Author: Emily Wilkins (NABH)

HHS Updates Covid-19 Reporting Guidance for Hospitals, Labs, and Acute-Care Facilities

In guidance released this week, the U.S. Health and Human Services Department (HHS) said hospitals, hospital laboratories, and acute-care facilities will be required to include incidences of patients with influenza in their Covid-19 data reporting data as of Dec. 18. The new influenza fields were added as optional elements to the Covid-19 data reporting set in October and will be mandatory starting next week. In addition, the new reporting requirements include weekly reporting on inventory and use of Covid-19 therapeutic medications. Please note the relevant new provisions highlighted in this week’s guidance, which is also available on NABH’s Covid-19 resources webpage.

CMS Hospital Price Transparency Final Rule Presentation Now Available

The Centers for Medicare & Medicaid Services (CMS) has provided slides from the agency’s Dec. 8 webinar about the hospital price transparency final rule. Beginning Jan. 1, all U.S. hospitals will be required to provide transparent and accessible pricing information online about the items and services they provide. According to CMS, hospitals will be required to do this in two ways: first as a comprehensive, machine-readable file that notes all items and services, and second as a display of shoppable services in a consumer-friendly format. The webinar identified who must comply with the rule, defined hospital “standard charges,” and outlined what items and services must be included.

Biden Chooses Becerra, Murthy, and Walensky for Top Federal Healthcare Posts

President-elect Joseph Biden has selected California Attorney General Xavier Becerra as his nominee to lead HHS and internist Vivek Murthy, M.D. to reprise his earlier role as U.S. surgeon general. Becerra, who represented California in the U.S. House of Representatives from 1993 to 2017, was chairman of the House Democratic Caucus from 2013 to 2017 and served on the powerful House Ways and Means Committee. He earned both his bachelor and law degrees from Stanford. If confirmed, Becerra would be the first Latino to lead HHS. A fierce champion of the Patient Protection and Affordable Care Act, Becerra is leading 20 states and Washington, D.C.  to protect the seminal 2010 healthcare law from being dismantled. Becerra would oversee the department at a critical time during the Covid-19 pandemic, as caseloads surge and a massive vaccination effort is set to launch soon. Murthy served as the nation’s 19th U.S. surgeon general during the Obama administration from December 2014 until January 2017. Murthy completed his internal medicine residency at Brigham and Women’s Hospital and Harvard Medical School, and also led and managed medical teams as a faculty member. Biden also named Rochelle Walensky, M.D., M.P.H., chief of infectious diseases at Massachusetts General Hospital, to lead the Centers for Disease Control and Prevention in Atlanta. Walensky also serves as professor of medicine at Harvard Medical School and is an expert on AIDS and HIV.

Well Being Trust and IHI Publish Resources to Help Providers and Communities Address Mental Health During Pandemic

Well Being Trust and the Institute for Healthcare Improvement (IHI) have released two resources to help healthcare providers, payors, and community partners implement strategies to help save lives from overdose and suicide, and care for front-line health workers during the Covid-19 pandemic. A Guide for Health Systems to Save Lives from “Deaths of Despair” and Improve Community Well-Being is a 37-page resource that explores the role of healthcare systems in improving health and well-being and proposes an approach that identifies who the population is, how to implement methods, and what interventions to use in communities. The shorter of the two resources, A Guide to Promoting Health Care Workforce Well Being During and After the Covid-19 Pandemic defines key concepts, such as “moral injury,” “psychological first-aid,” and “grief leadership,” and then offers applicable steps that healthcare organizations can take to build on existing support systems.

SAMHSA Releases Treatment Guide on Youth Suicide

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released Treatment for Suicidal Ideation, Self-harm, and Suicide Attempts Among Youth, a 57- page guide that provides interventions to treat suicidal ideation, self-harm, and suicide attempts among youth. Elinore McCance-Katz, M.D., Ph.D., assistant secretary for mental health and substance use, noted in a foreword that the guide is part of SAMHSA’s response to the 21^st Century Cures Act’s requirement to disseminate information on evidence-based practices and service delivery models. McCance-Katz also wrote that suicide is the second leading cause of death for youth in the United States. The suicide rate for youth aged 10 to 24 increased 56% to 10.6 per 100,000 people in 2017 from 6.8 per 100,000 people in 2007.

Reminder: NABH 2021 Board Election Ballots Due Thursday, Dec. 31

NABH this week e-mailed system members the NABH Board of Trustees candidate profiles and a ballot to elect new members to the 2021 Board. If you have not done so, please vote for the open Board Chair-Elect position and three available Board seats; sign the ballot (it is not valid without a signature); and return it to NABH. You can do this by scanning your completed ballot and e-mailing it nabh@nabh.org, or faxing it to 202-783-6041. NABH must receive all ballots no later than Thursday, Dec. 31, 2020. New Board members and the Board Chair-elect will take office in January 2021.

Save the Date: NABH 2021 Annual Meeting 

NABH will host its 2021 Annual Meeting from Wednesday, Oct. 6 – Friday, Oct. 8, 2021 at the Mandarin Oriental Washington, DC. The association re-scheduled for this later date in 2021 due to the ongoing Covid-19 pandemic. We hope you can join us! After 2021, NABH will host its subsequent Annual Meetings in June. Please save the date for these future NABH Annual Meetings:

• June 13-15, 2022

• June 12-14, 2023

We look forward to seeing you in Washington next year!

Fact of the Week

A new Morning Consult poll found that 36% of Americans reported their mental health has suffered during the Covid-19 global pandemic, while 19% said their physical health has worsened. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CDC Director Approves ACIP’s Covid-19 Vaccine Plan for Healthcare Workers, LTCFs

Centers for Disease Control and Prevention (CDC) Director Robert Redfield, M.D. on Thursday approved a CDC committee’s recommendation that healthcare personnel and long-term care facility (LTCF) residents be offered the Covid-19 vaccine in the vaccination program’s initial phase. The agency’s Advisory Committee on Immunization Practices (ACIP) Covid-19 Vaccines Work Group earlier this week outlined a phased allocation for the vaccines that highlighted the committee’s scientific and ethical considerations. The ethical principles include maximizing benefits, minimizing harm, promoting justice, and mitigating health inequities. ACIP members defined LTCF residents as “adults who reside in facilities that provide a variety of services, including medical and personal care, to persons who are unable to live independently,” and a footnote on slide 12 of the presentation includes psychiatric facilities in the LTCF definition. As part of this effort, NABH sent a letter to the National Governors Association that asked governors to prioritize behavioral healthcare providers in the first round of the Covid-19 vaccine distribution. In the letter, NABH President and CEO Shawn Coughlin emphasized that demand for mental health and addiction services has increased during the global pandemic, while challenges such as personal protective equipment shortages and reduced staff availability have placed additional burdens on behavioral healthcare providers. “It is critical that we preserve and even increase access to behavioral healthcare as a key component of the response to Covid-19,” Coughlin wrote. “Since the onset of the pandemic, our members have been intensely focused on implementing many new practices and protocols to address the increased demand for behavioral healthcare while preventing the spread of the coronavirus,” he added. “They have developed and implemented new screening and infection- control measures. Unfortunately, some of these measures, such as quarantine rooms, reduce their capacity to provide care.”

CMS Maintains Some Telehealth Provisions in 2021 Medicare Physician Fee Schedule 

In the Calendar Year (CY) 2021 Medicare Physician Fee Schedule rule released this week, the Centers for Medicare & Medicaid Services (CMS) said it will maintain some of the telehealth service coverage it authorized during the Covid-19 pandemic, including telehealth coverage for group psychotherapy and psychological and neurological testing. CMS said it will decline to continue covering evaluation and management services via audio-only technology, and instead will provide coverage on an interim basis during CY 2021 for an extended, audio-only assessment service to determine whether an in-person visit is needed. This rule also finalized regulations to allow Medicare coverage of telehealth services provided to existing patients while at home, regardless of where they live for treatment of substance use disorders and co-occurring mental health conditions. The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) authorized this exception to the Medicare rules that do not generally cover telehealth services that originate from the patient’s home and limit coverage of telehealth to certain geographic areas.

CMS Includes PHP Payment Rates in 2021 OPPS Rule

CMS this week included payment rates for partial hospitalization programs (PHPs) in the CY 2021 Outpatient Prospective Payment System (OPPS) final rule the agency released on Dec. 3. In the rule, CMS made final its August proposal to use its existing methodology for calculating the CY 2021 geometric mean per diem cost using the most recent updated claims and cost data. Based on available data at that point, the proposed per diem rates were $243.94 for hospital-based PHPs and $121.62 for community mental health centers (CMHCs). Using the most recent updated claims and cost data as proposed, the final CY 2021 hospital-based PHP geometric mean per diem cost is $253.76 and the final CMHC geometric mean per diem cost is $136.14. CMS also finalized the proposed payment rate for Level 2 Health and Behavior Services (Ambulatory Payment Classification 5822) at $78.54, based on existing claims data.

CMS Announces RFA for the Value in OUD Treatment Initiative

CMS has announced a request for application (RFA) for a new initiative intended to increase access to opioid use disorder (OUD) treatment services to eligible Medicare fee-for-service beneficiaries and those dually eligible for Medicare and Medicaid. Funded through the SUPPORT Act, the Value in Opioid Use Disorder Treatment is a four-year demonstration that creates two new payments to participating providers: 1) a per-beneficiary, per-month, care-management fee, and 2) a performance-based incentive payment. The SUPPORT Act makes available $10 million each of the fiscal years 2021-2024 for demonstration payments. According to CMS, these payments will be made in addition to the OUD treatment services Medicare covers already. The demonstration is open to a range of participants, including opioid treatment programs, certified community behavioral health clinics, and community mental health centers. CMS will accept applications through Jan. 3, 2021, and selected participants are expected to implement the demonstration by April 1, 2021, at which time payments will begin. Click here to learn more and apply.

CMS to Host Hospital Price Transparency Webcast on Dec. 8

CMS will host a Hospital Price Transparency Webcast on Tuesday, Dec. 8 to provide a more detailed overview of the resources the agency outlined in an Open Door Forum late last month. Before Thanksgiving, CMS hosted a Rural Health Open Door Forum to highlight hospital price transparency resources to help providers prepare for complying with the agency’s Hospital Price Transparency Rule that takes effect on Jan. 1, 2021. Next week’s webcast will also provide a question-and-answer session after the presentation. Click here to register for the hourlong webcast, which will begin at 2 p.m. ET on Dec. 8.

The Commonwealth Fund Examines Covid-19’s Long-term Effects on Mental Health

U.S. policymakers should consider increasing the mental health provider workforce and investing in telehealth as the global pandemic’s mental health repercussions are likely to grow, according to a new report from The Commonwealth Fund. The report cites modeling estimates from the Well Being Trust that show the Covid-19 pandemic could lead to more than 75,000 additional deaths from alcohol and drug misuse and suicide. Meanwhile, the report notes that the pandemic’s effect on social determinants of health—such as employment, income levels, housing and food security—have “threatened basic survival,” and that nearly one-quarter of adults surveyed in early November reported they had not received needed care in the past four weeks. In addition to their mental health workforce and telehealth recommendations, researchers also suggested that states examine their respective insurance laws to ensure that mental health parity or equal treatment of mental health and substance use disorders is enforced, and enact plans to help children access the mental health resources they received previously in schools.

Learn about Prime Healthcare in Our NABH Member Profile!

In our latest Member Profile, NABH member Prime Healthcare shared some of the effective programs and resources the award-winning health system has developed and implemented during the pandemic.   Click here to read Prime’s profile, and please contact Emily Wilkins at NABH if you would like to submit a profile about your organization.

Save the Date: NABH 2021 Annual Meeting

NABH is pleased to announce it will host its 2021 Annual Meeting from Wednesday, Oct. 6 – Friday, Oct. 8, 2021 at the Mandarin Oriental Washington, DC. The association re-scheduled for this later date in 2021 due to the ongoing Covid-19 pandemic. We hope you can join us! After 2021, NABH will host its subsequent Annual Meetings in June. Please save the date for these future NABH Annual Meetings:

• June 13-15, 2022

• June 12-14, 2023

Thank you for all you do to advance NABH’s mission and vision. We look forward to seeing you in Washington next year!

Fact of the Week

A study from the Centers for Disease Control and Prevention this summer found 15% of non-Hispanic Black adults had seriously considered suicide in the past 30 days, and 18.6% had started or increased their use of substances to cope with pandemic-related stress. For questions or comments about this CEO Update, please contact Jessica Zigmond

Former U.S. Rep. Jim Ramstad (R-Minn.), Addiction Recovery Champion, Dies at 74

Former U.S. Rep. Jim Ramstad (R-Minn.), a champion for addiction recovery, died Thursday at the age of 74. Ramstad, who had been ailing from Parkinson’s Disease, channeled his personal battle with addiction to become a strong advocate for recovery. He represented Minnesota’s third district in the U.S. House of Representatives for nine terms before he retired in 2009. The Minnesota Republican was the chief sponsor for the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, the bill that opened access to treatment for millions of Americans suffering from mental illness or chemical addiction. News outlets reporting Ramstad’s death described how the former congressman’s personal battle with alcoholism spurred him to help others battling addiction. The stories also mentioned Ramstad’s arrest for disorderly conduct while he served in the Minnesota state legislature, the event that caused him to give up drinking. “If I had not wound up in that jail cell, I would not have sought treatment,” Ramstad told The New York Times in 2006. Ramstad celebrated his 39^th year of sobriety at his death, according to news reports.

Federal Court Orders Class-Wide Remedies in Wit v. United Behavioral Health

NABH legal consultant and psychotherapist Meiram Bendat, Ph.D., J.D., sent the following summary to NABH this week regarding the remedies in the Wit v. United Behavioral Health case: In its 99-page ruling, the court explained the need for: (1) a 10-year injunction requiring UBH to exclusively apply medical necessity criteria developed by non-profit clinical specialty associations; (2) appointment of a special master; (3) training of UBH in the proper use of court-ordered medical necessity criteria; and (4) reprocessing of nearly 67,000 mental health and substance use disorder benefit claims denied during the class period. Today’s ruling stems from two consolidated class actions, Wit et al. v. United Behavioral Health. and Alexander et al. v. United Behavioral Health, brought by Psych-Appeal, Inc. and Zuckerman Spaeder LLP under the Employee Retirement Income Security Act of 1974 (“ERISA”) in 2014, certified in 2016, and tried in October 2017. While nearly 50,000 ERISA insureds will be eligible for class-wide relief in this case, non-ERISA insureds (such as governmental employees) adversely impacted by UBH’s defective guidelines must rely on state and federal regulators to intervene on their behalf. I trust that you recognize the significance of today’s ruling as much as we do.  -Meiram Bendat, Ph.D., J.D., Founder and President, Psych Appeal

DEA Publishes Regulations to Implement the Controlled Substances Act and the Preventing Drug Diversion Act

The Drug Enforcement Administration (DEA) this week published regulations to implement amendments that the 2018 SUPPORT Act made to the Controlled Substances Act. The regulations became effective on Friday, Oct. 30 and appeared in the Federal Register on Nov. 2. The updated regulations:

• Allow a practitioner to treat up to 100 patients if a practitioner meets additional credentialing requirements, or if the practitioner provides covered medications (MAT) in a qualified practice setting, and up to 275 patients if the practitioner meet specific additional requirements (42 CFR 8.610-8.655);
• Permanently include nurse practitioner or physician assistant in the definition of ”qualifying other practitioner,” and temporarily expand the definition (until Oct. 1, 2023) to include a clinical nurse specialist, certified registered nurse anesthetist, or a certified nurse midwife who meets certain qualifications;
• Provide an additional option for a physician to be considered a ”qualifying physician” if the physician graduates in good standing from an accredited school of allopathic medicine or osteopathic medicine in the United States five years prior to notifying HHS of his or her intention to dispense narcotic drugs for maintenance or detoxification treatment. This does not eliminate the SUPPORT Act’s eight-hour opioid training requirement; rather, it permits the training to be completed in medical school or residency, not just through post-residency continuing medical education; and
• Permit pharmacies to deliver a controlled substance to a prescribing practitioner’s location for the purpose of administering the medication (through implantation or injection) to the patient or research subject, as previously permitted under a DEA exception. This permits administration directly in the provider’s office without requiring a trip to the pharmacy.

In separate rulemaking, the DEA proposed its intention to amend the Preventing Drug Diversion Act of 2018 related to the identifying and reporting of suspicious orders by DEA registrants. The proposal offers a two-option framework for reporting suspicious orders, establishes a centralized database for reporting, defines four terms: “due diligence,” “order,” “order received under suspicious circumstances,” and “suspicious order,” and requires registrants to design and operate privacy-law-compliant systems. The provisions are intended to clarify procedures for registrants and address a lack of uniformity in reporting suspicious orders. Comments are due by Monday, Jan. 4, 2021.

HHS Extends Compliance Deadline for Information Blocking and Health IT Certification

The U.S. Health and Human Services Department (HHS) recently released an interim final rule that gives healthcare providers and vendors an additional five months to comply with healthcare information blocking and interoperability regulations by April 5, 2021. In March, HHS’ Office of the National Coordinator for Health IT (ONC) released a 21^st Century Cures Act final rule that established exceptions to the Cures Act’s information blocking provision and adopted new health information technology (health IT) certification requirements to improve patients’ smartphone access to their health information at no cost through application programming interfaces. The new interim final rule extends dates in the information blocking provisions—including a November compliance deadline for providers—as well as dates for the Conditions and Maintenance of Certification provisions that require electronic health records platforms to be interoperable. This is the second time HHS has extended the compliance deadline due to the Covid-19 pandemic. “We are hearing that while there is strong support for advancing patient access and clinician coordination through the provisions in the final rule, stakeholders also must manage the needs being experienced during the current pandemic,” Don Rucker, M.D., national coordinator for health IT, said in an announcement. “To be clear, ONC is not removing the requirements advancing patient access to their health information that are outlined in the Cures Act final rule,” he continued. “Rather, we are providing additional time to allow everyone in the health care ecosystem to focus on Covid-19 response.” The rules require that various types of clinical notes be shared with patients, although the rules do not apply to “psychotherapy notes recorded in any medium by a healthcare provider who is a mental health professional documenting or analyzing the contents of a conversation during a private counseling session or a group, joint, or family counseling session and that are separate from the rest of the individual’s medical record,” according to a summary.

Reminder: DOL’s Rural Healthcare Workforce Training Grant Applications Due Nov. 13

The U.S. Labor Department’s Employment and Training Administration (ETA) will accept applications for its H-1B Rural Healthcare Grant Program until next Friday, Nov. 13. Earlier this fall, ETA announced $40 million in available grant funding for employment and training programs in healthcare occupations—including behavioral and mental healthcare—that serve rural populations. According to the announcement, employment and training programs through this funding can propose a wide range of models, including Registered Apprenticeship Programs and Industry-Recognized Apprenticeship Programs. Pre-apprenticeships are permitted only “as on-ramps” to apprenticeship programs proposed as a response to the funding notice and must lead to apprenticeships during the life of the grant. Click here to learn more about the training programs and here to learn how to apply for the funding.

Bipartisan Policy Center to Host Telehealth Webinar Next Week

Sen. Angus King (I-Maine), Maine healthcare providers, and Bipartisan Policy Center experts will lead a webinar about the future of telehealth next Friday, Nov. 13 at noon ET. The webinar will address the investments and changes that both policymakers and healthcare providers need to make to sustain access to quality healthcare through telehealth. Click here to learn more and to register.

NABH to Host Next Annual Meeting in October 2021

NABH is pleased to announce it will host its 2021 Annual Meeting from Wednesday, Oct. 6 – Friday, Oct. 8, 2021 at the Mandarin Oriental Washington, DC. The association re-scheduled for this later date in 2021 due to the ongoing Covid-19 pandemic. We hope you can join us! After 2021, NABH will host its subsequent Annual Meetings in June. Please save the date for these future NABH Annual Meetings:

• June 13-15, 2022
• June 12-14, 2023

Thank you for all you do to advance NABH’s mission and vision. We look forward to seeing you in Washington next year! Fact of the Week Individuals with a serious mental illness have an average life expectancy 10 to 25 years lower than the rest of the population. For questions or comments about this CEO Update, please contact Jessica Zigmond.

Presidential Executive Order Establishes Coronavirus Mental Health Working Group

The White House last week issued an executive order to create a Coronavirus Mental Health Working Group that is expected to develop a plan that addresses Covid-19’s mental health effects on Americans and calls for agencies to maximize support for behavioral healthcare treatment. President Trump’s Saving Lives Through Increased Support for Mental—and Behavioral-Health Needs executive order notes that the working group’s efforts will consider the mental and behavioral health conditions of the vulnerable populations that the pandemic has affected, including minorities, seniors, veterans, small business owners, children, individuals potentially affected by domestic violence or physical abuse, persons living with disabilities, and individuals with substance use disorder (SUD). “We know that the Covid-19 pandemic has created or exacerbated serious behavioral health challenges for many Americans, both adding new stresses and disrupting access to treatment,” U.S. Health and Human Services (HHS) Secretary Alex Azar said in a statement.  “The president’s executive order is a welcome opportunity to increase efforts to address the mental health effects of the pandemic, which have already included hundreds of millions of dollars in grants and historic flexibilities to ensure Americans can continue to receive treatment for mental illness and substance use disorders.” Azar will co-chair the new working group with Brooke Rollins, acting director of the U.S. Domestic Policy Council.

U.S. Congress Joint Economic Committee Examines Covid-19’s Toll on Americans’ Mental Health

The United States Congress Joint Economic Committee has released a report that examines how Covid-19’s health and economic repercussions have led to “an unprecedented mental health crisis” in America. The 13-page report summarizes earlier surveys and studies that have found two-thirds of Americans fear that they or their loved ones will be exposed to the virus; more than 12 million Americans are unemployed, and, since February, more than 5 million have given up looking for work; and that nearly one-third of adult Americans are having trouble paying for typical household expenses. “There is yet no clear end in sight for the coronavirus pandemic, which will continue to have devastating effects on public health and on the economy,” the report said. “The Institute of Health Metrics and Evaluation projects more than 360,000 deaths by the end of 2020 under current circumstances, and upward of 430,000 if mandates continue to be eased,” it continued. “The Federal Reserve expects the unemployment rate to remain above pre-pandemic levels until at least the end of 2021. These intense stresses likely will have a growing and lasting impact on Americans’ mental health.

CMS Corrects Announcement to Say Providers Cannot Use PRF When Repaying Medicare Loans

The Centers for Medicare & Medicaid Services (CMS) corrected a misstatement in its Oct. 8 news release to say the nation’s healthcare providers and suppliers cannot use Provider Relief Funds (PRF) to repay Medicare loans the agency has made during the Covid-19  public health emergency. The correction first appeared in an FAQ on Oct. 9. CMS subsequently corrected its original release.

AAAP Releases Buprenorphine Provider Survey Report to Inform Policymakers

The American Academy of Addiction Psychiatry (AAAP) this week released the findings from a new survey that found 80% of X-waivered physicians, physician assistants, and nurse practitioners who treat patients with opioid use disorder (OUD) want telehealth options to continue after the Covid-19 public health emergency. The X-waiver permits office-based clinicians to prescribe Suboxone (buprenorphine/naloxone) for OUD patients. The AAAP led the project with help from other organizations, including the American Psychiatric Association, the American Society of Addiction Medicine, Boston Medical Center, Boston University, and the Yale Program in Addiction Medicine. According to the survey, 78% of respondents said the Covid pandemic has caused them to put on hold or reduce in-person visits. Meanwhile, 75% of physicians and other healthcare professionals said they have used virtual visits to help maintain medication to treat OUD, and 48% reported they used telehealth to initiate medication to help treat OUD. “During the pandemic, physicians and other health care professionals have adapted to quickly provide high-quality, evidence-based care, but this was only possible due to new flexibilities in telehealth rules,” the survey said.

National Addiction Treatment Week Begins Monday, Oct. 19

Monday kicks off National Addiction Treatment Week to build awareness that addiction is a disease, evidence-based treatment is available, and recovery is possible. The week is also meant to encourage people to enter the field of addiction treatment. The American Society of Addiction Medicine (ASAM) launched National Addiction Treatment Week three years ago with partner organizations. Partners include the National Institute on Drug Abuse, the American Medical Association, and the National Association of Addiction Treatment Providers. Click here for ASAM’s schedule of the week and toolkit. Separately, ASAM released an updated cannabis policy statement on Oct. 10.

Please Complete the 2020 NABH Annual Survey!

The 2020 NABH Annual Survey will close on Saturday, Oct. 31. NABH members should have received personalized links to the survey from consulting firm Dobson DaVanzo. If you have not received a link, please click here and follow the instructions to submit your survey today. Your feedback will help inform and improve NABH’s advocacy efforts. Thank you for your time!

Fact of the Week

The rate of domestic violence that women with serious mental illness experience throughout their adulthood was more than double than that of the general population: 69% versus 33%. Men with serious mental illness showed a similar trend when compared with the general population: 49% versus 17%, respectively. For questions or comments about this CEO Update, please contact Jessica Zigmond.

CMS Gives Medicare Part A & B Providers One More Year to Repay AAP Loans

The Centers for Medicare & Medicaid Services (CMS) said Thursday it will give Medicare Part A and B providers and suppliers an additional year to repay loans the agency made to them during the Covid-19 public health emergency (PHE). CMS had advanced payments to Medicare Part A and B providers and suppliers through the Accelerated and Advance Payment (AAP) program to help cover costs as the PHE disrupted healthcare services this year. Initially CMS had required providers to start making repayments in August 2020. “CMS’ advanced payments were loans given to providers and suppliers to avoid having to close their doors and potentially causing a disruption in service for seniors,” CMS Administrator Seema Verma said in an announcement. “While we are seeing patients return to hospitals and doctors providing care we are not yet back to normal,” she added. According to the agency’s new terms, after that first year, CMS will automatically recoup 25% of Medicare payments otherwise owed to the provider or supplier for 11 months. After that period, CMS will increase the recoupment amount to 50% for another six months. CMS said it will send letters to providers who have any outstanding balances after the entire period—a total of 29 months— informing them that repayment will be subject to a 4% interest rate. Those letters will also include guidance on how to request an Extended Repayment Schedule (ERS) due to financial hardship. The agency’s announcement urged providers and suppliers to contact their Medicare Administrative Contractor for information about how to request an ERS. An ERS will allow a provider or supplier to repay these debts over the course of three to five years. CMS also said providers and suppliers may use Provider Relief Funds to repay these Medicare loans. CMS said it will communicate with each provider and supplier about the amount they owe and all applicable terms in the coming weeks.

New CMS Guidance Requires Psychiatric Hospitals to Report Covid-19 Data Weekly

CMS has released guidance that requires Medicare- and Medicaid-participating psychiatric hospitals to report Covid-19 data to the agency on a weekly basis. CMS published an interim final rule in early September that said hospitals would be required to submit Covid-19 data during the public health emergency in a frequent, standardized way that the U.S. Health and Human Services Department (HHS) secretary specified. This week’s awaited guidance makes it clear that the nation’s psychiatric hospitals—along with rehabilitation hospitals—need to report their data weekly, and not on a daily basis as other hospital types are required to do. NABH advocated for CMS to lessen the reporting frequency for psychiatric hospitals and is pleased with the change. The agency listed the required data in new guidance and also developed an infographic that highlights when the agency plans to alert hospitals about gaps in reporting and compliance. These materials are also available on NABH’s Covid-19 resources webpage.

HRSA Releases Provider Relief Fund Phase 3 Distribution Guide and Fact Sheet

HHS’ Health Resources and Services Administration (HRSA) has released a 12-page provider guide and separate fact sheet to help the nation’s healthcare providers navigate the third phase of the Provider Relief Fund (PRF) distribution during the Covid-19 pandemic. The guide includes specific details on eligibility requirements, application requirements, and reporting guidelines, while the fact sheet condenses the guide’s information and also provides links. HHS announced an additional $20 billion in additional funding last week and encouraged behavioral healthcare providers to apply. The department also developed a list of providers eligible for the funding, including addiction counseling centers, mental health counselors and psychiatrists. The Phase 3 Distribution application process opened this past Monday, Oct. 5, and the application deadline is Friday, Nov. 6. HRSA has scheduled an informational webinar to learn more about the Phase 3 Distribution process next Thursday, Oct. 15 at 3 p.m. ET. Click here to register. HHS has scheduled a webinar about the Phase 3 Distribution process specifically for behavioral healthcare providers and the associations that represent them for Friday, Oct. 16 at 3 p.m. ET. Click here to register.

NABH Submits Comments to CMS on 2021 Physician Fee Schedule Proposed Rule

NABH on Oct. 2 provided feedback to CMS on the telehealth services and substance use disorder (SUD) provisions in the agency’s 2021 physician fee schedule (PFS) proposed rule. In a letter to CMS Administrator Seema Verma, NABH said it supports the proposed rule’s provisions that would continue some of the expanded Medicare coverage of services provided via telehealth, including provisions to extend permanently Medicare coverage for group psychotherapy and psychological testing. The association also said it supports those provisions clarifying that clinical social workers and clinical psychologists and therapists can furnish online assessment and management services, virtual check-ins, and remote evaluations. “We urge you to continue covering evaluation and management services and behavioral health counseling as well as opioid/addiction treatment program counseling and periodic assessment services provided via audio-only technology, i.e., telephone,” the letter said. “Furthermore, we recommend continuing to pay for these services at the same or comparable rates as in-person care—as well as paying for administrative fees to help cover the costs of this technology.” NABH also provided comments on the Opioid Treatment Program (OTP) bundled payment regulations, emphasizing more equitable reimbursement for naloxone and community education for naloxone, as well as reduced limitations on the frequency of reimbursement to align with medical necessity determinations. In addition, NABH’s letter said the association supports continued coverage of periodic telehealth assessments beyond the PHE (including audio-only), and to be reimbursed every 60-90 days, consistent with many state requirements to perform such assessments. The association encouraged CMS to continue the simple, one-bundle structure that has been used successfully to date and reiterated NABH’s recommendation from last year that CMS provide a 17% adjustment to encourage the development of rural OTPs. And NABH underscored the importance of continuing to permit greater flexibility in take-home medications, as well identifying the need to permit reimbursement for OTPs who are under a Substance Abuse and Mental Health Services-provisional certification. Finally, NABH supported the agency’s proposal to expand the PFS bundled payments for Opioid Use Disorder to all SUDs.

U.S. Labor Department to Provide $40 Million in Rural Healthcare Workforce Training Grants 

The U.S. Labor Department’s Employment and Training Administration has announced about $40 million in available grant funding for employment and training programs in healthcare occupations—including behavioral and mental healthcare—that serve rural populations. According to the announcement, employment and training programs through this funding can propose a wide range of models, including Registered Apprenticeship Programs and Industry-Recognized Apprenticeship Programs. Pre-apprenticeships are permitted only “as on-ramps” to apprenticeship programs proposed as a response to the funding notice and must lead to apprenticeships during the life of the grant. The deadline to apply is Friday, Nov. 13. Click here for additional information and how to apply.

U.S. Justice Department to Develop Guidelines to Manage Substance Withdrawal in Jail-based Settings

The U.S. Justice Department’s Bureau of Justice Assistance (BJA) and the National Institute of Corrections is seeking feedback to develop evidence-based, clinical guidelines and protocols that will help jail administrators, correctional officers, and jail-based clinicians identify and safely manage substance withdrawal in jail-based settings. According to an announcement, the guidelines will address a host of issues, including, but not limited to, rapid withdrawal from opioids, benzodiazepines, alcohol, methamphetamine, and cocaine individually or in combination, including specification of persons who exhibit withdrawal symptoms or report histories or information from other sources that indicate the necessity of immediate referral to medical facilities outside of the jail; screening for risk of suicide, specifically opioid withdrawal-potentiated suicides; and medication maintenance for entering detainees with prescriptions for opioid or antipsychotic medications. The BJA will select one applicant for a 10-month award to create a document that outlines the guidelines and protocols. Applications are due by Wednesday, Oct. 28. Click here for more information.

Joint Commission to Host Virtual Behavioral Health Care and Human Services Conference

The Joint Commission will host its Behavioral Health Care and Human Services conference in a virtual format on Friday, Oct. 28. This year, attendees will have the option to choose from two tracks: Track A, designed for organizations accredited under the Behavioral Health Care Accreditation Manual, and Track B, intended for those accredited under the Hospital Accreditation Manual and supplemented with the Behavioral Health Care Manual. Click here for more information and to register.

Today is the Deadline to Submit Recommendations for the 2021 NABH Board of Trustees

The deadline is today, Friday, Oct. 9, to submit nominees for NABH’s Board Chair-Elect and three NABH Board of Trustees seats that will become available in 2021. NABH’s Selection Committee is particularly interested in identifying senior managers who represent broad diversity within the NABH membership, including various levels of care, organizational structures, and size. If you have not done so yet, please download a nomination form to share your recommendations of individuals you would like to see included in the single-slate ballot for 2021. Please be sure to attached a curriculum vitae (CV) for each individual you recommend, which will help the Selection Committee in its deliberations. You are welcome to recommend yourself. Please send your completed form and all candidate CVs to NABH Director of Operations Maria Merlie. Thank you for your time!

Please Complete the 2020 NABH Annual Survey! 

The 2020 NABH Annual Survey opened in late August and NABH members should have received personalized links to the survey from consulting firm Dobson DaVanzo. If you have not received a link, please click here and follow the instructions to submit your survey today. Your feedback will help inform and improve NABH’s advocacy efforts. The survey closes on Saturday, Oct. 31. Thank you for your time!

Fact of the Week

In the first half of 2019, just more than one in 10 adults (11%) reported symptoms consistent with a diagnosable anxiety or depressive disorder. By July 2020, during the Covid-19 pandemic, that number had increased to 40%. For questions or comments about this CEO Update, please contact Jessica Zigmond.

NABH and Other Healthcare Advocacy Groups Provide Feedback on Latest Covid-19 Legislation

NABH this week weighed in on issues specific to behavioral healthcare providers in the $1 trillion Covid-19 stimulus package that Senate Majority Leader Mitch McConnell (R-Ky.) released on Monday, July 27. Referred to collectively as the HEALS Act, the legislation includes a total of eight bills from Senate Republicans. For detailed information on this latest Covid-19 bill, please see this section-by-section summary from the law firm Brownstein Hyatt Farber Schreck. On Thursday, NABH joined the American Hospital Association, the Federation of American Hospitals, the Catholic Health Association of the United States, the Children’s Hospital Association, the Association of American Medical Colleges, Premier Healthcare Alliance, and Vizient, Inc. in a letter regarding surprised medical billing. “Legislative proposals that would dictate a set payment rate for unanticipated out-of-network care are neither market-based nor equitable, and do not account for the myriad inputs that factor into payment negotiations between insurers and providers,” the organizations noted in the letter. “These proposals will only incentivize insurers to further narrow their provider networks and would also result in a massive financial windfall for insurers,” it continued. “As such, we oppose the setting of a payment rate in statute and are particularly concerned by proposals that would undermine hospitals and front-line caregivers during the Covid-19 pandemic.” And on Tuesday, NABH joined a handful of other advocacy groups—including Advocates for Opioid Recovery, the American Association for Opioid Dependence, Inc., and the MAT Leadership Council—in sending a letter to congressional leaders that calls for a total of $400 million in federal funding to support opioid treatment programs (OTPs) and recovery support services. “To ensure that the 450,000 OTP patients around the country continue to have access to this lifesaving care, we request that $300 million be included in the next COVID-19 stimulus package for opioid treatment programs,” the organizations said in the letter, adding later, “We also request that Congress set aside an additional funding stream of $100 million for recovery support services. Recovery support services can cover myriad types of programming including online and call-in All Recovery Meetings that support multiple pathways to recovery, peer support services, and evidence-supported programs that teach life skills and/or job skills and training for those in recovery or who are involved in the criminal justice system.” NABH will continue to keep members apprised of congressional developments on the latest coronavirus stimulus package.

CMS Approves DNV GL Healthcare USA as a Psychiatric Accreditation Program

The Centers for Medicare and Medicaid Services (CMS) announced in a final rule that it has approved an application from DNV GL Healthcare USA for initial recognition as an accrediting organization for   psychiatric hospitals that wish to participate in Medicare or Medicaid. According to the rule, CMS has approved DNV GL as a national accrediting organization for these facilities effective July 30, 2020 through July 30, 2024. CDC Releases New Covid-19 Guidance for Behavioral Healthcare  New guidance from the Centers for Disease Control and Prevention (CDC) this week clarified that the federal agency’s infection prevention and control guidance applies to all settings where healthcare is delivered, which includes psychiatric hospitals or other behavioral health facilities. The guidance also included challenges and potential solutions specific to behavioral health settings, such as group therapy sessions, cloth face coverings, alcohol-based hand sanitizer, and smoking.

HHS Joins Other Federal Agencies to Form Covid-19 Insights Partnership

HHS has joined the U.S. Veterans Affairs Department (VA) and the U.S. Energy Department to form the Covid-19 Insights Partnership to coordinate and share health data as well as expertise and research to fight against the coronavirus. “The volume and quality of the data HHS has on COVID-19 has advanced by leaps and bounds in recent months,” HHS Secretary Alex Azar said in an announcement about the partnership. “The Department of Energy’s world-class resources will help us derive new insights from the data we gather to help patients and protect our country.” The Covid-19 Insights Partnership’s research and analysis will focus on vaccine and therapeutic development and outcomes, virology, and other critical scientific topics to understand Covid-19 better. HHS and VA will provide additional updates and information on research projects as it becomes available.

MACPAC Responds to Covid-19 and Systemic Racism with New Resources

The Medicaid and CHIP Payment and Access Commission (MACPAC) has added a new section to its website and released a new issue brief to highlight the nation’s two public health crises: Covid-19 and systemic racism. An announcement from MACPAC noted that elevated rates of infection and mortality from Covid-19 are having a disproportionate effect on Black, Hispanic, and Native American communities. A new section of the commission’s website describes how Medicaid is using different legal authorities to respond to the deadly coronavirus, while a new issue brief highlights what MACPAC refers to as a “countercyclical role” responding to this current crisis as well as previous economic and public health emergencies.

Commonwealth Fund Releases Analysis on How States Can Address Mental Health

A new analysis from the Commonwealth Fund shows that 13.4% of adults 18 and older reported symptoms of serious psychological distress in April 2020, compared with 3.9% in April 2018. The findings also projected that deaths from suicide and alcohol or drug misuse could increase by an additional 75,000 before the U.S. economy recovers from Covid-19. In the report, researchers examine states’ mental health responses to Covid-19 by Medicaid and other insurers. The analysis also maps out effective strategies. “While no state has yet provided a comprehensive response, all have implemented measures to address the issue, providing a wealth of ideas and promising practices,” researchers K. Bryant Smalley and Jacob C. Warrant noted in the analysis released this week. “These strategies largely fall into five categories: telemental health, licensure and scope of practice, insurance changes, establishment of new services, and visibility and durability of efforts.”

Wit v. UnitedHealthcare Hearing Open to Public Via Webinar on Thursday, Aug. 6

Members of the public and press are welcome to join a webinar next week that will feature the remedies hearing in the Wit v. UnitedHealthcare case. Click here to follow the hearing via Zoom on Thursday, Aug. 6 at 12:30 p.m. ET/ 9:30 a.m. PT. For important information and guidance on technical preparation for the webinar, please click here.

Reminder: NABH Telehealth Survey Due Today, Friday, July 31

If you haven’t done so already, please fill out this survey about how expanded telehealth coverage during the Covid-19 pandemic has helped maintain and/or improve access to behavioral healthcare. This information will help us advocate for continued expanded telehealth coverage after the public health emergency ends. Please e-mail Kirsten Beronio, NABH’s director of policy and regulatory affairs, with any questions.

Fact of the Week

Three of the 20 most expensive conditions during hospital stays with an expected payer of Medicaid were related to mental and substance use disorders: schizophrenia spectrum and other psychotic disorders, depressive disorders, and alcohol-related disorders.   For questions or comments about this CEO Update, please contact Jessica Zigmond.

HHS Temporarily Suspends Quarterly Reports from Provider Relief Fund Recipients

HHS on June 13 updated previous guidance to say recipients of Provider Relief Fund payments do not need submit a separate quarterly report to HHS or the Pandemic Response Accountability Committee. The Coronavirus Aid, Relief, and Economic Security Act (CARES) had included the requirement, but HHS updated a Frequently Asked Questions document and said the agency will develop a report containing all information necessary for recipients of the payment to comply with this provision. HHS also indicated it would require reports in the future. “However, the Terms and Conditions for all Provider Relief Fund payments also require recipients to submit any reports requested by the Secretary that are necessary to allow HHS to ensure compliance with payment Terms and Conditions,” the updated guidance noted. “HHS will be requiring recipients to submit future reports relating to the recipient’s use of its PRF money.  HHS will notify recipients of the content and due date(s) of such reports in the coming weeks.”

NABH Sends Youth Education Funding Recommendations to Congressional Committees

  NABH this week sent a letter to two congressional committees that recommends how to allocate money from the Elementary and Secondary School Emergency Fund that the CARES Act authorized. In the letter to the Senate Health, Education, Labor & Pensions Committee and the House Committee on Education & Labor, NABH President and CEO Shawn Coughlin asked Congress to clarify that funding for state education agencies from the Elementary and Secondary School Emergency Relief Fund be allocated equitably to both non-profit and for-profit residential and other therapeutic settings, including specialized day schools that provide care for children and adolescents with serious behavioral and/or emotional conditions. In addition, NABH recommended that Congress dedicate funding in any upcoming legislation that addresses the Covid-19 pandemic to provide education services and supports for children and adolescents with these conditions. “An appropriation of $37.5 million for education services in residential and other treatment settings and specialized day schools would ensure these settings are able to provide digital devices, internet access, and online school content to these children and adolescents with special needs,” the letter said. “There are approximately 500 residential facilities serving 25,000 children and adolescents with serious behavioral and/or emotional conditions nationwide, and this would ensure that this population is also included and treated equitably.”

Kaiser Family Foundation Issue Brief Highlights Options for Medicaid Providers During Covid-19

  In a new issue brief, the Kaiser Family Foundation provides an overview of how states currently reimburse providers and the challenges for Medicaid providers that have resulted from the Covid-19 pandemic. The brief notes that although Congress enacted legislation with $175 billion in provider relief grants, the initial allocation of funds was “disadvantageous” to Medicaid providers. “HHS recently announced that $15 billion has been set aside to more directly support Medicaid providers, and an unspecified amount has been allocated to reimburse providers for COVID-19 treatment costs for the uninsured,” the issue brief said. “However, it is not clear if the current provider relief fund allocations will be sufficient to meet providers’ needs resulting from the pandemic. Congress will likely continue to debate additional funding for states through Medicaid and for providers. Without additional fiscal relief, states may be limited in their ability to support Medicaid providers and provider relief grants may not be adequate.”

News Report Shows 20% Increase in Drug Overdose Deaths in New Jersey

  Drug overdose deaths in New Jersey have increased 20% this year during the Covid-19 pandemic, news outlet NJ.com reported this week. Citing data from NJ Cares, the state’s drug information dashboard, the story reported that 1,330 people in New Jersey died of suspected overdoses in the first five months of 2020, which is 225 more people than the number recorded in the same period last year. May’s figures were especially grim, the story said, when suspected deaths reach a high of 307—nearly 10 people per day. State Police Lt. Jason Piotrowski was quoted in an online town hall saying seven deaths a day has been typical and that he hopes last month’s number proves to be an anomaly.

CMS Chicago Stakeholders to Host Webinar on Covid-19 Relief Funds and Medicaid Next Week

The Centers for Medicare & Medicaid Services (CMS) Chicago Local Engagement and Administration will host a 30-minute webinar about CARES Act Provider Relief Fund distribution in Medicaid on Wednesday, June 24. The event is part of CMS Chicago’s weekly “Real Time” series on Wednesdays at 9 a.m. CT. Click here for more information and to register.

Fact of the Week

A June Health Affairs article reports fewer than half of U.S. mental health treatment facilities provide services for children with autism spectrum disorder (ASD). For questions or comments about this CEO Update, please contact Jessica Zigmond.