlie maria@nabh.org or 202-393-6700, ext. 104. As always, thank you for your time and for all you do to advance NABH’s Mission and Vision!

Reminder: Please Submit Your Managed Care Denials Data to Enhance NABH Advocacy

Thank you to all members who have submitted data to NABH’s denial-of-care portal! We are still seeking data from additional members to support advocacy on health plan denials and prior-authorization timeliness. If you are a new participant, please e-mail NABH Administrative Coordinator Emily Wilkins for support.

Fact of the Week:

This summer Texas lawmakers enacted Tucker’s Law. which mandates that middle schools and high schools educate students about fentanyl abuse prevention and drug-poisoning awareness. NABH wishes its members, their teams, and families a happy and safe Labor Day weekend! For questions or comments about this CEO Update, please contact Jessica Zigmond.

Please Update Your Member Information for the 2023 NABH Membership Directory!

NABH is developing its online-only 2023 Membership Directory, an essential member benefit that helps the association in its advocacy efforts. Earlier this week NABH sent members a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use the link to verify your system’s information. The answers to these questions will help us provide a more accurate description of our diverse membership to policymakers, regulators, partner organizations, and the media. Please be sure to enter information for all your system’s facilities so that we have a better picture of our membership. The deadline to submit your changes to NABH is Wednesday, Sept. 13. If you need assistance, please contact Maria Merlie maria@nabh.org or 202-393-6700, ext. 104. As always, thank you for your time and for all you do to advance NABH’s Mission and Vision!

NABH Board Members Comment On SAMHSA’s 2023-2026 Strategic Plan

NABH Board Chair Harsh Trivedi, M.D., M.B.A. this week commented on behalf of the association about the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2023-2026 Strategic Plan.   Released last week, the plan presents a new person-centered mission and vision and identifies the following five priority areas to better meet the behavioral health needs of individuals, communities, and service providers: Preventing Substance Use and Overdose, Enhancing Access to Suicide Prevention and Mental Health Services, Promoting Resilience and Emotional Health for Children, Youth and Families, Integrating Behavioral and Physical Health Care, and Strengthening the Behavioral Health Workforce. In a Behavioral Health Business article published Aug. 23, NABH Board Chair Trivedi supported the plan and emphasized access, behavioral-physical healthcare integration, and preventing substance use and overdose. “Substance use is a chronic disease. We do not penalize people when their blood sugar goes out of whack or when their blood pressure goes a little too high,” said Trivedi, president and CEO of Sheppard Pratt. “We really do have to think about substance use in a different manner, which is that it’s going to be something that people battle over time. We can’t let a slip up mean that you, essentially, are out of treatment, which is exactly what you wouldn’t do for any other medical condition.” NABH board member David White, Ph.D., CEO of BayMark Health Services in Lewisville, Texas, was also interviewed for the article and noted that the behavioral healthcare industry needs to see a comprehensive implementation plan. “This agenda is huge, complex, and high-level,” White said. “The strategy, in most cases, is spot on, but it’s a very heavy lift for the execution phase and requires lots of great people with great abilities to impact each and every area in the way outlined.”

National Quality Forum to Join Joint Commission as An Affiliate

The Joint Commission and National Quality Forum (NQF) announced on Aug. 16 that NQF will join The Joint Commission enterprise, maintaining its independence in convening and developing consensus-based measures, implementation guidance, and practices that benefit all stakeholders. The organizations said in an announcement that the affiliation allows The Joint Commission and NQF to build upon their shared expertise in measuring quality and rationalizing the measurement landscape so the focus shifts from competing measures to advancing key outcomes. In addition, the affiliation is intended to strengthen The Joint Commission’s national and international accreditation and certification processes to be more evidence-based, data-driven, and outcomes-oriented.

Cigna Removes Prior Authorization Requirement for 25% of Medical Services

Cigna Healthcare on Thursday announced it would remove nearly 25% of medical services from prior authorization (or precertification) requirements. With the removal of these more than 600 additional codes, Cigna Healthcare has now removed prior authorization on more than 1,100 medical services since 2020, with the goal of simplifying the healthcare experience for both customers and clinicians, Cigna said in an announcement. More information about Cigna Healthcare’s approach to prior authorizations is available here.

Health Affairs: Five Urgent Steps to Address Violence Against Nurses in the Workplace

An Op-Ed published in the journal Health Affairs this week outlined five specific steps to address violence against nurses in the workplace, starting with enacting federal legislation to address workplace violence in healthcare, social service, and other sectors. Seven authors collaborated on the opinion piece, including several nursing school professors and one psychiatric mental health nurse practitioner at the University of New Mexico College of Nursing. “We write today, as psychiatric mental health nurses and workplace violence and nursing workforce researchers, to express our alarm: Our nurse colleagues aren’t safe at the bedside,” the authors wrote. “The American Psychiatric Nurses Association reports that fewer than two-thirds of nurses report feeling either safe or very safe at work. As nurses reported in last year in the National Plan for Health Workforce Well Being, violent injury of nursing staff by patients results in nurses’ short- and long-term disability, psychological stress, post-traumatic stress disorder, burnout, reduced quality of care, errors, and accidents.” In addition to federal legislation, other steps to address the issue include: emphasizing quality indicators that elevate efforts to protect staff from harm; strengthening data systems to better monitor worker exposure to aggressive events; improving reporting of workplace violence; and holding educational institutions accountable for teaching about quality and safety standards that protect nurses and staff from injury.

DEA and FDA Issue Joint Letter to the Public on Actions to Address Shortages in Prescription Stimulants

Earlier this month the Drug Enforcement Administration (DEA) and U.S. Food and Drug Administration (FDA) issued a joint letter updating the public about the ongoing prescription stimulant shortages affecting patients nationwide and actions to resolve these shortages. The DEA and FDA said both agencies are committed to working together on this issue and providing up-to-date information to the public. “The FDA and DEA do not manufacture drugs and cannot require a pharmaceutical company to make a drug, make more of a drug, or change the distribution of a drug,” FDA Commissioner Robert Califf, M.D. and DEA Administrator Anne Milgram wrote in the letter to the public. “That said, we are working closely with numerous manufacturers, agencies, and others in the supply chain to understand, prevent, and reduce the impact of these shortages. Click here to read the full letter.

Reminder: Please Submit Data to Enhance NABH’s Managed-Care Advocacy Efforts

Thank you to all members who have submitted data to NABH’s denial-of-care portal! We are still seeking data from additional members to support advocacy on health plan denials and prior-authorization timeliness. If you are a new participant, please e-mail NABH Administrative Coordinator Emily Wilkins for support.

Fact of the Week:

Half of parents say their child’s emotional and physical health has improved over the past year, according to a new Harris poll. Meanwhile, half also say their schools provide neither academic nor mental health counseling. For questions or comments about this CEO Update, please contact Jessica Zigmond.

Federal Lawmakers Introduce Bipartisan Behavioral Health IT Legislation

Reps. Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio) and Sens. Markwayne Mullin (R-Okla.) and Catherine Cortez Masto (D-Nev.) recently introduced the Behavioral Health Information Technology (BHIT) Coordination Act to improve coordination of mental and physical healthcare by supporting behavioral healthcare providers’ efforts to adopt health IT systems.                                   NABH is proud to support the BHIT Coordination Act, which:

• Provides $20 million a year in grant funding over five fiscal years (FY25-29) to finance behavioral health IT adoption through the Office of the National Coordinator for Health Information Technology (ONC).
• Requires a report to Congress on the number and type of behavioral healthcare providers that receive the grant, their ability to electronically exchange patient health information with other provider types, and clinical and non-clinical outcomes for patients.
• Directs ONC and the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop voluntary behavioral health IT standards.
• Directs the Centers for Medicare & Medicaid Services (CMS), SAMHSA, and ONC to develop joint guidance on how states can use Medicaid authorities and funding sources to promote the adoption and interoperability of certified Electronic Health Record (EHR) technology for behavioral health providers.

“Robust, interoperable EHRs are a core clinical and operational tool to expand coordinated, high-quality care – and now we must ensure that all of our behavioral health providers have access to these vital IT systems,” Rep. Matsui said in an announcement about the bill. “Despite widespread recognition of the value of health IT, behavioral health providers do not have the resources to utilize these tools,” she added. “The Behavioral Health IT Coordination Act will bridge this gap and ensure we invest the necessary resources for widespread adoption throughout the behavioral health community.” Rep. Matsui originally co-authored H.R. 3331, a bill to promote testing of incentive payments for behavioral healthcare providers to adopt and use certified electronic health record technology. In 2018, Congress included this legislation as Section 6001 of the SUPPORT Act. The BHIT Coordination Act seeks dedicated funding to fulfill the objectives of her previous efforts.

DEA Revises Existing Regulations to Expand Access to OUD Treatment Medication

The U.S. Drug Enforcement Administration (DEA) this week issued a final rule pursuant to the Easy Medication Access and Treatment of Opioid Addiction Act (the Act) that revises existing regulations to expand access to medications for Opioid Use Disorder (OUD). The Act directed DEA to revise its regulation to allow practitioners to dispense not more than a three-day supply of narcotic drugs to one person for one person’s use at one time to initiate maintenance treatment, detoxification treatment, or both. SAMHSA Report Highlights Cost and Financing Strategies for Coordinated Specialty Care for First- Episode Psychosis SAMHSA has released Coordinated Specialty Care for First Episode Psychosis: Costs and Financing Strategies, which offers states financing strategies to provide critical services for first-episode psychosis. SAMHSA estimates 100,000 people in the United States experience first-episode psychosis. Coordinated Specialty Care, or CSC, is a multi-component, evidence-based, early intervention service for individuals experiencing a first episode of psychosis who can improve their quality of life and social and clinical outcomes. The new report provides an overview of the costs and outcomes of providing services for first episode psychosis and strategies for financing the services in different states.

FDA Recommends Minimum of Six Months for Pivotal OUD Device Trials

The U.S. Food and Drug Administration (FDA) has released guidance cautioning device makers developing products to treat OUD to proceed carefully as they design clinical studies, recommending pivotal trials last at least six months. “Appropriate study duration is necessary because OUD is a condition with a high rate of relapse, and brief intervals of modification of drug use are unlikely to confer significant clinical benefit,” the guidance noted. FDA Commissioner Robert Califf, M.D. said in a statement that the guidance should prompt industry to collect more comprehensive, timely, and diverse data to support device submissions that may help improve the lives of those with OUD. “These and similar efforts will continue to advance within the agency, with the input from industry, stakeholders, and, most importantly, those managing opioid use disorder,” Califf added. Public comments about the guidance are due by Thursday, Oct. 26.

Biotech Company Cessation to Initiate U.S. Clinical Trial for Drug to Prevent Fentanyl Overdose

Clinical-stage biotechnology company Cessation has announced the FDA has authorized the Chapel Hill, N.C.-based company to initiate a clinical trial this month for CSX-1004, a monoclonal antibody designed specifically to prevent fentanyl overdose. The clearance follows the FDA’s review and approval of Cessation’s Investigational New Drug (IND) application and serves as a launching point for Cessation’s first in-human clinical trials, according to the company’s announcement. Cessation’s IND summarized years of the company’s safety and manufacturing data and included a detailed description of the planned clinical study in humans.   Cessation’s announcement said CSX-1004 works by sequestering fentanyl molecules as they enter the bloodstream, effectively neutralizing them in the blood before they reach the brain and preventing them from exerting their harmful effects.

Reminder: 2023 NABH Annual Meeting Photos Now Available

NABH is pleased to share photos from the 2023 Annual Meeting: Security the Promise of Parity. If you choose to download and use a photo, please credit photographer Chris Ferenzi. Thank you. Click here to learn more about the training.

Reminder: Please Submit Data to Enhance NABH’s Managed-Care Advocacy Efforts

Thank you to all members who have submitted data to NABH’s denial-of-care portal! We are still seeking data from additional members to support advocacy on health plan denials and prior-authorization timeliness. If you are a new participant, please e-mail NABH Administrative Coordinator Emily Wilkins for support.

CEO Update During the Congressional August Recess

NABH will publish CEO Update only on Friday, Aug. 11 and Friday, Aug. 25 during the congressional August recess.

Fact of the Week:

A recent study published in Neuropharmacology suggests that central Ghrelin receptors (GHSR) mediate binge-like alcohol intake. These data reveal novel pharmacological compounds with translational potential in the treatment of alcohol use disorder (AUD) and provide further evidence of the GHSR as a potential treatment target for AUD, the study noted. The National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism published the study. For questions or comments about this CEO Update, please contact Jessica Zigmond.

United Healthcare Sued by Labor Department

The US Department of Labor (DOL) has sued UnitedHealthcare and United Behavioral Health alleging the companies systematically limit coverage of mental healthcare more than medical and surgical care in violation of the Mental Health Parity and Addiction Equity Act and the Employee Retirement Income Security Act. The complaint filed by the DOL specifically points to discrepancies in reimbursement rates for out-of-network, non-physician mental health providers compared to rates for medical and surgical providers. In addition, the DOL complaint refers to a concurrent review program for outlier or unusual services that the companies apply broadly to all outpatient mental health benefits but only to a “very select set” of medical/surgical benefits. The complaint was filed as Walsh v. United Behavioral Health in the US District Court for the Eastern District of New York on Wednesday, Aug. 11, 2021.

The New York attorney general also sued UnitedHealth Group, United Behavioral Health, UnitedHealthcare and Oxford Health Plans, claiming the companies violated both federal and state mental health parity laws.

The companies will pay $2.5 million to resolve the Labor Department claims, $1.1 million to resolve the state’s claims, and $10 million to resolve private class action claims, according to two separate settlement agreements with the regulators and private parties.

 

Senate Finance Committee Launches Bipartisan Effort to Address Barriers to Mental Health Care

Senate Finance Committee Chairman Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) announced plans to develop bipartisan legislation addressing barriers to mental healthcare in a letter to Committee members issued Aug. 5, 2021. The letter requested proposals regarding the following issues in particular:

• Addressing the behavioral health workforce shortage,
• Supporting care integration, access, and coordination efforts,
• Improving oversight, data reporting, and enforcement of mental health parity laws, and
• Expanding access to telehealth services for behavioral health care.

The letter also cited Committee interest in enhancing mental health crisis care and addressing gaps in care for high need groups including individuals with serious mental illness, those experiencing homelessness, and individuals involved in the child welfare system. The letter also referred to the need to improve pediatric mental healthcare and strengthen prevention and treatment options for substance use disorders. Proposals from Committee members are due before Aug. 31, 2021. The letter also states the Committee will issue a separate request for input from public- and private-sector stakeholders. NABH is working on several fronts to ensure our legislative priorities are addressed as part of this initiative.  

California Mandates Covid-19 Vaccine for Healthcare Workers

The California Department of Public Health issued an order on Aug. 5, 2021 requiring workers in healthcare facilities to be vaccinated for Covid-19 by Sept. 30, 2021. The order explicitly applies to hospitals, acute psychiatric hospitals, chemical dependency recovery hospitals, clinics and doctor offices (including behavioral health), residential substance use treatment and mental health treatment facilities, as well as other healthcare facilities. Workers subject to this requirement include those that are paid and unpaid including nurses and nursing assistants, technicians, therapists, students and trainees, contract staff not employed by the facility, and persons not involved in patient care but who could be exposed to infectious agents including clerical, dietary, environmental services, laundry, security, engineering and facilities management, and volunteer personnel. Workers may seek an exemption based on religious beliefs or qualifying medical reasons corroborated in writing by a state licensed medical professional. Exempt workers must wear masks and be tested weekly. Healthcare facilities are required to maintain records of workers’ vaccination status and provide such records to local or state public health officials upon request.  

SAMHSA to Host Virtual Roundtable about Creating a Diverse Behavioral Health Workforce on Aug. 18

SAMHSA’s National Network to Eliminate Disparities in Behavioral Health will host a virtual roundtable later this month to discuss strategies that motivate racially and ethnically diverse individuals to consider behavioral healthcare as a career path. The event will address how community-based organizations are working to diversify the behavioral health workforce, such as recruiting and retaining a racially and ethnically diverse staff. SAMHSA will host the virtual roundtable on Wednesday, Aug. 18 at 1 p.m. ET. Click here to learn more and register.  

Joint Commission Behavioral Healthcare and Human Services Webinar Series

The Joint Commission will hold weekly webinars starting Aug. 24 for behavioral healthcare professionals responsible for meeting accreditation standards and survey compliance. These sessions will address the following topics:

• Information Management (IM), Record of Care, Treatment and Services (RC),
• Medication Management (MM),
• Environment of Care (EC), Life Safety (LS),
• Human Resources Management (HRM),
• Leadership (LD), Performance Improvement (PI),
• Infection Prevention and Control (IC),
• Care, Treatment, and Services (CTS),
• Emergency Management (EM),
• Safety Systems for Individuals Served (SSIS),
• Rights and Responsibilities (RI), Waived Testing (WT), and
• National Patient Safety Goals (NPSG).

Here’s a link to the registration page on the Joint Commission website.  

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is a new resource for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials. NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients. This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more. The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.  

Register Today for the NABH 2021 Annual Meeting!

Registration is open for the NABH 2021 Annual Meeting from Wednesday, Oct. 6 – Friday, Oct. 8, 2021 at the Mandarin Oriental Washington, DC. We hope you join us as we recognize our meeting theme, Expanding Access: Right Care. Right Setting. Right Time. Please visit our Annual Meeting webpage to register for the meeting and to reserve your hotel room. We look forward to seeing you in Washington!  

Fact of the Week

Mental illness and substance use disorders were among the top five reasons for inpatient treatment in community hospitals among individuals under 45 years old in 2018 according to a statistical brief issued by the Agency for Healthcare Research and Quality. For questions or comments about this CEO Update, please contact Kirsten Beronio.

Life expectancy in the U.S. fell by 1.5 years in 2020, biggest decline since at least World War II

Provisional data released by the Centers for Disease Control and Prevention showed that life expectancy dropped to 77.3 years in 2020, the largest single-year decline recorded since 1943. Nearly 75% of the decline in the 2020 life expectancy was due to Covid deaths, the report estimates. A further 11% of the decline was due to accidental and unintentional injuries — more than a third of which were due to a spike in drug overdose deaths.

Public Health Emergency Extended

On July 19, HHS Secretary Becerra renewed the Coronavirus Disease 2019 (COVID-19) pandemic public health emergency for 90 days, effective July 20, 2021.

$26B Opioid Settlement Announced

Attorneys general from seven states across the country announced that they had entered into a $26 billion proposed settlement agreement with three of the largest pharmaceutical distributors — McKesson, Cardinal Health and AmerisourceBergen — and drugmaker Johnson & Johnson that could resolve thousands of lawsuits focused on their role in the ongoing opioid epidemic.

The proposed global agreement — if approved by a substantial number of states and local governments across the country — would resolve the claims of nearly 4,000 entities that have filed lawsuits in federal and state courts against the four companies. States have 30 days to sign onto the proposed agreement. Local governments in the participating states will have up to 150 days to join. The total funding distributed will be determined by the overall degree of participation by both litigating and non-litigating state and local governments with the substantial majority of the money to be spent on opioid treatment and prevention. Each state’s share of the funding will be determined by an agreement among the states using a formula that takes into account the impact of the crisis on the state — specifically, the number of overdose deaths, the number of residents with substance use disorder, and the number of opioids prescribed — and the population of the state.

CMS releases proposed Medicare Hospital Outpatient Prospective Payment System Rule

In the proposed 2022 Medicare Hospital Outpatient Prospective Payment System rule released Monday, CMS proposed significant increases to penalties that could be assessed on hospitals for non-compliance with price transparency requirements. If the rule is finalized as proposed, the maximum annual penalty would increase from $109,500 to $2 million per hospital. The agency also proposed halting the Trump Administration’s elimination of the inpatient-only list and included an RFI focusing on the health and safety standards, quality measures, reporting requirements, and payment policies for Rural Emergency Hospitals (REHs), a new Medicare provider type.

Regarding Medicare partial hospitalization program (PHP) calendar year (CY) 2022 payment rates, in this rulemaking, CMS is proposing to maintain the existing unified rate structure, with a single PHP Ambulatory Payment Classification for each provider type for days with three or more services per day. CMS is also proposing to use the community mental health center (CMHC) and hospital-based PHP geometric mean per diem costs, consistent with existing methodology, but with a cost floor that would maintain the per diem costs finalized for CY 2021. Following this methodology, CMS proposes to use the cost floor value of $136.14 for CMHCs as the basis for developing the CY 2022 CMHC APC per diem rate, and to use the cost floor value of $253.76 as the basis for developing the CY 2021 hospital-based APC per diem rate. In addition, CMS is proposing to use CY 2019 claims data and cost report data for each provider type consistent with a broader CY 2022 OPPS rate-setting proposal to use claims and cost report data prior to the public health emergency.

HHS Announces Grant Availability Based on NABH supported Dr. Lorna Breen Health Care Provider Protection Act

The Health Resources and Services Administration (HRSA) announced the availability of $103 million in grants over a three-year period to reduce burnout and promote mental health among the healthcare workforce. The grants will help health care organizations establish a culture of wellness among the health and public safety workforce and will support training efforts that build resiliency for those at the beginning of their health careers.

There are three funding opportunities now accepting applications:

• Promoting Resilience and Mental Health Among Health Professional Workforce:  Approximately 10 awards will be made totaling approximately $29 million over three years to health care organizations to support members of their workforce. This includes establishing, enhancing, or expanding evidence-informed programs or protocols to adopt, promote and implement an organizational culture of wellness that includes resilience and mental health among their employees.
• Health and Public Safety Workforce Resiliency Training Program: Approximately 30 awards will be made totaling approximately $68 million over three years for educational institutions and other appropriate state, local, Tribal, public or private nonprofit entities training those early in their health careers. This includes providing evidence-informed planning, development and training in health profession activities in order to reduce burnout, suicide and promote resiliency among the workforce.
• Health and Public Safety Workforce Resiliency Technical Assistance Center: One award will be made for approximately $6 million over three years to provide tailored training and technical assistance to HRSA’s workforce resiliency programs.

NABH Joins Amicus Brief in Support of Using Opioid Litigation Settlement Distributions to Supplement Rather Than Supplant Existing Funding

NABH joined the Kennedy Forum, the American Foundation for Suicide Prevention and other leading behavioral healthcare organizations in an amicus brief to the United State Bankruptcy Court in the Southern District of New York calling for funds distributed from the National Opioid Abatement Trust (NOAT) to be used for opioid use disorder and co-occurring mental health and substance use disorder services. The amicus argued that funds distributed from the NOAT should be used to supplement, rather than supplant, existing funding for such services.

CMS Webinar on Advancing Housing-Related Supports for Individuals with Substance Use Disorders CMS announced a national webinar entitled, Lessons Learned from the Advancing Housing-Related Supports for Individuals with Substance Use Disorders State Medicaid Learning Collaborative. This nationally focused webinar will focus on key activities and lessons learned from states that are working to develop and expand innovative strategies to provide housing-related supports for Medicaid beneficiaries with substance use disorders. This webinar is scheduled on August 19, 2021 from 3:00 to 4:30 EDT.

Register here.

MACPAC Issue Brief Examines Implementation of the Mental Health Parity and Addiction Equity Act in Medicaid and CHIP

A newly issued MACPAC brief examines MHPAEA implementation in Medicaid and the State Children’s Health Insurance Program (CHIP). The brief provides a background on federal parity laws, describes Medicaid and CHIP requirements under MHPAEA, and includes findings from interviews with state Medicaid officials, managed care organizations (MCOs) and beneficiary advocates in three states, as well as officials from the Centers for Medicare & Medicaid Services (CMS) and representatives from other national organizations.

Report: State and Federal Officials Should Reduce Restrictions on New OTPs

A new report by the Pew Charitable Trusts calls on states and the federal government to make changes to support the accessibility of opioid treatment programs (OTPs). Noting that OTPs are vital components of our response to opioid use disorders, Pew calls on state and federal officials to reduce restrictions on opioid treatment programs (OTPs), including barriers that increase the difficulty of opening new facilities.

The Pew report cites integration issues in existing systems that prevent too many patients from accessing needed opioid use disorder treatment. To address these issues, the report calls for reforms to support the integration of OTPs into the broader healthcare system, using a hub-and-spoke model to better coordinate care and reduce wait times. The Pew report notes that Congress passed a law requiring states to temporarily cover OUD medications as a mandatory Medicaid benefit, but that provision ends in September 2025. Pew called on Congress to permanently require state Medicaid programs to cover all forms of medication for opioid use disorder.

New Report Examines Impact of Federal Law Requirements on Substance Use Disorder Care in Emergency Departments

A new report by the Legal Action Center examined the legal obligations of hospitals to provide evidence-based and lifesaving care to emergency department patients with substance use disorders. The report focuses on requirements to provide substance use disorder care under the Emergency Medical Treatment and Labor Act (EMTALA); the Americans with Disabilities Act (ADA); the Rehabilitation Act (RA); and Title VI of the Civil Rights Act (Title VI).

Reminder: NABH Denial-of-Care Portal is Open to Members

NABH’s Denial-of-Care Portal is a new resource for members to provide information about their experiences with managed care organizations that impose barriers to care through insurance-claim denials.

NABH’s Managed Care Committee worked for more than a year to develop the Denial-of-Care Portal as a way to collect specific data on insurers who deny care—often without regard for parity or the effects on patients.

This NABH member-only, survey-like tool allows users to add the name of a managed care organization, type of plan, level of care, type of care (mental health or substance use disorder), duration of approved treatment, duration of unapproved treatment, criteria used to deny a claim, and more.

The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts.

Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Register Today for the NABH 2021 Annual Meeting!

Registration is open for the NABH 2021 Annual Meeting from Wednesday, Oct. 6 – Friday, Oct. 8, 2021 at the Mandarin Oriental Washington, DC.

We hope you join us as we recognize our meeting theme, Expanding Access: Right Care. Right Setting. Right Time.

Please visit our Annual Meeting webpage to register for the meeting and to reserve your hotel room. We look forward to seeing you in Washington!

Fact of the Week

A new study of more than 1 million Medicaid enrollees with opioid use disorder (OUD) in 11 states between the years 2014-2018 found that prevalence of OUD in this population increased from around 3% in 2014 to 5% four years later.

NABH, MHA, and NAMI Send Letter to Congress About Citizens Commission on Human Rights

NABH, Mental Health America (MHA), and the National Alliance on Mental Illness (NAMI) this week sent a letter to Congress about the work of the Citizens Commission on Human Rights (CCHR), an activist organization representing Scientology that questions the legitimacy of psychiatric categories, diagnostic practices, and common forms of behavioral healthcare treatment. News outlets have reported for years that the Scientology movement’s goal is to replace mental health treatment with rituals that adhere to Scientology’s beliefs and practices. The letter from NABH, MHA, and NAMI is meant to inform federal lawmakers and their staff members that CCHR represents Scientology, and also to make them aware that CCHR’s goal is to discredit the mental health segment and undermine public faith in this field of medicine. The letter is also intended to debunk CCHR’s claims and highlight the positive effects of behavioral healthcare treatment. “When behavioral healthcare conditions are compared with other chronic conditions, behavioral healthcare outcomes are similar, and, in some cases, slightly better,” the letter said. “Consider these statistics: 30 percent to 50 percent of adults with type 1 diabetes (a chronic condition) will experience recurrence of symptoms each year, and approximately 50 percent to 70 percent of adults with hypertension or asthma will have a recurrence requiring additional medical care each year. By comparison, “40 percent to 60 percent of patients treated for alcohol or other drug dependence return to active substance use within a year following treatment discharge.” NABH, MHA, and NAMI concluded the letter by offering to serve as trusted resources for policymakers, journalists, patient advocates, and the general public to ensure that America’s most vulnerable patients can access the high-quality, evidence-based behavioral healthcare they need.

MACPAC Examindes Access to Medication-Assisted Treatment Under Medicaid

Medicaid utilization management policies for medication-assisted treatment (MAT) vary widely nationwide and the extent to which these policies build barriers to addiction treatment is unclear, the Medicaid and CHIP Payment and Access Commission (MACPAC) concluded in its report to Congress this week. The Report to Congress: Utilization Management of Medication-Assisted Treatment in Medicaidis based on analysis of available data on how MAT utilization management is used nationally. It is also based on interviews with industry experts, clinicians, and state officials to study how eight states—Arkansas, Illinois, Maine, Missouri, Tennessee, Utah, Washington, and West Virginia—apply preferred status, prior authorization, step therapy, prescription limits, quantity or dose limits, and lifetime limits to their Medicaid fee-for-service and managed care programs. “Our review found a trend among states to eliminate prior authorization,” MACPAC Chair Melanie Bella said in an announcement about the report. “This is encouraging, since it removes one potential barrier to MAT access,” she added. According to the report, the number of states requiring prior authorization for MAT medications declined to 30 in 2018 from 48 in 2011-2013.

SAMHSA Releases First-Episode Psychosis and Co-Occurring SUD

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released First-Episode Psychosis and Co-Occurring Substance Use Disorders, a new guide to help healthcare providers, systems, and communities address first-episode psychosis and co-occurring substance use disorders (SUD). The resource describes relevant research; explores emerging and best practices; identifies knowledge gaps and implementation challenges; and offers resources.

SUD Increases Risk of Death from Heart Infection

Patients who suffer from infective endocarditis (IE) and struggle with SUD have a 240-percent increased risk of dying within 6 months to 5 years after valve surgery compared with other IE patients, according to a new study published online in The Annals of Thoracic Surgery. According to an announcement from the Society of Thoracic Surgeons (STS), IE is a life-threatening bacterial infection in the endocardium, the inner lining of the heart chambers and valves. Although this condition is often associated with heart defects or abnormal valves, the STS said it is also a “notorious complication after using unsanitary needles and syringes to inject drugs, as bacteria from the skin’s surface and injection equipment release directly into the bloodstream.” Despite medical advances, SUD-IE remains difficult to treat and has a high recurrence rate, the STS notes. The Centers for Disease Control and Prevention reports that people with SUD-IE are 10 times more likely than other patients with IE to require a second surgery or die months after leaving the hospital.

Behavioral Healthcare Providers Elected to National Academy of Medicine

Six behavioral healthcare providers were elected as new members to the National Academy of Medicine (NAM) this week. Election to the NAM is considered among the highest honors in the fields of health and medicine and recognizes individuals who have demonstrated both outstanding professional achievement and commitment to service. David Amaral, Ph.D., a distinguished professor in the department of psychiatry and behavioral sciences at the University of California, Davis; Colleen Barry, Ph.D., M.P.P., chair of health policy and management at the Johns Hopkins Bloomberg School of Public Health; Debra Elaine Houry, M.D., M.P.H., director of the National Center for Injury Control and Prevention at the Atlanta-based CDC; David Meyers, M.D., chief physician at the Agency for Healthcare Research and Quality in Baltimore; Scott Rauch, M.D., president and psychiatrist-in-chief at McLean Hospital and professor of psychiatry at Harvard Medical School; and Rachel Yehuda, Ph.D., professor and vice chair for veterans affairs for psychiatry and neuroscience at the Icahn School of Medicine at Mount Sinai in New York City were elected when the NAM announced the election of 90 regular members and 10 international members during its annual meeting on Oct. 21.

National Prescription Drug Take-Back Day is Oct. 26

The Drug Enforcement Agency under the U.S. Justice Department is sponsoring National Prescription Drug Take-Back Day on Saturday, Oct. 26. The day is meant to provide a safe, convenient, and responsible way of disposing prescription drugs, while also educating the public about the potential for medication abuse. Click here to learn more about the program and to identify drop-off sites.

IPFQR Program Webinar Scheduled for Oct. 31

The Quality Reporting Center will host a webinar for participants in the Inpatient Psychiatric Quality Reporting (IPFQR) Program next Thursday, Oct. 31 at 2 p.m. ET. The presentation—IPFQR Program FY 2020 Data Review is Thursday, Oct. 31 at 2 p.m. ET— will provide a review of the FY 2020 measure and non-measure data results. Click here to register and download the slides here from the Quality Reporting Center one day before the presentation.

SAMHSA Grant Applications for Integrating Primary and Behavioral Healthcare Due Dec. 10

SAMHSA has announced it is accepting applications for fiscal year 2020 Promoting Integration of Primary and Behavioral Healthcare (PIPHC) grants. The program’s purpose is to promote full integration and collaboration in clinical practice between primary and behavioral healthcare, support integrated care models and improve the overall wellness and health of adults with serious mental illness or children with serious emotional disturbance, and promote and offer integrated care services related to screening, diagnosis, prevention, and treatment of mental and substance use disorders and co-occurring physical health conditions and chronic diseases. Applications are due Tuesday, Dec. 10.

Judy Collins and Tom Insel to Serve as Keynote Speakers at NABH 2020 Annual Meeting

Grammy award-winning folk singer Judy Collins and neuroscientist Tom Insel, M.D., the former director of the National Institute Mental Health, will headline NABH’s 2020 Annual Meeting in Washington. Please visit NABH’s Annual Meeting homepage today to learn more and to register for the meeting. Also please be sure to make your hotel reservation at the Mandarin Oriental Washington, DC from March 16-18, 2020. We look forward to seeing you next March!

Fact of the Week

The last time a World Series was played in Washington, D.C. was 1933, the same year nine physicians established the National Association of Private Psychiatric Hospitals (NAPPH), the precursor to the National Association of Psychiatric Health Systems (NAPHS) and NABH. For questions or comments about CEO Update, please contact Jessica Zigmond.

SAMHSA Releases Recovery Home Best Practices and Guidance

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week releasedbest practices and suggested guidelines for recovery housing. Last year’s Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act requires the HHS secretary to identify or facilitate developing best practices for recovery housing. SAMHSA’s report this week identifies 10 guiding principles to help states and federal policymakers both define and understand what comprises safe, effective, and legal recovery housing. In its guidance, SAMHSA noted the document is intended to provide a framework that builds on and extends the policy and practice work that has guided the development of recovery housing until now. The guidelines’ 10 areas include having a clear operational definition, recognizing that a substance use disorder (SUD) is a chronic condition that requires a range of recovery supports, promoting and using evidence-based practices, and ensuring quality, integrity, and patient safety.

MACPAC Releases Draft Report on Oversight of IMDs

The Medicaid and CHIP Payment Access Commission (MACPAC) recently released its draftreport on the oversight of Institutions for Mental Diseases (IMDs) a few months ahead of the commission’s January 2020 deadline for its final report to Congress. Divided into five chapters— 1) history and federal regulation, 2) services provided, 3) regulation and oversight of IMDs and outpatient behavioral health facilities, 4) Medicaid standards for behavioral health facilities, and protections for patients in IMDs, and 5) outpatient behavioral health facilities—the 24-page report includes key findings but does not offer recommendations. NABH sent MACPAC a letter about the regulatory environment at IMDs in late May as part of the commission’s process to develop the report.

Kaiser Permanente Pledges $2.75 Million in Research Funding to Prevent Childhood Trauma

Not-for-profit health plan Kaiser Permanente this week announced it will invest $2.75 million in new research to study childhood trauma and its effect on total health. In an announcement, Kaiser noted the study’s purpose is prevent and mitigate the health effects of adverse childhood experiences, or ACEs. ACEs are traumatic childhood events that occur before the age of 18 across multiple categories, including abuse, neglect, household dysfunction, systemic racism, and living in a high-crime neighborhood. “Our landmark research on ACEs brought new understanding to the long-term impacts of childhood trauma, and we are now expanding our work with the bold ambition to prevent and minimize ACEs— and create healthier and more resilient generations in the future,” Kaiser Permanente Chairman and CEO Bernard Tyson said in the announcement. One main goal for the new research effort is to provide insights for both clinical and community-based interventions to help address ACEs.

Health Affairs Examines the Effects of Violence on Health

In its latest issue, the journal Health Affairs this week examined the many ways violence affects health and concluded it is the “daily burden of violence in its many forms” that takes a greater toll on people. Introducing the Violence & Health issue, editor Alan Weil noted there were 2.3 million violence-related emergency department visits in 2017, of which 5 percent were due to firearms. He added that healthcare is the sector with the highest rate of workplace violence. The current issue includes two papers that examine the consequences of exposure to violence based on in-person surveys of 500 adults in two violent Chicago neighborhoods. From those findings, the authors concluded that exposure to violence relates to being in a state of hypervigilance, which carries with it negative health consequences. “Exposure to violence increases the odds of hypervigilance, with exposure to police violence associated with an almost 10-percentage-point increase,” Weil noted, adding that a separate paper in the issue found that exposure to neighborhood violence increases social isolation and loneliness. The issue also includes a paper that explores the relationship between alcohol misuse and subsequent arrest for intimate partner violence.

National Addiction Treatment Week is October 21-27, 2019

The American Society of Addiction Medicine (ASAM) will host National Addiction Treatment Week from October 21-27, 2019 to raise awareness about the gap in certified addiction medicine care and treatment. The week is also meant to expand the qualified workforce and build awareness around the important need for clinicians to enter the field of addiction medicine. To participate, follow @TreatmentWeek on Twitter and use #hashtag #TreatmentWeek to share your messages about addiction care and treatment.

Register Today for the NABH 2020 Annual Meeting!

Registration has opened for the NABH 2020 Annual Meeting, Expanding Access: Right Care. Right Setting. Right Time. Please visit NABH’s Annual Meeting homepage today to register for the Annual Meeting and also make your hotel reservation at the Mandarin Oriental Washington, DC from March 16-18, 2020. We hope to see you next March!

Fact of the Week

A new study posted in Psychiatry Online shows any involvement between family members and inpatient staff was significantly associated with patients’ attending an outpatient appointment by seven days after discharge. For questions or comments about CEO Update, please contact Jessica Zigmond.

NABH President and CEO Mark Covall to Retire; Shawn Coughlin Named as Successor

NABH President and CEO Mark Covall announced this week his plans to retire on Dec. 31, 2019 after more than 35 years with the association and 24 years as its president and CEO. The NABH Board of Trustees subsequently named Shawn Coughlin, the association’s executive vice president for government relations and public policy, as NABH’s next president and CEO, effective Jan. 1, 2020. “It has been a privilege to work closely for decades with people who manage and provide life-saving behavioral healthcare services to some of the most vulnerable citizens in our country,” Covall said in a news release this week about the transition. “For years, I’ve also enjoyed working with skilled and dedicated teams here in Washington who have helped expand our services and change U.S. public policy.” After he retires, Covall will serve as executive vice chairman of the NABH Board of Trustees for a two-year term. “I am honored to serve as NABH’s president and CEO after Mark’s long and impressive tenure,” Coughlin said in the news release. “Mark has been a mentor to me for nearly 20 years. His knowledge of—and passion for—improving mental health and addiction treatment services in the United States is unmatched.”

NABH Submits Recommendations to CMS on Bundled Rates for OTPs

NABH outlined a series of recommendations to the Centers for Medicare & Medicaid Services (CMS) in its Sept. 27 comment letter about the agency’s proposed physician fee schedule rule for 2020 that implements the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act. In the letter, NABH President and CEO Mark Covall highlighted that the value of a payment bundle is to simplify payment mechanisms in a way that treatment providers receive adequate compensation for treatment and patients receive the right care, in the right setting, at the right time. “Bundles that are highly prescriptive tend to disempower providers by directing medical decision-making,” Covall wrote. “At the same time, highly prescriptive bundles disempower patients by forcing them to engage in unnecessary and potentially burdensome care.” Covall also noted that because CMS’ proposed service model exceeds workforce capacity, “…the CMS proposal would put all OTPs at risk of not complying with the terms of the bundle and threaten the existing infrastructure and constrict treatment capacity at a time when more treatment is needed.”

NABH Submits Comments to CMS on PHP Rates and Price Transparency

NABH has recommended that CMS establish a task force to review and discuss improving the availability of partial hospitalization programs (PHPs) for Medicare beneficiaries. This suggestion was part of NABH’s Sept. 27 public comment letter to CMS on the agency’s proposed Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems (OPPS) and Quality Reporting Programs for 2020. Currently, 47.9 percent of NABH members offer PHP services, and more than 32.5 percent offer PHP addiction services. “We recommend that CMS include NABH, the Association for Ambulatory Behavioral Healthcare, the National Council for Behavioral Health, a sampling of PHP providers from the membership of each organization, Mental Health America, and the National Alliance on Mental Illness in this task force,” Mark Covall wrote in NABH’s letter. “We believe that together, CMS and these organizations can produce actionable steps to ensure Medicare beneficiaries continue to have the necessary and appropriate access to PHP services.”

NAMI Releases First Free Online Class for Parents of Children with Mental Illness

The National Alliance on Mental Illness (NAMI) has announced NAMI Basics OnDemand, a free, six-session education program for parents, caregivers, and other family who provide care for youth aged 22 or younger who are experiencing mental health symptoms. For the last 10 years, NAMI Affiliates have offered NAMI Basics in an in-person, group setting, serving about 20,000 participants in 43 states nationwide. This new resource meets an increasing demand for the program. “We know parents face barriers to attending an in-person class, especially when a child may be experiencing mental health challenges, but that’s when this information is needed the most,” NAMI Acting CEO Angela Kimball said in a news release. “We hope by providing this free, online course of NAMI Basics OnDemand, we’ll reach more people when and where it’s easiest for them to access this vital information,” she added. “We want parents to get the resources they need and to realize they are not alone.” The program’s six sessions focus on basic elements of coping with mental health conditions; brain biology and getting a diagnosis; communication skills and crisis preparation; treatment and connecting with others by sharing your story; navigating the mental health and education systems; and self-care and advocacy.

ASAM Seeks Public Comment on Clinical Practice Guideline

The American Society of Addiction Medicine is seeking both member and public comment on the draft of the society’s latest clinical practice guideline on alcohol withdrawal management in both inpatient and outpatient settings. Click here to learn about the methodology and for a copy of the draft guideline. The deadline to submit all comments is Monday, Oct. 7.

National Addiction Treatment Week is Oct. 21-27, 2019

The American Society of Addiction Medicine (ASAM) will host National Addiction Treatment Week from Oct. 21-27, 2019 to raise awareness about the gap in certified addiction medicine care and treatment. The week is also meant to expand the qualified workforce and build awareness around the important need for clinicians to enter the field of addiction medicine. To participate, follow @TreatmentWeek on Twitter and use #hashtag #TreatmentWeek to share your messages about addiction care and treatment.

Register Today for the NABH 2020 Annual Meeting!

Registration has opened for the NABH 2020 Annual Meeting, Expanding Access: Right Care. Right Setting. Right Time.   Please visit NABH’s Annual Meeting homepage today to register for the Annual Meeting and also make your hotel reservation at the Mandarin Oriental Washington, DC from March 16-18, 2020. We hope to see you next March!

Fact of the Week

The aggregate production quote of oxycodone (APQ) in the United States—which the U.S. Drug Enforcement Agency (DEA) establishes annually—increased more than 400 percent between 2002 and 2013. It wasn’t until 2017 that DEA significantly reduced the APQ for oxycodone, by 25 percent.   For questions or comments about CEO Update, please contact Jessica Zigmond.

NIH Has Awarded $945 Million to Address Nation’s Opioid Crisis in 2019

The National Institutes of Health (NIH) announced this week it has awarded $945 million in fiscal year 2019 to 41 states nationwide as part of its Helping to End Addiction Long-term Initiative, or NIH HEAL. NIH said its agency-wide research effort is meant to improve treatments for chronic pain; curb the rates of opioid use disorder (OUD) and overdose; and achieve long-term recovery from opioid addiction. The effort leverages the skills and expertise from nearly every NIH institute in the areas of translation of research to practice for opioid addiction, new strategies to prevent and treat opioid addiction, enhanced outcomes for infants and children exposed to opioids, novel medication options for OUD and overdose, clinical research in pain management; and pre-clinical and translational research in pain management. “It’s clear that a multi-pronged scientific approach is needed to reduce the risks of opioids, accelerate development of effective non-opioid therapies for pain, and provide more flexible and effective options for treating addiction to opioids,” NIH Director Francis Collins, M.D., Ph.D., said in an announcement. Collins launched the HEAL initiative in 2018.

VA Releases National Suicide Prevention Report

The number of U.S. Veteran suicide deaths per year rose to 6,139 in 2017 from 5,787 in 2005, increasing alongside the rise in suicide deaths in the United States broadly, according to the U.S. Veterans Affairs Department’s (VA) 2019 National Veteran Suicide Prevention Report. Released Sept. 20, the report includes findings from the VA’s most recent analysis of Veteran suicide data from 2005 to 2017. The analysis showed that the number of Veteran suicide deaths has exceeded 6,000 every year between 2008 and 2017. The report also noted 69 percent of all Veteran suicide deaths resulted in a firearm injury, and that males between the ages of 18 and 34 experienced the highest rates of suicide. Meanwhile, the VA reported that the rate of suicide was 2.2 times higher among female Veterans than non-Veteran adult women and 1.3 times higher among male Veterans than non-Veteran adult men. “VA is working to prevent suicide among all Veterans, whether they are enrolled in VA healthcare or not,” VA Secy. Robert Wilkie said in an announcement about the report. “That’s why the department has adopted a comprehensive public health approach to suicide prevention, using bundled strategies that cut across various sectors — faith communities, employers, schools and health care organizations, for example — to reach Veterans where they live and thrive.”

Study Shows Veterans with Mental Illness at Higher Risk for Cardiovascular Disease

A new study sponsored by the VA showed multiple mental illnesses were associated with an increased risk of cardiovascular disease (CVD) outcomes, which is consistent with the hypothesis that chronic stress leads to greater CVD. Published in the American Heart Association’s journal Circulation: Cardiovascular Quality and Outcomes, the study found that more severe mental illnesses—such as primary psychotic disorders—have the largest effect sizes even after controlling for other psychiatric diagnoses, conventional CVD risk factors, and psychotropic medication use. Among men, the study noted, depression, anxiety, psychosis, and bipolar disorder were all associated with an increased CVD risk, while among women, that link was found only for depression, psychosis, and bipolar disorder. “Surprisingly, a PTSD (post-traumatic stress disorder) diagnosis in men was tied to a lower risk, but in women, PTSD was not linked to any difference in CVD risk,” the study said.

Methadone Barriers Remain Despite Evidence of Effectiveness to Treat OUD

Despite evidence proving its effectiveness, methadone—one of three medications the U.S. Food and Drug Administration (FDA) has approved to treat OUD—continues to be one of the most heavily regulated drugs in the country at a time when additional methadone treatment capacity is needed, according to new Health Affairs blog post. Citing statistics from the 2018 National Survey of Substance Abuse Treatment Services (a survey of substance use disorder treatment facilities), the blog noted that about 383,000 people were treated with methadone in the past year. Meanwhile, opioid treatment programs (OTPs) are unavailable or inaccessible in many communities, with 88.6 percent of large, rural counties lacking a sufficient number of these programs. The blog offers recommendations for increasing access to methadone, including regulating mobile methadone vans; urging states to promote using medication units, which are dosing sites affiliated with an existing OTP; and revising policies that unnecessarily restrict the number of OTPs and the services they offer.

Mental Health Awareness Week: Oct. 6-12, 2019

The National Alliance on Mental Illness (NAMI) will recognize Mental Health Awareness Week with the theme WhyCare? between Oct. 6-12. In an overview about its campaign, NAMI noted there are too many myths surrounding mental illness, and that “with these myths comes stigma, misunderstanding, and discrimination.” NAMI will work to dispel a myth a day on the following topics: prevalence of mental illness (Oct. 6), obsessive-compulsive disorder (Oct. 7), PTSD (Oct. 8), children and mental illness (Oct. 9), anxiety and depression (Oct. 10), borderline personality disorder (Oct. 11), and mental health treatment (Oct. 12). NAMI will also highlight National Day of Prayer for Mental Illness Recovery and Understanding on Oct. 8 and World Mental Health Day on Oct. 10. Visit WhyCare? for statistics and resources.

Save the Date for the NABH 2020 Annual Meeting!

Please join us for the NABH 2020 Annual Meeting at the Mandarin Oriental Washington, D.C. from March 16-18, 2020. NABH will send Save-the-Date cards early next week with additional information about the Annual Meeting. Online registration and hotel booking information also will be available the week of Sept. 30. We look forward to seeing you in Washington!

Fact of the Week

The availability of opioid treatment programs (OTPs) varies widely by state. For example, the 4.7 million people in Louisiana have access to 10 OTPs in their state, while the 3.6 million residents of Connecticut have access to 41 OTPs. For questions or comments about CEO Update, please contact Jessica Zigmond.

CMS Announces 1.5-percent Increase for Inpatient Psychiatric Facilities for 2020 in Final Rule The Centers for Medicare and Medicaid Services (CMS) announced a Medicare payment increase of 1.5 percent next year for inpatient psychiatric facilities in the final Inpatient Psychiatric Facilities Prospective Payment Systems (IPF PPS) rule the agency released earlier this week. Compared with the 2019 payment rate, the increase reflects a total increase of $65 million for Medicare-participating inpatient psychiatric facilities in fiscal year 2020. The payment update aligns with the agency’s proposed rule earlier this year. The rule also adds one new claims-based measured starting in fiscal year 2021 payment determination and continuing in subsequent years. The measure—Medication Continuing Following Inpatient Psychiatric Discharge (National Quality Forum #3205)—assesses whether patients admitted to IPFs with diagnoses of Major Depressive Disorder, schizophrenia, or bipolar disorder filled at least one evidence-based medication within two days before discharge or during the 30-day, post-discharge period.   CMS Proposes Slight Payment Increase for PHPs and CMHCs in 2020 The CMS has proposed a hospital-based partial hospitalization program (PHP) payment rate of $228.20 for 2020, up from the 2019 rate of $220.86, in the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System (OPPS/ASC) proposed rule the agency released on July 29. CMS also proposed an increase for community mental health centers (CMHCs), which could see a payment rate of $124.59 in 2020 if the rule is made final. By comparison, CMHCs received a payment rate of $120.58 in 2019. The rates set in the proposed CY 2020 rule are not based on the most recent average cost data from the PHP program, a deviation from CMS’ long-standing policy. When CMS calculated the average PHP program cost for the CY 2020 proposed rule, the agency found it had decreased by nearly 15 percent for CMHCs and 11 percent for hospitals-based PHPs. After finding this decrease, CMS reviewed the data sets and found that a single provider in the CMHC set and a single provider in the hospital-based set had such dramatically lower reported costs that it significantly skewed the average cost for both data sets. Because the lower average costs were the result of single providers and could significantly reduce access for beneficiaries, CMS decide to use the CY 2019 cost average as a floor for both type of PHP rates in the CY 2020 rule. If not for this change, the rate for both types of PHPs would have been significantly lower than what CMS proposed in the rule. It is important to note that CMS stressed that it does not intent to carry this policy forward: “To be clear, this policy would only apply for the CY 2020 rate setting,” the agency said in the rule. CY 2020 Rates Level 1 Health and Behavior Services                                                     $28.59 Level 2 Health and Behavior Services                                                     $81.06 Level 3 Health and Behavior Services                                                     $130.27 Partial Hospitalization (3 or more services) for CMHCs                            $124.59 Partial Hospitalization (3 or more services) for Hospital-based PHPs        $228.20   NABH will submit comments on the proposed rule to CMS by the Sept. 27 deadline.   CMS Addresses OUD Treatment in OTPs and Office Settings in Proposed Rule  Also this week, CMS issued a proposed rule for establishing a Medicare Part B benefit and payment bundles for opioid use disorder (OUD) treatment services in opioid treatment program (OTP) settings and new HCPCS codes and bundled rates for office-based treatment of OUD.   The proposal implements Section 2005 of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act.   The rule proposes:

• A definition of OUD treatment services and OTPs, including an explanation that services include access to all FDA-approved medications, counseling and therapy, and toxicology testing;
• Enrollment policies that align with SAMHSA OTP regulation and that do not have additional conditions of participation;
• Bundled payment methodologies that separate drug from non-drug treatment components, account for different medications and variable intensity of services, provide for service add-ons and partial- and full-billing for weekly episodes;
• Use of audio-video communication technology; and
• Zero beneficiary cost-sharing requirement for a time-limited period.

  The agency also proposed a bundled payment for office-based OUD treatment services, to encourage the expansion of access to OUD care, including:

• Coverage of OUD management, care coordination, psychotherapy, and counseling; medication to be billed and reimbursed under existing Medicare Part B or D; toxicology testing to be billed under Clinical Lab Fee Schedule;
• Bundled payment methodologies that are based on monthly billing cycles to better align with office-based practices; one bundle for the initial month of treatment that is more service-intensive; and a second bundle for subsequent “maintenance months,” service add-on codes, and not restricted to addiction specialists;
• Three new HCPCS codes to Category I of the list of Medicare telehealth services for office-based substance use disorder (SUD)/OUD services, permitting a patient’s home as a telehealth originating site; and
• No changes to cost-sharing.

  In addition, the proposed rule requests information on emergency department practice patterns related to the initiation and use of MAT, and referral or follow-up care, for developing such bundles in future rulemaking. Comments are due September 27, 2019. NABH has engaged a consulting firm to help analyze the proposed bundled payment methodology and payment rates, and the association will submit comments. CMS Releases Informational Bulletins as Part of the SUPPORT Act CMS late last week released two informational bulletins as part of last year’s SUPPORT Act to provide states with guidance on treatment for infants, expectant mothers, and post-partum women.   In the first bulletin, the agency explains that neonatal abstinence syndrome (NAS) is a “constellation of symptoms in newborn infants exposed to any of a variety of substance in utero, including opioids.” The SUPPORT Act added an optional provider type, a residential pediatric recovery center, defined as a facility that offers items and services for which medical assistance is available under the state plan to infants who have NAS. This brief provides additional information about this condition and the impact of these recovery centers.   Meanwhile, the agency’s second bulletin provides background information about Medicaid coverage for pregnant and post-partum women and examines a new, limited exception to the IMD exclusion.   A section of the SUPPORT Act states that a woman who is eligible on the basis of being pregnant (and up to 60 days post-partum) who is a patient in an IMD for SUD treatment, and who is either enrolled under the state plan immediately before becoming an IMD patient, or who becomes eligible to enroll while a patient in an IMD, the exclusion cannot prohibit federal financial participation for medical assistance for items and services that are provided outside the IMD.   MACPAC Releases Issue Brief on Recovery Services for Medicaid Beneficiaries with SUD The Medicaid and CHIP Payment Commission (MACPAC) this week released an issue brief about recovery support services for Medicaid beneficiaries with SUD.   MACPAC documented coverage for clinical SUD services in the fourth chapter of its Report to Congress on Medicaid and CHIP in June 2018. This week’s issue brief complements that information by presenting results from the commission’s 50-state policy review of coverage for clinical SUD services.   The brief also describes how Medicaid programs pay for recovery support services and discusses opportunities to coordinate clinical treatment and recovery support services.   For questions or comments about CEO Update, please contact Jessica Zigmond.

Threat of Sequestration Ends with Bipartisan Budget Act White House and Congressional leaders agreed to large increases in base funding for defense and nondefense spending on Thursday, with the expectation of support by the Senate in a vote next week. The budget deal establishes a funding base above spending cap levels that could trigger mandatory automatic spending cuts, referred to as sequestration. The bipartisan compromise suspends the federal debt ceiling and spending caps for two years, thus marking the end of sequestration that was due to sunset in 2021. Defense spending was increased by $22 billion and nondefense spending was increased by $27 billion. As part of the negotiations, Congressional leadership agreed to avoid the inclusion of any contentious measures that do not have bipartisan support during the FY2020 appropriations process. This agreement will allow for a budget process that will avoid a government shutdown. Medicare Plans Dramatically Reduce Prior Authorization Rates A recent study published in a JAMA Research Letter found large reductions in the percentage of Medicare Part D and Medicare Advantage Plans using prior authorization for buprenorphine medications for opioid use disorder (OUD). In the two years between 2017 and 2019, the percentage of plans using preauthorization for generic buprenorphine-naloxone medications dropped from 96 percent to zero, and for brand buprenorphine-naloxone medication rates dropped from 88 percent to 3 percent. These findings follow two federal policy initiatives: a 2017 buprenorphine labeling change by the Food and Drug Administration, and a 2018 announcement by the Centers for Medicaid and Medicare Services (CMS) that they would no longer approve Medicare Part D formularies that preauthorize buprenorphine products more than once per year. Looking forward, the study states the importance of the data “because Medicare policy is often viewed as a standard that is subsequently adopted by private health plans and Medicaid.” Tami Mark, lead author of the study said, “Although Medicare has significantly reduced prior authorization for opioid use disorder medications, it is still in common use in Medicaid and private health plans.” Legal Action Center Calls for Removal of Prior Authorization in Medicaid The Legal Action Center (LAC) in a new report calls for Medicaid programs to adopt the successful “Medicare Model” of eliminating prior authorization for medications to treat opioid use disorder (OUD) and expanding coverage of all FDA-approved medications. Citing the success of a 2018 federal policy that virtually eliminated prior authorization for buprenorphine products in Part D and Medicare Advantage programs (see previous article), LAC reports that most Medicaid plans continue to require prior authorization for OUD medications. Specifically, buprenorphine-naloxone medication requires prior authorization in 40 Medicaid programs, and buprenorphine medication requires authorization in 35 Medicaid programs. Formulary restrictions and dose limitations also pose barriers to medication assisted treatment (MAT). MAT can reduce mortality by almost half. Medicaid covers four out of 10 adults with OUD and thus “plays a significant role in delivering effective OUD treatment and reducing barriers to FDA-approved medications,” the report states.  The Report recommends that CMS issue a guidance letter to State Medicaid Directors to increase the use of all medications for OUD. Arnold Ventures Funds Research on Insurance Fraud Arnold Ventures is funding a new two-year study to develop methods for identifying fraudulent opioid use disorder treatment and recovery services. Led by Boston University researchers and in collaboration with a former federal health-fraud investigator, the study intends to provide a broader view of fraudulent practices, including excessive medical testing, patient brokering, and the geographic scope of such practices. Through a review of insurance data for more than 50 million individuals and the deployment of secret shoppers, the study seeks to provide insurance companies with tools to improve detection and support policymakers in developing procedures to improve oversight. Fair Health Sheds Light on Rapid Growth of Telehealth A new white paper from FAIR Health found that provider-to-patient telehealth grew by 1,293 percent for non-hospital-based providers between 2014 and 2018, accounting for 84 percent of all telehealth claim lines. Telehealth for all providers grew by 624 percent. In a review of over 29 billion private claim records for 2018, the analysis found that mood disorders (six percent) and anxiety and other nonpsychotic mental disorders (five percent), were the second and third most common conditions for which individuals sought telehealth services. Upper respiratory infections were the most common reason. Telehealth gains were larger for urban providers, increasing 1,227 percent, with rural providers increasing by 897 percent. Rural areas, however, showed stronger gains than urban areas for telehealth after hospital discharge, with an increase of 407 percent. A previous FAIR Health study found that between 2016 and 2017, telehealth grew more than any other place of service, including emergency rooms and retail clinics. According to FAIR Health, the findings suggest “important implications for improving healthcare quality and lowering costs by reducing avoidable hospitalizations, readmissions and urgent/emergent care visits.” National Institutes on Drug Abuse to form Justice Community Opioid Innovation Network Ten research institutions and two centers have been funded by the National Institutes on Drug Abuse (NIDA) to support research on treatment for opioid use disorder (OUD) in criminal justice settings. Twelve grants were awarded to develop a Community Opioid Innovation Network (JCOIN) to shore up the response capacity of the justice system to the opioid epidemic. Awards total approximately $155 million for a multi-year initiative in which research investigators will collaborate with justice and behavioral health stakeholders to identify promising interventions on adoption of new medications, retention of individuals in treatment, and preventing relapse after community re-entry. JCOIN is part of the National Institute of Health grants called HEAL (Helping to End Addiction Long-term Initiative). SAMHSA Suicide Prevention Resource Center Hosts Webinar The Suicide Prevention Resource Center (SPRC) will host a webinar on the intersection between serious mental illness (SMI) and suicide Monday, July 29 at 4:30 p.m. ET. Webinar panelists will present an overview of approaches to addressing suicide risk for patients diagnosed with SMI who are seen in health and behavioral health organizations. Individuals with SMI are at higher risk of dying by suicide. Informational resources will be shared, as well as tailored interventions, methods of engagement, and supporting family and friends. SPRC is funded under a grant by the Substance Abuse and Mental Health Services Administration to advance the implementation of the National Strategy for Suicide Prevention. For questions or comments about CEO Update, please contact Jessica Zigmond.

House Energy and Commerce Committee Advances No Surprises Act The House Energy and Commerce Committee this week approved legislation to end “surprise” medical bills with the addition of third-party arbitration. House Energy and Commerce Committee Chairman Frank Pallone (D-N.J.) and Rep. Greg Walden (R-Ore.), the panel’s ranking member, co-sponsored the No Surprises Act, which advanced through the committee as part of the Reauthorizing and Extending America’s Community Health Act with amendments. Under the bill, healthcare facilities would be required to notify patients at least 24 hours before an elective treatment that an out-of-network provider would be involved in their care. The bill also would prohibit healthcare facilities and providers from balance-billing patients for that care and would establish rates for payments from commercial health plans to providers based on the local market. The initial bill did not include a process for providers and payers to challenge the basic median reimbursement, while the amended version that passed this week includes such a process. Overall hospital groups responded both favorably and cautiously to the news, suggesting that while the bill is significant for offering an arbitration option, the legislation could also set a precedent for the federal government to set private rates. The legislation now moves to the full House for a vote. JAMA Pediatrics Study Shows Parental Drug Use Has Led to Increase in Foster Care Cases A new JAMA Pediatrics study suggests that greater parental drug use has contributed to a rise in foster care caseloads and coincides with increasing trends in opioid use and overdose deaths. Researchers from Weill Cornell Medical College and Harvard Medical School examined data from the Adoption and Foster Care Analysis and Reporting System, a federally mandated collection system that receives case-level information on all children in foster care in the United States. They found that after more than a decade of declines in U.S. foster care caseloads, cases have risen steadily since 2012. Meanwhile, the number of foster care entries attributable to parental drug use rose substantially to 96,672 home removals from 39,130 removals between 2000 and 2017, reflecting a 147-percent increase during that period, according to the findings. “These findings suggest that greater parental drug use has contributed to increases in foster care caseloads and coincide with increasing trends in opioid use and overdose deaths nationwide during this period,” the study said. The authors noted the study’s limitations include potential reporting inconsistencies in parental drug use, and that it’s possible that factors other than drug use influenced entries for parental drug use. “Policymakers must ensure that the needs of this new wave of children entering foster care because of parental drug use are being met through [sic] high-quality foster care interventions,” the study said. “These have been shown to mitigate some of the adverse effects of early childhood deprivation and disruptions in attachment.” NQF Convenes Opioid Use Disorder TEP and Seeks Comment The National Quality Forum (NQF) will convene a Technical Expert Panel (TEP) to oversee a review of measures and concepts related to opioid use, opioid use disorder prevention, treatment, and recovery. In its announcement, the NQF said the move is meant to “further identify measure gaps and priorities relevant to the United States opioid overdose epidemic and the broad healthcare quality challenges that surround it.” The TEP will provide guidance on the environmental scan of current measures; identify and prioritize measure gaps in quality measurement to inform future measure development efforts; and provide recommendations on the use of opioids and opioid use disorder measures in federal programs. The NQF will accept comments on this process through July 26. Also this week, the NQF together with the Blue Cross Blue Shield Association releasedEnhancing Access to Medication-Assisted Treatment, a guide that provides strategies, implementation examples, tools, and resources to help healthcare delivery systems, practitioners, and payers expand using MAT. Netflix Removes Suicide Scene from ‘13 Reasons Why’ Netflix Inc. has removed a suicide scene from an episode in the first season of its teen drama “13 Reasons Why” after some debate over whether the show increased the risk of teen suicide. The Wall Street Journal reported this week that although a Netflix spokesman declined to comment, the company tweeted on July 16 that, based on advice from medical experts, the company decided to edit the scene from the episode. The National Institutes of Health released a study in late April that suggested “13 Reasons Why”—which premiered in March 2017—was a factor in increased teen suicides in the United States (see CEO Update, May 3, 2019). HRSA Awards $20 million to 27 Organizations to Increase Rural Workforce HHS’ Health Resources and Services Administration (HRSA) awarded about $20 million in Rural Residency Planning and Development Program (RRPD) grants to help boost the nation’s rural healthcare workforce. Recipients across 21 states will receive up to $750,000 over a three-year period to develop new rural residency programs. The funding is part of HRSA’s multi-year initiative to expand the physician workforce in rural areas by developing new, sustainable residency programs in family medicine, internal medicine, and psychiatry. Grant recipients include rural hospitals, community health centers, health centers that the Indian Health Service operates, Indian tribes or tribal organizations, and schools of medicine. Click hereto the see the list of grant awards. SAMHSA Releases Guidance to States on Using MAT in Criminal Justice Settings The Substance Abuse and Mental Health Services Administration (SAMHSA) has released a guide to states on using medication assisted treatment (MAT) in criminal justice settings. Use of Medication-Assisted Treatment for Opioid Use Disorder in Criminal Justice Settings is a 76-page resource that focuses on using MAT for opioid use disorder in the nation’s jails and prisons during the reentry process when justice-involved persons return to the community. It provides an overview of policies and evidence-based practices that reduce the risk of overdose and relapse. SAMHSA to Host Virtual Learning Series on Recovery SAMHSA will host a three-part virtual learning series focused on recovery supports for people considering using MAT for opioid use disorder or co-occurring disorders. Held on consecutive Wednesday afternoons — July 24, July 31, and August 7 — each hourlong session will feature presenters who will address common misperceptions about MAT; offer up-to-date, accurate information; and suggest ways to learn more and educate others about opioid use disorders, co-occurring disorders, and MAT. These free events will take place from 2 p.m. to 3 p.m. ET. Click here to register. For questions or comments about CEO Update, please contact Jessica Zigmond.

New Quality Summit to Assess HHS’ Quality Programs HHS Deputy Secretary Eric Hargan this week announced the department’s new Quality Summit, which will join government leaders and healthcare industry stakeholders to discuss how to adapt and streamline HHS’ current quality programs in a way that improves outcomes for patients. Hargan will co-chair the Quality Summit with Peter Pronovost, M.D., Ph.D., an internationally renowned expert on healthcare quality and patient safety. In March, Hargan discussed the regulatory barriers that often hinder treatment during his presentation at the 2019 NABH Annual Meeting in Washington. “Over the last decade we have seen efforts by HHS to incentivize the provision of quality care, only to be met with limited success,” Hargan said in a news release. “This is in part because patients have not been empowered with meaningful or actionable information to inform their decision making. At the same time, important quality programs across the department have remained uncoordinated among the various agencies and inconsistent in their demands on healthcare providers,” he added. “We believe the Quality Summit will not only strengthen the protections these programs afford patients, but also improve value by reducing costs and onerous requirements that are placed on providers and ultimately stand between patients and the high-quality care they deserve.” Late last month, President Trump signed the Improving Price and Quality Transparency in American Healthcare to Put Patients First executive order, which directs federal agencies to develop a Health Quality Roadmap intended to align and improve reporting on data and quality measures across federal health programs. OIG Report Finds Opioid Use Decreased and MAT Increased Among Medicare Part D Beneficiaries A new report from HHS’ Office of Inspector General (OIG) found a significant decrease in the number of Medicare Part D beneficiaries who received opioids in 2018 and a steady increase in the number of beneficiaries who received drugs for medication assisted treatment (MAT). Nearly three in 10 Medicare part D beneficiaries received opioids in 2018, the OIG reported, while at the same time the number of beneficiaries who received MAT for opioid use disorder reached 174,000. Meanwhile, about 354,000 beneficiaries received high amounts of opioids in 2018, with about 49,000 of them at serious risk of opioid misuse or overdose—which was also fewer than in the previous two years. “Progress has been made in decreasing opioid use in Part D, increasing the use of drugs for medication assisted treatment, and increasing the availability of naloxone,” the OIG reported noted. “It is imperative for the Department of Health and Human Services— including CMS (Centers for Medicare and Medicaid Services) and OIG— to continue to implement effective strategies and develop new ones to address this epidemic.” O’Neill Institute Evaluates Democratic Candidates’ Views on Addiction and Opioid Crisis The O’Neill Institute at Georgetown Law this week released an analysis of the 2020 Democratic presidential candidates’ plans to address America’s continued opioid crisis. In a post on the O’Neill Institute’s webpage this week, authors Regina LaBelle—a 2019 NABH Annual Meeting speaker—and Leigh Bianchi noted that most all of the presidential candidates have not issued detailed policy proposals on the topic. Instead, their positions on the issue were taken from statements at campaign events and from their record in public office. LaBelle and Bianchi categorized the candidates’ positions by federal officials, state and local officials, and other candidates. Click here to read their analysis. SAMHSA and CMS Issue Joint Bulletin on Addressing Mental Health and SUD in Schools The Substance Abuse and Mental Health Services Administration (SAMHSA) and CMS this week issued a joint information bulletin that describes Medicaid mandatory and optional state plan benefits and other Medicaid authorities states may use to cover mental health and substance use disorder (SUD) treatment for children in schools. The bulletin includes tools and resources to help states, educational agencies, and healthcare providers work together to identify and treat students’ mental illness or substance-related challenges in school-based settings. It also outlines best practices to help implement quality, evidence-based, and comprehensive mental illness and substance use-related services for students. Included in the 28-page bulletin are specific examples of state-level strategies for Medicaid and other financing of school-based mental health services. Study Examines Association of Nonmedical Prescription Opioid Use with Heroin Use Initiation in Adolescents A study published in JAMA Pediatrics this week found that nonmedical prescription opioid use was prospectively associated with subsequent heroin use initiation during four years of adolescence among youth in Los Angeles. Researchers conducted an eight-wave cohort study of 14-year-old and 15-year-old high school students in Los Angeles who had never used heroin at baseline and found that youth reporting no, prior, and current nonmedical prescription opioid use during high school showed estimated “cumulative probabilities” of subsequent heroin use initiation by the end of the 42-month follow-up of 1.7 percent, 10.7 percent, and 13.1 percent, respectively. The reason for the study stemmed from the concern that nonmedical prescription opioid use is associated with increased risk later of heroin use initiation among adolescents but that longitudinal data addressing this topic are lacking. The study’s authors noted that future research is needed to determine whether this association is causal. House Energy and Commerce Subcommittee Hearing Will Examine Spread of Illicit Fentanyl The House Energy and Commerce Subcommittee on Oversight and Investigations will host a hearing next Tuesday, July 16 to examine the increasing threat of illicit fentanyl. The hearing announcement noted recent statistics from the Centers for Disease Control and Prevention that show there were more than 47,000 drug overdose deaths involving opioids in 2017, of which 28,000 involved synthetic opioids such as fentanyl—a nearly 47-percent increase from the prior year. Tuesday’s hearing will feature witnesses from the key federal agencies responding to the nation’s opioid crisis. CMS to Host Webinar on QIOs and IPFs Working Together to Reduce Readmissions Quality experts from CMS and quality improvement organization MPRO will lead a webinar for participants in the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program next Thursday, July 18 at 2 p.m. ET. Christina Goatee, M.S.N., R.N. from CMS and Barbra Link, L.M.S.W., CIRS-A/D from MPRO will lead the hourlong webinar, Quality Improvement Organizations and Inpatient Psychiatric Facilities Working Together to Reduce Readmissions, to provide an overview of the Quality Improvement Organization (QIO) program and show how collaborative relationships with QIOs can reduce inpatient psychiatric facility readmissions and enhance outcomes. Click here to register.   For questions or comments about CEO Update, please contact Jessica Zigmond.

CDC Provisional Data Show Opioid Deaths Likely to Fall for First Time Since 1990 Provisional data from the Centers for Disease Control and Prevention (CDC) show drug-overdose deaths are on the brink of declining, but researchers are quick to caution the nation’s deadly opioid crisis is far from over. The CDC’s data predict there were nearly 69,100 drug deaths in the 12-month period ending in November 2018, down from almost 72,300 predicted deaths for the same 12-month period ending in 2017. If the trend continues through December— those data likely will be available next month—then annual drug deaths will fall for the first time since 1990, when about 8,400 people died from overdoses. “I think we’re probably looking at a decline,” Robert Anderson, Ph.D. chief of the Mortality Statistics branch at the CDC’s National Center for Health Statistics, told the Wall Street Journal this week. “We shouldn’t say oh, we’ve won and we’ve defeated the drug-overdose epidemic.” The story reported that health officials and epidemiologists say there is little cause for celebration, especially as the death rate remains “swollen by powerful synthetic opioids like fentanyl.” Meanwhile, the story noted one driving factor for the downward trend has been broadened access to the overdose-reversal drug naloxone, often known by the brand-name Narcan, according to officials in Ohio, Pennsylvania, and Rhode Island. Jim Hall, an epidemiologist at Nova Southeastern University in Florida, echoed Anderson’s measured optimism in his interview with the Wall Street Journal. “I’m ready to say that the opioid crisis in in early remission, yet at a high risk of relapse,” Hall said. CMS Announces Funding Opportunity for State Medicaid Agencies to Address SUD The Centers for Medicare & Medicaid Services (CMS) announced this week that up to $50 million is available to help increase capacity for Medicaid providers to deliver substance use disorder (SUD) treatment and recovery services. The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act authorized the planning grant funding, which is available to at least 10 states for 18 months, CMS announced in the funding opportunity notice. Meanwhile, up to five states that receive planning grants will be chosen to implement 36-month demonstration projects and receive enhanced federal reimbursement for increased expenditures for SUD treatment and recovery services. Click here to learn more and apply for a grant. Veterans with PTSD More Likely to Die from Suicide, Hepatitis Veterans with post traumatic stress disorder (PTSD) have a higher risk of dying from mental illness and other diseases than the general population, according to a new study published in the American Journal of Preventive Medicine. The study’s researchers analyzed mortality data from nearly 500,000 veterans who started treatment for their PTSD at a Veterans Affairs (VA) medical center between 2008 and 2013 and found that veterans with PTSD were about twice as likely to die from suicide, accidental injuries, and hepatitis than the general population. The study acknowledged a few limitations related to both the sample selection and follow-up. For one, the study’s approach did not account for relevant confounders, including race/ethnicity, psychiatric and medical comorbidity, and treatment. “Although the cohort was started in 2008 to account for changes in the VA delivery of evidence-based PTSD care, this study did not address patient-level treatment characteristics and was not designed to determine whether PTSD care affects mortality.” NABH Supports BETTER Act to Expand Medicare Telehealth Benefits NABH was one of more than a dozen organizations this week that signed a letter supporting the bipartisan Beneficiary Education Tools Telehealth Extender Reauthorization (BETTER) Act of 2019, a House bill intended to improve Medicare’s telehealth benefits for patients who need mental health services. In a letter to Reps. Richard Neal (D-Mass.) and Kevin Brady (R-Texas), the chairman and ranking member, respectively, of the House Ways and Means Committee, NABH and 13 other groups this week noted that CMS reports mental disorders are at the top of diagnoses for Medicare beneficiaries receiving telehealth services in 2016. “However, current law restrictions prohibiting the receipt of telehealth services in the home and limiting coverage to specific geographic areas hamper the accessibility of effective mental health services to treat Medicare beneficiaries,” the letter said. “We are very pleased that H.R. 3417 removes these barriers and allows Medicare patients to access psychotherapy services through telehealth no matter where they live and in their own homes. NABH Supports CREATE Act to Expand MAT Programs for Incarcerated Individuals with OUD NABH and other member organizations of the Coalition to Stop Opioid Overdose (CSOO) sent a letter this week to the federal lawmakers who introduced the Community Re-entry through Addiction Treatment to Enhance (CREATE) Opportunities Act, which is intended to expand Medication Assisted Treatment (MAT) programs for individuals with opioid use disorder (OUD) who are incarcerated. Specifically, the legislation from Rep. Ann Kuster (D-N.H.) and Sen. Ed Markey (D-Mass.) would provide $50 million each year from fiscal year 2020 through fiscal year 2023 for the U.S. Attorney General to make grants and enter into cooperative agreements with states and local governments to develop, implement, or expand programs to provide MAT to individuals who have OUD and are incarcerated. The bill also includes requirements for the covered programs. Click here to read the letter from the CSOO. CEO Update Will Publish Next on Friday, July 12 NABH’s office will be closed on July 4 and 5 for Independence Day and will not publish CEO Update next week. CEO Update will publish next on Friday, July 12. The entire NABH team wishes you a happy and safe Independence Day weekend!   For questions or comments about CEO Update, please contact Jessica Zigmond.

NABH Submits FY 2020 IPF PPS Rule Comments to CMS NABH this week urged the Centers for Medicare & Medicaid Services (CMS) not to include any new measures in the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program, but instead work with the behavioral healthcare provider community to improve existing measures. That was the broad message in NABH’s comment letter to CMS about the agency’s proposed fiscal year (FY) 2020 inpatient psychiatric facility prospective payment system (IPF PPS) rule. Commenting on CMS’ proposal to develop a new measure for a standardized patient perception of care, NABH President and CEO Mark Covall explained that the majority of NABH members participating in the IPFQR program use some version of a patient perception of care measure; however, there is not one single measure that all providers or a majority of providers use. “Therefore, we have strong concerns that CMS will make it mandatory for behavioral healthcare providers to adopt something such as the Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS) survey,” Covall wrote. NABH also recommended CMS work closely with the behavioral healthcare provider community to develop a safety-planning measure for patients who have suicidal ideation. Click here to read NABH’s letter. SAMHSA Releases The Behavioral Health Barometer, Volume Five The Substance Abuse and Mental Health Services Administration (SAMHSA) has released volume five of The Behavioral Health Barometer, one of a series of national, regional, and state reports that offer a glimpse of behavioral health in the United States. “Behavioral Health Barometers for the nation, 10 regions, and all 50 states and the District of Columbia are published as part of SAMHSA’s behavioral health quality improvement approach,” Elinore McCance-Katz, M.D., Ph.D., assistant secretary for mental health and substance use at SAMHSA, wrote in the report’s foreword. “Most importantly, the Behavioral Health Barometers provide critical information in support of SAMHSA’s mission of reducing the impact of substance abuse and mental illness on America’s communities.” The 74-page report examines youth, young adult, and adult mental health and substance use as well as adult mental health and mental health service use. SAMHSA also included a special focus on the misuse of prescription pain relievers, heroin use, and medication assisted therapy for opioid addiction. AMA Passes Opioid Policies that Address Barriers to Effective Treatment The American Medical Association (AMA) has approved several opioid-related policies meant to shift the focus of pain treatment back on patients and away from what the association referred to as “arbitrary third-party controls.” Physicians accepted the resolutions at the Chicago-based association’s annual meeting last week. In a news release, the AMA said the measures take aim at barriers to treatment that state and federal authorities, insurers, pharmacy benefit management (PBM) companies, and national pharmacy chains have enacted. ““The barriers include tactics such as prior authorization and step therapy – which can delay treatment – and misguided laws and other policies setting hard thresholds for prescriptions,” the announcement said. One proposal recommends developing treatment plans based on individual needs, rather than a one-size-fits-all approach of hard thresholds. Another measure opposes pharmacies, PBMs, and insurers using “high prescriber lists,” without due process, to keep physicians from writing prescriptions for controlled substances and preventing patients from filling prescriptions at their pharmacy of choice. Opioid Crisis Increases Number of Organs Available for Transplant Taken together, America’s opioid crisis and organ shortage have led the nation’s surgeons to consider transplanting organs deemed less than “perfect” in an effort to expand the donor pool and save more lives, according to new research published in The Annals of Thoracic Surgery. Nader Moazami, M.D. of NYU Langone Health in New York and his colleagues evaluated trends in organ donation and transplants among drug overdose deaths using data from the Scientific Registry of Transplant Recipients between 2000 and 2017. They found that of the 15,904 isolated heart transplants from adult donors during this period, opioid overdoses (10.8 percent) were the fourth common cause of death, behind blunt injury (30.5 percent), hemorrhage/stroke (22.1 percent), and gunshot wound (18.3 percent). “The opioid epidemic has increased the proportion of hearts transplanted from overdose death donors (ODD),” Moazami said in a news release from the Society of Thoracic Surgeons. “One of the roles of the transplant community is to at least partially mitigate the tragedy of this exponentially growing problem by maximizing the utilization of organs from ODD.” JAMA Psychiatry Study Finds Fewer Psychiatrists Accepting Medicaid Patients Post Expansion Fewer psychiatrists are accepting Medicaid patients even as more patients have gained coverage under the federal insurance program, according to a recent research letter published in JAMA Psychiatry. Although Medicaid is the principal payer of behavioral health services in the United States, little is known about recent trends in psychiatrists’ acceptance of Medicaid patients, the letter said. For this analysis, researchers used data from the 2010-2015 National Ambulatory Medical Care Survey (NAMCS), a nationally representative survey of physicians who were not federally employed, based in offices, and primarily engaged in patient care. The study found the number of psychiatrists accepting Medicaid patients fell to 35 percent between 2014-2015 from nearly 48 percent between 2010-2011. “This study was limited by the relatively small physician sample size in the NAMCS and only 2 years’ post expansion data in most expansion states,” the research letter said. “Furthermore, low Medicaid participation among primary care physicians has been attributed to low Medicaid physician fees, reimbursement delays, and administrative burden,” it added. “However, we lacked data to explore the relative importance of these potential factors in psychiatrists’ decision to accept Medicaid patients.” A Reuters story about the findings quoted the study’s co-author Adam Wilk, who said he suspects the nation’s shortage of psychiatrists is the reason why they haven’t expanded their capacity to accept Medicaid patients. “Market deficiencies allow psychiatrists to make more money by taking patients who have private insurance,” Wilk, an assistant professor of health policy and management at Emory University’s Rollins School of Public Health, told Reuters. “In fact, there’s a rising trend among psychiatrists of opting out of insurance altogether.”  JAMA Pediatrics Study Suggests Sexting Associated with Sexual Behaviors and Mental Health Risk Factors in Adolescents A meta-analysis of 23 studies has found that adolescent sexting is significantly associated with sexual activity, multiple sexual partners, lack of contraception use, delinquent behavior, internalizing problems, and substance use. Published in JAMA Pediatrics, the analysis comprising 41,723 participants found the association between sexting and multiple sexual partners, drug use, smoking, and internalizing problems were stronger in younger compared with older adolescents. “Results of this study suggest that sexting is associated with various sexual behaviors and mental health risk factors,” the authors noted in the study. “Moving forward, education campaigns should focus on providing youth with comprehensive information about sexting and digital citizenship.” Justice Department Releases Grant Solicitation for Rural Communities to Address Opioid Crisis The U.S. Justice Department’s Bureau of Justice Assistance (BJA) has announced the Rural Responses to the Opioid Epidemic Grant solicitation, which is intended to build local capacity, foster cross-sector collaboration, and support innovation to address the nation’s deadly opioid crisis. BJA is sponsoring the initiative with the Centers for Disease Control and Prevention and the State Justice Institute and will select up to eight rural communities or regions for grant awards up to $750,000, each for a 24-month period. BJA has scheduled a webinar to discuss the grant application process for Wednesday, June 26 at 2:30 p.m. ET. Applications are due by Friday, July 26. National Consortium of Telehealth Resource Centers Announces Webinars on Telehealth for SUD The National Consortium of Telehealth Resource Centers will explore what type of substance use disorder services a community health center can offer via telehealth in a webinar next Friday, June 28 at 9 a.m. ET. Click here to register. For questions or comments about CEO Update, please contact Jessica Zigmond.

Representatives Porter, Bilirakis, and Norcross Introduce Mental Health Parity Compliance Act Reps. Katie Porter (D-Calif.), Gus Bilirakis (R-Fla.), and Donald Norcross (D-N.J.) this week introduced the Mental Health Parity Compliance Act, the House version of the bill that Sens. Bill Cassidy, M.D. (R-La.) and Chris Murphy (D-Conn.) introduced last week. The legislation is based on a best-practice approach that state legislatures in Delaware, Illinois, New Jersey, and Washington, D.C. have enacted and ensures that health insurance providers are following the 2008 Mental Health Parity and Addiction Equity Act. “As part of removing the stigma for treating mental illness, we must ensure that mental health needs are recognized as legitimate healthcare issues,” Bilirakis said in a news release. “One way to do that is to ensure parity between coverage for healthcare and mental healthcare services—which happens to be the law.” NABH, a Mental Health Liaison Group member, signed on to letters supporting both the House and Senate bills. CMS Issues Request for Information for its Patients Over Paperwork Initiative The Centers for Medicare & Medicaid Services (CMS) recently issued a Request for Information (RFI) seeking new ideas from the public about how to continue the agency’s Patients over Paperwork initiative. Launched in 2017, Patients over Paperwork has worked to streamline regulations in healthcare that often take clinicians away from their primary purpose of caring for patients. The new RFI provides an opportunity for the public to share ideas that were not suggested during the first RFI period two years ago. Specifically, CMS is looking for ways to improve reporting and documentation requirements; coding for Medicare and Medicaid payments; prior authorization procedures; policies and requirements for rural providers, clinicians, and beneficiaries; policies and requirements for dually enrolled beneficiaries; beneficiary enrollment and eligibility determination; and CMS processes for issuing regulations and policies. In its comments to CMS, NABH will highlight The High Cost of Compliance, the association’s report that assessed the regulatory burden on the nation’s inpatient psychiatric facilities. Released in March, the report found that three specific regulatory areas impose $1.7 billion in compliance costs each year nationwide, which represent 4.8 percent of an average facility’s annual revenue for all inpatient psychiatric services from all sources. NABH will continue to work with CMS to address the report’s key findings and recommendations. Comments are due by Monday, August 12. HHS’ Office of Adolescent Health Releases Updated Data on Nation’s Teens New data from HHS’ Office of Adolescent Health (OAH) show 31 percent of U.S. high school students in 2017 reported they felt sad or hopeless almost every day for at least two weeks in a row in the past year. The findings are part of OAH’s updated national and state data sheets, which OAH released June 10 to provide estimates on a range of measures related to adolescent health and behavior. The analysis draws on large, nationally representative surveys, and measures include physical activity and nutrition, mentorship, family meals, cigarette and e-cigarette use, driving under the influence, depression systems, bullying, dating violence, and more. ASPE and RTI Recruiting Organizations to Participate in Telehealth Case Studies HHS’ Office of the Assistant Secretary for Planning and Evaluation (ASPE) and RTI International are recruiting organizations to participate in case studies as part of their new assessment of telehealth to treat mental and substance use disorders in youth and adolescent patients. According to ASPE, the goal of the project is to better understand how telehealth is used for these populations; what challenges providers and patients face; and what innovations are happening. This project will especially focus on understanding what policies influence the use of telehealth, including the role of Medicaid in promoting access to telehealth programs. RTI is recruiting organizations to participate in case studies, which will consist of RTI staff conducting in-person discussions with individuals involved in providing, coordinating, and supporting telehealth services (such as administrators, clinicians, and peer support specialists), and a walk-through of the site’s general telehealth model and the technology that is used for it. Discussions during the site visits will focus on challenges the organization may have encountered, strategies employed to overcome these challenges, and overall lessons learned in implementing telehealth to support the delivery of behavioral healthcare. Please e-mail Sarah Wattenberg, NABH’s director of quality and addiction services, if you would like your organization to participate. SAMHSA Accepting Applications for Mental and Substance Use Disorder Practitioner Data Grant The Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting applications for its fiscal year 2019 Mental and Substance Use Disorder (SUD) Practitioner Data grant, which is intended to provide comprehensive data and analysis on individuals who address these conditions. According to the funding notice, the program’s goal is to provide valid data on existing practitioners and usable information to SAMHSA that the agency can use to make policy and planning decisions. SAMHSA said total available funding is $1 million, and applications are due by Monday, Aug. 12. Click here to learn more and apply. CDC Study Examines Connection Between Prescription Opioid Misuse and Binge Drinking More than half of the 4.2 million people who misused prescription opioids during 2012-2014 were binge drinkers, and binge drinkers had nearly twice the odds of misusing prescription opioids, compared with non-drinkers, according to a new study published in the American Journal of Preventive Medicine. Binge drinking is consuming four or more drinks for women and consuming five or more drinks for men, according to the Centers for Disease Control and Prevention (CDC), which conducted the study. The CDC’s analysis shows that people who binge drank were nearly twice as likely to misuse prescription opioids as non-drinkers, even after accounting for other factors that could affect the relationship between prescription opioid misuse and binge drinking, such as age and sex. For this report, CDC researchers analyzed data from the National Survey on Drug Use and Health for 2012, 2013, and 2014 on self-reported binge drinking and prescription opioid misuse during the past 30 days. Scientists found that while young people who binge drank and had higher rates of prescription opioid misuse, two in three people who binge drank and misused prescription opioids were age 26 years and older. Study Finds Association Between Medical Cannabis Laws and Opioid Overdose Mortality Has Reversed Over Time Claims that enacting medical cannabis laws will reduce opioid overdose death should be met with skepticism, researchers noted in a new study in the Proceedings of the National Academy of Sciences (PNAS). Published earlier this week, the study explains that medical cannabis has been touted as a solution to the nation’s opioid overdose crisis since an earlier study found that from 1999 to 2010 states with medical cannabis laws experienced slower increases in opioid analgesic overdose mortality. This recent study used the same methods to extend that analysis through 2017 and concluded that not only did the findings from the original analysis not hold over the longer period, but the association between state medical cannabis laws and opioid overdose mortality reversed direction from -21 percent to +23 percent and remained positive after accounting for recreational cannabis laws. “A more plausible interpretation is that this association is spurious,” the researchers noted. “Moreover, if such relationships do exist, they cannot be rigorously discerned with aggregate data,” they added. “Research into therapeutic potential of cannabis should continue, but the claim that enacting medical cannabis laws will reduce opioid overdose death should be met with skepticism.” NABH Submits Comment Letters to CMS and FCC Extending an Electronic Health Record (EHR) incentive to behavioral healthcare providers and repurposing a national “N11” number for a suicide hotline were the topics of two comment letters that NABH sent recently to CMS and the Federal Communications Commission (FCC). In a letter to CMS, NABH said only a small portion of behavioral healthcare providers are using EHRs. According to data from CMS’ IPFQR program, about 30 to 40 percent of psychiatric hospitals use EHRs, a level that has remained constant. The fiscal year 2019 (FY19) Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) rule emphasizes this, noting: “performance on this measure [use of and electronic health record] has remained relatively static for the past two program years.” NABH urged CMS to establish a program—perhaps within the Innovation Center— that would extend EHR incentives to the behavioral healthcare providers who were excluded from the Health Information Technology for Economic and Clinical Health Act. Extending this funding to behavioral healthcare providers will do far more to improve care for Medicare beneficiaries than any change to conditions of participation, NABH President and CEO Mark Covall noted. The association also sent a letter this month to FCC Secretary Marlene Dortch asking the agency to establish a national number, or N11 number, for a national suicide prevention and mental health crisis hotline system. “Based on the urgency of the suicide crisis and the nature of suicidal ideation, the potential positive outcomes outweigh any costs associated with changing an existing N11 number,” Mark Covall wrote. “This is why we strongly encourage the FCC to move forward immediately and repurpose an existing N11 number for a national suicide prevention and mental health crisis hotline system.” Call for Presentations Now Open for Rx Drug Abuse & Heroin Summit 2020 The Rx Drug Abuse & Heroin Summit is now accepting submissions for its meeting in Nashville, Tenn. from April 13-16, 2020. The Summit will accept presentation proposals in two formats: breakout sessions lasting 75 minutes (including a question-and-answer period), and posters, which will be featured in the exhibit hall. All submissions are due by midnight ET on Friday, August 23. Click here for submission details. Learn about Recovery Centers of America in NABH’s Latest Member Profile! NABH member Recovery Centers of America has created a specialized program called Promoting Recovery through Intensive Support and Education, or PRISE, at its facility in Devon, Pa. to address the problem of multiple relapses for patients seeking addiction treatment. PRISE relies on a three-pronged, therapeutic, evidence-based approach to help patients who have relapsed. Click here to learn more. For questions or comments about CEO Update, please contact Jessica Zigmond.

FAIR Health Analyzes Claims to Determine Behavioral Health Trends from 2007-2017 Claim lines with behavioral health diagnoses increased 108 percent over 10 years, rising to 2.7 percent of all medical claim lines in 2017 from 1.3 percent of all medical claim lines in 2007, according to a new report from not-for-profit organization FAIR Health. Analyzing data from its database of more than 28 billion private healthcare claim records, FAIR Health found that in 2007 and 2017, major depressive disorder (MDD) was the most common diagnosis in the distribution of claim lines with mental health diagnoses, but its share of the distribution fell to 26 percent in 2017 from 28 percent in 2007. Meanwhile, opioid dependence overtook alcohol dependence to occupy the largest share of claim lines with substance use disorder diagnoses, the report said. Although opioid dependence claim lines increased overall during that 10-year period (1,180 percent, growing to 0.252 percent of all medical claim lines from 0.016 percent), they fell 50 percent between 2015 and 2017, the study showed. “FAIR Health conducted this study to provide a strong foundation of key indicators of behavioral health services rendered to the commercial healthcare population,” the report said. “We look forward to providing additional layers to this analysis, including the nature of the services rendered, the type of venue where services were rendered (including telehealth access) and the specialties of the healthcare professionals providing the services.” FAIR Health is a national, independent organization that collects data for and manages the nation’s largest database of privately billed health insurance claims and has Medicare parts A, B, and D claims data from 2013 to the present. Lancet Study Identifies Alcohol Use as a Leading Risk Factor for Global Disease Burden Alcohol use is a leading risk factor for global disease burden, and data on alcohol exposure are crucial to evaluate progress in achieving global, non-communicable disease goals, says a recent modelling study published in The Lancet. The study presents estimates on the main indicators of alcohol exposure in 189 countries from 1990 through 2017 and includes forecasts up to the year 2030. “Based on these data, global goals for reducing the harmful use of alcohol are unlikely to be achieved,” the study’s abstract noted, “and known effective and cost-effective policy measures should be implemented to reduce alcohol exposure. The Joint Commission Releases Standards FAQ Details on Suicide Risk Reduction The Joint Commission this week released a series of Standards FAQ Details related to suicide risk reduction. This series of six Standards FAQ Details center on hospital emergency departments, and include assessing suicide risk, monitoring patients, ligature-resistant requirements, ligature risks that cannot be removed, and safe rooms. NABH Submits Comments to MACPAC on Regulatory Environment in IMDs NABH on Friday sent comments to the Medicaid and CHIP Payment and Access Commission about the regulatory environment for Institutions for Mental Diseases (IMDs). In it, NABH highlighted its recent regulatory report, The High Cost of Compliance: Assessing the Regulatory Burden on Inpatient Psychiatric Facilities, and discussed how the bulk of regulatory costs imposed on the nation’s inpatient psychiatric facilities relate to B-tags and ligature-risk requirements. “Psychiatric providers care first and foremost about keeping patients safe, which includes protecting patients from self-harm or suicidal behaviors,” NABH President and CEO Mark Covall wrote to MACPAC. “However, it’s not feasible for providers to create “ligature-free” environments that are completely devoid of potential ligature-attachment points,” he continued. “Nonetheless, some surveyors demand major changes to psychiatric facilities’ infrastructure or staffing to address perceived issues that carry a minimal risk for patient harm. In our study, NABH facilities reported that, on average, it costs more than $15,600 per psychiatric bed in physical plant and equipment costs to address ligature-related issues.” Read the full letter here. Thank You for Supporting Mental Health Month NABH thanks all its members who helped support our Access to Care campaign during Mental Health Month throughout May. Launched in March, NABH’s Access to Care initiative focuses on two major challenges that too often prevent providers from offering patients a full range of behavioral healthcare services: unjust managed care contracts and countless regulations. Please continue to share our Access to Care video, Board resolution, and regulatory report with those who haven’t seen it yet. NABH Wants to Hear from Your Organization! NABH is eager to feature our member organizations’ good work and innovative programs to help other NABH members learn about new care and business models and practices. Please share with us a best practice or new program that your organization uses to improve patient care, manage your workforce, streamline costs, or all of the above. We will feature your story—along with a photo or other images you provide—in the Member Profile section of our website. If you have a story to share, please contact Cemal Ozgur at cemal@nabh.org for details. As always, thank you for your good work and commitment to advancing NABH’s mission and vision! For questions or comments about CEO Update, please contact Jessica Zigmond.

Mental Health Liaison Group Supports Behavioral Health Coverage Transparency Act NABH and more than 40 other organizations that comprise the Mental Health Liaison Group this week sent letters to House and Senate lawmakers that expressed strong support for the Behavioral Health Coverage Transparency Act of 2019. “In unity, we advocated tirelessly for the enactment of the Paul Wellstone and Pete Domenici Mental Health and Addiction Equity Act of 2008 and recognize that increased transparency and improved accountability of health insurers is essential to fully realizing both the letter and spirit of this landmark law, and its application to the Affordable Care Act,” the letter said. The legislation would require issuers to disclose the analysis they perform in making parity determinations, as well as their denial rates for mental health versus medical/surgical claims and reasons for those denials. In addition, the bill would require federal regulators to conduct a minimum of 12 random audits of health plans per year, and it would create a central online portal for consumers to access publicly available material, such as information about their parity rights and information insurers submit about how they make parity decisions. NABH will keep members apprised of the legislation’s progress. SAMHSA Releases Report on Older Adults Living with Serious Mental Illness The needs and growth of America’s older population with serious mental illness (SMI) exceeds the number of behavioral health providers who are trained in geriatric care, according to a new report from the Substance Abuse and Mental Health Services Administration (SAMHSA). The analysis, Older Adults Living with Serious Mental Illness: The State of the Behavioral Health Workforce, notes that of the 49.2 million adults over the age of 65 years old in the United States, 1.4 to 4.8 percent suffer from SMI. Meanwhile, the U.S. Census Bureau’s National Population Projections show that by 2030, all Baby Boomers— those born between the years 1946-1965—will be older than age 65. At that point, the number of older adults will exceed the number of children. SAMHSA’s report also includes information about workforce barriers, ideas for strengthening the geriatric workforce to address SMI, programs and resources that address the needs of older Americans, and recommendations. Sen. Tina Smith Shares Experience with Depression During Mental Health Month In conjunction with Mental Health Month, Sen. Tina Smith (D-Minn.) shared her personal experience with depression in remarks she gave last week on the U.S. Senate floor. Smith, a member of the Senate Health, Education, Labors and Pensions (HELP) Committee, noted that de-stigmatizing and de-mystifying mental illness is just the beginning, and that everyone can help those in need by urging them to take advantage of available resources. “But the 100 of us here in the Senate have a responsibility to make sure those resources are available to everyone,” Smith said. “We can’t afford to leave holes in the net we build to catch people when they fall.” Click here to read Sen. Smith’s remarks as prepared for delivery and to download the video of her remarks. U.S. News Analysis Shows Link Between Racial Bullying and Risky Health Behavior in Kids Students in California’s public high schools who said they had been bullied because of their race, ethnicity, or national origin were twice as likely to have smoked cigarettes, says a new analysis from U.S. News & World Report. Analyzing data from the California Healthy Kids Survey, U.S. News found that alcohol consumption also was higher—40 percent—among students who had suffered bias-related bulling, compared with 29 percent among those who had not, as were reported usage rates for marijuana, cocaine, and heroin, and for prescription opioids, sedatives, and tranquilizers. More than 395,000 students between ninth and 12^th grades took the survey for the 2017-2018 school year, and nearly 53,000 reported they experienced bullying because of their race, ethnicity, or national origin in the last 12 months. Black students were most likely to experience this type of bias-related bullying, according to the analysis, with more than one in five reporting it had happened to them. Meanwhile, nearly 70 percent of those students who said it happened to them said it happened more than once. Neuroscientist Tom Insel to Serve California as Advisor on Mental Health Issues California Gov. Gavin Newsom (D) this week named psychiatrist and neuroscientist Tom Insel as a key advisor to help the state develop strategies that address mental health issues. A nationally recognized mental health leader, Insel served as director of the National Institute of Mental Health (NIMH), the institute within the National Institutes of Health that conducts research on mental health disorders. Insel has also served as a professor of psychiatry at Emory University, where he was the founding director of the Center for Behavioral Neuroscience in Atlanta. Dr. Insel has led the Mental Health Team at Verily (formerly Google Life Sciences) and most recently served as co-founder and president of Mindstrong Health. Insel served as an Annual Meeting speaker when NABH was known as NAPHS. AATOD 2019 Conference to Highlight Issues and Challenges of Medicated Assisted Treatment This October, the American Association for the Treatment of Opioid Dependence, Inc. (AATOD) will focus on the issues and challenges of medication assisted treatment (MAT) at its annual conference. AATOD said in a conference announcement that it intends to “educate and promote acceptance and integration of MAT options by patients, families, clinicians, the medical system, judicial systems, government, policymakers, social service administrations, and the general public.” AATOD will host its conference October 19-23 at Disney’s Coronado Spring Resort. Click here for more information, and here to register. Separately, AATOD this week released a 20-page analysis of the National Academies of Sciences, Engineering, and Medicine’s report, Medications for Opioid Use Disorder Save Lives, which was released in March. Help Support Mental Health Month: Promote NABH’s Access to Care Initiative There is one week left of Mental Health Month, which the United States has observed throughout May since 1949 to promote awareness about the importance of mental health as a part of overall health. This year, NABH asks its members to promote this important national observance by supporting the association’s Access to Care initiative. Launched in March, NABH’s Access to Care initiative focuses on two major challenges that too often prevent providers from offering patients a full range of behavioral healthcare services: unjust managed care contracts and countless regulations. Please visit our Access to Care page, where you can find resources to post and share with your followers, including our Access to Care video (which you can post directly to your organization’s website and share with others), our Access to Care resolution, our regulatory report, The High Cost of Compliance: Assessing the Regulatory Burden on Inpatient Psychiatric Facilities, and social media messages, including a LinkedIn article from NABH President and CEO Mark Covall. Thank you for your help and support! NABH Wants to Hear from Your Organization! NABH is eager to feature our member organizations’ good work and innovative programs to help other NABH members learn about new care and business models and practices. Please share with us a best practice or new program that your organization uses to improve patient care, manage your workforce, streamline costs, or all of the above. We will feature your story—along with a photo or other images you provide—in the Member Profile section of our website. If you have a story to share, please contact Cemal Ozgur at cemal@nabh.org for details. As always, thank you for your good work and commitment to advancing NABH’s mission and vision! For questions or comments about CEO Update, please contact Jessica Zigmond.  

America’s Health Rankings’ Senior Report Shows Rise in Excessive Drinking and Depression Excessive drinking increased 12 percent from 2016 to 2019 among the nation’s seniors, while the percentage of seniors who reported a health professional has told them they have depression has risen 19 percent in the last year alone, according to America’s Health Rankings’ Senior Report  for 2019. Produced by the United Health Foundation, UnitedHealth Group’s not-for-profit arm, America’s Health Rankings has provided an analysis of national health for 30 years and relies on health, environmental, and socioeconomic data to determine national health benchmarks and state rankings. This year’s Senior Report included a special comparison of data from 2002 and 2017 to show how the health of younger seniors aged 65 to 74 has changed in the last 15 years. Younger seniors now represent 9.1 percent of the U.S. population compared with 6.4 percent of the U.S. population in 2002. Comparing 2017 with 2002, the report showed that excessive drinking is 42 percent higher, obesity is 36 percent higher, and death by suicide is 16 percent higher. All of the results were not negative, however. The findings also showed that among younger seniors today, the death rate is 22 percent lower, smoking is 16 percent lower, and reporting of “very good or excellent health” is 11 percent higher. HRSA Awards $24 million to 120 Rural Organizations for Opioid Response HHS’ Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy this week awarded $24 million for the second round of Rural Communities Opioid Response Program (RCORP) planning grants. Award recipients across 40 states will receive $200,000 for one year to formalize partnerships with local stakeholders, conduct needs assessments, and develop plans to implement and sustain substance use disorder (SUD), including opioid use disorder (OUD) prevention, treatment, and recovery interventions. The goal, according to a statement from HRSA Administrator George Sigounas, M.S., Ph.D., is to reduce the morbidity and mortality of the diseases in high-risk, rural communities. A complete list of all grant recipients is available here. For more information about the RCORP initiative, please contact the Federal Office of Rural Health Policy. Separately, the American Farm Bureau Federation this month sponsored a Morning Consult poll that surveyed rural adults and farmers/farmworkers to better understand factors that affect the mental health of farmers, availability of resources, perceptions of stigma, personal experiences with mental health challenges, and other relevant topics. According to the poll, farmers and farmworkers said financial issues (91 percent), farm or business problems (88 percent), and fear of losing the farm (87 percent) affect farmers’ mental health. Other factors included stress, weather, the economy, isolation, and social stigma. DEA Online Form Available for Physicians Reporting Phone Scams Physicians should be aware of a reported uptick in phone scams from people posing as U.S. Drug Enforcement Administration (DEA) or other federal agents, and report these practices in the DEA’s online form. Earlier this year, the DEA—an agency under the U.S. Justice Department—warned DEA-registered practitioners and members of the public to be cautious of telephone calls from criminals posting as DEA or other law enforcement personnel threatening arrest and prosecution for supposed violations of federal drug laws or involvement in drug-trafficking activities. The DEA’s warning listed more than a handful of types of phone scams, including callers who threaten arrest, prosecution, and imprisonment, and in the case of medical practitioners, revocation of their DEA numbers; as well as callers who demand thousands of dollars via wire transfer or, in some instances, in the form of untraceable gift cards taken over the phone. HRSA Accepting Applications for 2019 Graduate Psychology Education and Nurse Corps Programs The Health Resources and Services Administration (HRSA) is accepting applications for its Nurse Corps Scholarship Program (NCSP) through May 21. The NCSP awards funds to students enrolled in a diploma, associate, baccalaureate, or graduate degree nursing program accept applications for this program if those students commit to serving in high-need, underserved communities. Scholarship support covers tuition, required fees, other reasonable educational costs, and a monthly living stipend. Help Support Mental Health Month: Promote NABH’s Access to Care Initiative This week marked the midway point for Mental Health Month, which the United States has observed throughout May since 1949 to promote awareness about the importance of mental health as a part of overall health. This year, NABH asks its members to promote this important national observance by supporting the association’s Access to Care initiative. Launched in March, NABH’s Access to Care initiative focuses on two major challenges that too often prevent providers from offering patients a full range of behavioral healthcare services: unjust managed care contracts and countless regulations. Please visit our Access to Care page, where you can find resources to post and share with your followers, including our Access to Care video (which you can post directly to your organization’s website and share with others), our Access to Care resolution, our regulatory report, The High Cost of Compliance: Assessing the Regulatory Burden on Inpatient Psychiatric Facilities, and social media messages, including a LinkedIn article from NABH President and CEO Mark Covall. Thank you for your help and support! NABH Wants to Hear from Your Organization! NABH is eager to feature our member organizations’ good work and innovative programs to help other NABH members learn about new care and business models and practices.Please share with us a best practice or new program that your organization uses to improve patient care, manage your workforce, streamline costs, or all of the above. We will feature your story—along with a photo or other images you provide—in the Member Profile section of our website. If you have a story to share, please contact Cemal Ozgur at cemal@nabh.org for details. As always, thank you for your good work and commitment to advancing NABH’s mission and vision! For questions or comments about CEO Update, please contact Jessica Zigmond.

SUPPORT Act Expands Access to Medication Assisted Treatment The Substance Abuse and Mental Health Services Administration (SAMHSA) announced this week that several sections of last year’s SUPPORT Act made changes to the Controlled Substance Act that affords practitioners with greater flexibility in providing medication assisted treatment, or MAT, to patients. Signed into law in October 2018, the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act  allows qualified physicians who are board-certified in addiction medicine or addiction psychiatry, or practitioners who provide MAT in a qualified practice setting,  start treating up to 100 patients in the first year of MAT practice with a waiver. According to SAMHSA, current practitioners with an approved waiver from the agency that authorizes them to treat a maximum of 30 patients at one time are permitted to increase that number to 100 patients if they provide SAMHSA with a notification of their intention to treat 100 patients. Rep. Tonko Expected to Introduce Bill to Deregulate Addiction Treatment Rep. Paul Tonko (D-N.Y.) is expected to introduce legislation next week that would allow physicians to prescribe the addiction-treatment drug buprenorphine without restrictions. Life sciences and medical news outlet STAT reports that about 5 percent of U.S. physicians have undergone the eight-hour training required to prescribe buprenorphine (commonly marked as Suboxone). The bill from Tonko follows a recent announcement that the U.S. Justice Department filed suit again buprenorphine’s best-known manufacturer, Indivior, the British firm that has been accused of marketing Suboxone fraudulently as being safer than generic alternatives. Health Systems Commit to Transforming Behavioral Health in 100 Communities Nationwide Twenty-eight health systems met this week to kick off a new effort to transform the country’s behavioral healthcare resources especially in underserved communities. The collective effort is part of the Medicaid Transformation Project, a national initiative announced last year that is intended to transform healthcare and related social needs for the nearly 75 million Americans who are Medicaid beneficiaries. The announcement came from AVIA, a network of health systems. Citing statistics from SAMHSA, the National Institute of Mental Health, and the Kaiser Family Foundation, Avia noted in its announcement that 44.7 million American adults—including 10 million adults covered by Medicaid—experienced a mental health illness as of 2016, a number that is likely underestimated due to stigma issues. Meanwhile, about 35 percent of adults with a serious mental illness are not receiving mental health treatment. “As jarring as the national behavioral health statistics are, they only serve as the tip of the iceberg for the long-term consequences that we risk if we don’t take wide-reaching, decisive action to address this crisis today,” Andy Slavitt, chair for the Medicaid Transformation Project and former acting administrator at the Centers for Medicare & Medicaid Services, said in a news release. “Twenty-eight healthcare organizations have stepped up to proclaim with a singular, unmistakable voice that enough is enough,” Slavitt continued. “Within the next year, I expect dozens of new positive initiatives to launch. Within five to seven years, we could spark the transformation the country needs.” Last month, Molly Joel Coye, MD, MPH, physician leader in Medicaid transformation at AVIA, addressed attendees at the 2019 NABH Annual Meeting. Please click here for her presentation. Federal Officials Highlight Addiction Treatment Concerns at National Rx Drug Abuse & Heroin Summit The nation’s federal health agencies are concerned about substance use disorder policies that promote short-term medication treatment and premature tapering that could increase the risk of overdose and death, officials told attendees at this the annual Rx Drug Abuse & Heroin Summit in Atlanta this week. Therefore, representatives from the National Institutes of Health (NIH) and the National Institute on Drug Abuse emphasized that expanding the use of medications to treat opioid use disorders—including both access to medication and retention on medication—are essential for long-term recovery. The speakers from NIH also discussed the Healing Communities grants that were awarded to academic institutions in Massachusetts, Kentucky, Ohio, and New York. These studies will test interventions across healthcare, behavioral healthcare, law enforcement, and other community settings, with an emphasis on the impact of coordinated systems of care on reducing overdoses and fatalities; decreasing the incidence of OUD; increasing the numbers who receive opioid medications and are retained in treatment; use of recovery support services; and distributions of naloxone. In addition, the Centers for Disease Control and Prevention (CDC) is cautioning providers against over-generalizing the agency’s guideline on opioid prescribing to settings and populations for which the guideline was not intended. CDC officials noted that many physicians are terminating opioids inappropriately for cancer and other conditions, and also precipitating withdrawal and pushing patients to obtain opioids illegally. Speakers from this week’s summit also expressed concerns about the growing prevalence of stimulant use disorders, the use of cocaine with opioids (also known as speedballing), and the need for medication-based treatment research to better treat these conditions. Law enforcement officials, meanwhile, raised warnings about fentanyl-laced cocaine and fentanyl that is disguised to look like cocaine. They also expressed their concerns that illicit synthetic drug production is growing because the practice has become more profitable—as well as easier to manufacture and distribute. Recently, I was appointed to the National Quality Forum Opioid Technical Expert Panel. This panel was convened as part of last year’s SUPPORT Act to review the landscape of quality measures related to opioids and opioid use disorders, and to recommend measures for inclusion in value-based payment and reporting models under Medicare. A series of web-based meetings will take place through January 2020 and will be open to the public. If you have questions about the National Rx Drug Abuse & Heroin Summit specifically, or addiction treatment more generally, please contact me at sarah@nabh.org. —Sarah Wattenberg, NABH Director of Quality and Addiction Services Drug Enforcement Administration’s National Rx Take-Back Day is April 27 The U.S. Drug Enforcement Administration (DEA) will partner with federal, state, local, and tribal law enforcement agencies and businesses on Saturday, April 27 to host events to collect and safely dispose unwanted medications. Unused prescriptions thrown in the trash can be retrieved, abused, and/or sold illegally, DEA cautioned, and removing unwanted or expired medications from the medicine cabinet is an easy step Americans can take to make a difference in the nation’s opioid crisis. National Rx Take Back Day will take place from 10 a.m. until 2 p.m. ET, and the DEA has provided a Collection Site Locator on its Take Back Day homepage. Mental Health Month Starts Next Week 2019 marks the 70^th anniversary of Mental Health Month, which Mental Health America and its affiliates have observed each May since 1949. This year, Mental Health America will build on its 2018 theme—#4Mind4Body—as it explores the topics of animal companionship (including both pets and support animals), spirituality, humor, work-life balance, recreation, and social connections as ways to boost mental health and general wellness. See Mental Health America’s Mental Health Month toolkit for information and resources. HRSA Accepting Applications for 2019 Graduate Psychology Education and Nurse Corps Programs The Health Resources and Services Administration (HRSA) is accepting applications for its Graduate Psychology Education (GPE) program and its Nurse Corps Scholarship Program (NCSP) until May. HRSA’s GPE program trains doctoral health psychology students, interns, and post-doctoral residents to provide integrated, interdisciplinary, behavioral health and substance use prevention and treatment services in high-need and high-demand areas. The program also supports faculty development of health service psychology. According to HRSA, there is about $18 million in funding for about 40 awards, and it will accept applications through May 7. The NCSP awards funds to students enrolled in a diploma, associate, baccalaureate, or graduate degree nursing program accept applications for this program if those students commit to serving in high-need, underserved communities. Scholarship support covers tuition, required fees, other reasonable educational costs, and a monthly living stipend. HRSA will accept applications through May 21. 2019 NABH Annual Meeting Recorded Presentations Now Available! Recorded presentations, photos, and an updated attendance list from the 2019 NABH Annual Meeting in Washington are now available on NABH’s Annual Meeting homepage. The recorded presentations—along with copies of the speakers’ slide decks—are also available on NABH’s Annual Meeting Speakers & Presentations page. We look forward to seeing you at the 2020 NABH Annual Meeting next March!   For questions or comments about CEO Update, please contact Jessica Zigmond.

OTPs to Follow Standard Care Recommendations for People with Suicide Risk The nation’s opioid treatment programs will be begin following the National Action Alliance (Action Alliance) for Suicide Prevention’s recommended guidelines to care for people with suicide risk in June, the news outlet Stateline reported this week. The story cited statistics from the Centers for Disease Control and Prevention (CDC) that found people with an opioid addiction are at much higher risk for suicide than the rest of the population, and that opioid use was a contributing factor in more than 40 percent of all suicide and overdose deaths in 2017. Guidelines from the Action Alliance will become facilities’ minimum standard of care for patients in both inpatient and outpatient addiction-treatment settings, Michael Johnson, managing director for the Commission on Accreditation of Rehabilitation Facilities, which oversees opioid treatment programs, said in the story. “Right now, there’s no real standards for suicide prevention in addiction treatment programs,” Johnson told Stateline. “We want to change that.” The Action Alliance is a public-private partnership that works to advance the National Strategy for Suicide Prevention and reduce the nation’s suicide rate 20 percent by 2025. Report Finds Older Americans Turning to Suicide in Long-Term Care Settings A six-month investigation from Kaiser Health News (KHN) and the PBS NewsHour has found older Americans are dying by suicide in the nation’s nursing homes, assisted living centers, and adult care homes. KHN analysis of new data from the University of Michigan data suggests that hundreds of suicides by older adults each year, or nearly one per day, are related to long-term care. Meanwhile, thousands more people may be at risk in those settings, where up to a third of residents report suicidal reports, the research found. “Each suicide results from a unique blend of factors, of course,” the study noted. “But the fact that frail older Americans are managing to kill themselves in what are supposed to be safe, supervised havens raises questions about whether these facilities pay enough attention to risk factors like mental health, physical decline, and disconnectedness—and events such as losing a spouse or leaving one’s home,” it continued. “More controversial is whether older adults in those settings should be able to take their lives through what some fiercely defend as ‘rational suicide.’” CDC Finds Kratom Has Caused Nearly 100 Overdose Deaths in the United States The CDC has reported the herbal supplement kratom has caused 91 overdose deaths in 27 states from July 2016-December 2017. Kratom, a plant native to Southeast Asia, contains the alkaloid mitragynine, which the CDC reports can produce stimulant effects in low doses and some opioid-like effects at higher doses when consumed. “As of April 2019, kratom was not scheduled as a controlled substance,” the CDC report noted. “However, since 2012, the Food and Drug Administration has taken a number of actions related to kratom, and in November 2017 issued a public health advisory; in addition, the Drug Enforcement Administration has identified kratom as a drug of concern,” it added. “During 2011–2017, the national poison center reporting database documented 1,807 calls concerning reported exposure to kratom.” FDA Announces Reports of Seizures from Vaping The U.S. Food and Drug Administration (FDA) has announced it has learned some people who use e-cigarettes have experienced seizures, with most reports involving youth or young adult users. “Seizures or convulsions are known potential side effects of nicotine toxicity and have been reported in the scientific literature in relation to intentional or accidental swallowing of e-liquid,” the announcement said. “However, a recent uptick in voluntary reports of adverse experiences with tobacco products that mentioned seizures occurring with e-cigarette use (e.g., vaping) signal a potential emerging safety issue.” The FDA said it continues to monitor all adverse experiences reported to the agency about the use of e-cigarettes and urges the public to report any cases of individuals who use e-cigarettes and have had seizures to the online Safety Reporting Portal. DOJ Reverses Course on Funding for Drug Courts that Reject MAT The U.S. Justice Department (DOJ) has reversed course on its grant announcement earlier this year that rolled back an Obama administration policy that cut funding to courts denying entry to people on medication assisted treatment (MAT), the news outlet Politico reported this week. A clarification from DOJ this week said it will continue following the 2015 funding requirement after the department received a series of inquiries about the policy. HRSA Accepting Applications for 2019 Graduate Psychology Education and Nurse Corps Programs The Health Resources and Services Administration (HRSA) is accepting applications for its Graduate Psychology Education (GPE) program and its Nurse Corps Scholarship Program (NCSP) until May. HRSA’s GPE program trains doctoral health psychology students, interns, and post-doctoral residents to provide integrated, interdisciplinary, behavioral health and substance use prevention and treatment services in high-need and high-demand areas. The program also supports faculty development of health service psychology. According to HRSA, there is about $18 million in funding for about 40 awards, and it will accept applications through May 7. The NCSP awards funds to students enrolled in a diploma, associate, baccalaureate, or graduate degree nursing program accept applications for this program if those students commit to serving in high-need, underserved communities. Scholarship support covers tuition, required feeds, other reasonable educational costs, and a monthly living stipend. HRSA will accept applications through May 21. IPF PEPPER Review Webinar Scheduled for April 24 A webinar to review the Inpatient Psychiatric Facility (IPF) PEPPER (version Q4FY18)—released on Friday, April 5—will be held on Wednesday, April 24 at 3 p.m. ET. Click here to register. For those unable to participate, the session will be recorded and posted on PEPPER.CBRPEPPER.org in the “Training and Resources” section. 2019 NABH Annual Survey Available Online Until April 19 The 2019 NABH Annual Survey is available on the association’s website for members who have not completed it yet. Please take a moment to review the instructions for the survey before completing it. Respondents will not be able to pause the survey and start again. Thank you for your time Learn About Baymark Health Services in NABH’s Latest Member Profile! NABH’s latest member profile features Baymark Health Services, which provides evidence-based opioid use disorder treatment. Baymark focuses on providing individualized treatment options that integrate pharmacotherapy, clinical counseling, recovery support, and medical services. The Baymark system treats more than 50,000 patients each day in the United States and Canada. Learn more about Baymark here. For questions or comments about CEO Update, please contact Jessica Zigmond.

China Bans All Types of Fentanyl, Cutting U.S. Supply China this week announced it would ban all types of the opioid fentanyl, a decision that could slow the supply of the deadly drug to the United States. The decision fulfills a pledge that Chinese leader Xi Jinping made to President Trump in December. House Energy and Commerce Republicans hailed the move in a blog post, noting that fentanyl analogues—synthetic opioids that are 50 times more potent than heroin and 100 times more potent than morphine—are the leading cause of opioid overdose deaths in the United States. ONC Issues Proposed Rule to Revise Conditions of Participation HHS’ Office of the National Coordinator for Health Information Technology (ONC) has issued a proposed rule that would revise the conditions of participation for psychiatric hospitals and require facilities that have electronic health record (EHR) systems “to send electronic patient event notifications of a patient’s admission, discharge, and/or transfer to another health care facility or to another community provider.” The proposal would limit this requirement to only those Medicare- and Medicaid-participating hospitals that possess EHRs systems with the technical capacity to generate information for electronic patient event notifications. NABH is drafting comments on the proposed rule. House and Senate Introduce Bipartisan Bills to Align 42 CFR Part 2 With HIPAA Identical, bipartisan bills were introduced in the House and Senate this week to align 42 CFR Part 2, commonly referred to as Part 2, with the Health Insurance Portability and Accountability Act (HIPAA) for treatment, payment, and healthcare operations, while also strengthening protections against the use of addiction records in criminal, civil, or administrative proceedings. Reps. Earl Blumenauer (D-Ore.) and Markwayne Mullin (R-Okla.) introduced the Overdose Prevention and Patient Safety Act, or OPPS Act, while Senators Shelley Moore Caputo (R-W.V.) and Joe Manchin (D-W.V.) introduced Protecting Jessica Grubb’s Legacy Act, or the Legacy Act. NABH, a member of the Partnership to Amend 42 CFR Part 2, supports both pieces of legislation. GAO Finds Nearly 40 Million American Adults Have Untreated Substance Use Disorders or Mental Health Conditions A recent Government Accountability Office (GAO) report found that nearly 40 million American adults have untreated substance use disorders or mental health conditions, such as depression. According to the national survey, many of these Americans don’t think they need treatment, while others say it’s hard to get care. Left untreated, these behavioral health conditions can cause other health complications—such as drug overdoses—which, in turn, can raise healthcare costs. The GAO noted that the studies it reviewed were limited to specific conditions or locations, and most found higher healthcare costs for adults who didn’t receive behavioral healthcare treatment. There is no generally accepted estimate of the overall costs, the report said. Emergency Medicine News Releases Special Report on Psychiatric Patient Boarding The decline in the number of inpatient psychiatric beds available nationwide could be the most significant factor to help explain the increase in Emergency Department (ED) wait times for psychiatric patients, according to a special report published in Emergency Medicine News. “Those dropped 35 percent between 1998 and 2013,” the report noted, citing JAMA, “And the drop wasn’t just confined to the late 1990s and early aughts; a June 2016 report from the Treatment Advocacy Center, a national nonprofit focusing on making treatment available for severe mental illness, found that the United States had 37,679 state psychiatric beds in 2016, down about 13 percent from 2019,” the report continued. “That comes out to an average of 11.7 psychiatric beds for every 100,00 people, a number far below the 40-60 beds per 100,000 people the center recommends.” CMS Introduces Hospital Provider Burden Tool in April Newsletter The Centers for Medicare and Medicaid Services (CMS) this week introduced its Complexity and Burden of Hospital Reporting Ecosystem map to provide a visual representation of essential reporting interactions between hospital staff and external regulatory agencies, payers, and accrediting organizations. Featured in the April edition of the agency’s Patients Over Paperwork newsletter, the new map is the result of the agency’s work in the field, where CMS made more than 2,000 observations after meeting with 200 hospital leadership, management, and clinical staff last summer. From that research, CMS identified examples of burden, which it narrowed down to 130 themes and 16 insights, such as “hospital staff feel they spend too much time resolving misaligned requirements and interpreting conflicting guidance,” and “hospitals are required to send the same information to different places in slightly different formats. This means hospitals have to hire staff and consultants to manage this complexity.” Federal Leaders to Headline Rx Drug Abuse and Heroin Summit The directors of the National Institutes for Health (NIH) and Centers for Disease Control and Prevention (CDC) are among the plenary speakers at the Rx Drug Abuse and Heroin Summit in Atlanta from April 22-25. Francis Collins, MD, PhD of the NIH and the CDC’s Robert Redfield, MD, as well as Nora Volkow, MD, the director of the National Institute on Drug Abuse (NIDA), will address meeting attendees at this year’s conference. Click here to register for the meeting. IPF PEPPER Review Webinar Scheduled for April 24 A webinar to review the release of the Inpatient Psychiatric Facility (IPF) PEPPER (version Q4FY18)—released today, Friday, April 5—will be held on Wednesday, April 24 at 3 p.m. ET. Click here to register. For those unable to participate, the session will be recorded and posted on PEPPER.CBRPEPPER.org in the “Training and Resources” section. 2019 NABH Annual Survey Available Online The 2019 NABH Annual Survey is available on the association’s website for members who have not completed it yet. Please take a moment to review the instructions for the sruvey before completing it. Respondents will not be able to pause the survey and start again. Thank you for your time! For questions or comments about CEO Update, please contact Jessica Zigmond.

Centene Will Acquire WellCare for $17.3 billion Centene Corp. will acquire WellCare Health Plans, Inc. for $17.3 billion in a deal the two companies announced this week will create a new venture focused on government-sponsored healthcare programs that will have about 22 million members across all 50 states and combined revenue of about $100 billion. News outlet Politico reported that while Centene’s major focus is Medicaid managed care—where it had about 14 million members at the end of 2018—the health insurer has also emerged as a significant player in the Obamacare markets, with about 2 million members across 21 states, or nearly one in five exchange enrollees nationwide, at the start of this year. In 2016, Centene acquired Health Net, another Medicaid managed care plan, for $6.3 billion. Centene and WellCare said in a joint news release the board of the combined company will consist of 11 members, including nine members from Centene’s board and two from WellCare’s board. Centene’s Michael Neidorff will lead the combined company as chairman and chief executive officer, while Ken Burdick and Drew Asher from WellCare are expected to join Centene’s senior management team in new positions as a result of the acquisition. The National Academies Says Medications to Treat OUD Are Effective, but Barriers Prevent Access and Use Three U.S. Food and Drug Administration (FDA)-approved medications to treat opioid use disorder (OUD) are both safe and effective, but most people who would benefit from these treatments do not receive them and access is inequitable, according to a new report from the National Academies of Sciences, Engineering, and Medicine. According to Medications for Opioid Use Disorder Saves Lives, withholding or failing to have available these medications to treat OUD in any care or criminal justice setting is denying appropriate medical treatment. The report identified misunderstanding and stigma, inadequate education and training, current regulations, and the fragmented system of care for people with OUD as the barriers to treatment. “The United States is experiencing a public health crisis of almost unprecedented scale — an epidemic of opioid use disorder and related overdose deaths,” Alan Leshner, chief executive officer emeritus of the American Association for the Advancement of Science, and chair of the committee that conducted the study, said in a news release. “The factors impeding full use of FDA-approved medications to treat OUD must be addressed, including stigma surrounding both addiction and the medications used to treat it as well as counterproductive ideologies that consider addiction simply a failure of will or a moral weakness, as opposed to understanding that opioid use disorder is a chronic disease of the brain that requires medical treatment,” he continued. “Curbing the epidemic will require an ‘all hands on deck’ strategy across every sector — healthcare, criminal justice, people with OUD and their family members, and beyond — in order to make meaningful progress in resolving this crisis.” ASTHO Recommends Approaches to SUD Prevention and Treatment The Association of State and Territorial Health Officials (ASTHO) and the National Academy for State Health Policy (NASHP) have released four recommendations on how public health and Medicaid agencies can engage in cross-agency work to prevent and treat substance use disorder (SUD). In 2018, the two groups convened the Cross-Agency Leaders Roundtable—a group of 10 Medicaid and public health officials—to develop the recommendations. The roundtable included representatives from the state health departments in Alaska, California, Massachusetts, New York, Ohio, Oregon, Pennsylvania, Virginia, and Washington. According to the report, the leaders recommend that public health and Medicaid agencies determine an appropriate mechanism to catalyze cross-agency collaboration and create a unified administrative structure; optimize the use of state resources, including funding and staff, to maximize reach and impact; align policies across agencies for prescribing, treatment, training, and use of evidence-based best practices among providers; and utilizes a range of data sources to measure progress, inform state leadership and the public, and develop policy. Click here to learn more. Veterans Affairs Partners with Objective Zero Foundation on Suicide Prevention The Veterans Affairs Department announced this week that it has partnered with the not-for-profit Objective Zero Foundation to connect veterans with suicide prevention support and resources. The new partnership, which became formal in early December, provides a shared goal to prevent suicide among service members and veterans, and focuses especially on service members transitioning out of the military. Objective Zero offers a free mobile app that connects veterans, service members, their families and caregivers—instantly and anonymously—to suicide-prevention resources and a nationwide community of peer supporters via text, voice, and video chat. “At VA, we are working to prevent veteran suicide by using an approach that looks beyond our traditional health care settings,” VA Secretary Robert Wilkie said in a news release. “Our partnership with Objective Zero is an integral part of reaching veterans where they live, work, and thrive, and we are looking forward to working more closely with them.” NQF and AHA Release Telebehavioral Health Guide The National Quality Forum (NQF) and the American Hospital Association (AHA) have developed a guide to help hospitals and health systems deliver innovative, high-quality telebehavioral health services. Released at the NQF’s annual conference this week, Redesigning Care: A How-To Guide for Hospitals and Health Systems Seeking to Implement, Strengthen and Sustain Telebehavioral Health focuses on six “success factors,” including leadership commitment; organizational policies and clinical workflows; staff education and training; patient, family, and caregiver engagement; measurement, and community partnerships. Click here for more information and to purchase the guide. Center on Addiction Study Reviews and Compares Addiction Benefits in ACA Plans More than half of the states offered Affordable Care Act (ACA) plans in 2017 that did not comply with the 2010 healthcare law’s requirements for covering SUD benefits, according to Uncovering the Gaps II: A Review and Comparison of Addiction Benefits in ACA Plans, a new report from the Center on Addiction. Meanwhile, about 20 percent of the states offered ACA plans that year that violated parity requirements. The 79-page report highlights the coverage gaps in ACA plans sold to Americans in 2017 and compares the benefits in these plans to the benefits in 2017 Essential Health Benefit (EHB) benchmark plans. “Once again, our research demonstrates the need to improve insurance coverage for addiction treatment,” the report noted. “Commercial insurers tout their role in addressing the opioid epidemic, but most of their initiatives have addressed inappropriate prescribing of prescription opioids,” it added. “This is important but insufficient. Too many patients continue to be denied access to life-saving care, and their families are forced to battle with their insurance companies in a time of crisis.” Vista Research Group Releases Report on State of Addiction Treatment Vista Research Group, which focuses on improving treatment outcomes, has released The State of Addiction Treatment, a report that provides an overview of addiction treatment in the United States and also examines both commercial payer and regulatory trends, measurement outcomes, and the evolving landscape of SUD mergers and acquisitions. According to the report, in a small, informal study of 73 addiction treatment center leaders, 23 percent reported that they’re concerned about their ability to stay in business. When asked to identify their respective treatment center’s biggest challenge, respondents reported a range of issues, such as being paid sufficiently to cover their costs; keeping their census up; finding qualified staff; managing regulatory requirements; and dealing with rapid growth or acquisitions. CMS’ Medicaid Innovation Accelerator Program to Host SUD Webinar on April 3 The Centers for Medicare & Medicaid Services (CMS) Innovation Accelerator Programs Reducing Substance Use Disorder program area will host a national learning webinar on Wednesday, April 3 from 3 p.m. to 4 p.m. ET. The webinar is meant to help participants identify and treat complex conditions, the unique challenges and needs of the SUD population with these conditions, and reasons why customizing approaches for this population is necessary.Click here to register. IPF PEPPER Review Webinar Scheduled for April 24 A webinar to review the release of the Inpatient Psychiatric Facility (IPF) PEPPER (version Q4FY18)—which is scheduled for April 5—will be held on Wednesday, April 24 at 3 p.m. ET. Click here to register. For those unable to participate, the session will be recorded and posted on PEPPER.CBRPEPPER.org in the “Training and Resources” section. For questions or comments about CEO Update, please contact Jessica Zigmond.

NABH Launches Access to Care Initiative at 2019 Annual Meeting NABH this week kicked off Access to Care, the association’s new initiative that will provide information and resources to help inform policymakers, regulators, payers, and patient advocates that only true access can lead to recovery. Access to Care focuses on two major challenges: unjust managed care contracts and countless regulations, both of which often prevent behavioral healthcare providers from offering patients a full range of services. As part of this initiative, the NABH Board of Trustees on March 18 adopted the Access to Care resolution, which addresses unfair managed-care practices and recommends guiding principles for providers and payers to incorporate in contracts with managed care organizations (MCOs). NABH’s provider systems are committed to ensuring patient access to behavioral healthcare treatment across the entire behavioral healthcare continuum, which includes inpatient, residential, partial hospitalization, intensive outpatient, outpatient, and recovery and support services. Too often, MCOs limit coverage to crisis stabilization or short-term, acute-care services for all levels of care because they use internally developed and/or proprietary and non-transparent, medical-necessity criteria. “As our Access to Care resolution states, ‘Fair and appropriate coverage for behavioral healthcare services must ensure—not solely offer—access to the entire behavioral healthcare continuum,” NABH Board Chair Pat Hammer, president and CEO of Oconomowoc, Wis.-based Rogers Behavioral Health, said in a news release about the resolution. “For this to happen, fair and reasonable managed care contracts must include and apply generally accepted standards of professional practice.” NABH created a Managed Care Committee last fall to identify problems and propose solutions in managed care contracts. The association shared copies of the resolution with attendees at the meeting and NABH Board Chair Pat Hammer introduced NABH’s Access to Care video—which personalizes behavioral healthcare services—at the Annual Meeting’s opening session. On March 19, NABH released The High Cost of Compliance: Assessing the Regulatory Burden on Inpatient Psychiatric Facilities, a comprehensive report that examines the burdens that certain regulations impose on the nation’s inpatient psychiatric facilities. commissioned Manatt Health to conduct this first-of-its-kind study that focuses on three federal regulatory domains attached to participation in the Medicare program: the so-called “B-tag” requirements, a detailed set of standards for patient evaluations, medical records, and staffing in inpatient psychiatric facilities; “ligature risk points,” or those aspects of the physical environment that a patient could use to attempt self-strangulation; and the Emergency Medical Treatment and Labor Act (EMTALA), which obligates a hospital to screen all patients for emergency medical conditions, and, if an emergency condition is identified, to stabilize the patient before the patient may be discharged or transferred. The findings estimate that, taken together, these three regulatory areas impose $1.7 billion in compliance costs nationwide each year. Put another way, these regulatory burdens represent about 4.8 percent of an average facility’s annual revenue for all inpatient services from all sources. NABH President and CEO Mark Covall presented a copy of the report to HHS Deputy Secretary Eric Hargan on Tuesday before the deputy secretary addressed Annual Meeting attendees. In his presentation, Deputy Secy. Hargan called the report “timely” and later tweeted about how he had the opportunity to discuss HHS’ efforts to fund substance use disorder treatment and recovery services—and examine the regulatory barriers that stand in the way of improvement—with NABH. NABH urges its members to visit the Access to Care for these resources, to post the new Access to Care video online, and to share it on Twitter and LinkedIn. And please remember to follow us @NABHBehavioral and on LinkedIn at the National Association for Behavioral Healthcare! 2019 NABH Annual Meeting Materials Available Online NABH thanks its members, exhibitors, sponsors, and other guests who traveled to Washington this week for the 2019 NABH Annual Meeting. Please visit the Speakers & Presentations tab on NABH’s Annual Meeting homepage to download the presentations that included PowerPoint slide decks, the Access to Care page for all materials related to the association’s new initiative, and NABH’s Be an Advocate page for all Hill Day materials. Video recordings of the presentations will be posted to NABH’s website at a later date. The NABH team looks forward to seeing you again in 2020! For questions or comments about CEO Update, please contact Jessica Zigmond.

President’s Budget Maintains Opioid Funding Levels and Cuts Behavioral Healthcare Funding In his Fiscal Year 2020 budget released this week, President Donald Trump proposed $4.8 billion—which maintains congressional funding levels—to combat the nation’s opioid crisis and proposed hundreds of millions in funding cuts to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) budget and to behavioral healthcare research. According to the president’s proposal, SAMHSA would see a $65 million cut to its total budget, while the behavioral healthcare-related institutes within the National Institutes of Health would see even more severe funding decreases with $436 million in cuts to behavioral healthcare research. For the third year in a row, the president has proposed cutting the Office of National Drug Control Policy’s by more than 95 percent and repealing the Patient Protection and Affordable Care Act’s Medicaid expansion. The budget proposal would also require states to choose between a per-capita cap or a block grant for their Medicaid programs. Each year, the president’s budget is important because it provides a blueprint for the president’s priorities and policy recommendations to Congress. The president’s budget is also significant because it marks the start of the legislative appropriations process. Watch HHS Secretary Alex Azar’s testimony about the Trump administration’s Fiscal Year 2020 budget here. National Survey Shows More Teens and Young Adults Experiencing Mental Health Issues A new nationwide survey found a 50-percent increase in depressive episodes for individuals between the ages of 12 and 17 between 2005 and 2017. Published in the Journal of Abnormal Psychology, the study examined 200,000 people aged 12–17 and 400,000 people aged 18 and older at various points between 2005 and 2017 about any psychological distress and depressive episodes they had experienced. The findings showed a slightly bigger increase—63 percent—in young adults aged 18–25 than in the younger age group. “Cultural trends contributing to an increase in mood disorders and suicidal thoughts and behaviors since the mid-2000s, including the rise of electronic communication and digital media and declines in sleep duration, may have had a larger impact on younger people, creating a cohort effect,” the study said. In its general scientific summary, the study noted that more “U.S. adolescents and young adults in the late 2010s (versus the mid-2000s) experienced psychological distress, major depression, and suicidal thoughts, and more (people) attempted suicide, and took their own lives.” SAMHSA Releases Guidance on Strategies to Promote Best Practice in Antipsychotic Prescribing for Children and Adolescents SAMHSA has released its Guidance On Strategies to Promote Best Practice in Antipsychotic Prescribing for Children and Adolescents. The new resource offers six key principles for system-level strategies, including youth and family engagement, a multi-modal approach, prescribing clinician engagement, consideration for the unique needs of special populations, coordination with other youth-serving systems, and sustainable financing mechanisms. SAMHSA Releases Principles of Community-Based Behavioral Health Services for Criminal Justice Involved Individuals SAMHSA recently released Principles of Community-Based Behavioral Health Services for Criminal Justice Involved Individuals to provide a framework for a quality, community-based behavioral health treatment system that responds to individuals with mental and substance use disorders. The guide is meant to help community-based behavioral healthcare providers in their clinical and case management practices with people who have mental and substance use disorders and are currently involved with or have been involved in the adult criminal justice system. It’s also intended for agency leaders and program developers responsible for shaping how their organizations deliver community-based services. The guide is composed of eight guiding principles, as well as frequently asked questions, resources for additional reading, and a glossary of terms for behavioral healthcare providers and criminal justice professionals. HRSA to Host Webinar on Opioid Response Program Funding Opportunity on March 27 The Health Resources and Services Administration’s (HRSA) Rural Communities Opioid Response Program (RCORP) has released a funding opportunity for implementation grants. HRSA will make available about 75 awards of up to $1 million each to networks and or/consortia to enhance substance use disorder (SUD), including opioid-use disorder (OUD). HRSA will host a webinar about this opportunity on Wednesday, March 27 from 11:30 a.m. ET until 1 p.m. ET. Click here for the weblink. Separately, the Centers for Medicare & Medicaid Services updated its opioid prescribing mapping tool. For the first time, the tool includes data for opioid prescribing in the Medicaid program. The tool also makes geographic comparisons of Medicare part D opioid prescribing rates over time for both urban and rural communities. Join Us! The 2019 NABH Annual Meeting—Behavioral Healthcare: Improving Coordination, Collaboration, Integration— kicks off on Monday, March 18. If you haven’t done so yet, please take a moment to read our updated preliminary program and visit our speakers page. Also, NABH thanks all of the companies that will serve as exhibitors or sponsors at this year’s Annual Meeting. Please take a moment to view our exhibitors and sponsors on our Annual Meeting homepage, where you can click on each organization to learn more. Also, please remember to visit with our exhibitors and sponsors during at the Mandarin Oriental Washington, DC next week. We look forward to seeing you in Washington! For questions or comments about CEO Update, please contact Jessica Zigmond.

NABH Applauds Landmark Behavioral Healthcare Coverage Ruling in California NABH applauded the decision filed in California’s Northern District earlier this week that will open access to behavioral healthcare services for those who need it. “It has been 10 years since President George W. Bush signed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, and we have yet to achieve full parity,” NABH President and CEO Mark Covall said in a statement on March 5. “Today’s decision in California’s Northern District is a turning point. The federal court’s ruling made it clear that insurance companies must use generally accepted standards in the full behavioral healthcare continuum to help patients gain access to the care they need for recovery.” In a nationwide class action lawsuit, the U.S. District Court for the Northern District of California on Tuesday held that United Behavioral Health (UBH) — the country’s largest managed behavioral healthcare organization — developed restrictive medical-necessity criteria that it used to deny coverage for outpatient, intensive outpatient, and residential treatment services. According to the decision, the Court found that UBH’s internal guidelines limited coverage to acute care services, disregarding highly prevalent, chronic, and co-occurring disorders that required greater intensity and/or duration. The Court also found that UBH failed to meet a requirement related to children and adolescents, asserting that although generally accepted standards of care do not require UBH to “create an entirely separate set of guidelines to address the needs of children and adolescents… they do, however, require that UBH’s guidelines instruct decision-makers to apply different standards when making coverage decisions involving children and adolescents, where applicable, including relaxing the criteria for admission and continued stay to take into account their stage of development and the slower pace at which children and adolescents generally respond to treatment.” NABH is especially pleased to see the Court acknowledge that mental health and substance use disorders are chronic illnesses, and that managed care organizations must cover care that not only stabilizes the acute aspects of a patient’s illness, but also addresses a patient’s underlying condition. President Trump Creates Task Force to Develop Blueprint for Suicide Prevention Among Veterans President Trump this week signed an executive order creating a Cabinet-level task force to draft a blueprint for suicide prevention among veterans within one year. The new President’s Roadmap to Empower Veterans and End a National Tragedy of Suicide (PRESENTS) initiative will work to develop a grant system that extends funding to state and local programs and coordinate suicide-prevention research across agencies in the Veterans Affairs, Defense, and Homeland Security departments. Bipartisan Group of Senators Ask HHS to Update Part 2 Thirteen U.S. senators this week sent a letter to HHS Secretary Alex Azar asking his department to initiate a rulemaking process to update the Confidentiality of Alcohol and Drug Abuse Patient Records 42 Code of Regulations 2, known as Part 2. “Part 2 provisions are not compatible with the way health care is delivered currently,” said the letter from 7 Republicans and 6 Democrats. “In order to bring them in line with 21^st Century medicine, it is imperative to modernize the regulations,” the letter continued. “Initiating a rulemaking process will open the door for necessary reforms, allowing for better coordination, safer and more effective treatment for patients, and stronger patient protections.” Mental Health Liaison Group Sends Senate HELP Committee Behavioral Healthcare Priorities Strengthening parity enforcement and compliance, stabilizing the health insurance marketplace, and integrating behavioral healthcare are the top three steps the federal government and the states could take to lower U.S. healthcare costs, the Mental Health Liaison Group said in a letter to the Senate Committee on Health, Education, Labor and Pensions (HELP) this week. “In order to make meaningful, effective and long-lasting change within the U.S. healthcare system, we need to make long-term investments,” the letter said. “If we continue to look for cost-saving measures in the short-term, we will continue to fall short for American families, providers, and employers.” NABH has been a longtime member of the Mental Health Liaison Group. Missouri Hospital Association Examines Suicidality Rates After Psychiatric Hospitalizations Among Children The 60-day suicidality rate following a psychiatric hospitalization nearly doubled for children and adolescents with insurance coverage that shifted from Medicaid fee for service to Medicaid managed care organizations in Missouri following statewide expansion of managed care in May 2017, according to a new report from the Missouri Hospital Association. The report said the average length of stay at psychiatric hospitals for children and adolescents with Medicaid managed care coverage is 7.3 days, while the average duration is 12.5 for Medicaid fee-for-service patients “— a difference of 5.2 days, or 71 percent — which can be critical time needed to stabilize the child or adolescent before discharge back into the community.” Child and adolescent suicide is a pervasive problem in Missouri, where it is the second-leading cause of death among children ages 5 to 19. Missouri had the 11^th-highest rate of child and adolescent suicide in the country during 2017 with 6.4 suicide deaths per 100,000 children in this age group. The Joint Commission Issues Ligature Risk and Suicide Risk Reduction Alerts The Joint Commission this week sent two alerts regarding ligature risk and suicide risk reduction. Both the National Patient Safety Goals alert and Environment of Care alert examines if video monitoring and electronic sitters can be used to watch patients at high risk for suicide. Thank you to Our 2019 NABH Annual Meeting Exhibitors and Sponsors! The 2019 NABH Annual Meeting—Behavioral Healthcare: Improving Coordination, Collaboration, Integration— is a little more than one week away! NABH thanks all of the companies that will serve as exhibitors or sponsors at the 2019 NABH Annual Meeting in March. Please take a moment to view our exhibitors and sponsors on our Annual Meeting homepage, where you can click on each organization to learn more. Also, please remember to visit with our exhibitors and sponsors during the Annual Meeting from March 18-20 at the Mandarin Oriental Washington, DC. And if you haven’t done so yet, please take a moment to read our updated preliminary program and visit our speakers page. We look forward to seeing you in Washington! For questions or comments about CEO Update, please contact Jessica Zigmond.

SAMHSA Reports Total Behavioral Health Spending Rose 62 Percent from 2006-2015 Total mental health and substance use disorder (SUD) treatment spending rose about 62 percent to $212 billion in 2015 from $131 billion in 2006, according to a new report from the Substance Abuse and Mental Health Services Administration (SAMHSA). The federal health agency noted in its 72-page analysis that SUD spending was more pronounced than mental health spending, particularly between 2010-2015, when spending climbed to $56 billion from $23 billion. Spending growth for mental health, meanwhile, generally matched total healthcare spending growth between 2006 and 2015. “Public versus private spending on mental health was relatively constant, with private spending accounting for 42 percent of spending in 2015,” the report noted. “Conversely, spending on SUD treatment saw greater growth and major shifts in payer sources and care settings compared with mental and total health spending,” it continued. “Private insurance and Medicaid both became larger payers of SUD treatment.” NIDA Releases 2018 Monitoring the Future Survey Results Prescription opioid misuse has dropped significantly among the nation’s 12^th graders in the last five years, while vaping rates are second only to alcohol among substances surveyed, the National Institute on Drug Abuse (NIDA) reported in the 2018 Monitoring the Future (MTF) survey released this week. Researchers at the Institute for Social Research at the University of Michigan conduct the annual survey of 8^th, 10^th, and 12^th graders under a grant from the National Institute on Drug Abuse. Since 1975, the survey has measured how 12^th graders report their drug and alcohol use; the survey added 8^th and 10^th graders to the survey in 1991. In 2018, 44,482 students from 392 public and private schools participated. The report noted there has been a significant decline in monthly cigarette use among 12^thgraders since 1993, while the rate of monthly marijuana use has increased. Monthly cigarette use among 12^th graders was 7.6 percent in 2018, compared with a rate of 36.5 percent in 1997, the peak year for cigarette use among teams. Meanwhile, the rate for monthly marijuana use among teens was 22.2 percent in 2018, compared with a rate of 15.5 percent in 1993. CMS and ONC Propose Rules to Improve Electronic Health Information Interoperability The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) this week proposed rules intended to support the secure access, exchange, and use of electronic health information seamlessly. CMS has proposed that Medicaid, the Children’s Health Insurance Program, Medicare Advantage plans and Qualified Health Plans in the federal health insurance exchanges must provide enrollees with immediate electronic access to medical claims and other health information electronically by 2020. To support patient-centered healthcare, CMS would require these healthcare providers and plans to implement open data sharing technologies to support transitions of care as patients move between these plan types. “Today’s announcement builds on CMS’ efforts to create a more interoperable healthcare system, which improves patient access, seamless data exchange, and enhanced care coordination,” CMS Administrator Seema Verma said in an announcement.  “By requiring health insurers to share their information in an accessible, format by 2020, 125 million patients will have access to their health claims information electronically. Kaiser Family Foundation Releases Data on Medicaid Coverage of Behavioral Health Services The Kaiser Family Foundation (KFF) this week released data on Medicaid coverage of behavioral health services across the country based on a survey of Medicaid directors in all 50 states and Washington, D.C. KFF contracted with Health Management Associates for the survey, which asked Medicaid directors to identify the behavioral health services covered for adult beneficiaries in their programs. The survey gathered information about services covered, cost-sharing requirements, and notable limits on those services as of July 1, 2018. All but four states—Illinois, Iowa, New York, and South Carolina—submitted survey responses. The Medicaid Behavioral Health Services Database breaks down information in five categories: Institutional Care and Intensive Services; Outpatient Facility Services and/or Provider Services; Other Behavioral Health Services; Substance Use Disorder Services; and Naloxone. To view a summary table, see page 3 here. California Attorney General Xavier Becerra Urges Insurers to Improve Access to Care California Attorney General Xavier Becerra this week pressed insurance providers to remove prior authorization requirements for medication assisted treatment (MAT) for individuals with an opioid use disorder.   In his letter to 17 health insurance executives, Becerra noted that authorization requirements for MAT burdens individuals suffering from opioid use disorder by creating barriers to treatment. “I urge insurance providers to join us in our efforts to give patients the treatment they need and deserve,” Becerra said in an announcement, “without the burdens of lengthy medical paperwork and processes.” American Psychiatric Association Names Jeffrey Geller, M.D., M.P.H. as President-Elect The American Psychiatric Association (APA) announced this week that its members have chosen Jeffrey Geller, M.D., M.P.H. as the medical society’s next president-elect. Geller is the professor of psychiatry and director of public sector psychiatry at the University of Massachusetts Medical School. He has held a number of APA leadership positions and serves on the SAMHSA National Advisory Council, according to the APA. “I plan to focus on improving the profession, partly by easing the administrative, documentation and certification burdens placed on our members as they work to deliver high-quality care and treatment to our patients,” Geller said in the APA’s announcement. “I will also strive to advocate for equal coverage of mental illnesses as mandated by law, but not enforced, and to combat the terribly harmful discrimination against both psychiatric patients and psychiatrists.” Geller’s appointment will become official after the APA Board of Trustees confirms the association’s election results at its March meeting.   Federal Grant Available to Fuel Research for Improving Employment Outcomes for People with Psychiatric Disabilities The Rehabilitation Research and Training Center on Improving Employment Outcomes for People with Psychiatric Disabilities—under HHS’ Administration on Community Living—has announced a grant opportunity to conduct research, training, and other related activities to contribute to better employment outcomes for adults with psychiatric disabilities. The funding opportunity is part of an ongoing collaboration between SAMHSA and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). Click here to learn more about the grant funding opportunity. Applications are due by Saturday, April 13, 2019. Learn About American Addiction Centers in NABH’s Latest Member Profile NABH members can learn about the work that American Addiction Centers (AAC) is doing in the area of pharmacogenetics in the association’s latest Member Profile. American Addiction Centers’ Addiction Labs—one of the few labs in the United States dedicated solely to addiction treatment—applies a personalized approach to ensure patients receive the right medication and dosage with fewer side effects and faster results. Part of AAC’s approach includes pharmacogenetic testing, which combines the study of medications and genetic traits. Through genetic testing, physicians can develop personalized treatment protocols to improve therapeutic initiatives and ensure that patients receive proper medication at the earliest point in their treatment. If you would like your organization to be featured in a Member Profile on NABH’s website, please contact Cemal Ozgur at (cemal@nabh.org). Please Join Us for Hill Day 2019! Building on last year’s success, NABH is pleased to present Hill Day 2019 at the association’s Annual Meeting in Washington, DC next month. The NABH team will schedule Capitol Hill meetings and briefings for interested Annual Meeting attendees during Hill Day on Tuesday, March 19, 2019 from 1:30 to 5 p.m. ET. NABH will provide background materials and legislative priority documents to attendees before Hill Day, and will also conduct advocacy training during the Annual Meeting. To take advantage of this free opportunity, please indicate that you want to participate in Hill Day when you register for the 2019 NABH Annual Meeting, or contact Julia E. Richardson, director of advocacy and senior counsel, at julia@nabh.org or 202.393.6700, ext. 103. Please visit NABH’s Annual Meeting homepage to view the meeting’s preliminary program and learn about the meeting’s speakers, exhibitors, and sponsors. We look forward to seeing you in Washington!   For questions or comments about CEO Update, please contact Jessica Zigmond.

Senate Confirms Jim Carroll as Nation’s ‘Drug Czar’ The Senate this week confirmed Jim Carroll as the director of the Office of National Drug Control Policy (ONDCP). Carroll had served as acting director at ONDCP since last February, and President Trump nominated him as permanent director in late April. This is the nation’s first permanent “drug czar” since Michael Botticelli held the post from 2014 until 2017 during the Obama administration. Carroll has served as White House Chief of Staff and earlier held positions at the Office of Management and Budget as well the Office of the White House Counsel. Joint Commission Publishes Report on Improving Depression Screening Depression is the leading cause of disability and often goes unaddressed, particularly for minorities, immigrants, and refugees, according to a new study published in the January 2019 issue of The Joint Commission Journal on Quality and Patient Safety. The article — “Not Missing the Opportunity: Improving Depression Screening and Follow-Up in a Multicultural Community”— also reports that although evidence-based guidelines recommend screening for the adequate diagnosis, treatment, and follow-up of depression, only seven states report depression screening and follow up. Researchers implemented the following four core interventions at a rural, federally qualified health center that were shown to improve results: using written, standardized Patient Health Questionnaire (PHW) screening tools in six languages; using a standardized tool to help clients who screen positive for depression to share what matters most to them; using a “right care” tracking log to assist providers in documenting follow-up phone calls and visits for clients who screen positive for depression; and hosting team meetings and in-services to support building capacity. Click here to access the article. Alcohol-related Deaths on the Rise Alcohol misuse accounted for 35,823 deaths in 2017, reflecting a nearly 46-percent increase over almost two decades, according to an investigative report in the Washington Examiner that used Centers for Disease Control and Prevention (CDC) data. The data showed that alcohol-related deaths have increased steadily since the 19,469 deaths related to alcohol misuse that were recorded in 1999. Meanwhile, deaths from misusing alcohol did not decline at any time since that period, and they included alcohol poisonings, alcoholic liver disease, and cirrhosis. The story noted that the figures do not include deaths from accidents people have while they are drinking, because in those cases the cause of death would be from drowning, a car accident, or a fall. Pat Hammer Begins Term as 2019 NABH Board Chair Congratulations to Pat Hammer, president and CEO of Oconomowoc, Wis.-based Rogers Behavioral Health, who began his term as 2019 NABH Board Chair on Jan. 1. Hammer succeeds Acadia Healthcare President Brent Turner in the position. Following the recent Board elections, Jim Shaheen, president of Strategic Behavioral Health in Memphis, Tenn., is now Board Chair-elect; and Jennifer Ziccardi-Colson, chief nurse executive and vice president for behavioral health at Atrium Health’s Behavioral Health Services in Charlotte, N.C., and John Hollinsworth, senior vice president at Universal Health Services, Inc. in Louisville, Ky., joined the Board as members through 2021. Register Now for the 2019 NABH Annual Meeting If you haven’t done so yet, 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. And please watch for upcoming NABH Annual Meeting Alerts, which will keep meeting attendees informed about the latest speaker and programming information. This month, NABH will post the 2019 Annual Meeting preliminary program on the NABH website. This online preliminary program will replace the previous printed preliminary program. All meeting attendees will receive a final printed program on site at the Annual Meeting. 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.

CMS Requests Feedback on Conflict of Interest at Accrediting Organizations The Centers for Medicare and Medicaid Services (CMS) this week requested public comment about the appropriateness of some Medicare-approved accrediting organizations (AO) offering fee-based consultative services to providers and suppliers they also accredit as part of their business model. “CMS is seeking to receive stakeholder input which can help us determine whether the AO practices of consulting with the same facilities which they accredit could create actual or perceived conflicts of interest between the accreditation and consultative functions of the AO,” the agency said in its announcement, adding that it will consider the information it receives to help with future rulemaking.   CMS Features FAQ on Price Transparency Provision in IPPS CMS has released two FAQ (here and here) documents on the Affordable Care Act (ACA) requirement that all hospitals establish, update, and publish publicly online a list of the hospital’s “standard charges” for services the hospital provides. CMS included this ACA provision—which becomes effective Jan. 1, 2019—in its final FY 2019 inpatient prospective payment system (IPPS) rule. The final rule did not provide a definition of “standard charge,” but CMS noted that hospitals can make public a chargemaster “or another form of the hospital’s choice.” CMS also said the form must be in a “machine-readable” format and added that PDF documents are not considered permissible under that definition.   NIDA Highlights Details for National Drug and Alcohol Facts Week The National Institute on Drug Abuse (NIDA) has posted information about National Drug and Alcohol Facts Week, a national health observance from Jan. 22–27, 2019 that will link teens to science-based facts about drugs. NIDA’s website features details about hosting an event, as well as an online teaching guide, free materials, toolkits, and more. World Congress to Host Opioid Management Summit in February World Congress—which hosts conferences and events in healthcare, life sciences, and pharmaceuticals—will host its third annual Opioid Management Summit at the Wink Hotel in Washington, D.C. from February 26-27, 2019. Sarah A. Wattenberg, NABH’s director of quality and addiction services, will moderate a panel discussion titled Ensure Resources and an Integrated Care Continuum Support Treatment and Recovery on the second day of the conference. Click here to learn more and register for the meeting.   NABH Introduces 2019 Online Membership Directory This week NABH posted the digital edition of the 2019 NABH Membership Directory, which presents essential information about our members in an interactive format for the first time. Please click here to access the online directory. NABH will send the printed version of the 2019 NABH Membership Directory to members in January.   Register Now for the 2019 NABH Annual Meeting If you haven’t done so yet, 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. This week NABH sent the first in a series of NABH Annual Meeting Alerts to keep meeting attendees informed about the latest speaker and programming information. In early January, NABH will post the 2019 Annual Meeting preliminary program on the NABH website. This online preliminary program will replace the previous printed preliminary program. All meeting attendees will receive a final printed program on site at the Annual Meeting. We look forward to seeing you at the Mandarin Oriental Washington, D.C. from March 18-20, 2019! Happy Holidays from NABH! NABH’s office will be closed from Monday, Dec. 24 through and including Tuesday, Jan. 1.CEO Update will not publish on Friday, Dec. 28 and will resume on Friday, Jan. 4. The entire NABH team wishes you and your families a very happy holiday season!   For questions or comments about CEO Update, please contact Jessica Zigmond.

HRSA Releases Behavioral Health Workforce Projections About 276,400 people are expected to enter the behavioral health workforce during the five-year period between 2016 and 2021, HHS’ Health Resources and Services Administration (HRSA) estimates in a new analysis. The findings are part of HRSA’s Behavioral Health Workforce Projections that the agency compiled following a mandate from the 21^st Century Cures Act. In the analysis, HRSA provides national-level workforce estimates for the following occupations between 2016 and 2030: addiction counselors, marriage and family therapists, mental health and school counselors, psychiatric technicians and psychiatric aides, psychiatric nurse practitioners and psychiatric physician assistants, psychiatrists, psychologists, and social workers. According to a 2017 report from the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly one in five adults in the United States—or about 44.7 million people—suffered from a mental illness in the last year, and in 2016 about 28.6 million people aged 12 and older used an illicit drug in the past 30 days. “Beyond the direct toll on individuals and families,” HRSA noted on its website, “mental illness and substance use disorders are well-established drivers of disability, mortality, and healthcare costs.” The HRSA analysis also included state-level behavioral health workforce estimates.   PwC Health Research Institute Previews Top Health Industry Issues for 2019 In its annual forecast, PwC Health Research Institute predicts that providers and payers that have served Medicaid patients will have a significant effect on the healthcare industry in the New Year. “In 2019 the health industry will see value lines created by innovative providers and payers that have figured out how to subsist—comfortably, thank you very much—by serving almost entirely Medicaid or cash-strapped patients,” the report noted. PwC’s 54-page analysis—The New Health Economy Comes of Age—also predicts that life sciences companies will market digital therapeutics and connected devices targeting atrial fibrillation, hemophilia, substance abuse, birth control, depression, diabetes, epilepsy and other conditions. “Once thought to operate outside the greater U.S. economy, the industry—with its byzantine payment system, complicated regulatory barriers and reliance on face-to-face interactions—is being disrupted,” the report noted. “Finally, there’s robust evidence that what PwC calls the New Health Economy is kicking into gear.” According to PwC’s analysis, 84 percent of Fortune 50 companies are involved with healthcare, and venture capital funding for digital health startups is projected to top $6.9 billion in 2018, reflecting a 230-percent increase from five years ago. Meanwhile, the report noted that “American consumers have told PwC’s Health Research Institute since 2013 that they’re “eager to embrace more convenient, digitally enabled and affordable care; finally, they’re finding it, with options that resemble the choices they have in other parts of their lives.”   CDC’s NSVR Reports on Drugs Most Frequently Used in Overdoses: 2011-2016 Fentanyl, heroin, hydrocodone, methadone, morphine, oxycodone, alprazolam, diazepam, cocaine, and methamphetamine were the 10 most frequently mentioned drugs among drug overdose deaths that noted at least one specific drug between 2011 and 2016, according to the Centers for Disease Control and Prevention’s (CDC) National Vital Statistics Report (NVSR). Oxycodone ranked first in 2011; heroin during 2012-2015; and fentanyl in 2015. During the study period, cocaine consistently ranked second or third, researchers found. The report’s conclusion said these findings highlight “the importance of complete and accurate reporting in the literal text on death certificates.” PCORI Board Approves $12.7 million for Mental Health Research Study The Patient-Centered Outcomes Research Institute (PCORI) Board of Governors this week approved $12.7 million to fund a study that will examine the effectiveness of different strategies to treat anxiety and depression in expectant and new mothers. Funding will go to researchers in Chapel Hill, N.C.; Chicago; and Toronto to study four different methods of providing treatment, in-person sessions with either a specialist provider or nurse, or the same sessions delivered via telemedicine. “Depression and anxiety symptoms pose a significant burden and lead to high costs among mothers worldwide,” PCORI noted in an announcement about the study. “Psychological treatments—also known as talk therapies, including behavioral, cognitive and interpersonal therapies—have a robust evidence base and are preferred by women and their families over pharmacological treatments,” the announcement continued. “Unfortunately, as few as one in five women can access these effective treatments due to a dearth of available specialists and barriers including cost, transportation, and access. There is therefore a need for widely accessible, low-cost, and innovative psychological treatments for depression and anxiety during pregnancy and postpartum.” Click here to learn about the project’s details. U.S. Preventive Services Task Force Seeks Comments on Opioid Interventions The U.S. Preventive Services Task Force (USPSTF) this week opened the public comment period for its draft research plan on interventions to prevent opioid use disorder. The USPSTF notes clearly that the plan is in draft form and has been distributed for the sole purpose of gaining feedback. The task force will accept public comments through Wednesday, Jan. 16, 2019 at 8 p.m. ET. CMMI Posts Fact Sheet on Integrated Care for Kids and Maternal Opioid Misuse Models The Center for Medicare and Medicaid Innovation (Innovation Center) has posted a fact sheet on its Integrated Care for Kids (InCK) and Maternal Opioid Misuse, or MOM, Models designed to improve care delivery and reduce expenditures for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries affected by the nation’s opioid crisis. “By catalyzing state-driven care transformation and aligning financial incentives, both models aim to improve health outcomes and address fragmentation of care for affected beneficiaries,” the Innovation Center noted. “Ultimately, the InCK and MOM models aim to enable better coordination of clinical care and the integration of other services critical for health, wellbeing, and recovery.” Manatt, AMA & Pennsylvania Medical Society Release Report on Practices to End Opioid Crisis Manatt Health, the American Medical Association (AMA), and the Pennsylvania Medical Society this week released a report that examines what Pennsylvania has accomplished in the areas of substance use disorder treatment, pain management, and harm reduction to combat the opioid crisis. The report focuses on the work of two agencies—the Pennsylvania Medicaid agency and the Pennsylvania Insurance Department—and highlights in particular Pennsylvania’s broad support for Medication Assisted Treatment (MAT), parity law enforcement, and comprehensive naloxone access. Researchers also included recommendations on how Pennsylvania can “build on its successes, including expanding efforts in emergency departments and law enforcement to link patients to high-quality care, and requiring insurers to enhance access to non-opioid care so that patients have alternative treatments as opioid prescriptions are reduced.” CHCS and ACAP Release Report on Social Determinants of Health via Medicaid Managed Care The Center for Health Care Strategies (CHCS) and the Association for Community Affiliated Plans (ACAP) this week released findings of a nationwide review of Medicaid managed care contracts and section 1115 demonstrations to identify common themes in state approaches to incentivizing and requiring social determinant of health-related activities (SDOH). Addressing Social Determinants of Health via Medicaid Managed Care Contracts and Section 1115 Demonstrations includes five specific policy recommendations from CHCS to support SDOH activities: make  it easier for vulnerable populations to access needed health services; enhance agency collaboration at the federal level; provide guidance on addressing SDOH through managed care; approve section 1115 demonstrations that test strategies to address SDOH; and support outcomes-based payment for SDOH interventions.   Associations Among Motor Activity, Sleep, Energy & Mood Could Suggest New Focus for Depression Treatment Instability in activity and sleep systems could lead to mood changes—which could suggest new approaches for depression treatment, according to new findings published online in the journal JAMA Psychiatry. Current theories of depression suggest that sleep problems, low energy, and low activity levels result from depressed mood, but this new study that examines these factors among people with bipolar disorder or depression suggest the opposite may be true, the National Institute of Mental Health noted in its announcement about the study. Researchers “discovered a unidirectional relationship between motor activity and mood, suggesting that motor activity affects subsequent mood, but that mood does not affect subsequent motor activity and sleep systems could lead to mood changes,” the NIH posting said.   Register Now 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. Beginning next week, NABH will send periodic NABH Annual Meeting Alerts to keep meeting attendees informed about the latest speaker and programming information. And in January, NABH will post the 2019 Annual Meeting preliminary program on the NABH website. This online preliminary program will replace the previous printed preliminary program. All meeting attendees will receive a final printed program on site at the Annual Meeting. 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.