Author: Emily Wilkins (NABH)

Registration is Open for the 2023 NABH Annual Meeting: Securing the Promise of Parity!

Please join us in Washington, DC from June 12-14, 2023 for this year’s NABH Annual Meeting at the Salamander Washington, DC (formerly the Mandarin Oriental hotel). NABH’s theme this year is Securing the Promise of Parity, which recognizes the Mental Health Parity and Addiction Equity Act’s (MPAEA) 15^th anniversary and that we have more work to do to ensure the landmark law is implemented fully. Please visit our Annual Meeting homepage to register, reserve your hotel room, and view our Annual Meeting At-a-Glance. We look forward to seeing you in Washington!

Please Send Us Your Feedback on Workforce Challenges & Solutions

The NABH Research and Education Foundation is seeking comments from NABH members on 1) the main drivers of your system’s workforce shortages, and 2) your ideas for solutions. NABH will gather this collective feedback and respond to the request for information (RFI) that the Senate Health, Education, Labor & Pensions (HELP) Committee announced thursday. The RFI follows a Feb. 16 hearing the Senate HELP Committee held to examine the root causes of America’s current healthcare workforce shortages and explore potential solutions. Please send your comments as an attachment to foundation@nabh.org by the close of business on Monday, March 13. Thank you for your help with this critical issue!

DEA Proposes Two Telemedicine Regulations

The Drug Enforcement Administration (DEA) recently published two telemedicine rules that, taken together, largely revert to pre-COVID requirements for an in-person medical evaluation prior to prescribing controlled substances. DEA’s Notices of Proposed Rulemaking (NPRM) for buprenorphine and telemedicine without an in-person medical evaluation propose permitting the following two scenarios under which a telemedicine prescription can take place: Scenario A: Permitting a virtual first prescription by the prescribing practitioner without an in-person medical evaluation for an initial 30-days of non-narcotic Schedule III-V or buprenorphine-controlled substances. The NPRM proposes specific processes and documentation requirements for this scenario, such as checking the PDMP and noting ‘telemedicine’ on the face of the prescription. Scenario B: Permitting a qualified telemedicine referral in which a second DEA-registered practitioner performs an in-person exam and makes a referral to the prescribing practitioner. Under this scenario, Schedule II-V and narcotic substances can be prescribed. The NPRM proposes processes and documentation for these referrals, such as a written referral and transfer of medical records prior to prescribing. To continue prescribing after 30-days under Scenario A, a one-time in-person medical evaluation is required. The in-person evaluation requirement can be satisfied in three ways:

• Through an evaluation by the telemedicine prescribing practitioner;

• Through an evaluation conducted as a three-way audio-visual exam in which the prescribing practitioner, another DEA-registered referring provider, and the patient participate;

• Through a ‘qualified telemedicine referral’ by another DEA-registered practitioner who has seen the patient in-person and who adheres to specific procedures and documentation for the referral.

Meanwhile, if a telemedicine prescription for a controlled substance was initiated during the public health emergency (PHE), the NPRM proposes a 180-day transition period during which time an in-person medical evaluation must take place. If the NPRM is finalized by May 11, 2023 (the designated end of the PHE), an individual inducted during the PHE would have to have an in-person medical evaluation by November 2023. This extends to all prescriptions for controlled substances II-V initiated during the PHE. The NPRM do not include the long-awaited special registration rule, which would have allowed certain clinicians to prescribe controlled substances via telemedicine without an in-person evaluation. Moreover, DEA said this NPRM satisfies its obligation to propose rules for a special registration. In addition, the revisions align with the Centers for Medicare & Medicaid Services’ updated definition of telehealth to include audio-only telemedicine of controlled substances for mental health where states permit it. These instances are both limited and situational. NABH will provide comments to DEA by the agency’s March 31 deadline. Please send any comments to Sarah Wattenberg at sarah@nabh.org by Friday, March 17.

SAMHSA Releases Report on Long COVID’s Effects on Behavioral Health

A meta-analysis of studies around the world showed that the overall prevalence of depression, anxiety, and sleep disturbances among COVID-19 survivors was 45%, 47%, and 34%, respectively, according to a report released this week from the Substance Abuse and Mental Health Services Administration (SAMHSA). The Centers for Disease Control and Prevention (CDC) defines Long COVID as “new, returning, or ongoing symptoms that last four or more weeks following acute COVID-19 diagnosis.” SAMHSA’s report, Overview of the Impacts of Long COVID on Behavioral Health, examines the effects of the deadly virus in a variety of areas, including cognitive and psychiatric symptoms associated with Long COVID, a widening of health disparity gaps, potential long-term implications, and future directions for Long COVID recovery. “Among the most common symptoms of Long COVID is a gradient of cognitive and psychiatric sequelae (e.g., depression, anxiety, PTSD), which may portend significant consequences for patient functioning and quality of life,” the report noted. The study also said that in comparison with those not affected, COVID-19 survivors show increased rates of mental health and cognitive problems.

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. Your data will help NABH highlight problems in the field related to health plan denials and timeliness. Several policymaking entities are interested in these data, which could support advocacy for expanded access to care. For new participants, please e-mail Emily Wilkins, NABH’s administrative coordinator, for support.

Fact of the Week

Research has shown that, regardless of COVID-19 status, 53% of healthcare workers reported symptoms of at least one mental health condition, including depression (32%), anxiety (30%), PTSD (37%), and suicidal ideation (8%), according to SAMHSA’s Overview of the Impacts of Long COVID on Behavioral Health. For questions or comments about this CEO Update, please contact Jessica Zigmond.

Registration is Open for the 2023 NABH Annual Meeting: Securing the Promise of Parity!

Please plan to join us in Washington, DC from June 12-14, 2023 for this year’s NABH Annual Meeting at the Salamander Washington, DC (formerly the Mandarin Oriental hotel). NABH’s theme this year is Securing the Promise of Parity, which recognizes the Mental Health Parity and Addiction Equity Act’s (MPAEA) 15^th anniversary and that we have more work to do to ensure the landmark law is implemented fully. Please visit our Annual Meeting homepage to register, reserve your hotel room, and view our Annual Meeting At-a-Glance. We look forward to seeing you in Washington!

Reminder: NABH-Manatt Telehealth Issue Brief Webinar on Wednesday, March 1

Manatt will host a webinar featuring NABH President and CEO Shawn Coughlin and NABH members as panelists on Wednesday, March 1 at noon ET to highlight findings from the telehealth issue brief that the NABH Education and Research Foundation and Manatt released this month. The telehealth issue brief is the first resource from the NABH Education and Research Foundation, which worked with NABH members and Manatt to compile and evaluate data to measure the impact that telehealth services have had on access and outcomes. The study showed how telehealth services effectively augment traditional partial hospitalization programs (PHP) and intensive outpatient programs (IOP). NABH urges its members to read the issue brief and share it with others. The association has also created a social media toolkit with shareable graphics that highlight key research from the study. Members can access the issue brief and social media toolkit on the NABH Education and Research Foundation’s Resources page. Click here to register for next week’s free webinar.

Biden Administration Will Allow States to Use Medicaid to Cover SUD for Incarcerated Persons

The Biden administration will allow states to use Medicaid funding to cover substance use disorder (SUD) treatment for incarcerated persons at state jails and prisons, news outlets reported this week. According to Politico, Rahul Gupta, M.D., director of the Office of National Drug Control Policy, said Tuesday that the Centers for Medicare & Medicaid Services (CMS) plans to release guidance this spring that outlines how states could use the program and federal dollars to pay for treatments before people are released. The story also quoted Gupta as saying the guidance is a “smart move” and that all 112 of the nation’s federal prisons will offer medication-assisted treatment for SUD by this summer.

NIH Trial to Compare Effects of Prescribed Buprenorphine or Methadone in Office Settings

The National Institutes of Health (NIH) will conduct a hybrid effectiveness/implementation trial to compare patients’ ability to remain in treatment when they’re prescribed buprenorphine or methadone in an office-based setting, STAT News reported today. According to the story, the clinical trial, scheduled for this year, is the first of its kind in the “fentanyl era.” “While we do have hints from the scientific literature that methadone has better outcomes with respect to retention in treatment and decreases in illicit drug use, we actually don’t have that literature in patients who are primarily using fentanyl,” David Fiellin, M.D., director of Yale Medical School’s Program in Addiction Medicine and the researcher overseeing the trial, said in the story. Click here for details about the NIH study.

CMS Releases Preliminary Medicaid and CHIP Data Snapshot

CMS this week released Medicaid and CHIP and the Covid-19 Public Health Emergency, a data snapshot that compares healthcare service utilization patterns, including behavioral healthcare services, in Medicaid and the Children’s Health Insurance Program (CHIP) during the Covid-19 pandemic from March 2020 through July 2022. Section five of the report presents the behavioral healthcare content, including services delivered via telehealth and a breakdown of services for adults and children enrolled in these programs. More than 137 million Americans—including children, pregnant women, parents, seniors, and individuals with disabilities—were enrolled across each state’s Medicaid or CHIP for at least one day during the public health emergency.

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. Your data will help NABH highlight problems in the field related to health plan denials and timeliness. Several policymaking entities are interested in these data, which could support advocacy for expanded access to care. For new participants, please e-mail Emily Wilkins, NABH’s administrative coordinator, for support.

Fact of the Week

Black patients are 1.6 times more likely to experience an involuntary psychiatric hospital admission than non-Black patients, according to a study about racial and ethnic inequities published in Psychiatric Services.   For questions or comments about this CEO Update, please contact Jessica Zigmond.

FDA Advisors Recommend Over-the-Counter Use of Narcan

A U.S. Food and Drug Administration (FDA) advisory panel this week voted 19-0 to recommend the agency approve the anti-opioid overdose drug Narcan be made available as an over-the-counter drug. Narcan is currently available by prescription only, and the change would make it the first opioid overdose reversal drug to be made available over the counter. News reports noted the FDA advisors also asked that the manufacturer make it more clear to users how to administer the product. The FDA is expected to make a final decision by March 29.

CDC Releases Youth Risk Behavior Survey Data Summary & Trends Report: 2011-2021

Female students were nearly twice as likely to attempt suicide during the past year compared with their male peers, with nearly six in 10 feeling persistently sad or hopeless and more than one in 10 attempting suicide, the Centers for Disease Control and Prevention (CDC) reported in its Youth Risk Behavior Survey Data Summary & Trends Report: 2011-2021 this week. The data provide a critical view of U.S. adolescent health and well-being related to sexual behavior, substance use, experiences of violence, mental health, and suicidal thoughts and behaviors. This year’s report also includes data on students’ experiences of unstable housing, school connectedness, and parental monitoring to expand understanding of young people’s environments and opportunities to improve them. In the CDC’s words, the findings “tell a distressing story” about the health and well-being of our country’s young people. According to the report, female students experienced more violence, mental health challenges, suicidal thoughts and behaviors, and substance use than their male peers. For instance, the percentage of female students who had ever experienced forced sex increased for the first time in 10 years, with 14% of female students having this experience. Meanwhile, attempted suicide was higher among Black students than students from other groups and increased among Black and White students from 2011 to 2021. And LGBQ+ students were nearly four times as likely as their heterosexual peers to attempt suicide during the past year, with more than two in 10 reporting this experience.

CDC Provisional Data Show U.S. Drug Overdose Deaths High but Declining

Provisional data from the CDC this week show the number of U.S. drug overdose deaths, while still high, has declined. The CDC predicts there were 106,840 drug overdose deaths for the 12-month period ended September 2022 compared with 107,937 predicted drug overdose deaths for the 12-month period ended August 2021. And when comparing month-over-month statistics in 2022, the numbers show a steady decline, starting with 110,317 predicted overdose deaths in March 2022. In a statement last month, Office of National Drug Control Policy (ONDCP) Director Rahul Gupta, M.D. attributed the progress to the Biden administration’s efforts to remove barriers to treatment and disrupting the supply of illicit drugs.

SAMHSA Releases National Substance Use and Mental Health Services Survey, 2021

More than two-thirds of substance use treatment facilities (69.5%) offered pharmacotherapies as part of their treatment services, with a higher percentage of substance use facilities reporting they used medication-assisted treatment (MAT) for treating opioid use disorder (55.3%) than for treating alcohol use disorder (37.9%). Those were among the findings of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Substance Use and Mental Health Services Survey, 2021 released this week.   Researchers gathered data from April 30, 2021 through January 10, 2022 for the 35-page report, which is the most comprehensive national source of data on substance use and mental health treatment facilities, its territories, and Washington, D.C.

NABH Submits Comments to SAMHSA on Opioid Treatment Program Regulations

This week NABH submitted a comment letter to SAMHSA on the Opioid Treatment Program (OTP) regulations 42 CFR part 8. In it, NABH wrote that the association appreciates SAMHSA’s flexibility to OTPs, including new authority to provide methadone induction via telehealth. NABH was the first organization to advocate for this change when COVID-19 social-distancing measures made it hard for individuals to access methadone treatment. NABH expressed concerns and called for SAMHSA to remove changes to accreditation standards that would prematurely trigger one-year or non-accreditation status. Click here to read NABH’s letter.

NABH Submits Comments to CMS on Medicare Advantage

Also this week, NABH submitted comments to the Centers for Medicare & Medicaid Services (CMS) about policy and technical changes to Medicare Advantage (MA) for calendar year 2024. NABH noted that the association appreciates the proposed rule’s focus on improving access to and quality of care through increasing both the oversight and transparency of insurers. In particular, NABH supports the rule’s proposed improvements related to prior authorization, network adequacy, and quality of care, many of which NABH and its partners have long pursued. The association outlined a series of recommendations to CMS on topics such as clarifying “Original Medicare” standards as minimum requirements for MA; improving medical necessity; streamlining prior authorization requirements; and, regarding the rule’s proposed reduction of the overpayment window, allowing a reasonable time of about six months for providers to conduct investigations, and, when necessary, process a refund. Click here to read NABH’s letter.

Reminder: NABH-Manatt Telehealth Issue Brief Webinar on Wednesday, March 1

Manatt will host a webinar featuring NABH President and CEO Shawn Coughlin and some NABH members as panelists on Wednesday, March 1 at noon ET to highlight findings from the telehealth issue brief that the NABH Education and Research Foundation and Manatt released this month. The telehealth issue brief is the first resource from the NABH Education and Research Foundation, which worked with NABH members and Manatt to compile and evaluate data to measure the impact that telehealth services have had on access and outcomes. The study showed how telehealth services effectively augment traditional partial hospitalization programs (PHP) and intensive outpatient programs (IOP). NABH urges its members to read the issue brief and share it with others. The association has also created a social media toolkit with shareable graphics that highlight key research from the study. Members can access the issue brief and social media toolkit on the NABH Education and Research Foundation’s Resources page. Click here to register for next month’s free webinar.

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. Your data will help NABH highlight problems in the field related to health plan denials and timeliness. Several policymaking entities are interested in these data, which could support advocacy for expanded access to care. For new participants, please e-mail Emily Wilkins, NABH’s administrative coordinator, for support.

Details Coming Soon for the NABH 2023 Annual Meeting

Please plan to join us in Washington, DC from June 12-14, 2023 for this year’s NABH Annual Meeting at the Salamander Washington, DC (formerly the Mandarin Oriental hotel). Details coming soon.

Fact of the Week

Some data brokers are marketing highly sensitive data on individuals’ mental health conditions on the open market, with seemingly minimal vetting of customers and seemingly few controls on using purchased data, according to a study from Duke University’s Sanford School of Public Policy. For questions or comments about this CEO Update, please contact Jessica Zigmond.

Becerra Renews COVID-19 Public Health Emergency Through May 11

U.S. Health and Human Services Department (HHS) Secretary Xavier Becerra on Thursday renewed the nation’s COVID-19 public health emergency (PHE) status for another 90 days through May 11. “Based on current trends regarding COVID-19, the U.S. Department of Health and Human Services is planning for this to be the final renewal and for the COVID-19 PHE to end on May 11, 2023,” Becerra wrote to the nation’s governors on Feb. 9. “Rather than 60 days’ notice, I am providing 90 days’ notice before the COVID-19 PHE ends to give you and your communities ample time to transition.” Becerra’s letter also noted that the Biden administration’s whole-of-government approach to combatting the deadly virus has helped transition the country away from the emergency phase. Since Omicron peaked at the end of January 2022, daily COVID-19 reported cases are down 92%; COVID-19 deaths have declined by more than 80%; and new COVID-19 hospitalizations are down nearly 80%, Becerra’s letter noted.

NIMH to Host Webinar Next Week on the Opioid Crisis and HEALing Communities Study

The National Institute on Mental Health (NIMH) will host a webinar next Tuesday to discuss how the HEALing Communities Study (HCS) is testing the prevention and treatment of opioid misuse in communities that the nation’s opioid crisis has hit hardest. Sharon L. Walsh, Ph.D., professor of behavioral science, psychiatry, pharmacology and pharmaceutical sciences at the University of Kentucky’s Colleges of Medicine and Pharmacy, will describe how the HCS has begun to expand access to evidence-based care, improve data availability and timeliness, address social determinants of health, reduce stigma through public health communications campaigns, and modify relevant policies. Walsh also serves as director of the Center on Drug and Alcohol Research and the Substance Use Disorder Priority Research Area. She is the principal investigator of the HCS at the University of Kentucky. The HCS tests the integration of prevention, overdose treatment, and medication-based treatment in select communities. Click here to register for the free webinar, which will begin at 2 p.m. ET on Tuesday, Feb. 14.

SAMHSA Announces Funding Opportunity for Assertive Community Treatment Programs for Youth and Adults with SMI

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week announced it will award more than $5 million to establish or expand and maintain Assertive Community Treatment (ACT) programs for transition-aged youth and adults with serious mental illness (SMI).   The program’s purpose is to improve behavioral health outcomes for individuals by reducing rates of hospitalization, mortality, substance use, homelessness, and involvement with the criminal justice system. Click here to learn more about the opportunity. Applications are due by Monday, April 10.

NIDA Reports Increased Activity in ‘Blue Lotus’ Drug

The National Institute on Drug Abuse (NIDA) reported this week that, in response to mentions of blue lotus for the first time from a Rapid Street Reporting (RSR) site visit in Austin, the substance has experienced steady activity in the past three years, with activity peaking in early and late 2022. Also known as Nymphae caerulea, blue lotus is a water lily primarily found in East Africa and the Arabian Peninsula. The flower contains aphorphine, a dopamine agonist, and is sold primarily as tea extracts or incense. Click here to learn more about blue lotus and the RSR team’s other recent findings in NIDA’s Feb. 10 newsletter.

In Case You Missed It: NABH Education and Research Foundation and Manatt Produce Issue Brief on Telehealth Services in PHP and IOP

The NABH Education and Research Foundation on Feb. 1 released an issue brief that shows how telehealth services effectively augment traditional partial hospitalization programs (PHP) and intensive outpatient programs (IOP). The telehealth issue brief is the first resource from the NABH Education and Research Foundation, which worked with NABH members and Manatt to compile and evaluate data to measure the impact that telehealth services have had on access and outcomes. NABH urges its members to read the issue brief and share it with others. The association has also created a social media toolkit with shareable graphics that highlight key research from the study. Members can access the issue brief and social media toolkit on the NABH Education and Research Foundation’s Resources page. Manatt will host a webinar about the issue brief’s findings on Wednesday, March 1 at noon ET. Click here to learn more and register for the free webinar. The NABH Education & Research Foundation fields independent studies and partners with other organizations to identify and develop best practices and improve NABH members’ ability to support the country’s behavioral health needs.

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. Your data will help NABH highlight problems in the field related to health plan denials and timeliness. Several policymaking entities are interested in these data, which could support advocacy for expanded access to care. For new participants, please e-mail Emily Wilkins, NABH’s administrative coordinator, for support.

Details Coming Soon for the NABH 2023 Annual Meeting

Please plan to join us in Washington, DC from June 12-14, 2023 for this year’s NABH Annual Meeting at the Salamander Washington, DC (formerly the Mandarin Oriental hotel). Details coming soon.

Fact of the Week

Medicare Advantage (MA) enrollment increased by 22.2 million beneficiaries, or 337%, from 2006 through 2022, while traditional Medicare enrollment declined by 1.0 million, or −2.9% during that period, according to a study published this week in the journal Health Affairs. The increase in MA enrollment and penetration “indicates that beneficiaries are reforming Medicare with their feet,” the study’s authors wrote. For questions or comments about this CEO Update, please contact Jessica Zigmond.

NABH Education and Research Foundation Partners with Manatt to Produce Issue Brief on Telehealth Services in PHP and IOP

The NABH Education and Research Foundation this week released an issue brief that shows how telehealth services effectively augment traditional partial hospitalization programs (PHP) and intensive outpatient programs (IOP). The telehealth issue brief is the first resource from the NABH Education and Research Foundation, which worked with NABH members and Manatt to compile and evaluate data to measure the impact that telehealth services have had on access and outcomes. Results from the study show that using telehealth services improved access to care and optimized the reach of existing personnel. The initial findings from several NABH members also indicated that, relative to in-person services, telehealth delivery-of-care produced similar or better outcomes for PHP and IOP patients. The telehealth issue brief’s key findings also include: During the COVID-19 crisis, regulatory flexibilities enabled traditional in-person PHPs and IOP programs to implement telehealth services rapidly. Using telehealth to deliver PHP and IOP services has improved access to care for remote patients and those facing other access obstacles. Emerging research is showing that, relative to in-person care, the use of telehealth in PHPs and IOPs generally is improving the quality of clinical care, patient satisfaction and the overall efficiency of the healthcare system. NABH urges its members to read the issue brief and share it with others. The association has also created a social media toolkit with shareable graphics that highlight key research from the study. Members can access the issue brief and social media toolkit on the NABH Education and Research Foundation’s Resources page. Manatt will host a webinar about the issue brief’s findings on Wednesday, March 1 at noon ET. Click here to learn more and register for the free webinar. The NABH Education & Research Foundation fields independent studies and partners with other organizations to identify and develop best practices and improve NABH members’ ability to support the country’s behavioral health needs.

New 9th Circuit Court of Appeals Ruling Threatens Behavioral Healthcare Coverage

A three-judge panel in the 9^th U.S. Circuit Court of Appeals on Jan. 26 replaced its March 2022 ruling in the Wit v. United Behavioral Health (UBH) case with a new opinion that is a major disappointment to both mental health patients and providers. NABH asserts the latest opinion will materially reduce the benefit of insurance because it does not protect medically necessary treatment based on generally accepted standards of care. NABH refuses to allow insurers to deny medically appropriate care to those who need it and will file a new amicus brief and request that the 9^th Circuit rehear the case. The U.S. District Court for the Northern District of California’s initial ruling on this class action case in 2019 affects more than 100 million health insurance enrollees. The ruling, considered one of the most significant of the last decade, found that UBH’s reimbursement guidelines for psychiatric conditions were non-compliant with generally accepted standards of care and treatment. In its ruling, the District Court articulated a series of clinical standards for behavioral healthcare treatment that emphasized the need for treatment to sustain improvement, rather than only address an immediate clinical crisis. The District Court also applied a holistic approach that required treatment for both primary and comorbid impairments, such as the combination of depression and a substance use disorder. A year after this finding, the District Court ordered UBH to reprocess more than 50,000 claims it had initially denied. The 9^th Circuit Court of Appeals subsequently undid this ruling with its 2022 memorandum. While the latest ruling in this case is a disappointment, NABH and other behavioral healthcare groups found both positive and negative elements in it. These include: Positive Factors:

• The 9^th U.S. Circuit Court of Appeals found that UBH violated its fiduciary duty to all class members by using medical necessity criteria that were infected by UBH’s financial conflict of interest.
• The 9^th U.S. Circuit Court of Appeals upheld the U.S. District Court’s finding that UBH broke the laws of four states, which required UBH to apply specific substance use criteria to evaluate medical necessity.

Negative Factors:

• The 9^th U.S. Circuit Court of Appeals held that UBH does not have to reprocess over 60,000 claims for class members denied coverage under UBH’s flawed guidelines, contrary to longstanding precedent on reprocessing as an ERISA remedy.
• The 9^th U.S. Circuit Court of Appeals held that all ERISA class action members must first exhaust their administrative remedies, even if doing so would be futile, as the U.S. District Court found was the case here.
• The 9^th U.S. Circuit Court of Appeals held that insurers may use medical necessity criteria that are inconsistent with generally accepted standards of care.

CMS Updates Audit Protocol for Medicare Advantage Payments

The Centers for Medicare and Medicaid Services (CMS) on Jan. 30 issued a final rule related to using risk adjustment to ensure accurate payment for services provided under Medicare Advantage (MA). Modifications to the risk adjustment audit protocol, called risk adjustment data validation (RADV), and the related overpayment refund process were initially issued in a 2018 proposed rule. Final action was delayed until now, in part, due to the COVID-19 pandemic. The final rule reflects estimates from the HHS Office of the Inspector General of more than $15 billion in MA overpayments in fiscal year 2019, or about 7% of total payments. The final rule takes effect April 3, 2023 and has an estimated recovery amount of $4.7 billion in over 10 years. NABH supports this final rule’s objective to increase oversight of payment accuracy under MA and improve the alignment between payments and medically necessary services for enrollees. To align MA payments with the clinical needs of enrollees, CMS risk-adjusts payments based on patients’ health status and key characteristics. The goal of risk adjustment is to pay less for healthier enrollees and more for more medically complex enrollees. To identify any inaccuracies in MA risk-adjustment’s impact on payments, CMS conducts retrospective RADV audits of a sample of each plan’s enrollees—typically about 200 per plan— to review their medical records to quantify any gaps between medically necessary care and reimbursed services. Extrapolation: Beginning with payment year (PY) 2018, rather than PY 2011, as proposed, the overpayments quantified through RADV audits will be extrapolated to the full MA contract. While not articulated in the final rule, CMS’ extrapolation methodology will be disclosed to MA insurers and be focused on insurers identified as being at highest risk for improper payments. CMS stated that its use of extrapolation is intended to incentivize meaningful steps by its contractors to reduce improper MA risk-adjusted payments. Overpayments identified for PYs 2011 through 2017 will be refunded to CMS without the application of extrapolation. FFS Adjuster: In addition, as proposed, the final rule will not apply an adjustment factor (known as an FFS Adjuster) to RADV audit findings, which is a form of risk adjustment. This final position is based on recent case law, which found that the FFS adjuster must be applied to MA payments but not refunded overpayments, including those identified during a RADV audit.

Congressional Research Services Releases Parity Report

The Congressional Research Service (CRS)—the public policy research institute of the U.S. Congress—this week released a report that explains mental health/substance use disorder benefit coverage and parity requirements and the types of private health insurance plans subject to those requirements. The report includes a brief review of relevant legislative history, including changes enacted in December 2022, and a discussion and examples of required federal agency activities. The CRS focused on federal private insurance requirements; it does not compare state requirements or actual plan variation in coverage. It also does not examine mental health benefits in Medicare and Medicaid. Click here to read the report.

National Institute of Mental Health Develops Strategic Framework to Address Youth Mental Health Disparities

The National Institute of Mental Health (NIMH) has developed the National Institute of Mental Health (NIMH) Strategic Framework for Addressing Youth Mental Health Disparities for fiscal years 2022–2031, a resource intended to provide a conceptual approach to help guide NIMH activities, including research funding, stakeholder engagement, and workforce development related to research on the mental health needs of youth affected by racial and ethnic health disparities. “Our country is in the midst of a youth mental health crisis, including alarming increases in youth suicide in recent years,” Christina P.C. Borba, Ph.D., M.P.H., wrote in the framework’s foreword message. “We also know that youth exposed to racism, discrimination, and other adverse experiences, as well as those from disadvantaged and underserved communities, are disproportionately impacted by mental illnesses, and frequently experience reduced access to high-quality, evidence-based mental health services and receive fewer follow-ups in a variety of provider settings,” Borba continued. “Addressing these challenges will require sustained attention, effort, and resources – all built on a foundation of high-quality research.”

News Report Shows How States are Responding to Synthetic Opioid Nitazene

The news outlet Axios recently examined how nitazene, a synthetic opioid thought to be 40 times more powerful than fentayl, is complicating the public health response to the opioid crisis in various states. Nitazene comes in powder, pill, and liquid form and requires significant lab work to trace. “Often laced into substances that users think is fentanyl or heroin, it’s potentially lethal or can cause a more severe onset of withdrawal symptoms,” the story noted. The Centers for Disease Control and Prevention (CDC) last September published a study on nitazene-related deaths in Tennessee from 2019-2021 and reported that nitazenes are an emerging group of highly potent psychoactive substances for which tests are not often included in standard toxicology panels. “Given their potency, raising awareness about nitazenes and implementing strategies to reduce harm through increased testing, surveillance, and linkage to treatment for substance use disorders are of vital importance,” the CDC study said. “More data are required to better understand this emerging group of psychoactive substances in the United States.”

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. Your data will help NABH highlight problems in the field related to health plan denials and timeliness. Several policymaking entities are interested in these data, which could support advocacy for expanded access to care. For new participants, please e-mail Emily Wilkins, NABH’s administrative coordinator, for support.

Details Coming Soon for the NABH 2023 Annual Meeting

Please plan to join us in Washington, DC from June 12-14, 2023 for this year’s NABH Annual Meeting at the Salamander Washington, DC (formerly the Mandarin Oriental hotel). Details coming soon.

Fact of the Week

A new Pew Research Center study shows that 40% of parents report they are “extremely/very” worried that their children might struggle with anxiety or depression at some point. For questions or comments about this CEO Update, please contact Jessica Zigmond.

NABH Submits Comment Letter on Federal and State Health Exchange Proposed Rule for 2024 Today, NABH submitted comments on the Contract Year 2024 proposed rule related to the federal and state health exchange marketplace. NABH expressed support for the generally positive rule, including its multiple proposals to assist consumers seeking to enroll in exchange-based health plans and, ultimately, to access mental health and substance use disorder treatments. Our comments also called for the Centers for Medicare & Medicaid Services (CMS) to, rather than merely requiring a minimal contracting attempt, as proposed, require health plans to meet a minimum contracting level based on a percentage of available mental health facilities and substance use disorder treatment centers. In addition, the letter urged CMS to evaluate the current level of actual coverage for mental health services being provided by plans on the federal and state marketplace. We also called on CMS to study the impact of insurer network expansion practices that result in some behavioral health sites and services being unilaterally added to, or “deemed” members of, health plan networks and paid an in-network rate that was already rejected by the provider. The comment deadline for this proposed rule is Monday, January 30. CMS Approves California’s Medicaid 1115 Demonstration Amendment to Support Care for Justice-Involved Individuals and Contingency Management  The Centers for Medicare & Medicaid Services (CMS) approved a first-of-its-kind demonstration amendment in California which will provide a set of critical pre-release services and improve access to needed care for people returning home from jails and prisons. This approval marks the first time Medicaid will pay for pre-release services to incarcerated individuals.  As part of the approval, California will also increase and sustain provider payment rates and Medicaid managed care payment rates in behavioral health and select other services. In another first for the country, the waiver also includes approval for the use of contingency management for individuals with stimulant use disorders (StUDs). The waiver outlines procedures and protocols for using financial incentives in a 24-week program to reinforce the non-use of stimulants. The protocol is followed by six or more months of additional recovery support services. Importantly, the protocols integrate measures to protect against fraud and abuse, first identified by the Motivational Incentives Policy Group, of which NABH is a member. The waiver introduced Medicaid reimbursable services provided by a Contingency Management Coordinator, a new job classification. It is believed that this pilot will serve as a template for other states that are seeking to integrate treatment for individuals with StUD.

SAMHSA Announces Funding Opportunity for Community Programs to Help Youth and Young Adults at High Risk for Psychosis

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced that applications are open for a program to provide trauma-informed, evidence-based interventions to youth and young adults who are at clinical high risk for psychosis. Award recipients are expected to use evidence-based intervention to improve symptomatic and behavioral functioning; enable youth and young adults to resume age-appropriate social, academic, and/or vocational activities; delay or prevent the onset of psychosis; and minimize the duration of untreated psychosis for those who develop psychotic symptoms. The deadline for applications is Tuesday, March 14. Click here to learn more and to apply.

CDC Study Shows that Treating Substance Use Disorders Costs Employer-sponsored Health Insurance over $35 Billion per Year

This week, the Centers for Disease Control and Prevention (CDC) released a study assessing the medical cost of substance use disorders for US employers, employees, and health insurance plans.  The study assessed 162 million non-Medicare eligible enrollees with employer-sponsored health insurance in 2018.  The study determined that the total annual medical cost in that population was $35.3 billion and alcohol-related disorders and opioid-related disorders were the most costly. It should be noted that this amount is a fraction of the $1.1 trillion of the total personal health care expenditures paid by private insurance in the US in 2018.

NABH Mourns Behavioral Healthcare Industry Leader Joey Jacobs

NABH mourns the passing of retired behavioral healthcare executive and leader Joey J. Jacobs, 69, who died Jan. 14 in Nashville following an extended illness. Jacobs held various roles at Nashville, Tenn.-based HCA Healthcare and co-founded Psychiatric Solutions before he sold the company 13 years ago. Jacobs was also the chair and CEO of Franklin, Tenn.-based Acadia Healthcare, all NABH system members.  A former member, Jacobs served on the NABH Board from 2005 through 2009 when NABH was the National Association of Psychiatric Health Systems. In addition to his wife, Debbie Hammer Jacobs, Jacobs is survived by two sons, Brent and Scott; three grandchildren; and other family members. Services were held on Jan. 20.

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. Your data will help NABH highlight problems in the field related to health plan denials and timeliness. Several policymaking entities are interested in these data, which could support advocacy for expanded access to care. For new participants, please e-mail Emily Wilkins, NABH’s administrative coordinator, for support.

Details Coming Soon for the NABH 2023 Annual Meeting

Please plan to join us in Washington, DC from June 12-14, 2023 for this year’s NABH Annual Meeting at the Salamander Washington, DC (formerly the Mandarin Oriental hotel). Details coming soon.

Fact of the Week

A new cross-sectional study including 74,474 opioid-involved deaths, buprenorphine was involved in 2.6% of opioid-involved overdose deaths during July 2019 to June 2021. Although monthly opioid-involved overdose deaths increased, the proportion of involving buprenorphine fluctuated—but did not increase. For questions or comments about this CEO Update, please contact Jessica Zigmond.

SAMHSA Announces Monica Johnson as 988 & Behavioral Health Crisis Coordinating Office Director

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced this week that Monica Johnson, M.A., LPC is the new director of the 988 & Behavioral Health Crisis Coordinating Office. Johnson has worked in the behavioral health field for 26 years and most recently served as the interim commissioner for the Georgia Department of Behavioral Health & Developmental Disabilities. SAMHSA’s announcement noted that Johnson has overseen and implemented successfully several programs funded through SAMHSA, the Bureau of Justice Assistance, the Office of Juvenile Justice Delinquency Prevention, and the U.S. Education Department. Johnson earned an undergraduate degree in psychology from Kennesaw State University in Georgia and a graduate degree in professional counseling and psychology at Argosy University in Virginia. She is the recipient of the Intensive Cognitive Behavior Therapy for Schizophrenia Certification at the Aaron T. Beck Institute for Cognitive Behavior Therapy in Philadelphia.

CMS to Host Call About Administration Simplification Proposed Rule on Jan. 25

The Centers for Medicare & Medicaid Services (CMS) National Standards Group will host a call to discuss the Administrative Simplification: Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction proposed rule next Wednesday, Jan. 25 from 2 p.m. to 3:30 p.m. ET. The agency will use the 90-minutes session to provide an overview of the proposed rule and also offer background on the current standards, expectations of what the proposed rule is meant to do, and information about how to submit comments. Click here to register.

CMS to Host Educational Session on Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule

The CMS Office of Burden Reduction and Health Informatics will host a virtual education about the Advancing Interoperability and Improving Prior Authorization Processes proposed rule on Thursday, Feb. 9 from noon to 1 p.m. ET. On Dec. 6, CMS issued the prior authorization proposed rule, which aims to improve patient and provider access to health information and streamline processes. Click here to read the agency’s fact sheet.     Next month’s educational session is intended to help participants learn about the rule’s provisions and hear how the proposed rule builds on current CMS interoperability policies. Participants will be permitted to ask questions. Click here to register by Feb. 8.

ASAM to Release Training Module on Level of Care Certification Next Month

The American Society of Addiction Medicine (ASAM) and CARF International announced that a training module to introduce updated rating elements to the ASAM Level of Care Certification (LOCC) will be available on Feb. 15. ASAM and CARF International announced the LOCC’s updated rating elements in July 2022, and residential treatment programs that are applying for the ASAM LOCC for levels 3.1, 3.5, and 3.7 will be responsible for meeting the updated elements as part of their certification survey. These facilities will also be responsible for meeting the existing rating elements listed in the ASAM LOCC manual.

Joint Commission Releases Sentinel Event Alert About Eliminating Racial & Ethnic Disparities in Pregnant and Postpartum Patients

The Joint Commission this week released a Sentinel Event Alert about eliminating barriers and racial disparities causing mortality and morbidity in pregnant and postpartum women. Along with the announcement, the Joint Commission released a Quick Safety that addresses mental health conditions and their role in maternal death.

SAMHSA Publishes Guide on Expanding Access to Behavioral Healthcare Services for People Experiencing Homelessness

SAMHSA this week released a guide that highlights strategies for behavioral healthcare and housing providers to conduct outreach and engage with individuals experiencing homelessness. The new resource also includes strategies for how to initiate behavioral healthcare treatment as individuals wait to receive housing and retain them in their recovery efforts after they find housing.

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. Your data will help NABH highlight problems in the field related to health plan denials and timeliness. Several policymaking entities are interested in these data, which could support advocacy for expanded access to care. For new participants, please e-mail Emily Wilkins, NABH’s administrative coordinator, for support.

Details Coming Soon for the NABH 2023 Annual Meeting

Please plan to join us in Washington, DC from June 12-14, 2023 for this year’s NABH Annual Meeting at the Salamander Washington, DC (formerly the Mandarin Oriental hotel). Details coming soon.

Fact of the Week

A recent study found that those on medical addiction therapy had a 63% lower likelihood of an alcohol-related liver disease diagnosis. For questions or comments about this CEO Update, please contact Jessica Zigmond.

HHS Awards Nearly $245 Million to Support Youth Mental Health and the Healthcare Workforce

The U.S. Health and Human Services Administration (HHS) announced this week it awarded nearly $245 million in funding from the Bipartisan Safer Communities Act to support youth mental health and help the healthcare workforce address mental health needs.   The funding—released through the Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA)—is for a variety of programs and grants, including Project Advancing Wellness and Resiliency in Education (Project AWARE) to help develop and support school-based mental health programs and services; Mental Health Awareness Training grants to prepare and train school personnel, emergency first responders, law enforcement, and others to recognize the signs and symptoms of mental health challenges to enable early intervention; the National Child Traumatic Stress Initiative to improve treatment for children, adolescents, and families who have experienced traumatic events, and more.   In its announcement, HHS noted that the Bipartisan Safer Communities Act included nearly $60 million to support the integration of mental health training into the training of primary care clinicians, with a specific focus on preparing primary care providers to treat the mental health needs of children and adolescents. “Often the first person you turn to when you or your kids need mental health support is your trusted primary care provider—yet for too long, we haven’t given those primary care providers the mental health training they need to help, HRSA Administrator Carole Johnson said in the announcement. “With funding from the Bipartisan Safer Communities Act, the Health Resources and Services Administration is investing in making mental health a part of primary care training so that there is no wrong door when your family needs support.”

National Academies to Host Virtual Webinars About 988 Implementation on Jan. 20 and 23

The National Academies Forum on Mental Health and Substance Use Disorders will host two virtual webinars about the challenges and opportunities related to the implementation of the 988 behavioral health crisis hotline at the state and local levels. The discussions will provide an overview of how 988 has been implemented and will also feature best practices. The two-hour webinars will be held on Friday, Jan. 20 and Monday, Jan. 23; both will begin at 12:30 p.m. ET. Click here to register.

CMS to Host National Stakeholder Call with Administrator Brooks-LaSure on Jan. 24

The Centers for Medicare & Medicaid Services (CMS) will host a national stakeholder call featuring CMS Administrator Chiquita Brooks-LaSure and her leadership team to discuss the agency’s accomplishments in 2022 and priorities for 2023. Click here to register.

Register Today for the 2023 Rx and Illicit Drug Summit in Atlanta

The 2023 Rx and Illicit Drug Summit will be held in Atlanta from April 10-13 and will include nearly 100 educational sessions organized in nine different tracks to highlight the most effective strategies for prevention, treatment, and recovery. The meeting’s advanced rate ends on Jan. 27. Click here to register.

NABH’s 2023 Priorities Featured in Mental Health Weekly & Alcohol and Drug Abuse Weekly

In case you missed it, NABH President & CEO Shawn Coughlin discussed the association’s priorities for 2023 and NABH Director of Quality and Addiction Services Sarah Wattenberg reflected on accomplishments of 2022 and hopes for the New Year in Mental Health Weekly and Alcohol and Drug Abuse Weekly, respectively.

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. Your data will help NABH highlight problems in the field related to health plan denials and timeliness. Several policymaking entities are interested in these data, which could support advocacy for expanded access to care. For new participants, please e-mail Emily Wilkins, NABH’s administrative coordinator, for support.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting! Details coming soon.

Fact of the Week

In a cohort study of 5,142,577 commercially insured adults across all 50 states, the weekly rate of in-person mental health service utilization decreased by more than 50% after the Covid-19 pandemic started; however, concurrent increases in telehealth led to a slight increase in total utilization for anxiety disorders and stability in total volume of service for other disorders, according to a new study published in JAMA Health Forum. For questions or comments about this CEO Update, please contact Jessica Zigmond.

NABH Welcomes Harsh K. Trivedi, M.D., M.B.A as 2023 Board Chair

NABH is pleased to welcome Sheppard Pratt President & CEO Harsh K. Trivedi, M.D., M.B.A as the association’s board chair for 2023. Harsh has served as an NABH board member as well as a member of the association’s workplace violence prevention workgroup and Covid-19 task force. A graduate of the Mount Sinai School of Medicine, Harsh completed his general psychiatry residency at the Zucker Hillside Hospital/Albert Einstein College of Medicine. He completed his child and adolescent psychiatry training at Children’s Hospital Boston/Harvard Medical School. Harsh has served as president and CEO at Sheppard Pratt in Baltimore since 2016. NABH is eager to work with Harsh as the association celebrates its 90^th anniversary in 2023!

SAMHSA Releases National Survey on Drug Use and Health for 2021

About one in four U.S. adults had a mental illness and more than 16% of the population—or more than 46 million people—met the criteria for substance use disorder (SUD) in 2021, according to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey of Drug Use and Health (NSDUH).   Released annually, the latest report for the 2021 calendar year also found that younger people reported even higher levels of mental illness—one in three for those between the ages of 18 and 25. Meanwhile, nearly 94% of people with SUD didn’t receive any treatment in 2021. “Every year since 1971, this survey has given us a window into our nation’s mental health and substance use challenges and 2021 was no different,” HHS Secretary Xavier Becerra said in an announcement about the survey. “As the findings make clear, millions of Americans young and old faced mental health and substance use challenges – sometimes both at once – during the second year of the pandemic,” he continued. “As we work to improve behavioral health across the nation, HHS is committed to ensuring that all people facing mental health or substance use challenges are connected to appropriate services and supports.” SAMHSA noted that estimates from the 2021 NSDUH should not be compared with estimates from previous years because the Covid-19 pandemic necessitated methodological changes to the data collection process.

CMS Issues Information Bulletin on Medicaid Provisions in Consolidated Appropriations Act, 2023

The Centers for Medicare and Medicaid Services (CMS) on Thursday issued an informational bulletin that highlights provisions in the Consolidated Appropriations Act, 2023 (CAA, 2023) related to the Medicaid continuous enrollment condition. The CAA, 2023 updates certain Medicaid and Children’s Health Insurance Program (CHIP) provisions, including significant changes to the continuous enrollment condition of the Family First Coronavirus Response Act. Under the CAA, 2023, expiration of the continuous enrollment condition will no longer be linked to the Covid-19 public health emergency (PHE); instead, the condition will end on March 31, 2023. After the condition ends, states will have up to 12 months to initiate, and 14 months to complete, a renewal for all individuals enrolled in Medicaid, CHIP, and the Basic Health Program. Click here for more details.

HRSA Urges Nurses to Apply for Nurse Corps Loan Repayment Program

The Health Resources and Services Administration (HRSA) this week announced a reminder that the Nurse Corps Loan Repayment Program opens soon. As part of the program, certain eligible nurses could qualify for up to 85% of unpaid debt. In return, they would be required to serve at least two years in a critical shortage facility in a high need area or accredited school of nursing in a U.S. state or territory. Nurses must work at eligible facilities for this program, which include public or non-profit medical facilities. Click here to learn about eligibility and application requirements.

Bipartisan Policy Center to Host Behavioral Healthcare Workforce Panel Discussion

The Bipartisan Policy Center (BPC) will host a panel discussion about the organization’s federal policy recommendations to address the huge gap between need and care on Tuesday, Jan. 24. The BPC noted that as of March 2021, about 37% of Americans lived in mental health shortage areas. Panelists will highlight findings of a new BPC report, Filling the Gaps in the Behavioral Health Workforce, which recommends ways to bolster the role of behavioral healthcare workers such as peer specialists, community health workers, and paraprofessionals, as well as community members who can help support the licensed workforce. Click here to register for the hourlong webinar that starts at noon ET on Jan. 24.

Reminder: Apply for HRSA Grants to Reduce Neonatal Abstinence Syndrome in Rural Settings

The Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy will invest $20 million in about 40 grants to reduce the incidence of neonatal abstinence syndrome (NAS) in the nation’s rural communities. According to HRSA’s announcement, grant recipients will collaborate with local, state, and regional stakeholders to provide coordinated, trauma-informed, and family centered behavioral and maternal healthcare services—including medication-assisted treatment—to rural pregnant and post-partum women and their families. Applicant organizations may be in either an urban or rural area; however, all activities supported by the program must exclusively occur in HRSA-designated, rural areas. The agency will accept applications through March 8, 2023.

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. Your data will help NABH highlight problems in the field related to health plan denials and timeliness. Several policymaking entities are interested in these data, which could support advocacy for expanded access to care. For new participants, please e-mail Emily Wilkins, NABH’s administrative coordinator, for support.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

While visits to pediatric emergency rooms rose 1.5% from 2015 to 2021, visits for mental health crises increased 8% a year, according to a new study in JAMA Pediatrics. The study also found that 13% of those young patients returned in six months. For questions or comments about this CEO Update, please contact Jessica Zigmond.

Two Proposed Rules Would Improve Prior Authorization and Network Adequacy

The Centers for Medicare & Medicaid Services (CMS) this week released two proposed rules related to longstanding concerns with Medicare Advantage (MA) plans and other insurers that are designed to improve quality of care and plan accountability. These rules respond to the HHS Office of Inspector General’s report earlier this year about inappropriate prior authorization denials by MA plans as well as 4,000 comments in 2022 from stakeholders, including NABH, on related concerns. Contract Year 2024 Proposed Rule on Medicare Advantage: Released Wednesday, this proposed rule includes significant MA refinements related to behavioral healthcare, such as a prior authorization exemption for emergency mental health services needed to evaluate and stabilize patients. It also proposes implementing a 10-percentage point payment add-on for telehealth services provided by clinical psychologists, licensed clinical social workers, and those who prescribe medication for opioid use disorder. To assist patients seeking care, the rule proposes appointment wait-time standards for primary care and behavioral healthcare services. It would also require mid-year notices for enrollees with a behavioral health or primary care provider who dropped from their plan network. Regarding network adequacy, CMS proposes adding clinical psychologists, licensed clinical social workers, and those who prescribe medication for opioid use disorder to the list of specialty types that CMS uses to evaluate MA networks. To improve parity in access, the proposed rule would also require most MA organizations to include behavioral healthcare services in care coordination programs. In addition, the rule clarifies that plans should include both physical and mental conditions in their coverage of emergency medical care. Also, to address stakeholders’ concerns regarding the dramatic increase in opioid overdose deaths during the Covid-19 pandemic, the rule proposes that MA organizations designate in their provider directories those who obtained a waiver from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration to treat patients with medications for opioid use disorder and are listed on SAMHSA’s Buprenorphine Practitioner Locator. Comments to CMS are due by Monday, Feb. 13, 2023. Federal Health Exchange Notice of Benefit and Payment Parameters for 2024: On Monday, the agency issued a proposed rule related to all health insurers participating in federal and state health insurance exchanges. Specifically, CMS would categorize mental health facilities and substance use disorder (SUD) treatment centers as essential community providers and require insurers to include at least one of these providers in each network. Previously, mental health facilities and SUD treatment centers had been designated in the “other” category. In addition, the rule would require contract reviews to assess the actual availability of SUD and mental health services. To address concerns about reduced access to care after the Covid-19 public health emergency ends, CMS has proposed extending by 60 to 90 days those who would otherwise lose Medicaid or Children’s Health Insurance Program coverage in January 2024. Comments on this rule will be accepted during the 45-day period after the rule is published in the Federal Register.

SAMHSA’s Proposed Rule Permits Methadone Prescribing for New Patients via Telemedicine

SAMHSA this week proposed updating federal regulations to permit using audio-visual telehealth services for any new patient treated with methadone in an Opioid Treatment Program (OTP) under specific conditions. In a proposed rule, SAMHSA said federal regulations should be updated to allow using audio-visual telehealth services for patients treated with methadone in OTPs only if a program physician, or an authorized healthcare professional under the supervision of a program physician, determines that an adequate evaluation of the patient can be accomplished via an audio-visual telehealth platform. This change is not extended to using audio-only telehealth platforms and applies only to ordering methadone that an OTP dispenses under existing OTP procedures. In addition, SAMHSA’s proposed changes would update 42 CFR Part 8 by removing stigmatizing or outdated language; supporting a more patient-centered approach to treatment; and reducing barriers to receiving care. SAMHSA’s proposed changes also would revise standards to reflect an OTP accreditation and treatment environment that has evolved since Part 8 became effective in 2001. Consequently, SAMHSA said its proposed revisions reflect evidence-based practice, language that aligns with current medical terminology, effective patient engagement approaches, and the workforce providing services in OTPs, including:

• expanding the definition of an OTP treatment practitioner to include any provider who is appropriately licensed to dispense and/or prescribe approved medications. The current Part 8 rule defines a practitioner as being: “a physician who is appropriately licensed by the State to dispense covered medications and who possesses a waiver under 21 U.S.C.823(g)(2).” During the Covid-19 public health emergency, this has been formally expanded to align with broader definitions of a practitioner (nurse practitioners, physician assistants, etc.), and OTPs reported that this change was essential in supporting workflow and access;
• adding evidence-based delivery models of care, such as split dosing, telehealth, and harm-reduction activities;
• removing such outdated terms as “detoxification”;
• updating criteria for provision of take-home doses of methadone;
• strengthening the patient-practitioner relationship through promoting shared and evidence-based decision-making;
• allowing for early access to take-home doses of methadone for all patients, to promote flexibility in creating plans of care that facilitate such every-day needs as employment, while also affording people with unstable access to reliable transportation the opportunity to also receive treatment; likewise, promoting mobile medication units to expand an OTPs geographic reach; and
• reviewing OTP accreditation standards.

According to SAMHSA, the changes– which are part of President Biden’s National Drug Control Strategy – come at a time when fewer than one out of 10 Americans can access treatment for substance use disorder. SAMHSA will accept public comments on the proposed rule until Feb. 14, 2023.

NASHP Brief Highlights State Opioid Spending Plans

The National Academy for State Health Policy has released Understanding Opioid Settlement Spending Plans Across States: Key Components and Approaches, which highlights how states are implementing structures to disburse the more than $50 billion in opioid settlement funds awarded to them. Opioid settlement funds began pouring into states this year, including about $26 billion from a settlement that 46 states agreed to with Johnson & Johnson (J&J), AmerisourceBergen, Cardinal Health, and McKesson in July 2021. To understand common challenges and potential best practices for state leaders, NASHP engaged state leaders nationwide to understand both the structure and status of their current opioid settlement planning activities. NASHP is also analyzing governing materials and entities such as state legislation, opioid settlement agreements and spending plans, advisory committees, and other groups charged with disbursing state funding, which are referenced in NASHP’s tracker.

SAMHSA Releases Resource Highlighting Drug-Related ED Visits in 2021

SAMHSA has released Drug Abuse Warning Network (DAWN): Findings from Drug-Related Emergency Department Visits, 2021, an analysis of DAWN data with a variety of information for drug-related emergency department (ED) visits last year. The report highlights nationally representative weighted estimates, including percent and unadjusted rates per 100,000, for all drug-related ED visits; nationally representative weighted estimates for the top five drugs in drug-related ED visits; an assessment of trends and drugs involved in polysubstance ED visits in a subset of sentinel hospitals; and the identification of drugs new to DAWN’s Drug Reference Vocabulary.

Brookings Institution Releases Papers on Behavioral Health Integration and Youth Services

The Brookings Institution this week released two academic white papers related to behavioral healthcare: Making Progress on Integration of Behavioral Health Care and Other Medical Care and Meeting the Moment Children’s Mental Health: Recommendations for Federal Policy.   The first is a 10-page analysis of recent policy efforts in the nation’s evolving healthcare system, and the second paper seeks to clarify the potential sources of the persistent problems in mental illnesses in children. The 22-page youth services white paper also considers what tools the federal government should employ to address the crisis.

Reminder: Apply for HRSA Grants to Reduce Neonatal Abstinence Syndrome in Rural Settings

The Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy will invest $20 million in about 40 grants to reduce the incidence of neonatal abstinence syndrome (NAS) in the nation’s rural communities. According to HRSA’s announcement, grant recipients will collaborate with local, state, and regional stakeholders to provide coordinated, trauma-informed, and family centered behavioral and maternal healthcare services—including medication-assisted treatment—to rural pregnant and post-partum women and their families. Applicant organizations may be in either an urban or rural area; however, all activities supported by the program must exclusively occur in HRSA-designated, rural areas. HRSA will offer a webinar for applicants on Wednesday, Jan. 4, 2023 from 2 p.m. to 3 p.m. ET; registration is not required. The agency will accept applications through March 8, 2023.

Reminder: NABH 2023 Board Election Ballots Due Friday, Dec. 30 

NABH has e-mailed system members NABH Board of Trustees candidate profiles and a ballot to elect new members to the 2023 Board. If you have not done so, please vote for the open Board Chair-Elect position and one available Board seat; 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. 30, 2022. New Board members and the Board Chair-elect will take office in January 2023.

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. Your data will help NABH highlight problems in the field related to health plan denials and timeliness. Several policymaking entities are interested in these data, which could support advocacy for expanded access to care. For new participants, please e-mail Emily Wilkins, NABH’s administrative coordinator, for support.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

Fentanyl is now the leading cause of death for Americans between the ages of 18 and 49, according to a Washington Post analysis of death data for 2021 from the Centers for Disease Control and Prevention. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CMS Proposes Electronic Prior Authorization for Providers and Payers

The Centers for Medicare & Medicaid Services (CMS) this week released a proposed rule that would require certain providers and payers to implement an electronic prior-authorization process, shorten the timeframe for payers to respond to prior-authorization requests, and work to make the prior-authorization process more efficient and transparent. An announcement from CMS said the proposed requirements would apply to Medicare Advantage (MA) organizations, state Medicaid and Children’s Health Insurance Program (CHIP) agencies, Medicaid managed care plans, CHIP managed care entities, and qualified health plan issuers on the federally facilitated exchanges. The agency estimates that these proposed policies could create efficiencies that would save physician practices and hospitals more than $15 billion over a 10-year period. The rule would automate essential prior-authorization functions related to documentation, requests, and decisions. Also, payers would be required to provide a clear reason for denials and to respond to urgent prior-authorization requests within 72 hours and standard requests within seven days. The proposed electronic platform is the already-established “Patient Access API,” which uses the Health Level 7^® format. The rule also would enhance patients’ access to their own information on prior- authorization requests, approvals, and related information by requiring online reporting of certain performance metrics. CMS is seeking information from stakeholders on the following topics:

• How to standardize data on patients’ social risk factors (e.g., housing instability, food insecurity) that influence patient health and health care utilization;
• How to advance electronic data exchange among behavioral health providers;
• How to improve the exchange of medical documentation between and among providers/suppliers and patients (for the purpose of care coordination);
• How to enable the connection of health information networks to advance cross-organization interoperability, such as the prior-authorization improvements in this rule, including incentives for payers; and
• Evidence-based policies that CMS could pursue to leverage health IT, data sharing, and interoperability to improve maternal health outcomes.

NABH will address these and the rule’s other key provisions in the association’s formal comments. CMS will publish the rule in the Federal Register on Dec. 13, 2022 and accept comments through March 13, 2023.

Biden Administration Launches Opioid Overdose Dashboard

The Biden Administration on Thursday unveiled a website featuring the Office of National Drug Control Policy’s (ONDCP) new Opioid Overdose Tracker to monitor non-fatal, opioid overdoses in the pre-hospital setting in an effort to prevent overdose deaths. Non-fatal overdoses are a good predictor of fatal overdoses, Biden administration officials said during a news briefing Wednesday according to Politico. People who experience at least one non-fatal overdose are about two to three times more likely to eventually die from one, they said. Earlier this year, the Centers for Disease Control and Prevention estimated that 80,816 Americans died from opioid overdoses in 2021, increasing from an estimated 70,029 in 2020. Using data submitted to the National Emergency Medical Services Information System (NEMSIS), the new dashboard contains one interactive page with a geo-surveillance view, and its data set includes all de-duplicated Emergency Medical Services (EMS) patient care reports for a rolling time period that meet specific inclusion criteria. In 2022, all 50 states, three territories (the Virgin Islands, Guam, and the Northern Mariana Islands), and Washington, D.C. had submitted data to the national database, according to NEMSIS. The NEMSIS Technical Assistance Center collects data from about 95% of all EMS agencies in the United States that respond to 911 requests for emergency care and transport patients to acute care facilities. According to a National Public Radio story, ONDCP Director Rahul Gupta, M.D. told reporters during a call that “We could see tens of thousands of additional lives saved” with the new tool, which Gupta said he hopes first responders, clinicians, and policymakers will use to connect people to care and also minimize response times and ensure that resources are available. NABH has advocated that the dashboard be updated in 2023 to use numbers at the state and county levels, as well as the national level.

New Report Shows Number of Patients Receiving Medications for Opioid Use Disorders in OTPs

Of the 512,224 patients in Opioid Treatment Programs (OTPs) who reported using medications for opioid use disorders (MOUDs), 476,763 reported using methadone, 33,473 reported buprenorphine, and the remaining 1,988 reported using naltrexone, according to a new report from the National Association of State Alcohol and Drug Abuse Directors (NASADAD). NASADAD partnered with the American Association for the Treatment of Opioid Dependence (AATOD) for the study, which was funded to determine the number of patients who receive MOUDs in OTPs, the types of federally approved medications that patients use in treatment, and the specific formulations of medication used among the patient population. Researchers analyzed data from 1,547 Opioid Treatment Programs (OTPs) nationwide that completed the survey, reflecting an 85-percent response rate. The Substance Abuse and Mental Health Services Administration funded the study through the agency’s Opioid Response Network.

MedPAC Discusses Draft Recommendations for 2024 Physician Payment Increases

The Medicare Payment Advisory Commission (MedPAC) this week discussed draft recommendations to increase the Medicare base payment rate for physician and other health professional services by 1.25% in 2024, a rate that is half of the forecasted increase in the Medicare Economic Index for 2024. Current law calls for no updates to 2024 payment rates relative to 2023 levels. The commission also discussed supporting a payment add-on for services for low-income Medicare beneficiaries (15% for primary care; 5% for non-primary care), which new Medicare spending would fund. The purpose of these items is to help maintain access to physician services for Medicare beneficiaries. Both measures received substantial support from the commissioners, and they are expected to be approved as formal recommendations to Congress when MedPAC convenes in January to vote on these and other Medicare payment adequacy recommendations for 2024.

HHS Highlights Progress to Mark One-Year Anniversary of HHS’ Overdose Prevention Strategy

Since the Biden administration released its Overdose Prevention Strategy a year ago, the number of healthcare providers with waivers to prescribe buprenorphine for opioid use disorder increased by 19% and the number of naloxone prescriptions filled in pharmacies has increased by 37%, HHS announced late last week. The announcements were made in conjunction with a news conference HHS Secretary Xavier Becerra held to mark the first anniversary of the Biden administration’s Overdose Prevention Strategy. During the news conference, Becerra highlighted some of the strategy’s recent actions, including an announcement from the Centers for Disease Control and Prevention (CDC) that state, local, and territorial awardees of the CDC Overdose Data to Action cooperative agreement can use a portion of their funds to purchase naloxone; and the U.S. Food and Drug Administration’s notice last month that certain naloxone products have the potential to be safe and effective for over-the-counter use.

HRSA to Invest $20 Million in Grants to Reduce Neonatal Abstinence Syndrome in Rural Settings

The Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy will invest $20 million in about 40 grants to reduce the incidence of neonatal abstinence syndrome (NAS) in the nation’s rural communities. According to HRSA’s announcement, grant recipients will collaborate with local, state, and regional stakeholders to provide coordinated, trauma-informed, and family centered behavioral and maternal healthcare services—including medication-assisted treatment—to rural pregnant and post-partum women and their families. Applicant organizations may be in either an urban or rural area; however, all activities supported by the program must exclusively occur in HRSA-designated, rural areas. HRSA will offer a webinar for applicants on Wednesday, Jan. 4, 2023 from 2 p.m. to 3 p.m. ET; registration is not required. The agency will accept applications through March 8, 2023.

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. Your data will help NABH highlight problems in the field related to health plan denials and timeliness. Several policymaking entities are interested in these data, which could support advocacy for expanded access to care. For new participants, please e-mail Emily Wilkins, NABH’s administrative coordinator, for support.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

A new study published in The Lancet Psychiatry found that people with severe mental illness have an elevated risk for several chronic health problems even before they receive their first diagnosis of a severe mental illness. For questions or comments about this CEO Update, please contact Jessica Zigmond.

Senate Finance Committee Releases ‘Fifth and Final’ Mental Health Parity Discussion Draft

Senate Finance Committee leaders on Thursday released what they said is their fifth and final legislative mental health parity discussion draft in their effort to place access to behavioral healthcare on par with physical healthcare in Medicare and Medicaid.   Previous iterations of the draft were released in May, June, September, and November this year. Policies in the final draft include: strengthening the accuracy of provider directories in Medicare Advantage plans; strengthening requirements in Medicaid for managed care organizations and states to maintain regularly updated provider directories that include, in part, information on accessing care from behavioral health professionals; directing the Government Accountability Office (GAO) to conduct a study of the differences in enrollee cost-sharing and utilization management between behavioral and non-behavioral health services in Medicare Advantage and compared with traditional Medicare; requiring Medicare to provide guidance to health care providers detailing the extent to which Medicare beneficiaries with substance use disorders can receive partial hospitalization program services; and directing GAO to report on Medicaid payment rates for behavioral health services compared to medical and surgical services across a sample of states. “Too often the notion of mental health parity falls short of reality,” Senate Finance Committee Chairman Ron Wyden (D-Ore.) said in an announcement about the discussion draft. “These policies represent the first step towards addressing the mental health parity and ghost network challenges that I intend to build on in the coming months—especially the challenges I hear about consistently from families at home who aren’t able to find available mental health professionals covered in their insurance networks,” he added.

HHS Releases Proposed Rule to Revise 42 CFR Part 2 Regulations

The U.S. Health and Human Services Department (HHS) this week released a proposed rule to revise regulations known as 42 CFR Part 2, or “Part 2,” which protect the confidentiality of substance use disorder (SUD) treatment records. Specifically, Part 2 protects “records of the identity, diagnosis, prognosis, or treatment of any patient which are maintained in connection with the performance of any program or activity relating to substance abuse education prevention, training, treatment, rehabilitation, or research, which is conducted, regulated, or directly or indirectly assisted by any department or agency of the United States.”  The protections are meant to address concerns that discrimination and fear of prosecution deter people from entering treatment for SUD. The rule proposes a host of revisions, including, but not limited to: permitting Part 2 programs to use and disclose Part 2 records based on a single prior consent signed by the patient for all future uses and disclosures for treatment, payment, and healthcare operations; permitting the redisclosure of Part 2 records as permitted by the Health Insurance Portability and Accountability Act (HIPAA) privacy rule by recipients that are Part 2 programs, HIPAA-covered entities, and business associates, with certain exceptions; and expanding prohibitions on using and disclosing Part 2 records in civil, criminal, administrative, or legislative proceedings conducted by a federal, state, or local authority against a patient, absent a court order or the consent of the patient. HHS released a summary of the proposed rule’s provisions and will accept comments for up to 60 days after the proposed rule is published in the Federal Register.

DEA Lab Testing Reveals 6 out of 10 Fentanyl-Laced, Fake Prescription Pills Contain a Potentially Lethal Dose of Fentanyl

The Drug Enforcement Administration (DEA) this week alerted the public of a sharp rise nationwide in the lethality of fentanyl-laced, fake prescription pills.   In a public safety alert, the agency said the DEA laboratory found that of the fentanyl-laced, fake prescription pills analyzed in 2022, six out of 10 contained a potentially lethal dose of fentanyl. This is an increase from DEA’s previous announcement in 2021 that four out of 10 fentanyl-laced fake prescription pills were found to contain a potentially lethal dose. According to the alert, the pills are largely made by two Mexican drug cartels, the Sinaloa Cartel and the Jalisco (CJNG) Cartel, to look identical to real prescription medications, including OxyContin®, Percocet®, and Xanax®, and they are often deadly. In 2021, the DEA seized more than 20.4 million fake prescription pills, and earlier this year, the DEA conducted a nationwide operational surge to target the trafficking of fentanyl-laced fake prescription pills and, seized 10.2 million fake pills in all 50 states in just more than three months. The DEA’s One Pill Can Kill campaign alerts the American public of the dangers of fake prescription pills.

NIDA Director Volkow Calls for Dismantling Stigma at Intersection of HIV and Meth Use 

In her blog post to commemorate World Aids Day on Thursday, Dec. 1, National Institute on Drug Abuse (NIDA) Director Nora Volkow, M.D. promoted NIDA’s video “Sex, Meth and HIV,” to emphasize that in order to end the HIV epidemic it is important to recognize and respect both the complexity and needs of sexual and gender minorities who use drugs. “Like other drugs, methamphetamine may help individuals cope with mental health challenges like depression, anxiety, and trauma,” Volkow wrote. “Some gay and bisexual men use methamphetamine to enhance sexual experience and sense of connectedness,” she added. “It can also temporarily boost self-confidence among individuals who may experience stigma and shame surrounding sexuality or other aspects of their lives.” Volkow referenced a 2020 study in the Journal of Acquired Immune Deficiency Syndromes (JAIDS), which showed that a third of new HIV transmissions among sexual and gender minorities who have sex with men were in people who regularly use methamphetamine.   On a related note, at a conference in Boston last month, Volkow said American physicians should “absolutely” be allowed to prescribe methadone to their patients. “There’s absolutely no reason why not,” Volkow said, according to a story in STAT. “There are countries where physicians are providing methadone, and the outcomes are actually as good as those they get [at] methadone clinics.”

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. Your data will help NABH highlight problems in the field related to health plan denials and timeliness. Several policymaking entities are interested in these data, which could support advocacy for expanded access to care. For new participants, please e-mail Emily Wilkins, NABH’s administrative coordinator, for support.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting! Fact of the Week The likelihood that someone with serious mental illness will be the victim of a violent crime is 11.8 higher when compared with the general public. For questions or comments about this CEO Update, please contact Jessica Zigmond.

HHS Announces $350 Million Initiative to Boost Covid-19 Vaccinations

The U.S. Health and Human Services Department’s (HHS) Health Resources and Services Administration (HRSA) on Tuesday announced a $350 million initiative for HRSA-supported health centers to increase Covid-19 vaccinations in their communities, with a specific focus on underserved populations. The funding will help health centers provide Covid-19 vaccines through mobile, drive-up, walk-up, or community-based vaccination events, including working with community-based organizations and other efforts to increase administering Covid-19 vaccines. According to HHS, health centers have administered more than 22 million vaccines in underserved communities nationwide, of which 70% to patients of racial and ethnic minorities.

Study Shows Shortage of Mental Healthcare Providers Associated with Higher Youth Suicide Rate

Counties with a shortage of mental healthcare providers were connected to higher rates of youth suicide, researchers reported this week in JAMA Pediatrics. The study noted that that while the findings are based on data from 2015 and 2016, the report comes at a time with the number of Americans living in areas with a shortage of mental health professionals is growing. Federal data show more than 150 million people live in such areas. Meanwhile, researchers initially found that counties with provider shortages had a 41% higher youth suicide rate: 5.09 per 100,000 youths compared with 3.62 per 100,000 in counties without shortages. And when the researchers controlled for socioeconomic and other confounding factors—rural and high-poverty areas are known to have higher suicide rates—they still found that living in a county with a shortage of mental health workers was associated with a 16% higher youth suicide rate. “Strategies to ameliorate mental health professional workforce shortages…. may be considered in comprehensive youth suicide prevention programs,” the authors concluded.

NABH and Other Groups Urge Congress to Support Medicare Mobile Crisis Intervention Benefit

NABH is one of more than 50 organizations that sent a letter to House and Senate leaders urging the federal lawmakers to include a mental health crisis intervention benefit in the Medicare program in Congress’ end-of-year legislative package. The organizations represent mental health and substance use treatment providers, crisis centers, family members, advocates, justice-focused organizations, and payers committed to strengthening access to mental healthcare and substance use treatment. The letter explains that in the most recent discussion draft on Integration, Coordination, and Access to Care, the Senate Finance Committee included a key provision of payment for mobile crisis response intervention services under the Physician Fee Schedule, which would add this benefit to the Medicare program. Mobile crisis teams include mental health professionals and individuals who provide peer-support services who are trained to de-escalate a situation and help the individual connect with services and supports.   “Since its launch in July, calls to the 988 Lifeline increased exponentially even more than predicted in SAMHSA’s December 2020 capacity report to Congress. Data from September 2022 vs. September 2021 show calls answered increased by 40%, chats answered increased by 218%, and texts answered increased by 1153%,” the letter said. “While one-time grant funds are helpful to initiate programs, they are not sufficient to sustain them, especially in light of increasing demand,” the letter continued. “In 2021, Congress provided incentives to states to increase Medicaid coverage of mobile crisis teams. Now, it should allow a mobile crisis intervention benefit in Medicare.”

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. Your data will help NABH highlight problems in the field related to health plan denials and timeliness. Several policymaking entities are interested in these data, which could support advocacy for expanded access to care. For new participants, please e-mail Emily Wilkins, NABH’s administrative coordinator, for support.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

Researchers have identified variations in 10 genes that significantly raise the risk for schizophrenia—information that could help identify new treatment targets, according to the National Institutes of Health, which funded one of the largest genetic studies of its kind.

Happy Thanksgiving from NABH!

The NABH staff wishes its members and their families a very happy, healthy, and safe Thanksgiving! For questions or comments about this CEO Update, please contact Jessica Zigmond.

News Reports Signal HHS Will Extend Covid-19 PHE Through April 2023

Several news outlets have reported that the U.S. Health and Human Services Department (HHS) intends to extend the existing Covid-19 Public Health Emergency (PHE) through April 2023. The current PHE—which has been extended many times since 2020—is effective through Jan. 11, 2023.

FDA Announces Preliminary Assessment of Certain Naloxone Products for Over-the-Counter Use

The U.S. Food and Drug Administration (FDA) this week issued a Federal Register notice that includes the agency’s preliminary assessment that certain naloxone drug products—up to 4 milligrams (mg) nasal spray and up to 2 mg autoinjector for intramuscular (IM) or subcutaneous (SC) use—may be approvable as safe and effective for nonprescription use. In its announcement about the notice, FDA said this move is “intended to facilitate both the development and approval of nonprescription naloxone products; however, it is not a final determination that certain naloxone drug products are safe and effective for nonprescription use, and it does not mandate an immediately effective switch to nonprescription/over-the-counter (OTC) availability for naloxone.” The announcement also said the FDA needs additional data, such as product-specific data on the nonprescription user interface design, including packaging and labeling, before it makes its final determination.

CMS Releases Medicaid and CHIP Access Data Brief

The Centers for Medicare & Medicaid Services (CMS) this week released a data brief that includes a snapshot of selected metrics in three essential dimensions of Medicaid and Children’s Health Insurance (CHIP) access. Culling data from various sources, CMS developed the brief to show access to Medicaid and CHIP coverage, measured by enrollment and retention; access to services, with a focus on mental health conditions and substance use disorders; and perceived access, measured by beneficiary experiences in managed care.

SAMHSA’s GAINS Center to Host Webinar About Project ECHO and SUD on Nov. 21

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) GAINS Center on Monday, Nov. 21 will host “Black Robes and White Coats: Using Project ECHO to Increase Judiciary Knowledge about Substance Use Disorder,” a webinar that will provide an overview of the pilot Project ECHO for the Judiciary. The purpose of Project ECHO for the Judiciary is for participating judges to learn about treatments for opioid disorder and develop a better understanding of substance use disorders to help inform their decisions in the courtroom. The webinar will begin at 2:30 p.m. ET on Monday. Click here to register.

FDA to Host Stakeholder Call About Naloxone Access on Nov. 28

The top leaders at FDA and SAMHSA will host a stakeholder call on Monday, Nov. 28 to discuss naloxone access and harm reduction. FDA Commissioner Robert Califf, M.D. and Marta Sokolowska, deputy center director for substance use and behavioral health in FDA’s Center for Drug Evaluation and Research, will lead the call, and SAMHSA Assistant Secretary for Mental Health and Substance Use Miriam Delphin-Rittmon, Ph.D. will participate. “Every person who experiences an opioid overdose, whether it is with prescribed medication or an illicit drug, should have access to naloxone,” FDA said in its announcement about the call. “Entities such as harm-reduction programs help save lives by making naloxone available in underserved communities,” it continued. “The agency intends to stand by these efforts by supporting their ability to acquire FDA-approved naloxone products, and we recently issued the guidance, Exemption and Exclusion from Certain Requirements of the Drug Supply Chain Security Act (DSCSA) for the Distribution of FDA-Approved Naloxone Products During the Opioid Public Health Emergency,” it said, adding that FDA recognizes this action alone is not enough and that there is more work to do. The hourlong Zoom call will begin at 2:30 p.m. ET. Click here to register.

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

Thank you to all members who have already submitted your data to NABH’s denial-of-care portal. Your data will help NABH highlight problems in the field related to health plan denials and timeliness. Several policymaking entities are interested in these data, which could support advocacy for expanded access to care. For new participants, please e-mail Emily Wilkins, NABH’s administrative coordinator, for support.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

Demand for anxiety and depression treatment remains high for the third consecutive year, and 60% of practitioners report they no longer have openings for new patients, according to the American Psychological Association’s 2022 Covid19 Practitioner Impact Survey. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CMS Releases Final Physician Fee Schedule and OPPS Rules for 2023 

Telehealth services authorized temporarily during the Covid-19 public health emergency (PHE) will extend through at least 2023 and for at least 151 days after the PHE ends, the Centers for Medicare & Medicaid Services (CMS) announced in the agency’s final 2023 Physician Fee Schedule (PFS) this week. CMS’ decision to extend the telehealth services benefit will allow for additional data collection to evaluate a possible permanent addition as a Medicare benefit. CMS issued the regulation on the same day it released the final Outpatient Prospective Payment System (OPPS) rule for next year. In that regulation, CMS implemented a 4.1% payment increase for outpatient facilities in 2023. Please read below for additional details about the final regulations. 2023 Physician Fee Schedule Final Rule: The PFS final rule directs CMS to implement an approximately 4.5-percent reduction—reflecting a decrease of $1.55— in the conversion factor, which the agency uses to calculate payments for physicians and the other clinicians paid under the PFS. CMS also updated the payment amount for the drug component of the opioid treatment bundle using the Producer Price Index (PPI) for Pharmaceuticals for Human Use and will do so annually to account for inflation. CMS will also modify the payment rate for the non-drug bundle to base the rate on a 45-minute –rather than a 30-minute—session, which better comports with OTP practices. Under the final rule, OTPs may also use audio-visual and audio-only telehealth for buprenorphine intake if the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration (DEA) grant permission. Also pending authorization from SAMHSA and DEA, OTPs may furnish periodic assessments via audio-only when video is not available for the duration of 2023. CMS also made final billing for mobile units in accordance with SAMHSA and DEA guidance. Locality adjustments will be applied and based on the location of the OTP hub. Meanwhile, the PFS final rule implements an exception to supervision requirements to allow marriage and family therapists, licensed professional counselors, addiction counselors, certified peer recovery specialists, and others to provide behavioral healthcare services while under general supervision, rather than “direct” supervision. This means practitioners now will be able to provide services without requiring that a physician or nurse practitioner be present on site. Responding to comments from the behavioral healthcare field, CMS also made final a new behavioral health integration service that a clinical psychologist or clinical social worker can perform when mental health services are the focal point of care integration, along with allowing a psychiatric diagnostic evaluation to initiate such integration services. CMS also made final several provisions related to accountable care organizations to grow participation in the program, incorporate recent lessons related to episode payment approaches, and advance equity among program participants. Outpatient Prospective Payment System Final Rule: Although the 4.1% payment increase for outpatient services is larger than CMS had proposed, NABH does not consider this payment update adequate to address the intense cost pressures—stemming from considerable increases in labor, supplies, equipment, drugs, and other expenses—that the association had highlighted. Regarding payments for 340B hospitals, the final OPPS rule ends the cuts that the U.S. Supreme Court found to be unlawful. Per the high court’s ruling, 340B payments in 2023 will return to pre-2018 levels: the average sale price plus 6% with an offsetting reduction to make the measure budget neutral, as required by law. The final rule falls short of reimbursing 340B payment cuts from previous years. NABH expects additional 340B rules from CMS by the summer of 2023. Both the PFS and OPPS final rules will take effect Jan. 1, 2023. NABH and Other Organizations Urge Federal Appropriators to Include Behavioral Health Funding in Continuing Resolution NABH and a dozen other behavioral health organizations on Friday send a letter to House and Senate appropriators requesting that federal lawmakers include appropriate funding levels for behavioral health treatment in the upcoming Continuing Resolution (CR) to keep the federal government operating. Specifically, NABH and the other organizations—including the American Psychiatric Association, the American Psychological Association, Mental Health America, the National Association of State Mental Health Program Directors— requested that Congress include $1.42 billion for the Community Mental Health Block Grant (MHGB), including a 10% set-aside for mental health crisis services within the MHGB; $60 million to expand the Mental Health Crisis Response Partnership Pilot Program; $747 million for the 988 behavioral health crisis hotline, including $30 million to provide specialized services for LGBTQ+ youth; $400 million for Certified Community Behavioral Health Clinics; and $10 million for the Behavioral Health Crisis 988 Coordinating Office. “Additional federal investments are needed to strengthen the 988 system to transform how our country responds to people in crisis,” the organizations wrote in the letter. “A continuing resolution of any length threatens our ability to meet the high and growing need for behavioral health treatment and care.”

SAMHSA to Host Webinar About CCBHC Certification Criteria Next Week

SAMHSA will host a webinar open to the public next Wednesday, Nov. 9 regarding updates to the Certified Community Behavioral Health Clinic (CCBHC) certification criteria. SAMHSA will provide a brief overview of CCBHCs, describe key elements of certification criteria and SAMHSA’s process for soliciting feedback from the field, and discuss how the public can provide feedback. The Zoom webinar will begin at 4 p.m. ET. The meeting ID is 160 306 8999 and the passcode is 160547.

SAMHSA Names Jennifer Fan as Director of Center for Substance Abuse Prevention

SAMHSA this week named Capt. Jennifer Fan, Pharm.D., J.D. as the acting director of the agency’s Center for Substance Abuse Prevention (CSAP). A commissioned officer in the U.S. Public Health Service, Fan served in SAMHSA from 2007 through 2021 in several roles, including acting CSAP deputy director, special assistant for the CSAP director, and CSAP’s subject matter expert on opioids and prescription drug misuse. She also served as the senior editor for the Surgeon General’s Spotlight on Opioids Report and helped to create SAMHSA’s Strategic Prevention Framework for Prescription Drugs (SPF Rx) grants and the Grants to Prevent Prescription Drug/Opioid Overdose-Related Deaths (PDO). Fan earned her doctorate in pharmacy from the University of Maryland School of Pharmacy and her law degree from the University of Baltimore School of Law.

SAMHSA Introduces ‘Screen 4 Success’ to Help Parents and Caregivers Understand Wellbeing of Children

SAMHSA recently announced Screen4Success, a new screening tool from the agency’s “Talk. They Hear You.” national prevention campaign that can help parents and caregivers better understand children’s health, wellness, and wellbeing, and find resources to address needs. Parents and caregivers can access the new tool on mobile devices through the Talk. They Hear You. campaign mobile app, which is available for free on the App Store, Google Play, and Microsoft store.

Enhanced NABH Denial-of-Care Portal is Now Available

NABH recently made enhancements to its Denial-of-Care Portal that are intended to make the portal easier for members to use. A year ago, NABH developed the Denial-of-Care Portal to collect specific data on insurers who deny care—often without regard to parity or the effects on patients. Now the association has updated this resource to make it more user-friendly for members and also more aligned with what regulators need to identify parity violations. The updated portal includes fewer questions, which will require less time for members to complete. In addition, all questions are now optional. NABH hopes this will make it more likely for members to share the data they have. Lastly, NABH has added a checklist of “red flags” that were included in the 2022 MHPAEA Report to Congress from the U.S. Health and Human Services, Labor, and Treasury Departments in January. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

Fifty-three percent of those polled said the new 988 behavioral health crisis hotline will be effective to keep people in crisis out of jail, with Black (64%) and Hispanic (54%) adults more optimistic, the American Psychiatric Association reports. For questions or comments about this CEO Update, please contact Jessica Zigmond.

GAO Report Identifies Challenges and Opportunities to Recruit and Retain Behavioral Health Workforce

Financial, educational, and workplace challenges are three categories that pose the greatest challenges to recruiting and retaining behavioral health providers, the Government Accountability Office (GAO) concluded in a new report. The GAO was assigned to review what is known about the behavioral health workforce, offer information regarding both barriers to and incentives for recruiting and retaining providers, and identify what actions various U.S. Health and Human Services department (HHS) agencies are taking to recruit and retain these providers. In its comprehensive review, the GAO interviewed NABH staff as a stakeholder group. “Reimbursement rates and compensation for behavioral health services are low, according to stakeholders from multiple research organizations and behavioral health associations,” the report noted, adding that many programs designed to recruit diverse behavioral health providers only benefit individuals already studying in a behavioral health field and do not address the lack of a pipeline for underserved populations to enter the workforce. The GAO recommended that incentives such as loan repayment and scholarships for students seeking behavioral healthcare professions could help to address some of the barriers to entering the field. Learn more in highlights from the study and the full report.

HHS and U.S. Surgeon General’s Office to Host Mental Health Briefing Monday, Oct. 31

HHS and the U.S. Surgeon General’s office will host a briefing on Monday, Oct. 31 to discuss the Surgeon General’s Framework for Workplace Mental Health & Well-being, which will outline the foundational role that workplaces should play in promoting the health and well-being of workers and communities. The briefing will highlight the five essentials for workplace mental health and is intended to help organizations develop, institutionalize, and update policies, processes, and practices that best support the mental health and well-being of all workers. Click here to register for the 30-minute briefing, which will begin at 1:30 p.m. ET.

Commonwealth Fund Study Examines How Changing Opioid Addiction Treatment Delivery Could Reduce Death and Suffering

A new study from the Commonwealth Fund analyzes how government regulation and inadequate treatment capacity can limit patients’ access to lifesaving care and what policymakers could do to help combat opioid addiction. According to the report’s findings, opioids are involved in almost 75% of overdose deaths in the United States, which claim more than 100,000 lives per year. But while opioid addiction can be treated with effective medications, only 10% to 15% of U.S. residents with opioid use disorder receive them. “During Covid-19, the federal government showed flexibility by allowing OTPs (opioid treatment programs) to provide more take-home methadone doses, allowing buprenorphine treatment initiation via telehealth, and removing buprenorphine waiver training requirements for providers treating 30 or fewer patients,” the report noted. “Data indicate that methadone take-home flexibilities have not been associated with worse outcomes or significant misuse, and telehealth services have been associated with improved medication retention and lower overdose risk,” it continued. “Some of these provisions are temporary and could sunset or change after the COVID-19 public health emergency ends.”

CMS Administrator Brooks-LaSure to Host Webinar Next Week on CMS’ Strategic Plan

Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure and her leadership team will provide an update on the agency’s strategic plan next Tuesday, Nov. 1. This is the agency’s fourth national stakeholder call with the administrator this year, and it’s intended to provide an opportunity for stakeholders to learn how they can partner with CMS to implement the agency’s strategic plan. The hourlong call will begin next Tuesday at 3 p.m. ET. Click here to register.

SAMHSA to Host Behavioral Health Services Information Virtual Workshop on Nov. 2

SAMHSA will host a virtual workshop next week to help providers learn how to access the agency’s available data on Behavioral Health Services Information System (BHSIS) and online treatment locator. Herman Alvarado, a supervisory social science analyst at SAMHSA’s Center for Behavioral Health Statistics and Quality, will provide an overview for participants. The event is intended to provide technical assistance to National Network to Eliminate in Behavioral Health (NNED) members and minority-service and under-resourced community-based organizations. The 90-minute virtual workshop will begin at 3 p.m. next Wednesday, Nov. 2. Click here to register.

NIH’s HEAL Initiative Highlights Examples of Successful Programs to Prevent and Treatment Opioid Misuse and Addiction

The National Institutes of Health’s (NIH) Helping to End Addiction Long-term, or HEAL, initiative— a trans-NIH research effort focused on improving prevention and treatment for opioid misuse and addiction and enhancing pain management—recently released examples of programs that have helped some of the youngest patients battling opioid misuse or addiction. HEAL funds more than 1,000 research projects in every U.S. state and is a $2.5 billion effort that has grown substantially this year, adding 10 new programs and more than 200 new projects that are seeking scientific solutions to prevent overdose and connect people to treatment for pain and addiction. Click here to learn about some innovative programs related to mobile apps.

Enhanced NABH Denial-of-Care Portal is Now Available

NABH recently made enhancements to its Denial-of-Care Portal that are intended to make the portal easier for members to use. A year ago, NABH developed the Denial-of-Care Portal to collect specific data on insurers who deny care—often without regard to parity or the effects on patients. Now the association has updated this resource to make it more user-friendly for members and also more aligned with what regulators need to identify parity violations. The updated portal includes fewer questions, which will require less time for members to complete. In addition, all questions are now optional. NABH hopes this will make it more likely for members to share the data they have. Lastly, NABH has added a checklist of “red flags” that were included in the 2022 MHPAEA Report to Congress from the U.S. Health and Human Services, Labor, and Treasury Departments in January. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal. Save the Date for the NABH 2023 Annual Meeting!  Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

By 2030, HHS’ Health Resources and Services Administration (HRSA) estimates a 20% decrease in the supply of adult psychiatrists to 27,020, while the agency estimates a 22% increase in the supply of child and adolescent psychiatrists to 9,830. For questions or comments about this CEO Update, please contact Jessica Zigmond.

MHA Releases ‘State of Mental Health in America’ Report for 2023

More than 50 million Americans experienced a mental illness between 2019 and 2020, while more than one in 10 youth in the United States experience depression that is severely impairing their ability to function at school or work, at home, with family, or in their social life, according to a new report from Mental Health America (MHA). The State of Mental Health in America is a nearly 40-page chartbook that provides a baseline to answer some questions about how many people in America need and have access to mental health services. The report is a companion piece to interactive data available on MHA’s website. Using publicly available data from the 50 states and Washington, D.C., MHA used a set of 15 measures, such as adults with any mental illness, adults with thoughts of suicide, and youth with substance use disorder in the last year. MHA noted that the Covid-19 pandemic negatively affected the ability to collect data for national surveillance in 2020; consequently, the indicators in this year’s report cannot be compared with previous years. The findings also reported that the majority of individuals with a substance use disorder in the U.S. are not receiving treatment, and that there are about 350 individuals for every one mental healthcare provider in the United States.

SAMHSA Announces $15 Million in Early 2023 for CCBHCs

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week announced it will award $15 million early next year to expand access to planning grants for certified community behavioral health clinics (CCBHCs) to all 50 states. This funding—along with the $300 million that SAMHSA awarded in September for both new and existing CCBHCs—comes from the Bipartisan Safer Communities Act that President Biden signed in June.

CMS Releases FAQs About Medicaid and CHIP Determinations and Renewals After PHE Ends

The Centers for Medicare & Medicaid Services on Oct. 17 answers to frequently asked questions about the agency’s March 2022 guidance to states regarding planning efforts to resume Medicaid and Children’s Health Insurance Program (CHIP) eligibility determinations and renewals after the Covid-19 public health emergency ends. The FAQs address the unwinding period, renewals and changes in circumstances, non-MAGI ex parte renewals, section 1902(e)(14)(A) waivers, premiums, fraud, and more.

New Reports Examine Telehealth Laws & Medicaid Policies and Trauma & Recovery for Youth

The Center for Connected Health Policy (CCHP) this week released its Fall 2022 summary of telehealth laws and Medicaid program policies, which allows users to export data for each state into a PDF document. CCHP provides bi-annual summary reports to provide a snapshot of the progress made in the past six months. Also this week, the National Child Traumatic Stress Network released A Trauma-Informed Guide for Working with Youth in Multiple Settings, which is intended for people who work with youth involved in multiple systems (YIMS) and their families to use a traumatic stress perspective and provide trauma-informed care. The report defines YIMS as children and adolescents who are under the care or supervision of multiple child and family-serving systems. They include “crossover youth” or “dually involved youth” who are involved in child welfare (CW) and in the juvenile justice (JJ) system. In addition to CW and JJ involvement, YIMS are also often simultaneously involved in an array of other service systems including immigration, legal, education, family services, physical and behavioral health systems and systems designed to serve those with developmental disabilities or who experience homelessness.

Register Today for Oct. 27 Webinar on CPT Coding and Billing Changes for Mental Health in 2023

The Association for Behavioral Health and Wellness, the American Psychological Association, and the American Psychiatric Association will host a webinar about what to expect in CPT coding and billing changes for mental health in 2023 on Thursday, Oct. 27. Stephen Gillaspy, Ph.D., senior director of health and healthcare financing at the American Psychological Association, will lead the presentation about the Centers for Medicare and Medicaid Services’ (CMS) proposed changes outlined in the agency’s 2023 physician fee schedule proposed rule. The webinar will focus on new CPT codes and changes to existing codes, expanding the outpatient Evaluation and Management (E/M) documentation guidelines to the facility setting, and other CMS proposals, such as “incident to” billing that, if implemented, will have a significant effect on mental and behavioral clinicians beginning Jan.  1, 2023. The hourlong webinar will begin at 12:30 p.m. ET. Click here to register.

Enhanced NABH Denial-of-Care Portal is Now Available

NABH recently made enhancements to its Denial-of-Care Portal that are intended to make the portal easier for members to use. A year ago, NABH developed the Denial-of-Care Portal to collect specific data on insurers who deny care—often without regard to parity or the effects on patients. Now the association has updated this resource to make it more user-friendly for members and also more aligned with what regulators need to identify parity violations. The updated portal includes fewer questions, which will require less time for members to complete. In addition, all questions are now optional. NABH hopes this will make it more likely for members to share the data they have. Lastly, NABH has added a checklist of “red flags” that were included in the 2022 MHPAEA Report to Congress from the U.S. Health and Human Services, Labor, and Treasury Departments in January. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

More seniors in 2022 (28%) than in 2021 (20%) said the cost of care affected their ability to seek treatment for a mental health condition, according to a survey of seniors that the Pan Foundation conducted in May 2022. For questions or comments about this CEO Update, please contact Jessica Zigmond.

NABH 2023 Board Position Nominations Due Today!

The deadline to submit nominations for the 2023 NABH Board Chair-Elect and two available NABH Board seats is today, Friday, Oct. 14. The NABH Selection Committee is seeking senior managers who represent the association’s diverse membership related to levels of care, organizational structures, and size. Please download a nomination form to recommend individuals for the single-slate ballot in 2023. Also, please attach a curriculum vitae (CV) for every individual you recommend. This will help the Selection Committee in its deliberations. All NABH members are welcome to suggest themselves. Please return this form and candidates’ curricula vitae by Friday, Oct. 14, 2022, to maria@nabh.org.

Becerra Extends Covid-19 PHE for Another 90 Days

HHS Secretary Xavier Becerra on Thursday renewed the Covid-19 public health emergency (PHE) for an additional 90 days. Former HHS Secretary Alex Azar declared the Covid-19 PHE for the first time in January 2020 Since then, it has been renewed—either by Azar or Becerra— 10 times, making this week’s announcement the 11^th renewal.

Bipartisan Policy Center Recommends Extending Medicare Telehealth Benefits for Two Years Post Pandemic

Congress and the Biden administration should extend most of the Medicare program’s telehealth flexibilities for beneficiaries for two years after the Covid-19 pandemic ends and then evaluate the effects, the Bipartisan Policy Center (BPC) recommended in a report released this week. And that’s for a start. The report—totaling more than 80 pages—also concluded that researchers should evaluate the benefits of hybrid (both in-person and virtual) care models for primary and specialty care, including for which conditions and specialties it is most effective; further evaluate full telehealth flexibilities in the context of value-based payment models; and assess rigorously the quality of audio-only care. “Throughout this report, BPC recommends targeted adjustments to the current telehealth flexibilities; all recommended changes are in response to emerging evidence on benefits versus risks and to stakeholder concerns,” the researchers noted. “This approach would enable beneficiaries to maintain their access to telehealth services while minimizing risks to patients and the Medicare program, as well as provide time for policymakers to continue to review and assess the evidence.”

ONDCP to Host Webinar About Low-Threshold Buprenorphine on Monday, Oct. 17

The White Office of National Drug Control Policy (ONDCP) will host a webinar on Monday, Oct. 17 to examine low-threshold buprenorphine programs, which seek to reduce barriers that often limit access or reduce retention in care. ONDCP Director Rahul Gupta, M.D. will welcome participants to the webinar, which will feature evidence from experts in the field and include a panel discussion about policy and practice. The webinar will be held from 1 p.m. – 3 p.m. ET. Click here to register.

Register Today for Webinar on CPT Coding and Billing Changes for Mental Health in 2023

The Association for Behavioral Health and Wellness, the American Psychological Association, and the American Psychiatric Association will host a webinar about what to expect in CPT coding and billing changes for mental health in 2023 on Thursday, Oct. 27. Stephen Gillaspy, Ph.D., senior director of health and healthcare financing at the American Psychological Association, will lead the presentation about the Centers for Medicare and Medicaid Services’ (CMS) proposed changes outlined in the agency’s 2023 physician fee schedule proposed rule. The webinar will focus on new CPT codes and changes to existing codes, expanding the outpatient Evaluation and Management (E/M) documentation guidelines to the facility setting, and other CMS proposals, such as “incident to” billing that, if implemented, will have a significant effect on mental and behavioral clinicians beginning Jan.  1, 2023. The hourlong webinar will begin at 12:30 p.m. ET. Click here to register.

JAMA Pediatrics Examines Continued Rise of Unintentional Ingestion of Edible Cannabis in Toddlers

An analysis in JAMA Pediatrics this week concluded that immediate action should be taken to alter the current trajectory of unintentional pediatric ingestion of edible cannabis products. The article noted that cannabis is the third most used psychoactive substance worldwide, with use continuously rising in the U.S. adult population. Meanwhile, cannabis products are used commonly and stored in homes in which children are present and education from healthcare professionals about safe storage is lacking, the article continued. Consequently, children are at risk of being drawn to THC (tetrahydrocannabinol, the psychoactive compound of marijuana)-infused products that resemble their favorite snacks or candy. “Children with THC intoxication can present with neurologic impairment, including lethargy, ataxia, tachycardia, mydriasis, seizures, altered mental status, and hypotonia,” the article said. “However, given the unpredictability of the dose ingested, patient presentation can vary. Altered mental status in children results in broad differential diagnoses ranging from traumatic to infectious causes.”

Enhanced NABH Denial-of-Care Portal is Now Available

NABH recently made enhancements to its Denial-of-Care Portal that are intended to make the portal easier for members to use. A year ago, NABH developed the Denial-of-Care Portal to collect specific data on insurers who deny care—often without regard to parity or the effects on patients. Now the association has updated this resource to make it more user-friendly for members and also more aligned with what regulators need to identify parity violations. The updated portal includes fewer questions, which will require less time for members to complete. In addition, all questions are now optional. NABH hopes this will make it more likely for members to share the data they have. Lastly, NABH has added a checklist of “red flags” that were included in the 2022 MHPAEA Report to Congress from the U.S. Health and Human Services, Labor, and Treasury Departments in January. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

A 2016 parent survey shows 64% of children with Attention Deficit/Hyperactivity Disorder (ADHD) had at least one other mental, emotional, or behavioral disorder, the Centers for Disease Control and Prevention reports. October is ADHD Awareness Month. Help the National Institute of Mental Health raise awareness by sharing these resources. For questions or comments about this CEO Update, please contact Jessica Zigmond.

NABH Seeking Candidates for 2023 Board Positions

The NABH Selection Committee is seeking nominations to fill the NABH Board Chair-Elect and two NABH Board seats that will become available in 2023. In particular, the committee wants to identify senior managers who represent the association’s diverse membership related to levels of care, organizational structures, and size. Please download a nomination form to recommend individuals for the single-slate ballot in 2023. Please attach a curriculum vitae (CV) for every individual you recommend. This will help the Selection Committee in its deliberations. All NABH members are welcome to suggest themselves. Please return this form and candidates’ curricula vitae by Friday, Oct. 14, 2022, to maria@nabh.org.

Harris Poll Shows Strong Public Support for Mental Health and Uncertainty on How to Help

Two in three U.S. adults say they believe they don’t have enough knowledge to tell if someone is considering suicide, while eight in 10 adults say they are open to learning how to help someone in need, according to a Harris Poll survey released this week. Since 2015, the American Foundation for Suicide Prevention (AFSP), the National Action Alliance for Suicide Prevention (Action Alliance), and the Suicide Prevention Resource Center (SPRC) have commissioned the Harris Poll to conduct bi-annual, nationally representative survey of adults in the United States to understand the public’s beliefs and attitudes about mental health and suicide. The survey evaluates what the public knows about to support someone who is struggling and their perceptions of barriers to help those at risk for suicide. This latest poll offers an early read on public awareness of 988, the national behavioral health crisis hotline that launched in July. Researchers found that while gains have been made in valuing mental health, there is not consistent societal support for mental healthcare. The findings show that 76% of Americans surveyed said they perceive mental health as equal to physical health, while 51% said they feel that physical health is treated as more important of the two. Meanwhile, 67% of those surveyed said they believe they have had a mental health condition at some point in their lives, up from 60% who said so in 2018 and 57% in 2018. “Overall, the poll indicates that progress has been made, but there is more to do,” the report noted. “We must continue to learn more about suicide and mental health particularly through increased research efforts, teach everyone how to help prevent suicide and strengthen mental health, and advocate for improved access to care and robust crisis services.”

ONDCP to Host Webinar About Low-Threshold Buprenorphine on Oct. 17

The White House Office of National Drug Control Policy (ONDCP) will host a webinar on Monday, Oct. 17 to examine low-threshold buprenorphine programs, which seek to reduce barriers that often limit access or reduce retention in care. ONDCP Director Rahul Gupta, M.D. will welcome participants to the webinar, which will feature evidence from experts in the field and include a panel discussion about policy and practice. The webinar will be held from 1 p.m. – 3 p.m. ET. Click here to register.

HRSA Previews Behavioral Health Training Opportunities for Primary Care Residents

The Health Resources and Services Administration (HRSA) this week announced a funding opportunity totaling nearly $60 million during a five-year period to support training to expand the public health workforce. The new program will train primary care residents in the prevention, identification, diagnosis, treatment, and referral of services for mental and behavioral health conditions. It is intended to benefit pediatric, adolescent, young adult, and other populations who are at-risk or have experienced abuse, trauma, or mental health and/or substance use disorders, including those related to the effects of gun violence. According to HRSA, awards will support both classroom training and clinical rotations that focus on mental and behavioral health conditions. Eligible entities include accredited public or not-for-profit private hospitals; schools of allopathic medicine or osteopathic medicine; residency programs accredited by the Accreditation Council for Graduate Medical Education in family medicine, general internal medicine, general pediatrics or combined internal medicine and pediatrics (“med-peds”); and tribes and tribal organizations, if otherwise eligible. Click here to be notified when this funding opportunity opens.

Enhanced NABH Denial-of-Care Portal is Now Available

NABH recently made enhancements to its Denial-of-Care Portal that are intended to make the portal easier for members to use. A year ago, NABH developed the Denial-of-Care Portal to collect specific data on insurers who deny care—often without regard to parity or the effects on patients. Now the association has updated this resource to make it more user-friendly for members and also more aligned with what regulators need to identify parity violations. The updated portal includes fewer questions, which will require less time for members to complete. In addition, all questions are now optional. NABH hopes this will make it more likely for members to share the data they have. Lastly, NABH has added a checklist of “red flags” that were included in the 2022 MHPAEA Report to Congress from the U.S. Health and Human Services, Labor, and Treasury Departments in January. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

A Harris Poll survey released this week found that more than half of adults in the United States say seeing a mental health professional is a sign of strength. For questions or comments about this CEO Update, please contact Jessica Zigmond.

House to Vote Friday on Senate-Approved Stopgap Spending Measure

The House of Representatives is expected to vote Friday on the short-term spending bill the Senate approved Thursday to avert a federal government shutdown and increase aid to Ukraine. Included in the legislation is a provision to continue funding the national 988 behavioral crisis hotline through Sept. 30, 2023, for which Congress has appropriated $62,000,000.

TODAY: SAMHSA to Moderate Recovery Month Panel at 1:15 p.m. ET

Acting Deputy Assistant Secretary Tom Coderre of the Substance Abuse and Mental Health Services Administration (SAMHSA) will moderate a panel discussion at 1:15 p.m. ET today, Friday, Sept. 30, the last day of National Recovery Month. Titled “Making Small Choices, Every Day,” the event will feature panelists who will discuss their recovery experiences while sharing success stories and providing hope that recovery is possible. The panel will address seeking treatment for mental illness or substance use disorders, overcoming challenges such as stigma, and helping the public understand the importance of helping those in recovery. SAMHSA will livestream the event on the agency’s Facebook page.

House Passes Bill to Bolster Mental Health Parity Protections for Workers

The House earlier this week passed the Mental Health Matters Act of 2022, a bill intended to hold employer-based health plans more accountable for inappropriate denials of mental health and substance use benefits. The legislation would give the U.S. Labor Department more authority to enforce plan requirements under the Mental Health Parity and Addiction Equity Act and the Employee Retirement Income Security Act. It also would ban forced arbitration agreements when plans deny benefits improperly, and ensure a fair standard of review from the courts. Before the bill passed, the White House released a Statement of Administrative Policy supporting the legislation. The White House noted that the Mental Health Matters Act also would improve the well-being of young children in Head Start and K-12 schools by building on President Biden’s efforts to increase the number of school-based mental health services providers, as well as authorizing grants to partnerships between high-need, local educational agencies, and institutions of higher education. NABH will continue to track developments related to this bill.

CMS Releases Latest Enrollment Figures for Medicare, Medicaid, and CHIP

The Centers for Medicare & Medicaid Services (CMS) this week released the agency’s latest enrollment figures for Medicare, Medicaid & the Children’s Health Insurance Program (CHIP), and the health insurance marketplaces, reporting that 156.5 million Americans have coverage in these federal health insurance programs. According to the latest figures, there are 89.4 million enrollees in Medicaid and CHIP, 64.6 million enrollees in Medicare, and 14.5 million people enrolled in state-based and federal health insurance marketplaces. The agency reported a subtotal figure of 168.5 million enrollees, which CMS then adjusted by subtracting 12 million to account for Americans who are dually eligible for both Medicare and Medicaid. Click here for a breakdown of the individual programs.

Former ONDCP Leaders Pen Opinion Piece on Increasing Recovery Services

On this last day of National Recovery Month, two former leaders at the White House Office of National Drug Control Policy wrote an opinion piece in The Hill newspaper to call for more training in addiction science and policymaking. In their blog, former ONDCP Director Michael Botticelli and Regina LaBelle, a former acting director at ONDCP and director of the Addiction and Public Policy Initiative at the Georgetown University Law Center’s O’Neill Institute, recognized the role that people in recovery play by building healthier communities. They also emphasized the need to remove barriers to healthcare, housing, and employment and education, including modifying the regulatory hurdles that reduce access to methadone.

Enhanced NABH Denial-of-Care Portal is Now Available

NABH recently made enhancements to its Denial-of-Care Portal that are intended to make the portal easier for members to use. A year ago, NABH developed the Denial-of-Care Portal to collect specific data on insurers who deny care—often without regard to parity or the effects on patients. Now the association has updated this resource to make it more user-friendly for members and also more aligned with what regulators need to identify parity violations. The updated portal includes fewer questions, which will require less time for members to complete. In addition, all questions are now optional. NABH hopes this will make it more likely for members to share the data they have. Lastly, NABH has added a checklist of “red flags” that were included in the 2022 MHPAEA Report to Congress from the U.S. Health and Human Services, Labor, and Treasury Departments in January. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

Early intervention in psychosis programs contributed to, on average, 3.2 fewer hospitalizations and 2.7 more years employed during the course of patients’ lives compared with individuals with the same diagnosis who received standard care, according to a study published in Psychiatric Services. For questions or comments about this CEO Update, please contact Jessica Zigmond

Biden Administration Announces More Than $1.6 Billion for Communities to Address Addiction & Overdose Crises

The U.S. Health and Human Services Department (HHS) on Friday announced it will award more than $1.6 billion in investments to communities nationwide to address America’s addiction and overdose crises. Funding will come from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) State Opioid Response (SOR) program and Tribal Opioid Response (TOR) grant program and the Health Resources and Services Administration’s (HRSA) rural communities’ opioid response programs.   “I have heard many stories of despair from individuals battling addiction and from families who have lost loved ones to overdose,” HHS Secretary Xavier Becerra said in the grant announcement. “Through these grants, we are investing in evidence-based supports and services for individuals, families, and communities on the road to recovery.” Click here to learn about the four individual grant opportunities.

Covid-19 PHE Will Likely Be Extended Due to Absence of 60-Day Termination Notice from HHS

The Covid-19 public health emergency (PHE) will most likely be extended for another 90 days after the PHE’s current Oct. 13, 2022 expiration date because HHS has not given states 60 days’ notice before termination. In January 2021, HHS’s Administration for Strategic Preparedness & Response (ASPR0 sent a letter to the nation’s governors outlining the commitment to a 60-day, PHE termination notice. HHS Assistant Secretary for Public Affairs Sarah Lovenheim posted a message on Twitter this past Monday, Sept. 19, that assured states and providers there will be at least two months’ notice before the PHE is allowed to expire. NABH will notify members about any updates related to the PHE’s end date.

National Center on Substance Abuse and Child Welfare to Host Sept. 27 Webinar on Contingency Management

SAMHSA announced this week that the National Center on Substance Abuse and Child Welfare will host a webinar on Thursday, Sept. 29 that highlights how contingency management can help families affected by substance use disorders. The webinar will provide an overview of contingency management, including details about implementation with different cultural populations. It will also show how Montefiore Medical Center in New York, a Regional Partnership Grant awardee, has implemented contingency management, and provide practical strategies for implementation. The webinar will begin next Thursday at 1:30 p.m. ET. Click here to register.

NIH-Led Study Shows Heart Medication Could Be Effective for Alcohol Use Disorder

A medication to treat heart problems and high blood pressure may also be effective for treating alcohol use disorder, according to a new study from researchers at the National Institutes of Health (NIH) and published in Molecular Psychiatry. The research shows evidence from experiments in mice and rats—as well as a cohort study in humans—that suggests the medication spironolactone could play a role in reducing alcohol drinking. Researchers from the NIH’s National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, as well as from the Yale School of Medicine, produced the study. “Combining findings across three species and different types of research studies, and then seeing similarities in those data, gives us confidence that we are onto something potentially important scientifically and clinically,” Lorenzo Leggio, M.D., Ph.D., chief of the clinical psychoneuroendocrinology and neuropsychopharmacology section, a joint laboratory of NIDA and NIAAA, and one of the senior authors, said in an announcement about the research. “These findings support further study of spironolactone as a potential treatment for alcohol use disorder, a medical condition that affects millions of people in the U.S.”

Enhanced NABH Denial-of-Care Portal is Now Available

NABH recently made enhancements to its Denial-of-Care Portal that are intended to make the portal easier for members to use. A year ago, NABH developed the Denial-of-Care Portal to collect specific data on insurers who deny care—often without regard to parity or the effects on patients. Now the association has updated this resource to make it more user-friendly for members and also more aligned with what regulators need to identify parity violations. The updated portal includes fewer questions, which will require less time for members to complete. In addition, all questions are now optional. NABH hopes this will make it more likely for members to share the data they have. Lastly, NABH has added a checklist of “red flags” that were included in the 2022 MHPAEA Report to Congress from the U.S. Health and Human Services, Labor, and Treasury Departments in January. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

Prenatal cannabis exposure following the middle of the first trimester is associated with attention, social, and behavioral problems in children that persist into early adolescence, according to a recent study in JAMA Pediatrics based on research funded by the National Institute on Drug Abuse. For questions or comments about this CEO Update, please contact Jessica Zigmond.

NABH Annual Membership Updates Are Due Today, Sept. 16!

Today, Friday, Sept. 16, is the deadline for members to submit changes about their organizations for the online-only NABH 2022 Membership Directory. Last month NABH sent its system members a message with a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use this tool to verify your system’s information. NABH has added several new categories this year. 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 diverse membership. If you need NABH to re-send the link, please contact Maria Merlie at maria@nabh.org. Thank you for your cooperation!

NABH Submits Comments on CMS’ Proposed Rule for Medicare Hospital Outpatient Prospective Payment System

NABH this week sent comments and recommendations to the Centers for Medicare & Medicaid Services (CMS) regarding the agency’s proposed Medicare Hospital Outpatient Prospective Payment System (OPPS) for calendar year 2023 (CY 2023). In its five-page letter, NABH proposed that CMS examine ways to account for increased costs to ensure that beneficiaries continue to have access to quality outpatient care and offered a range of recommendations, including: reducing the productivity cut for CY 2023; ensuring that non-340B hospitals remain unharmed; expanding telehealth services; and more.

CMS Announces Approval of Nation’s First Medicaid Mobile Crisis Intervention Services Program

The Centers for Medicare & Medicaid Services (CMS) this week announced approval of the Oregon Health Authority’s proposal to cover community-based stabilization services throughout the state. Oregon is the first state to seek and be granted approval for the new Medicaid option that became available to states in April 2022.  The program will provide community-based stabilization services to individuals experiencing mental health and/or substance use crises by connecting them to a behavioral health specialist 24 hours a day, every day of the year.

Sound the Alarm for Kids Virtual Roundtable is Today, Friday, Sept. 16 at 1 p.m. ET

Sound the Alarm for Kids will host “Helping Girls Thrive: A Conversation Examining Trends in Girls’ Mental Health” is today, Friday, Sept. 16 at 1 p.m. ET. The virtual roundtable discussion will examine the national campaign to raise awareness about today’s mental health crisis among children and teens and how to create change. Some of the speakers include Christina Bethell, Ph.D., M.P.H., M.B.A, director of the Child and Adolescent Health Measurement Initiative at Johns Hopkins University and Kelley Haynes-Mendez, Psy.D., senior director of the human rights team at the American Psychological Association. Click here to register.

Enhanced NABH Denial-of-Care Portal is Now Available

NABH recently made enhancements to its Denial-of-Care Portal that are intended to make the portal easier for members to use. A year ago, NABH developed the Denial-of-Care Portal to collect specific data on insurers who deny care—often without regard to parity or the effects on patients. Now the association has updated this resource to make it more user-friendly for members and also more aligned with what regulators need to identify parity violations. The updated portal includes fewer questions, which will require less time for members to complete. In addition, all questions are now optional. NABH hopes this will make it more likely for members to share the data they have. Lastly, NABH has added a checklist of “red flags” that were included in the 2022 MHPAEA Report to Congress from the U.S. Health and Human Services, Labor, and Treasury Departments in January. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

Based on data from 14 state maternal mortality review committees, the Centers for Disease Control and Prevention (CDC) reports that mental health conditions—including suicide—are the 6th leading cause of pregnancy-related death. For questions or comments about this CEO Update, please contact Jessica Zigmond

NABH Welcomes Rochelle Archuleta as Executive Vice President for Government Relations and Public Policy

Rochelle Archuleta has joined NABH as executive vice president for government relations and public policy, effective Sept. 6. Rochelle brings to NABH 30 years of experience in the health policy, healthcare delivery system, and legislative arenas. During her 20-year tenure as a policy director for the American Hospital Association (AHA), Rochelle led AHA’s post-acute care policy team. In this role, Rochelle partnered with providers, policymakers, and leading trade associations on issues pertaining to the home health, skilled nursing facility/nursing home, inpatient rehabilitation facility, and long-term care hospital sectors. These advocacy efforts expanded to include issues of common concern to all post-acute care providers and their hospital partners, including issues pertaining to Medicare Advantage and commercial insurers, as well as the Medicare program’s effort to create a new, unified payment system to reimburse the aforementioned, post-acute care settings. “We are pleased to welcome Rochelle to our team,” said Shawn Coughlin, president and CEO at NABH. “Rochelle’s extensive work in healthcare policy, as well as her strong relationships with partner associations, will enhance NABH’s advocacy efforts—both with legislators and regulators.” Rochelle is a research fellow in the Georgetown University McCourt School of Public Policy and is a former David Winston Health Policy Fellow. She earned a master of science in health administration and a master of business administration from the University of Alabama at Birmingham School of Health Professions and a bachelor of arts in political science from the University of Colorado at Boulder.

NABH Submits Comments on CMS’ Proposed Medicare Physician Fee Schedule for 2023

NABH this week sent comments and recommendations to the Centers for Medicare & Medicaid Services (CMS) regarding the agency’s proposed Medicare physician fee schedule for fiscal year 2023. In its nine-page letter, NABH proposed revisions to the “Incident to” regulations and offered a range of recommendations related to the 2023 conversion factor, telehealth, opioid treatment services, coding and payment mechanisms, adjustments to the rate-setting methodology for behavioral health, and more.

HHS-OIG Report Shows Medicare Telehealth Fraud Was Rare During Covid-19 Pandemic

A new report from HHS’ Office of Inspector General (OIG) found a very small fraction of provider claims for Medicare telehealth services during the Covid-19 pandemic may have indicated fraud, waste, or abuse of those services.   The OIG’s offices analyzed Medicare fee-for-service claims data and Medicare Advantage encounter data from March 1, 2020 to Feb. 28, 2021 and focused on about 742,000 providers who billed for a telehealth services. Examining seven measures on different types of billing, investigators identified 1,1714 providers whose billing for telehealth services during the first year of the pandemic posed a high risk to the Medicare program. Those providers billed for telehealth for about half a million beneficiaries and received a total of about $127.7 million in Medicare fee-for-service payments, according to the report.   “Each of these 1,714 providers had concerning billing on at least 1 of 7 measures we developed that may indicate fraud, waste, or abuse of telehealth services,” the report noted. “All of these providers warrant further scrutiny. For example, they may be billing for telehealth services that are not medically necessary or were never provided.”

NABH Annual Membership Updates Are Due Next Friday, Sept. 16!

Next Friday, Sept. 16 is the deadline for members to submit changes about their organizations for the online-only NABH 2022 Membership Directory. Last month NABH sent its system members a message with a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use this tool to verify your system’s information. NABH has added several new categories this year. 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 diverse membership. If you need NABH to re-send the link, please contact Maria Merlie at maria@nabh.org. Thank you for your cooperation!

Sound the Alarm for Kids to Host Virtual Roundtable on Friday, Sept. 16

Sound the Alarm for Kids will host “Helping Girls Thrive: A Conversation Examining Trends in Girls’ Mental Health” next Friday, Sept. 16 at 1 p.m. ET. The virtual roundtable discussion will examine the national campaign to raise awareness about today’s mental health crisis among children and teens and how to create change. Some of the speakers include Christina Bethell, Ph.D., M.P.H., M.B.A, director of the Child and Adolescent Health Measurement Initiative at Johns Hopkins University and Kelley Haynes-Mendez, Psy.D., senior director of the human rights team at the American Psychological Association. Click here to register.

Enhanced NABH Denial-of-Care Portal is Now Available

NABH recently made enhancements to its Denial-of-Care Portal that are intended to make the portal easier for members to use. A year ago, NABH developed the Denial-of-Care Portal to collect specific data on insurers who deny care—often without regard to parity or the effects on patients. Now the association has updated this resource to make it more user-friendly for members and also more aligned with what regulators need to identify parity violations. The updated portal includes fewer questions, which will require less time for members to complete. In addition, all questions are now optional. NABH hopes this will make it more likely for members to share the data they have. Lastly, NABH has added a checklist of “red flags” that were included in the 2022 MHPAEA Report to Congress from the U.S. Health and Human Services, Labor, and Treasury Departments in January. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

A recent study of 175,778 Medicare beneficiaries found that receipt of opioid use disorder-related telehealth services during the Covid-19 pandemic was associated with improved medications for opioid use disorder (MOUD) retention and lower odds of medically treated overdose, JAMA Psychiatry reports. For questions or comments about this CEO Update, please contact Jessica Zigmond.

September is National Recovery Awareness Month

This week kicked off National Recovery Month, a national observance every September since 1989 intended to promote and support new evidence-based treatment and recovery practices, the nation’s recovery community, and the dedication of service providers and community leaders who make recovery possible. During this past week’s Overdose Awareness Week, which concludes tomorrow, President Biden issued a National Recovery Month proclamation in which he acknowledged the more than 20 million Americans recovering from substance use disorder and highlighted his administration’s efforts to support recovery. “This year, we secured nearly $22 billion from the Congress to support drug prevention, treatment, harm reduction, and recovery support services, with a focus on underserved communities,” the president said in his proclamation. “With the additional $4 billion investment from our American Rescue Plan, my administration is expanding recovery community organizations, recovery high schools, collegiate recovery programs, and recovery residences.” For more information about National Recovery Month, please visit the Substance Abuse and Mental Health Administration’s (SAMHSA) website, and please remember to follow NABH @NABHbehavioral and on LinkedIn at the National Association for Behavioral Healthcare. HHS Announces $47.6 Million in New Grant Funding for School-Based Mental Health The U.S. Health and Human Services Department (HHS) this week announced $47.6 million in new grant funding opportunities through this Bipartisan Safer Communities Act to support mental health programs in schools. Of that amount, $37.6 million is allocated for Project Advancing Wellness and Resiliency in Education, or AWARE, which is meant to develop a sustainable infrastructure for school-based mental health programs and services that promote the healthy social and emotional development of school-aged youth and prevent youth violence in schools. The remaining $10 million is for the Resiliency in Communities after Stress and Trauma (ReCast) grant program, which helps assist high-risk youth and families by promoting resilience and equity in communities that have recently experienced civil unrest, community violence, and/or collective trauma through evidence-based, violence prevention, and community youth engagement programs, as well as connections to trauma-informed behavioral health services.

Nonfatal Opioid-Involved Overdoses in Emergency Departments Are Rising

The rate of nonfatal, opioid-involved overdose emergency medical services (EMS) encounters increased by an average of 4% quarterly from January 2018 – March 2022, according to new research from the Centers for Disease Control and Prevention (CDC). The findings also reported that rates increased across most sociodemographic and county characteristics. Researchers noted that monitoring nonfatal, opioid-involved overdose trends in EMS data in near real time can help identify where overdose affects communities disproportionately and direct equitable response and prevention efforts, such as increased access to harm-reduction services and connections to care and treatment. Click here to read the full CDC report.

Reminder: HRSA Announces Funding for 2023 Rural Health Network Development Program

Both not-for-profit and for-profit organizations are eligible to apply for the Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy’s (FORHP) 2023 Rural Health Development Program, a four-year program to support integrated healthcare networks to improve outcomes and strengthen the nation’s rural healthcare system. The FORHP will make 44 awards of up to $300,000 each as part of the program, which focuses on four domains: improving access by addressing gaps in care, workforce shortages, better workflows and/or improving the quality of healthcare services; expanding capacity and services by creating effective systems through the development of knowledge, skills, structures, and leadership models; enhancing outcomes by improving patient and/or network development outcomes through expanding or strengthening the network’s services, activities or interventions; and establishing sustainability by positioning the network to prepare for sustainable health programs through value-based care and population health management. FORHP will hold a webinar for applicants on Wednesday, Sept. 7, 2022 from 2 p.m. to 3:30 P.M. ET. Click here for more information about the grants and here for next month’s webinar link.

NABH Submits Medicare Advantage Program Recommendations to CMS

NABH this week responded to a request for information from the Centers for Medicare & Medicaid Services (CMS) about the Medicare Advantage (MA) program and behavioral health. In its letter, NABH cited a recent study that found MA networks included only 23% of psychiatrists in a county on average — lower than all other medical specialties. “Not surprisingly, MA enrollees with depressive symptoms report more difficulty accessing needed treatment and rated their experience with the MA plans as worse than in traditional Medicare,” the letter said. The association provided information and outlined recommendations related to advancing health equity, expanding access, encouraging innovation to promote patient-centered care, and engaging partners.

Extended Deadline: NABH Annual Membership Updates Are Due Friday, Sept. 16

NABH has extended the deadline to Friday, Sept. 16 for members to submit changes about their organizations for the online-only NABH 2022 Membership Directory. Last month NABH sent its system members a message with a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use this tool to verify your system’s information. NABH has added several new categories this year. 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 diverse membership. If you need NABH to re-send the link, please contact Maria Merlie at maria@nabh.org. Thank you for your cooperation!

Enhanced NABH Denial-of-Care Portal is Now Available 

NABH recently made enhancements to its Denial-of-Care Portal that are intended to make the portal easier for members to use. A year ago, NABH developed the Denial-of-Care Portal to collect specific data on insurers who deny care—often without regard to parity or the effects on patients. Now the association has updated this resource to make it more user-friendly for members and also more aligned with what regulators need to identify parity violations. The updated portal includes fewer questions, which will require less time for members to complete. In addition, all questions are now optional. NABH hopes this will make it more likely for members to share the data they have. Lastly, NABH has added a checklist of “red flags” that were included in the 2022 MHPAEA Report to Congress from the U.S. Health and Human Services, Labor, and Treasury Departments in January. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

Since October, the use of hashtags related to self-harm – such as “#shtwt, short for Self-Harm Twitter – has increased roughly 500%, averaging tens of thousands of mentions per month, according to a new study from the Network Contagion Research Institute and Rutgers University. For questions or comments about this CEO Update, please contact Jessica Zigmond

Extended Deadline: NABH Annual Membership Updates Are Due Friday, Sept. 16

NABH has extended the deadline to Friday, Sept. 16 for members to submit changes about their organizations for the online-only NABH 2022 Membership Directory. Last month NABH sent its system members a message with a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use this tool to verify your system’s information. NABH has added several new categories this year. 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 diverse membership. If you need NABH to re-send the link, please contact Maria Merlie at maria@nabh.org. Thank you for your cooperation!

NABH and Partner Groups Ask HHS Secretary Becerra to Integrate Mental and Physical Health Within ASPR

NABH and more than 50 other advocacy organizations this week sent a letter to U.S. Health and Human Services Department (HHS) Secretary Becerra that urged the Biden administration to integrate mental and physical health within the Administration for Strategic Preparedness and Response (ASPR). Last month HHS announced that Becerra had elevated the then-existing Office of the Assistant Secretary for Preparedness and Response from a staff division to an operating division—taking the new name of the Administration for Strategic Preparedness and Response—in an effort to elevate ASPR to a standalone agency with the department, similar to the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and Substance Abuse and Mental Health Services Administration (SAMHSA). HHS’ announcement said the change would allow ASPR to mobilize a coordinated national response more effectively and efficiently during future disasters and emergencies. This week, NABH was one of many organizations that called on HHS to use this opportunity to integrate mental and physical health when forming a national response to such events. “Therefore, with the elevation of ASPR within HHS, the Biden administration must seize this important opportunity to integrate our mental and physical health response in order to truly ensure ASPR is able to fulfill its mission to prepare and respond to health crises,” the organizations wrote in their letter to Becerra. “Needed steps include having senior positions within ASPR dedicated to ensuring the integration of mental health and substance use into all of ASPR’s work, as well as broader staff training to ensure personnel have sufficient background on why mental health is so important to emergency preparedness and response.” Click here to read the entire letter.

CEO Alliance for Mental Health Releases Updated Unified Vision for Transforming Mental Health and Substance Use Car

The CEO Alliance for Mental Health—of which NABH is a member organization— this week released an update Unified Vision for Transforming Mental Health and Substance Use Care for 2022. Please read the updated vision, which includes information related to the national 988 behavioral health crisis line that launched last month. Also, please remember to follow us @NABHbehavioral and on LinkedIn at the National Association for Behavioral Healthcare to share our posts about the vision.

HRSA Announces Funding for 2023 Rural Health Network Development Program

Both not-for-profit and for-profit organizations are eligible to apply for the Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy’s (FORHP) 2023 Rural Health Development Program, a four-year program to support integrated healthcare networks to improve outcomes and strengthen the nation’s rural healthcare system. The FORHP will make 44 awards of up to $300,000 each as part of the program, which focuses on four domains: improving access by addressing gaps in care, workforce shortages, better workflows and/or improving the quality of healthcare services; expanding capacity and services by creating effective systems through the development of knowledge, skills, structures, and leadership models; enhancing outcomes by improving patient and/or network development outcomes through expanding or strengthening the network’s services, activities or interventions; and establishing sustainability by positioning the network to prepare for sustainable health programs through value-based care and population health management. FORHP will hold a webinar for applicants on Wednesday, Sept. 7, 2022 from 2 p.m. to 3:30 P.M. ET. Click here for more information about the grants and here for next month’s webinar link.

Coalition on Physician Education in Substance Use Disorders Extends Submission Deadline for Curriculum Innovation Challenge

The Coalition on Physician Education in Substance Use Disorders (COPE), a partner organization to the Opioid Response Network, has extended the deadline for its Innovative Learning and Teaching About Substance Use/Opioid Use Disorders Curriculum Innovation Challenge to next Wednesday, Aug. 31 at 11:59 p.m. ET. The challenge is intended to support teams of medical school faculty and students in integrating addiction medicine/psychiatry content into core clerkship rotations. It is designed to foster engagement and collaboration between addiction medicine experts, medical school faculty (clerkship directors or the equivalent), and medical students using cutting-edge concepts and training tools. Through a series of virtual conferences, winning teams will be led in developing addiction medicine/psychiatry curriculum and planning subsequent implementation based on the needs of their school. Click here to learn more and apply.

Marijuana and Hallucinogen Use Among Young Adults Reached All-Time High in 2021

Marijuana and hallucinogen use reported by young adults 19 to 30 years old increased significantly in 2021 compared with five and 10 years ago, reaching historic highs in this age group since 1988, according to statistics released this week from the National Institute on Drug Abuse. The findings came from the Monitoring the Future panel study, which also reported that rates of past-month nicotine vaping, which have been gradually increasing in young adults for the past four years, also continued a general upward trend in 2021, despite leveling off in 2020. Past-month marijuana vaping, which had significantly decreased in 2020, rebounded to pre-pandemic levels in 2021. Click here to learn more.

Enhanced NABH Denial-of-Care Portal is Now Available

NABH recently made enhancements to its Denial-of-Care Portal that are intended to make the portal easier for members to use. A year ago, NABH developed the Denial-of-Care Portal to collect specific data on insurers who deny care—often without regard to parity or the effects on patients. Now the association has updated this resource to make it more user-friendly for members and also more aligned with what regulators need to identify parity violations. The updated portal includes fewer questions, which will require less time for members to complete. In addition, all questions are now optional. NABH hopes this will make it more likely for members to share the data they have. Lastly, NABH has added a checklist of “red flags” that were included in the 2022 MHPAEA Report to Congress from the U.S. Health and Human Services, Labor, and Treasury Departments in January. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

About 6% of behavioral health providers and 29% of substance use treatment centers use electronic health record (EHR) technology, compared with more than 80% of hospitals that use EHRs, according to the Medicaid and CHIP Advisory Committee’s June report to Congress (see p. 84). For questions or comments about this CEO Update, please contact Jessica Zigmond

CMS Releases ‘Roadmap’ for Providers to Prepare for End of Covid-19 PHE

The Centers for Medicare & Medicaid Services this week released a series of fact sheets and resources to help the nation’s healthcare providers prepare for the end of the Covid-19 public health emergency (PHE), which will also end many of the flexibilities the agency offered during the global pandemic. A blog post from three CMS leaders noted that the agency learned from providers, facilities, insurers, and other stakeholders about what worked well—and didn’t—in relation to the agency’s waivers and other temporary measures. “Expanding telehealth is an example of a congressional change,” said the blog post from Jonathan Blum, CMS’ chief operating officer and principal deputy administrator; Carol Blackford, director of the agency’s hospital and ambulatory policy group; and Jean Moody-Williams, deputy director of the Center for Clinical Standards and Quality. “The Consolidated Appropriations Act, 2021 expanded access to telehealth services for the diagnosis, evaluation, or treatment of mental health disorders after the end of the PHE,” the authors continued. “These services have been so important to the health and well-being of Americans affected by Covid-19.” The post also noted that U.S. Health and Human Services Department (HHS) Secretary Xavier Becerra will give the healthcare community 60 days’ notice before the PHE ends. Providers can refer to a host of fact sheets and resources from CMS in links at the end of the blog post to help prepare as the PHE winds down.

CMS Rule Proposes Requiring Behavioral Health Quality Data Reporting

CMS on Thursday released a proposed rule that would require annual state reporting for three quality measure sets, including the behavioral health measures in the Core Set of Adult Health Care Quality Measures for Medicaid. The Behavioral Health Core Set includes 13 measures: a depression measure under the Primary Care Access and Preventive Care domain; four measures related to individuals with substance use disorders including one related to medication assisted treatment; two related to the prescribing of opioids; and six measures related to individuals with mental disorders. These core sets are designed to measure the overall national quality of care for beneficiaries, monitor performance at the state level, improve the quality of health care, and provide a national view of quality. CMS has proposed that reporting these measures—currently a voluntary practice—become mandatory in fiscal year 2024. Data reported in 2024 will reflect care delivered in calendar year 2023. “The Medicaid and CHIP Core Sets of quality measures for children, adults, and health home services are key to promoting health equity,” CMS Administrator Chiquita Brooks-LaSure said in an announcement. “They will allow us not only to identify health disparities but also to implement interventions based on the very data that make those disparities clear.” In addition to the Child and Adult Core Sets, CMS has proposed establishing reporting requirements for states that elect to implement one or both of the optional Medicaid health home benefits under sections 1945 or 1945A of the Social Security Act, which will measure healthcare quality for states that choose to establish “health homes.” Public comments about the proposed rule are due Oct. 21, 2022. The rule will be published in the Federal Register on Monday, Aug. 22.

New JAMA Study Shows Pervasiveness of Methamphetamine Use in Rural America

Findings from a JAMA Network Open study released this week show that nearly four of five people taking drugs in rural areas across 10 states used methamphetamine in the past 30 days. Meanwhile, non-fatal overdoses in the past six months were higher among people using both methamphetamines and opioids (22%), compared with opioids alone (14%), or methamphetamines alone (6%). “The challenge is compounded in rural communities that often lack buprenorphine prescribers: more than one-half of U.S. counties (53.4%) do not have a buprenorphine prescriber, leaving 30 million people in those counties without access to treatment,” the researchers wrote. “Similarly, rural opioid treatment programs are rare, leading to long driving times to access methadone,” they continued, adding that educational interventions are needed to train primary care physicians, who are essential providers of opioid use disorder treatment in rural America. “For example,” they wrote, “contingency management training interventions could be adapted to support rural primary care practitioners.”

NABH Annual Membership Updates Are Due Today

The deadline to submit changes about your organization for the online-only NABH 2022 Membership Directory is today, Friday, Aug. 19. Last month NABH sent its system members a message with a link to the association’s membership-update tool. To help ensure we have the most accurate information on our members, please use this tool to verify your system’s information. NABH has added several new categories this year. 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 diverse membership. If you need assistance, please contact Maria Merlie at maria@nabh.org. Thank you!

Enhanced NABH Denial-of-Care Portal is Now Available

NABH recently made enhancements to its Denial-of-Care Portal that are intended to make the portal easier for members to use. A year ago, NABH developed the Denial-of-Care Portal to collect specific data on insurers who deny care—often without regard to parity or the effects on patients. Now the association has updated this resource to make it more user-friendly for members and also more aligned with what regulators need to identify parity violations. The updated portal includes fewer questions, which will require less time for members to complete. In addition, all questions are now optional. NABH hopes this will make it more likely for members to share the data they have. Lastly, NABH has added a checklist of “red flags” that were included in the 2022 MHPAEA Report to Congress from the U.S. Health and Human Services, Labor, and Treasury Departments in January. Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

A new study in The Lancet Psychiatry shows that up to two years after Covid-19 infection, the risk of developing conditions such as psychosis, dementia, brain fog, and seizures is still higher than after other respiratory infections; however, the findings also showed that while anxiety and depression are more common soon after a Covid-19 diagnosis, the mood orders are transient, becoming no more likely after the two months than following similar infections, such as the flu. To learn more, read this story in STAT. For questions or comments about this CEO Update, please contact Jessica Zigmond

Final 2023 IPF-PPS Rule Calls for 2.5% Payment Increase to IPFs in 2023

In a final rule released Thursday, the Centers for Medicare & Medicaid Services (CMS) said total estimated payments to inpatient psychiatric facilities (IPFs) are estimated to increase by 2.5%, or $90 million, in fiscal year 2023 relative to IPF payments in 2022. This is larger than the 1.5% payment increase the agency proposed this spring. For 2023, CMS is updating the IPF prospective payment system (PPS) rates by 3.8%, based on the final IPF market basket update of 4.1% minus a 0.3 percentage point productivity adjustment. CMS is also updating the outlier threshold so that estimated outlier payments remain at 2% of total payments. The agency estimates this will result in a 1.2% decrease to aggregate payments, due to updating the outlier threshold. CMS noted that due to rounding, the 3.8% increase to payment rates and the 1.2% decrease to outlier payments yield a 2.5% overall increase in IPF payments. A fact sheet from CMS highlights the final rule’s major provisions, including a permanent 5% cap policy to ease the impact of year-to-year changes in IPF payments related to decreases in the IPF wage index. Finally, CMS did not make final any changes for the IPF Quality Reporting Program in the 2023 final rule. Gov. Phil Murphy Announces ‘Strengthening Youth Mental Health Care’ as NGA Chair’s Initiative Incoming National Governors Association (NGA) Chair Gov. Phil Murphy (D-N.J.) announced “Strengthening Youth Mental Health Care” is his chair’s initiative as he leads the organization from 2022-2023. “We are all aware of the youth mental health crisis in our country,” Murphy said during the closing session of the NGA’s summer meeting in Portland, Maine. “It is a crisis that the pandemic did not create but exposed more fully,” he added. “It is one that we must tackle together, and tackle now.” Murphy also acknowledged access-to-care problems and highlighted the four pillars of his chair’s initiative: prevention and resilience building; increasing awareness and reducing stigma; access and affordability of quality treatment and care; and caregiver and educator training and support. Click here to read more about Murphy’s initiative. Opioid Response Network & National Association of Counties Offer Guidance on Managing Opioid Litigation Funds    The Opioid Response Network (ORN) and the National Association of Counties (NACo) have partnered to strengthen the association’s new Opioid Solutions Initiative and resource center, which offers guidance to U.S. counties about how to use funding from litigation between states and opioid manufacturers and distributors. The support center provides guidance on managing opioid litigation funds, information about effective substance use prevention, treatment and recovery approaches that are approved uses of settlement funds, case studies on evidence-based practices, and  — with help from the ORN — free, on-demand education and training. Click here to read more about NACo’s Opioid Solutions Center and click here to submit requests for free education and training. NABH Annual Membership Update: 2022 Membership Directory NABH is developing its online-only 2022 Membership Directory, an essential member benefit that helps the asssociation in its advocacy efforts. Earlier this week, NABH sent its system members a separate message that includes 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 our membership-update tool and verify your system’s information. NABH has added several new categories this year. 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 diverse membership. The deadline to submit your changes to NABH is Friday, Aug. 19, 2022. If you need assistance, please contact Maria Merlie at maria@nabh.org. Thank you! Enhanced NABH Denial-of-Care Portal is Now Available! NABH recently made enhancements to its Denial-of-Care Portal that are intended to make the portal easier for members to use. A year ago, NABH developed the Denial-of-Care Portal to collect specific data on insurers who deny care—often without regard to parity or the effects on patients. Now the association has updated this resource to make it more user-friendly for members and also more aligned with what regulators need to identify parity violations. The updated portal includes fewer questions, which will require less time for members to complete. In addition, all questions are now optional. NABH hopes this will make it more likely for members to share the data they have. Lastly, NABH has added a checklist of “red flags” that were included in the 2022 MHPAEA Report to Congress from the U.S. Health and Human Services, Labor, and Treasury Departments in January. “We know the best way to advocate for parity enforcement with regulators is to provide hard data from our members that show how insurers are not complying with the landmark 2008 parity law,” said NABH President and CEO Shawn Coughlin. “We hope these new changes will make it easier—and faster—for our members to use so that we can gather that critical data.” Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal. Save the Date for the NABH 2023 Annual Meeting! Please mark your calendars and plan to join us in Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting! Fact of the Week Calls to the new, national 988 behavioral health crisis hotline increased by 45% during the week after it transitioned to a three-digit number from a longer one. For questions or comments about this CEO Update, please contact Jessica Zigmond

ONDCP Director Identifies Gaps and Proposes Better System for Tracking Nonfatal Overdoses

In a recent JAMA commentary, the head of the White House Office of National Drug Control Policy (ONDCP) said the lack of real-time data for both fatal and nonfatal drug overdoses in the United States undermines the ability to respond accountably and restricts the potential to understand the effects of actions and investments. ONDCP Director Rahul Gupta, M.D., M.B.A., M.P.H., and David Holtgrave, Ph.D., also of ONDCP, argued that it’s essential to build the national data system while taking actions to prevent overdoses and save lives in the near term. “Once established, this national system should rapidly yield higher-quality, more complete, more timely, and more actionable data to inform increasingly effective policy making to prevent and treat overdose occurrences and build health equity,” the authors wrote. “Doing so will require the partnership of many, but there is not a moment to lose.”

Uniform Law Commission Agrees to Propose a Bill to State Legislatures That to Create More Consistency in Telehealth Laws

Politico reported this week that the influential Uniform Law Commission agreed to propose legislation to state legislatures that would try to create more consistency in telehealth laws and expand access to care across state lines. The commission nearly unanimously approved the model legislation after two years of deliberations and guidance from the American Medical Association, Federal Trade Commission, state medical boards, and telehealth groups. “It’s unclear how many states will move to create new laws around telehealth — or use the Uniform Law Commission’s model — but legislatures have embraced past proposals on issues ranging from regulation of organ donation to taxation of people who work in multiple states,” the story noted.

HRSA Payment Program for Rural Health Clinic Buprenorphine-Trained Providers Still Open

The nation’s rural health clinics (RHCs) still have an opportunity to apply for funding from the Health Resources and Services Administration’s (HRSA) program that pays providers who are waivered to prescribe buprenorphine, a medication used to treat opioid use disorder. Launched in 2021, HRSA’s program has about $1.2 million in program funding still available, and RHCs may apply for a $3,000 payment on behalf of each provider who trained to obtain the necessary waiver. HRSA said funds will be paid on a first-come, first-served basis until funds are exhausted. Please direct any questions to DATA2000WaiverPayments@hrsa.gov. In addition, the American Osteopathic Academy of Addiction Medicine and the Providers Clinical Support System are offering a free online course for waiver-eligibility training. Click here for more information.

Enhanced NABH Denial-of-Care Portal is Now Available!

NABH has made enhancements to its Denial-of-Care Portal that are intended to make the portal easier for members to use. A year ago, NABH developed the Denial-of-Care Portal to collect specific data on insurers who deny care—often without regard to parity or the effects on patients. Now the association has updated this resource to make it more user-friendly for members and also more aligned with what regulators need to identify parity violations. The updated portal includes fewer questions, which will require less time for members to complete. In addition, all questions are now optional. NABH hopes this will make it more likely for members to share the data they have. Lastly, NABH has added a checklist of “red flags” that were included in the 2022 MHPAEA Report to Congress from the U.S. Health and Human Services, Labor, and Treasury Departments in January. “We know the best way to advocate for parity enforcement with regulators is to provide hard data from our members that show how insurers are not complying with the landmark 2008 parity law,” said NABH President and CEO Shawn Coughlin. “We hope these new changes will make it easier—and faster—for our members to use so that we can gather that critical data.” Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Save the Date for the NABH 2023 Annual Meeting!

Please mark your calendars and plan to join us at the Mandarin Oriental Washington, DC from June 12-14, 2023 for next year’s NABH Annual Meeting!

Fact of the Week

Sixty-four percent of dual-eligible beneficiaries have a mental health diagnosis, according to a recent profile from research firm. ATI Advisory. For questions or comments about this CEO Update, please contact Jessica Zigmond

CMS Proposes to Modernize Coverage for Behavioral Health Services in 2023 Physician Fee Schedule Rule

The Centers for Medicare & Medicaid Services (CMS) on Thursday proposed new policies to update coverage for behavioral health services in the agency’s physician fee schedule proposed rule for 2023. In the rule, CMS proposes to address the behavioral healthcare workforce shortage by allowing licensed professional counselors (LPCs), marriage and family therapists (LMFTs), and other types of behavioral health practitioners to provide behavioral health services under general, rather than direct, supervision. CMS also proposes to pay for clinical psychologists and licensed clinical social workers to provide integrated behavioral health services as part of a patient’s primary care team. In addition, the rule proposes to bundle certain chronic pain management and treatment services into new monthly payments to help improve patient access to team-based, comprehensive, chronic pain treatment. And the agency is proposing to cover opioid treatment and recovery services from mobile units, such as vans, to increase access to services for people who are homeless or live in rural areas. Meena Seshamani, M.D., Ph.D., director for the Center for Medicare at CMS, and Douglas Jacobs, M.D., M.P.H., chief transformation officer at the Center for Medicare, co-authored a blog post Thursday about the behavioral health changes in the proposed rule.

Federal Health Officials Recommend ‘Preaddiction’ to Treat SUDs

Directors at the National Institutes of Health and the founder of the Treatment Research Institute this week recommended that the DSM-5 diagnostic categories “mild to moderate SUD” be a starting definition for the term preaddiction, a term they said could generate greater attention to the risks associated with early state substance use disorder (SUD) and help direct policies and resources to support preventive and early intervention measures. Nora Volkow, M.D., director of the National Institute on Drug Abuse, George Koob, Ph.D., director of the National Institute on Alcohol and Abuse and Alcoholism, and Tom McClellan, founder of the Treatment Institute wrote a commentary in JAMA Psychiatry this week that pushed for using the term preaddiction and highlighted lessons learned from Type 2 Diabetes and the role of “prediabetes” in their argument. As the authors explained, the American Diabetes Association in 2001 suggested the term prediabetes (defined by elevated scores on two laboratory tests: impaired glucose tolerance and impaired fasting glucose) to leverage public motivation to avoid serious diabetes. “Intervening early is not a new concept, nor is it easy to implement,” the authors wrote. “The diabetes field likely succeeded owing to a broad, well-organized, and sustained strategy applied concurrently at the clinical, public, and policy levels,” they said, adding that if an analogous approach is to be effective in the SUD field, it will require similarly integrated efforts in three areas: measures to define and detect preaddiction; engaging, effective interventions for preaddiction; and public and clinical advocacy. “The diabetes example illustrates why a similar strategy has not yet happened in the SUD field: poor integration into the rest of mainstream healthcare, lack of a prominent advocacy group demanding clinical and policy changes, and little reimbursement for interventions with less severe SUDs,” the authors noted. “Nonetheless, the diabetes example shows that an early intervention approach can work given a comprehensive, sustained effort. That example also suggests the potential impact from a parallel strategy to reduce addiction problems by more aggressive efforts to identify and reverse preaddiction.” Volkow discussed the issue further in her blog on July 6.

HUD Announces $365 Million Package to Address Unsheltered Homelessness and Homeless Encampments

The U.S. Housing and Urban Development Department (HUD) recently announced $322 million for permanent housing, supportive services, and other costs, and $43 million to fund about 4,000 new incremental housing choice vouchers. The Initiative for Unsheltered and Rural Homelessness through HUD promotes partnerships with healthcare organizations, public housing authorities and mainstream housing providers, and people with lived experience and expertise of homelessness. “President Biden is following through on his promise to unite our country by delivering funding for healthcare and services that support individuals who are unhoused,” Rahul Gupta, M.D., director of the White House Office of National Drug Control Policy, said in an announcement. “As a physician I have seen firsthand how important it is to address the social and economic conditions of a person’s life in order for them to realize the health and well-being every American deserves.” Click here to learn more in the full HUD announcement.

SAMHSA Releases Advisory on Peer Supports Services in Crisis Care

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released an advisory that discusses the role of peer support workers and models that are available to help individuals in crisis. The 17-page resource includes information about the evidence base for peer support services in crisis care, what peer support workers should do, how the recovery process looks different for everyone, and more.

Reminder: National Academies’ Forum on Mental Health and SUD to Host Workshop Next Week

The National Academies’ Forum on Mental Health and Substance Use Disorders will host a public workshop that focuses on early intervention for psychosis, current data on the epidemiology and outcomes for people at high risk for psychosis and those who have experienced a first psychosis, and ways to improve care for these patients. Sessions will provide an overview of the epidemiology for people with psychosis, discuss what services are available and highlight successful models of care, and examine policy solutions and strategies that the most effective for coordinated specialty services. The workshop will be held on Monday, July 11 from 11 a.m. to 5 p.m. ET. Click here to register.

Reminder: 2022 Annual Meeting Evaluation

If you attended the 2022 Annual Meeting in Washington, please take a few moments to complete this evaluation via Survey Monkey. Your feedback will help inform our future programs. Thank you.   Fact of the Week Comparing the Public Health Emergency (PHE) period (March 2020 to January 2022) with the pre-PHE period, mental health services for children covered by Medicaid has declined about 23%, according to preliminary data from CMS. For questions or comments about this CEO Update, please contact Jessica Zigmond

SAMHSA to Host Webinar on 42 CFR Part 2 Compliance Next Week

The Substance Abuse and Mental Health Services Administration (SAMHSA) will host a 90-minute webinar for business managers and compliance officers on July 7 to help ensure their organizations comply with SAMHSA’s 42 CFR Part 2 regulations. The lesson will highlight the latest updates released in January 2018; examine multiple scenarios and frequently asked questions related to SAMHSA’s mental health, substance abuse, and alcohol abuse records; and address proper ways to secure and/or release this information. SAMHSA urges practice managers, business associates who work with health records, compliance officers, physicians, and other medical professionals to attend the webinar on Thursday, July 7 at 1 p.m. ET. Click here to register.

White House Maternal Health Blueprint Aims to Increase Access to Behavioral Health Services

In its new White House Blueprint for Addressing the Maternal Health Crisis, the Biden administration has recommended 50 actions that more than a dozen federal agencies will take to improve maternal care in the United States, including some related to behavioral health. Released in June, the 68-page blueprint outlines five goals, starting with Goal #1: Increase Access to and Coverage of Comprehensive High-Quality Maternal Health Services, Including Behavioral Health Services. “We will continue to invest in maternal behavioral health by launching a 24/7 national support hotline for pregnant individuals and new mothers facing mental health challenges and improving provider education,” the blueprint noted in this first goal. “We will also strengthen access to perinatal addiction services by partnering with hospitals and community-based organizations to implement evidence-based practices,” it continued. “Congress must also take critical steps to bolster access to and coverage of maternal health services.” Other behavioral health-related action items include strengthening supports and access to perinatal addiction services for individuals with substance use disorder by partnering with hospitals and community-based organizations to implement evidence-based interventions, and appointing a dedicated associate administrator for women’s services at SAMHSA to lead its efforts in promoting positive mental health during pregnancy and in the postpartum period.

NABH Responds to AHRQ’s RFI About CAHPS Survey for Inpatient Mental Healthcare Settings

NABH this week responded to the Agency for Healthcare Research and Quality’s (AHRQ) request for information (RFI) regarding potential Consumer Assessment of Healthcare Providers and Systems (CAHPS) for Inpatient Mental Healthcare Settings. AHRQ’s detailed RFI seeks to identify the highest priority aspects patient experiences to include in measures and surveys, the benefits of collecting information about a patient’s experience from family members and caregivers, the challenges that exist in collecting this information, and much more. “During inpatient stays, patients are typically experiencing an increase in psychiatric symptomatology, including, but not limited to, hallucinations, paranoia, delusions, emotional lability, and fragmented cognitive processes,” NABH’s letter said in response to a question about the challenges in administering measures and surveys in mental healthcare settings. “Patients may thus be limited in their ability to express thoughts and feelings, to comprehend written material, or sustain their attention to complete a survey,” the letter continued. “For these reasons, we suggest limiting surveys to 20-25 questions, or 8-10.”

Reminder: National Academies’ Forum on Mental Health and SUD to Host Summer Workshop on Early Intervention for Psychosis on July 11

The National Academies’ Forum on Mental Health and Substance Use Disorders will host a public workshop that focuses on early intervention for psychosis, current data on the epidemiology and outcomes for people at high risk for psychosis and those who have experienced a first psychosis, and ways to improve care for these patients. Sessions will provide an overview of the epidemiology for people with psychosis, discuss what services are available and highlight successful models of care, and examine policy solutions and strategies that the most effective for coordinated specialty services. The workshop will be held on Monday, July 11 from 11 a.m. to 5 p.m. ET. Click here to register.

Reminder: 2022 Annual Meeting Evaluation

If you attended the 2022 Annual Meeting in Washington, please take a few moments to complete this evaluation via Survey Monkey. Your feedback will help inform our future programs. Thank you.

Fact of the Week

The United States requires about 6,600 new mental health practitioners to meet demand in regions the federal government has identified as health professional shortage areas, according to data from the Kaiser Family Foundation.

The NABH staff wishes you, your teams, and your families a happy and safe Independence Day weekend!

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

Senate Passes Gun-Control Bill with Mental Health Provisions

The Senate on Thursday passed the most significant gun-control legislation since the mid-1990s in a bill that includes about $15 billion in mental health and school security funding. The House is expected to vote today, June 24, on the measure. The Bipartisan Safer Communities Act expands the existing Medicaid Certified Community Behavioral Health Clinic (CCBHC) demonstration program to all states; helps states to implement, enhance, and expand school-based health programs under Medicaid through updated guidance, technical assistance, and state planning grants; requires the Centers for Medicare & Medicaid Services (CMS) to provide guidance to states on how they can increase access to behavioral health services through telehealth under Medicaid and CHIP; appropriates $150 million to help implement the upcoming 988 behavioral health crisis hotline; provides $500 million through the School-Based Mental Health Services Grant Program to increase the number of qualified mental health service providers that provide school-based mental health services to students in school districts with demonstrated need; and more. President Biden said he intends to sign the bill into law. “Last month, President Biden spent hours with the family members whose lives were forever changed by the recent shootings at a grocery store in Buffalo, New York and an elementary school in Uvalde, Texas,” said a Statement of Administration Policy from the Office of Management and Budget. “The family members delivered a simple message, which the president then relayed to the American people: do something. Do something to stop the carnage of gun violence that leaves behind grief and trauma in communities, both big and small, across the country.” The statement added that the bill advances President Biden’s agenda to expand access to mental health services and address the trauma of gun violence affecting so many communities. Click here to read the legislation.

House Passes Mental Health Bill to Reauthorize Funds for SAMHSA & HRSA

In a 402-20 vote Wednesday, the House of Representatives passed H.R. 7666, the Restoring Hope for Mental Health and Well-Being Act, which would reauthorize essential Substance Abuse and Mental Health Services (SAMHSA) and Health Resources and Services Administration (HRSA) programs to address the nation’s mental health and substance use crises. The bill would reauthorize and modify several programs, including the Community Mental Health Services Block Grant, the Substance Abuse Prevention and Treatment Block Grant, and grants related to suicide prevention and the behavioral health workforce. In remarks on the House floor, House Majority Leader Steny Hoyer (D-Md.) applauded the House Energy and Commerce Committee and all House members whose legislation was included in the package. “I hope this strong vote today will help move these critical policies through the Senate and see them quickly enacted into law,” Hoyer added. On Tuesday, the Biden administration said it supported the bill in a Statement of Administrative Policy.

World Health Organization Releases First World Mental Health Report Since 2001

The World Health Organization (WHO) has released its largest review of world mental health since it released World Health Report 2001: Mental Health: New Understanding, New Hope. The latest iteration, Transforming Mental Health for All, provides a roadmap for governments, academics, health professionals, and others to support the world in transforming mental health. “As the world comes to live with, and learn from, the far-reaching effects of the Covid-19 pandemic, we must all reflect on one of its most striking aspects – the huge toll it has taken on people’s mental health,” the nearly 300-page report noted. “Rates of already-common conditions such as depression and anxiety went up by more than 25% in the first year of the pandemic, adding to the nearly one billion people who were already living with a mental disorder,” it continued. “At the same time, we must recognize the frailty of health systems attempting to address the needs of people with newly-presenting as well as pre-existing mental health conditions.” The report also said that since 2001, countries worldwide have formally adopted international frameworks that guide them to act for mental health. And, it continued, WHO member states have adopted the Comprehensive Mental Health Action Plan 2013-2030, which commits them to meeting 10 global targets for improved mental health. Categorized in eight sections, the report examines principles and drivers in public mental health, assesses world mental health today, argues for investment in mental health, considers promotion and prevention strategies for change, and explores how to restructure and scale up care.

MACPAC Examines How Medicaid Policy Can Support Adopting Behavioral Health IT

In its June report to Congress, the Medicaid and CHIP Payment and Access Commission (MACPAC) analyzed how Medicaid policy can be used to support adopting health information technology among behavioral healthcare providers. The report highlighted that Medicaid programs play a critical role in financing behavioral health services and that those programs are focused on ways to provide behavioral health in more integrated settings. Therefore, the Commission recommended, “…that CMS issue guidance to help states use Medicaid authorities and other federal resources to promote behavioral health IT adoption, and that the Office of the National Coordinator for Health Information Technology and the Substance Abuse and Mental Health Services Administration work together to develop voluntary standards that would encourage health IT uptake appropriate for behavioral health.” See chapter 4 of the report, Encouraging Health Information Technology Adoption in Behavioral Health: Recommendations for Action, to learn more.

CDC Introduces Tool to Check Drinking and Create a Plan to Drink Less

The Centers for Disease Control and Prevention (CDC) has launched an alcohol-screening tool for adults to check their drinking, identify barriers to drinking less frequently, and create a personalized plan to make healthier drinking choices—all anonymously. The resource is part of the Atlanta-based agency’s new Drink Less, Be Your Best campaign that highlights the harmful effects of alcohol and provides resources to help adults drink less. CDC noted in its announcement that the tool is not intended for medical diagnosis or treatment.

‘Hiding in Plain Sight: Youth Mental Illness’ Documentary to Air June 27 and 28

Award-winning filmmaker Ken Burns presents Hiding in Plain Sight: Youth Mental Illness, a two-part documentary film by Erik Ewers and Christopher Loren Ewers on Monday and Tuesday, June 27 and 28 at 9 p.m. ET on PBS. Click here to see a preview of the film, which includes a brief introduction from Burns.

2022 Annual Meeting Presentations Available Online

Please visit our Annual Meeting homepage to view available slide presentations from this year’s Annual Meeting. NABH will post recorded presentations on a later date.   And if you attended the 2022 Annual Meeting in Washington, please take a few moments to complete this evaluation via Survey Monkey. Your feedback will help inform our future programs. Thank you.

Reminder: National Academies’ Forum on Mental Health and SUD to Host Summer Workshop on Early Intervention for Psychosis Next Month

The National Academies’ Forum on Mental Health and Substance Use Disorders will host a public workshop this summer that focuses on early intervention for psychosis, current data on the epidemiology and outcomes for people at high risk for psychosis and those who have experienced a first psychosis, and ways to improve care for these patients. Sessions will provide an overview of the epidemiology for people with psychosis, discuss what services are available and highlight successful models of care, and examine policy solutions and strategies that are the most effective for coordinated specialty services. The workshop will be held on Monday, July 11 from 11 a.m. to 5 p.m. ET. Click here to register.

Save the Date for the 2023 Annual Meeting!

Please save the date for NABH’s next Annual Meeting: June 12-14, 2023 at the Mandarin Oriental Washington, DC.

Fact of the Week

In 2019, nearly a billion people – including 14% of the world’s adolescents – were living with a mental disorder, the World Health Organization reports. For questions or comments about this CEO Update, please contact Jessica Zigmond

NABH Annual Meeting Kicks Off on Monday!

We’re pleased to devote this week’s edition of CEO Update to details about our Annual Meeting that starts on Monday, June 13! Our theme this year is Shaping the Future of Behavioral Healthcare, and our speakers—including HHS Secretary Xavier Becerra— will address topics that affect our industry today and in the years ahead. From parity and access to care, to the Biden’s administration’s behavioral health and drug control strategies, to the 2022 midterm elections, to workforce challenges and solutions, to the upcoming 988 behavioral health crisis hotline, this year’s program is one you won’t want to miss. On Monday, please be sure to look for an Annual Meeting Alert, which will include a link to our mobile app that contains important details about sessions, events, committee meeting room assignments, exhibitors and sponsors, our priorities for the 117^th Congress, restaurant recommendations in the Washington area, and more. We’ll open our meeting on Monday with two dynamic speakers: Ben Nemtin will discuss his personal battle with clinical depression and how to thrive personally and professionally, and journalist Sam Quinones will share his experiences writing his most recent book, The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth. Sam will sign copies of his book after his presentation. As with previous Annual Meetings, we will post presentations on our website after the meeting ends. Registration opens on Monday at noon, and our first session kicks off in the Mandarin Oriental’s Grand Ballroom at 2:30 p.m. I hope to see you there! -Shawn Coughlin, President and CEO

HHS Secretary Becerra to Address Attendees on Tuesday, June 14

HHS Secretary Xavier Becerra, the 25^th secretary of the U.S. Health and Human Services Department and the first Latino to hold that office, will address Annual Meeting attendees on Tuesday, June 14 at 8:30 a.m. in the Grand Ballroom. Secretary Becerra will offer brief remarks and then engage in a question-and-answer session with NABH President and CEO Shawn Coughlin. Previously Secretary Becerra was California’s attorney general and before that served for 12 terms in the U.S. House of Representatives, where he was the first Latino to serve as a member of the powerful House Ways and Means Committee. He also served as chairman of his party’s caucus and as the ranking member of both the Ways and Means Subcommittee on Health and Ways and Means Subcommittee on Social Security. Secretary Becerra will discuss the Biden administration’s comprehensive strategy to address America’s mental health crisis, which includes promoting the well-being of the nation’s frontline healthcare workforce, piloting new approaches to training behavioral health paraprofessionals, strengthening the country’s crisis care and suicide prevention infrastructure, integrating mental health and substance use treatment into primary care, expanding and strengthening parity, and more.

ONDCP Director Rahul Gupta, M.D., M.B.A., FACP to Present on Tuesday, June 14

Following Secretary Becerra’s presentation on Tuesday, Office of National Drug Control Policy (ONDCP) Director Rahul Gupta, M.D., M.B.A., FACP will provide a presentation at 9:30 a.m. in the Grand Ballroom. Dr. Gupta is the first medical doctor to serve as director and lead ONDCP, a component of the Executive Office of the President. ONDCP coordinates the nation’s $40 billion drug budget and federal policies, including prevention, harm reduction, treatment, recovery support, and supply reduction. Through his work as a physician, a state and local leader, an educator, and a senior leader of a national nonprofit organization, Dr. Gupta has dedicated his career to improving public health and public safety. He is also a buprenorphine-waivered practitioner, who has provided medication-assisted treatment for people with opioid use disorder. The son of an Indian diplomat, Dr. Gupta was born in India and grew up in the suburbs of Washington, D.C. At age 21, he completed medical school at the University of Delhi and later completed subspecialty training in pulmonary medicine. Dr. Gupta earned a master’s degree in public health from the University of Alabama-Birmingham and a global master’s of business administration degree from the London School of Business and Finance.

Panel to Examine Ways to Address Behavioral Healthcare Workforce Challenges

Workforce shortages have challenged NABH members for years before the pandemic worsened the problem. For this year’s Annual Meeting, NABH has developed a panel to discuss potential solutions. Please join us in the Grand Ballroom on Tuesday, June 14 at 11 a.m. to learn from panelists Megan Baird of the Office of Apprenticeship in the U.S. Labor Department’s Employment and Training Administration; Malissa Lewis, LL.M of the Health Resources and Services Administration; and David Long of Pinnacle Treatment Centers, an NABH member organization. NABH Director of Quality and Addiction Services Sarah Wattenberg, L.C.S.W. will moderate a discussion that will highlight apprenticeships, loan repayment programs, and more.

Political Commentator Amy Walter to Discuss 2022 Midterm Elections

Be sure to attend this year’s Annual Meeting Luncheon at noon on Tuesday, June 14 in the Oriental Ballroom to learn from political commentator Amy Walter, who will preview this fall’s midterm election season. Walter, editor in chief of the Cook Political Report with Amy Walter and a political commentator for the PBS NewsHour, provides analysis of the issues, trends, and events that shape the political environment. She is also a regular Sunday panelist on NBC’s Meet the Press and CNN’s Inside Politics and appears frequently on Special Report with Bret Baier on Fox News Channel. From 2017 until early 2021, Walter was the host of the weekly nationally syndicated program “Politics with Amy Walter” on The Takeaway from WNYC and PRX. She’s also the former political director of ABC News.

Learn Details about the Wit v. UBH Case During Wednesday’s Policy Breakfast

Join us on Wednesday morning, June 15 to hear from Meiram Bendat, J.D., founder and president of Psych Appeal and consultant to NABH, who will discuss details of the Wit v. UBH case.   The policy breakfast will begin at 8 a.m. on Wednesday and the Annual Meeting will adjourn at 10 a.m.     The NABH team wishes everyone a safe trip to Washington, and we look forward to seeing you soon! For questions or comments about this CEO Update, please contact Jessica Zigmond

White House Releases Fact Sheet on Strategy to Address Nation’s Mental Health Crisis

The Biden Administration concluded Mental Health Month this week by announcing new actions to advance President Biden’s mental health strategy in three previously announced objectives: strengthening system capacity, connecting more Americans to care services, and creating a continuum of support. The White House noted that America’s mental health crisis is unprecedented, as two in five American adults report symptoms of anxiety and depression, and more than half of U.S. parents express concern about their children’s mental well-being. Meanwhile, the announcement continued, more than 40% of teenagers report they struggle with persistent feelings of sadness and hopelessness. “These growing demands have exposed longstanding cracks in our care infrastructure while compounding many other challenges, from criminal justice to homelessness to the labor shortage,” the White House announcement said. In a new fact sheet, the Biden Administration outlined applicable action steps to address the crisis, such as promoting the well-being of the healthcare workforce, piloting new approaches to training behavioral health paraprofessionals, bolstering the nation’s crisis care and suicide prevention infrastructure, building capacity for long-term care facilities to deliver behavioral health services, making care affordable across all types of health insurance coverage, integrating mental health services in ways that reduce stigma and access barriers, and more.

HHS’ Office on Women’s Health Announces Grant Program to Reduce Maternal Deaths Due to SUD

HHS’ Office on Women’s Health is accepting applications for projects designed to strengthen the perinatal (from conception to birth) and postnatal (up to 12 months after birth) to support structures for patients with substance use disorder (SUD) and reduce deaths during those two time periods. Applicants who receive funding will be expected to partner with hospital and community-based organizations to implement evidence-based interventions that strengthen perinatal and postnatal support structures for patients with SUD; create a technologically innovative education and outreach products to provide support accessible to perinatal and postpartum patients with SUD at home and on the go to reduce triggers, decrease stress, and increase feelings of support; and improve health outcomes and reduce deaths among perinatal and postpartum patients associated with SUD. Both for-profit and not-for-profit organizations are eligible to apply. Click here to learn more and apply.

National Academies’ Forum on Mental Health and SUD to Host Summer Workshop on Early Intervention for Psychosis

The National Academies’ Forum on Mental Health and Substance Use Disorders will host a public workshop this summer that focuses on early intervention for psychosis, current data on the epidemiology and outcomes for people at high risk for psychosis and those who have experienced a first psychosis, and ways to improve care for these patients. Sessions will provide an overview of the epidemiology for people with psychosis, discuss what services are available and highlight successful models of care, and examine policy solutions and strategies that are most effective for coordinated specialty services. The workshop will be held on Monday, July 11 from 11 a.m. to 5 p.m. ET. Click here to register.

NABH Working to Enhance Denial-of-Care Portal

NABH’s Denial-of-Care Portal is temporarily unavailable as the association works to enhance features of this member-only resource. NABH developed the portal so members could submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation and is intended to help the association in its advocacy efforts with policymakers and regulators. NABH will inform members when the updated portal is ready to use.

Learn About Our 2022 Annual Meeting Speakers!

The NABH 2022 Annual Meeting is fewer than two weeks away. Please be sure to learn more about this year’s speakers here on our Annual Meeting homepage. And please be sure to register for the meeting, if you have not done so yet. We look forward to seeing you soon in Washington!

Fact of the Week

A new study in JAMA Psychiatry found that after sustaining a mild traumatic brain injury (mTBI), some individuals—on the basis of education, race/ethnicity, history of mental health problems and cause of injury—were at substantially increased risk of post-traumatic stress disorder (PTSD) and/or major depressive disorder (MDD). For questions or comments about this CEO Update, please contact Jessica Zigmond

HHS Leaders Encourage States to Prioritize Efforts to Support Children’s Mental Health   Following Tuesday’s shooting at Robb Elementary School in Uvalde, Texas—the deadliest U.S. school shooting in 10 years in which a gunman killed 19 children and two teachers—U.S. Health and Human Services Department (HHS) agency leaders sent a joint letter to states, tribes, and jurisdictions urging them to maximize and prioritize their efforts to strengthen children’s mental health and well-being. According to the National Survey of Children’s Health, the number of children ages 3-17 years diagnosed with anxiety grew by 29% and those with depression by 27% between 2016 and 2020. Meanwhile, there was a 21% increase in children diagnosed with behavioral or conduct problems between 2019-2020. The letter provided a list of existing opportunities, partnerships, grants, and programs that states, tribes, and jurisdictions can access to support children’s mental health. Including HHS Secretary Xavier Becerra, leaders from the Administration for Children and Families, Administration for Community Living, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, Health Resources and Services Administration, and the Substance Abuse and Mental Health Services Administration (SAMHSA) signed the letter on May 25.

U.S. Surgeon General Releases Advisory on Health Worker Burnout

U.S. Surgeon General Vivek Murthy, M.D., M.B.A. this week released Addressing Health Worker Burnout, a 76-page advisory intended to draw the American people’s attention to an urgent public health issue and provide recommendations about how to manage it. In a video accompanying the advisory, Murthy noted that 54% of the nation’s physicians and nurses were experiencing burnout before the pandemic began, eight out of 10 health workers have experienced workplace violence, and 66% of U.S. nurses have considered resigning. “Healthcare systems, health insurance companies, and government must prioritize health worker well-being,” Murthy said in his recorded message. “This means increasing access to mental health services; reducing workplace burdens to prioritize time with patients; and protecting the health and safety of all health workers.” The advisory includes separate categories describing what healthcare organizations, federal, state, local, and tribal governments, insurers and payers, healthcare technology companies, academic institutions, clinical training programs, and accreditation bodies can do to help address health worker burnout.

George Washington University & Health Landscape Create Mental Health-SUD Workforce Database

With support from a SAMHSA grant, the George Washington University Fitzhugh Mullan Institute for Health Workforce Equity and data research firm Health Landscape have developed a national database on the country’s mental health and substance use disorder workforce to provide evidence-based support for creating policy and targeting resources appropriately. The new Behavioral Health Workforce Tracker is a comprehensive national database that identifies almost 1.2 million behavioral health providers, including more than 600,000 behavioral health specialists, including psychiatric and addiction medicine specialists, psychologists, counselors, and therapists; about 400,000 primary care physicians and advanced practice providers who provided 11 more behavioral health medications, and an additional 173,556 physician specialists who also wrote more than 11 behavioral health medications. Click here to learn more about the database.

National Academies’ Forum on Mental Health and SUD to Host Workshop on Early Intervention for Psychosis

The National Academies’ Forum on Mental Health and Substance Use Disorders will host a public workshop this summer that focuses on early intervention for psychosis, current data on the epidemiology and outcomes for people at high risk for psychosis and those who have experienced a first psychosis, and ways to improve care for these patients. Sessions will provide an overview of the epidemiology for people with psychosis, discuss what services are available and highlight successful models of care, and examine policy solutions and strategies that are most effective for coordinated specialty services. The workshop will be held on Monday, July 11 from 11 a.m. to 5 p.m. ET. Click here to register.

NABH Working to Enhance Denial-of-Care Portal

NABH’s Denial-of-Care Portal is temporarily unavailable as the association works to enhance features of this member-only resource. NABH developed the portal so members could submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation and is intended to help the association in its advocacy efforts with policymakers and regulators. NABH will keep members apprised of when the updated portal is ready to use.

NABH 2022 Annual Meeting Hotel Reservation Cutoff Date is Wednesday, June 1

The Mandarin Oriental Washington, DC has extended the hotel reservation cutoff date for the 2022 NABH Annual Meeting this coming Wednesday, June 1, 2022. Please be sure to reserve your hotel room today! And please visit our Annual Meeting webpage to register for the meeting, if you have not done so yet. We look forward to seeing you in Washington!

Fact of the Week 

There has been a 213% increase in the death rate of Black men from drug overdoses from 2015 to 2020, the American Psychological Association reports. Before 2015, Black men were considerably less likely than both White men and American Indian or Alaska Native men to die from drug overdoses. Since then, the death rate among Black men has more than tripled.   For questions or comments about this CEO Update, please contact Jessica Zigmond

NABH and Other Healthcare Groups Request Review of Three-Judge Panel’s Ruling in Wit v. UBH

NABH last week requested that the full 9^th U.S. Circuit Court of Appeals review a recent ruling from a three-judge panel that erroneously reversed a trial court’s landmark decision last year in the mental health class action, Wit v. United Behavioral Health.   NABH filed an amicus brief to request a “rehearing en banc.” If granted, a rehearing could vacate the appellate panel’s deeply flawed ruling. The American Hospital Association, American Psychological Association, American Association for the Treatment of Opioid Dependence, California Hospital Association, Federation of American Hospitals, National Association of Addiction Treatment Providers, National Council for Mental Wellbeing, and REDC added their organization names to the amicus brief. “Unfortunately, the likely consequence of the panel decision is that the gains achieved as a result of the district court’s rulings will be wiped out as even further restrictions are placed on the care patients receive for treatment of mental illness,” the amicus brief states. “Instead of medical necessity determinations based on GASC developed by non-profit expert bodies, the decision-making power will be left to the discretion of for-profit insurers such as UBH.”   Click here to read the news release that NABH distributed on Monday, May 16.

SAMHSA Introduces First ‘Behavioral Health Recovery Innovation Challenge’

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week introduced its first “Behavioral Health Recovery Challenge” to identify innovations that peer-run or community-based organizations—and entities that partner with them, including hospitals and health systems—have developed to advance recovery. SAMHSA defines recovery as “a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.” SAMHSA’s announcement noted that the agency encourages participants to share details about the practices they use to advance recovery and also demonstrate how these practices have: 1) expanded on SAMHSA’s definition of recovery, or 2) helped them overcome challenges in incorporating recovery into their behavioral health services or systems. “By using this vehicle, we hope to gain a better understanding of effective and innovative recovery practices from a very diverse field,” HHS Assistant Secretary for Mental Health and Substance Use Miriam E. Delphin-Rittmon, Ph.D., said in an announcement. Delphin-Rittmon also leads SAMHSA. “We aim to take what works for a small group and scale up to a larger population.” Click here to learn more from SAMHSA’s Recovery Innovation Challenge webpage.

SAMHSA Announces Funding Opportunity to Establish Center of Excellence on Social Media and Wellbeing

SAMHSA this week announced a funding opportunity that will award $2 million per year up to five years to establish a national Center of Excellence (CoE) that will develop and disseminate information, guidance, and training on the effects of children and youth’s social media use, including both its risks and benefits. SAMHSA’s grant announcement noted that the new CoE will pay particular attention to the potential risks social media platforms pose to the mental health of children and youth, as well as the clinical and societal interventions that could be used to address those risks. Eligible applicants include states, political divisions of states, Indian tribes or tribal organizations, health facilities, programs operated by or in accordance with a grant contract with the Indian Health Service, or other public of private, not-for-profit entities. The deadline to apply is Monday, July 18. Click here to learn more.

SAMHSA Announces $1.5 billion for State Opioid Response Program

SAMHSA this week said the agency’s State Opioid Response Program grant will fund up to $1,439,500,000 in fiscal year 2022 to 59 states and territories, including a set-aside for states with the highest opioid use disorder-related mortality rates. Grant funds may be used on contingency management to treat stimulant use disorder.   In announcement about the grant funding, Office of National Drug Control Policy Director Rahul Gupta, M.D., M.P.H., M.B.A., FACP said that fewer than one out of 10 people in the United States who need addiction care receive it.   “That is why President Biden released a National Drug Control Strategy to beat the overdose epidemic by going after its drivers: untreated addiction and drug trafficking,” Gupta said in the announcement. “Today we are delivering on key parts of our Strategy through this new funding, which will expand access to treatment for substance use disorder and prevent overdoses, while we also work to reduce the supply of illicit drugs in our communities and dismantle drug trafficking.” The use of contingency management for the treatment off stimulant use disorder is a permitted use of grant funds. The application process opened on Thursday, May 19 and will remain open through Monday, July 18. Click here to learn more.

NABH Working to Enhance Denial-of-Care Portal

NABH’s Denial-of-Care Portal is temporarily unavailable as the association works to enhance features of this member-only resource. NABH developed the portal so members could submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation and is intended to help the association in its advocacy efforts with policymakers and regulators. NABH will keep members apprised of when the updated portal is ready to use.

NABH 2022 Annual Meeting Hotel Reservation Cutoff Date Extended Until June 1

The Mandarin Oriental Washington, DC has extended the hotel reservation cutoff date for the 2022 NABH Annual Meeting to Wednesday, June 1, 2022. Please be sure to reserve your hotel room today! And please visit our Annual Meeting webpage to register for the meeting, if you have not done so yet. We look forward to seeing you in Washington!

Fact of the Week

In a recent Cigna survey of 1,000 parents, 80% said their children are struggling with mental health, and nearly one-fifth (18%) say their child’s needs are negatively affecting their job performance and productivity. For questions or comments about this CEO Update, please contact Jessica Zigmond

CDC Predicts U.S. Overdose Deaths Surpassed 107,000 in 2021

More than 107,000 Americans died of drug overdoses in 2021, according to provisional data from the Centers for Disease Control and Prevention (CDC) released this week. The troubling statistic—the CDC predicts the total to be 107,622 lives lost— hit a new record, as the number of predicted overdose deaths in 2021 reflects a 15-percent increase in the previous record set in 2020. “It is unacceptable that we are losing a life to overdose every five minutes around the clock,” the Office of National Drug Control Policy Director Rahul Gupta, M.D., M.P.H., M.B.A., FACP, said in a White House statement. “That is why President Biden’s new National Drug Control Strategy signals a new era of drug policy centered on individuals and communities, focusing specifically on the actions we must take right now to reduce overdoses and save lives.” Separately this week, the United States Drug Enforcement Administration (DEA) recognized the first Fentanyl Awareness Day on Monday, May 9. The DEA reports that the synthetic opioid fentanyl is about 50 times more potent than heroin and 100 times more potent than morphine. It is also inexpensive, widely available, and highly addictive. DEA Administrator Anne Milgram released a video announcement about the dangers of fentanyl and the need for urgent action.

HRSA Extends Deadline to Submit for Extenuating Circumstances Request to May 18

HHS’ Health Resources and Services Administration (HRSA) this week announced it has extended the deadline for providers to request to submit a late Provider Relief Fund (PRF) Reporting Period 2 (RP2) report to Wednesday, May 18 at 11:59 p.m. ET. According to HRSA, providers may submit a request if certain extenuating circumstances prevented them from submitting their RP2 report by the initial deadline of March31. All requests must be completed through the PRF Reporting Portal.

Center for Connected Health Policy Releases Bi-Annual Summary of State Telehealth Policy Changes

The Center for Connected Health Policy (CCHP) this week released a summary of state telehealth policy changes for Spring 2022. Covering state telehealth policy updates between January and April 2022, the 11-page summary examines state laws and reimbursement policies, private payors, online prescribing, and more. The resource also includes a state summary chart and an infographic of CCHP’s essential findings.

NABH Working to Enhance Denial-of-Care Portal

NABH’s Denial-of-Care Portal is temporarily unavailable as the association works to enhance features of this member-only resource. The portal was developed so NABH members could submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation and is intended to help the association in its advocacy efforts with policymakers and regulators. NABH will keep members apprised of when the updated portal is ready to use.

NABH 2022 Annual Meeting Preliminary Program Now Available!

The NABH 2022 Annual Meeting online preliminary program is now available. 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 next month in Washington!

Fact of the Week

Adolescent female youth who attempted suicide had an elevated risk of substance use disorders up to three decades later, according to a new study in JAMA Psychiatry.   For questions or comments about this CEO Update, please contact Jessica Zigmond.