Author: Maria

NABH Sends Comments to HHS about Family First Prevention Services Act NABH this week sent comments and a series of recommendations to HHS’ Administration for Children and Families (ACF) on how to implement the Family First Prevention Services Act (FFPSA) effectively. In the letter, NABH emphasized that FFPSA creates a separate system of care for foster children in which judges and administrators—not clinicians—are left to make treatment decisions. The association urged ACF to work with stakeholders to create programs and services that can be tailored to every child’s needs and circumstances. Specifically, NABH recommended that ACF clarify the definition of Qualified Residential Treatment Program (QRTP); specify assessor credentials; provide options under court review; and allow for flexibility in providing services and including families in treatment. Click here to read the letter. SAMHSA Developing Mental Health Workforce Initiative The Substance Abuse and Mental Health Services Administration (SAMHSA) is developing a mental health workforce initiative that could be in place by late September, Assistant Secretary for Mental Health and Substance Use Elinore McCance-Katz, M.D., Ph.D., told federal lawmakers Thursday in a congressional hearing about implementing the 21st Century Cures Act. According to a hearing summary, McCance-Katz said the program would set up specialized training programs targeted toward mental health and substance use disorders that focus on local needs. She also said SAMHSA has partnered with the U.S. Department of Agriculture to address needs in rural areas, and added that her agency is working on additional guidance for states on telehealth to better serve rural populations. Click here to read McCance-Katz’s written testimony from the hearing. Azar Names CMMI Director Boehler to Lead Value-based Agenda HHS Secretary Alex Azar has named Centers for Medicare and Medicaid Innovation Director Adam Boehler as a senior adviser for value-based transformation and innovation at HHS. In this role, Boehler—who was appointed CMMI director in April—will lead the department’s broader value-based care agenda. Politico reported this week that Azar’s selection completes his team of officials responsible for overseeing HHS’ main policy priorities. The others are Assistant Secretary for Health Brett Giroir as the top official to oversee the opioid crisis; Dan Best as senior adviser on drug pricing; and James Parker as senior adviser on health reform. Opioid-related Deaths in the United States Increased by 345 percent from 2001-2016 The number of opioid-related deaths rose by a staggering 345 percent between 2001 and 2016, according to a new JAMA study that used data from the Centers for Disease Control and Prevention. Researchers used a method in which they examined cross sections at different points to investigate deaths from opioid-related causes in the United States between Jan. 2, 2001 and Dec. 31, 2016. They concluded that while opioid prescribing and overdose are leading public health problems in North America, the precise public health burden has not been quantified. The study showed that the burden was particularly high among adults aged 24 to 35 years old, and that 20 percent of deaths in this age group involved opioids in 2016. “Furthermore, the aging population of people with opioid use disorder requires attention, as the burden of opioid overdose among adults aged 55 to 64 years is growing at a concerning rate,” the researchers noted. “These trends highlight a need for tailored programs and policies that focus on both appropriate prescribing and harm reduction in these demographics.” Study Shows “Warm Handoffs” Do Not Improve Attendance at Behavioral Health Intake Appointments Boston Medical Center researchers have found that “warm handoffs”—in which primary care clinicians introduce patients to behavioral health professionals—are not associated with better attendance at behavioral health intake appointments. Rather, the most significant predictor of attendance at an initial intake was the time from referral until appointment, the researchers concluded in their study published in the Annals of Family Medicine. Meanwhile, the authors call for a prospective study that compares different types of warm handoffs with standard referrals to determine if warm handoffs improve attendance at initial intake appointments, as well as which features are most beneficial. Partial Hospitalization Program PEPPER Available A release of the Partial Hospitalization Program (PHP) Program for Evaluating Payment Patterns Electronic Report, or PEPPER, with statistics through December 2017 is now available. Freestanding PHPs can find their PEPPER through the PEPPER Resources Portal. Also, the TMF Health Quality Institute will host a webinar training session about the PHP PEPPER on Thursday, August 2 from 2 p.m. to 3 p.m. ET.   For more information, visit the PHP Training and Resources page, and access the PHP PEPPER User’s Guide before the webinar.  SAMHSA to Host Webinar on Supervising Peer Workers Next Week SAMHSA will host a webinar about supervising peer workers on Thursday, July 26 from 2 p.m. to 3 p.m. ET. The webinar’s presenters will outline the principles of supervising peer workers; share administrative, educational, and supportive supervisory practices; and discuss their own experiences supervising peer workers in different settings. Click here to register for the webinar. In addition, SAMHSA has announced a series of webcasts that include discussions from experts in the field of addiction treatment, research, and policy on overcoming stigma and ending discrimination; why addiction is a disease; and reducing discriminatory practices in clinical settings. SAMHSA developed the webcasts together with Massachusetts General Hospital’s Recovery Research Institute.  

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

Number 15 July 13, 2018 Justice Department Announces Regulations to Address Opioid Crisis The Justice Department this week made final a rule it proposed in April to improve the Drug Enforcement Administration’s (DEA) ability to control diverting dangerous drugs during the nation’s opioid crisis. The rule establishes that DEA will consider the extent to which a drug is diverted for abuse when the agency sets its annual opioid production limits. This means that if DEA officials believe a particular opioid or a particular company’s opioids are being diverted for misuse, the agency can reduce the amount that can be produced in a given year. Click here for more information.  NIMH-Supported Study Examines EHR Model to Predict Suicide Attempts and Suicide Deaths The National Institute of Mental Health this week highlighted a study published earlier online in the American Journal of Psychiatry in which researchers at the Kaiser Permanente Washington Health Research Institute sought a better way to predict suicide attempts and suicide deaths in the 90 days after a mental health diagnosis.  The model used data from electronic health records (EHRs) from seven health systems, including the Henry Fords Health System in Detroit, the HealthPartners Institute in Minneapolis, and the Kaiser Permanente regions of California, Colorado, Hawaii, Oregon and Washington. “By leveraging existing electronic health record data and advancements in statistical modeling, it is possible to significantly improve the prediction of death by suicide and suicide attempts over conventional self-report methods,” said Michael Freed, Ph.D., chief of the Services Research and Clinical Epidemiology Branch in NIMH’s Division of Services and Intervention Research. “Valid and reliable suicide risk prediction models hold tremendous promise to reduce death by suicide, especially when integrated with evidence-supported approaches to suicide prevention.” New Research Highlights Increasing Medications to Treat Opioid Addictions A recent study in the Annals of Internal Medicine has heightened interest in using medications to treat opioid addictions. “Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: A cohort study” (Annals of Internal Medicine, June 19, 2018) found that for the year after a nonfatal overdose:

• Methadone reduced overdose deaths by 59 percent
• Buprenorphine reduced overdose deaths by 38 percent
• Fewer than one-third of all patients received a medication for opioid use disorder in the year following a nonfatal overdose
• Naltrexone showed a one-month average retention rate, compared to five months for methadone and four months for buprenorphine.

Following the study, the July 5th issue of The New England Journal of Medicine published three articles about strategies that promote using medications in primary care settings to treat opioid use disorders. These include: “Primary care and the opioid crisis”: Authors Wakeman and Barnett dispel stigma and certain myths about buprenorphine prescribing that make primary care physicians reluctant to prescribe ‘bupe,” including perceptions that bupe treatment is more dangerous, substitutes one addiction for another, more onerous than other treatments, and that reducing the prescribing of opioids will put an end to the overdose epidemic. The authors also debunk as myth that detoxification treatment is effective. Defined as short-term, abstinence-based residential treatment, the article states that research demonstrates this model is ineffective and may increase opioid overdoses by reducing tolerance and increasing the risk of death. “Improving the quality of buprenorphine treatment”: Authors Saloner, Stoller, and Alexander suggest that primary care-based buprenorphine prescribing provides a unique opportunity for true integration of addiction and medical care, including coordination across care to detect the use of opioids and benzodiazepines.  The authors recommend collaboration between specialty and primary care to increase the number of bupe providers; increase the duration of bupe treatment; use quality outcome measures to evaluate population-wide outcomes across levels of care; and improve reimbursement methodologies and extend bundled payments and shared savings arrangements to specialty addiction providers. “Methadone in primary care—one small step for congress, one giant leap for addiction treatment”: Authors Samet, Botticelli, and Walley propose that it’s time for the U.S. to permit methadone to be administered in the primary care setting, as is done in Canada, Great Britain, and Australia. Permitting administration by buprenorphine prescribers would not only fill geographical gaps caused by zoning issues, but also allow all three opioid medications to be offered in one place.  Justification for this approach is found in a risk-benefit analysis in evaluating potential safety issues against 2017 research that shows a reduction in all-cause mortality for those treated with methadone or buprenorphine. HRSA Applications for SUD and Mental Health Services Funding Due Monday, July 16 Applications for federal money to support Health Services and Resources Administration (HRSA)-funded health centers by implementing and advancing evidence-based strategies to expand access to integrated substance use disorder and mental health services are due on Monday, July 16. According to HHS, there is about $350 million available for these awards, which will be announced in September. Click here to learn more and apply for funding. Webinar Presentation on IPFQR Program FY 2019 Requirements Now Available The Quality Reporting Center has posted slides from a webinar this week that summarizes the Fiscal Year (FY) 209 Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program requirements and includes tips to submit data successful. Click here to view the presentation. SAMHSA to Award Opioid-Related Funding Awards The Substance Abuse and Mental Health Services Administration (SAMHSA) will award 59 grants to state governments for prevention, treatment and recovery efforts for opioid use disorder (OUD). Grantees of the program will use data to identify gaps in availability of treatment by geographic, demographic and service-level terms, and use evidence-based implementation strategies “to identify which system design models will most rapidly and adequately address the gaps in their systems of care.” The application deadline is August 13. Click here for more information. SAMHSA will also award 263 grants to supplement current activities for federally recognized American Indian/Alaska Native tribes or tribal organizations to increase access to culturally appropriate and evidence-based treatment of OUDs. The deadline is August. 20. SAMHSA will host three webinars on this topic in the coming weeks. Click here to learn more.   For questions or comments about CEO Update, please contact Jessica Zigmond.