NABH Statement on ERIC Lawsuit Against Final Parity Regulations
In its recent lawsuit, the ERISA Industry Committee (ERIC) purports to represent the interests of large (self-funded) employers, although NABH – including its large employer members – surely support the newly enacted regulations that attempt to implement the Mental Health Addiction and Equity Treatment Act of 2008 fully and fairly.
Compounding matters, ERIC’s lawsuit risks harming consumers with fully insured health plans, even though ERIC does not represent their or their employer’s interests.
Most notably, it is striking that, in the second paragraph of its complaint, ERIC states that “All that is required is parity in particular plan terms and their application, not parity in access to MH/SUD benefits, much less provision of particular benefits.”
In this way, ERIC is challenging even the parity comparative analysis intended to promote transparency and compliance. Essentially, ERIC is arguing that parity should exist in name only and need not result in real world access to care or equitable outcomes. This is perverse, and NABH strongly objects to this interpretation.
About NABH
The National Association for Behavioral Healthcare (NABH) represents provider systems that treat children, adolescents, adults, and older adults with mental health and substance use disorders in inpatient behavioral healthcare hospitals and units, residential treatment facilities, partial hospitalization and intensive outpatient programs, medication assisted treatment centers, specialty outpatient behavioral healthcare programs, and recovery support services in 49 states and Washington, D.C. The association was founded in 1933.
Medicaid Policy Proposals May Disrupt Behavioral Healthcare Access
Background
Behavioral health conditions such as major depressive disorder, schizophrenia, and opioid use disorder are highly prevalent among Medicaid beneficiaries; in 2020, almost 40% of nonelderly adult beneficiaries had a mental or substance use disorder.[1] These individuals depend on the wide range of behavioral health benefits in Medicaid programs, including clinical services across the continuum of care, prescription drugs, and recovery support services. Medicaid is also the single largest payer for behavioral healthcare services in the United States and is an essential revenue source for behavioral healthcare organizations such as outpatient clinics, inpatient and residential facilities, and Opioid Treatment Programs (OTPs).[2]
Several policy proposals have been made to lower federal financial participation (FFP) in Medicaid, such as changing the current formula for Federal Medical Assistance Percentages, instituting caps to FFP at the state- or enrollee-levels (such as by transitioning Medicaid to a block grant), or limiting the existing safe harbor preventing a portion of state taxes on providers’ net patient revenue from being considered when calculating FFP.[3] Additionally, proposals have been made to institute work requirements for Medicaid beneficiaries.[4]
Medicaid Financing Proposals Could Exacerbate Existing Challenges
Reductions in FFP could prompt states to make harmful changes to their Medicaid programs to offset reduced revenue, such as:
- Decreasing provider payments.
- Restricting benefits, particularly optional benefits such as prescription drugs and home- and community-based services.
- Limiting eligibility, such as for the Medicaid expansion population.
These changes could make it much more difficult for people with behavioral health conditions to access needed care. Despite Medicaid being the nation’s largest payer of behavioral healthcare services, there is still significant unmet need for care[5]; each year, millions of people with behavioral health conditions do not receive any treatment.[6] This gap in treatment is largely attributable to a pervasive misalignment between payment for and coverage of behavioral healthcare services, and the positive impact these services have on people and communities.
Existing insurance payment rates for behavioral healthcare services are inadequate, and reductions would worsen this problem. Substantial disparities exist between behavioral healthcare providers and the rest of the healthcare system: an analysis found that, compared with psychiatrists and psychologists, benchmarked commercial insurance reimbursement for office visits with specialist medical/surgical physicians was 25% and 29% higher, respectively.[7]
Meanwhile, Medicaid payment is typically much lower than other insurance programs, with average Medicaid reimbursement for physician office visits being 38% less than employer-sponsored insurance and 26% less than Medicare.[8] Another study found that psychiatrists were reimbursed by Medicaid fee-for-service 19% less on average than by Medicare.[9] Further, Medicaid rates do not necessarily cover provider costs; in 2018, Medicaid payments for community hospital services amounted to only 89% of the cost to deliver those services.[10]
Therefore, reduced payment may further disincentivize behavioral healthcare providers’ participation in Medicaid, exacerbating current issues with inadequate insurance networks of behavioral healthcare providers. For example, a secret shopper survey in New York found that only 14% of calls made to mental healthcare providers listed as in-network by health plans led to an appointment being offered.[11] Another analysis found that over half of mental healthcare providers in Oregon Medicaid managed care plan directories did not see Medicaid beneficiaries in 2018.[12] This reflects the current state of low in-network use of behavioral healthcare services. In 2021, commercially insured patients had out-of-network office visits with psychiatrists 8.9 times more and with psychologists 10.6 times more than with medical/surgical specialists.7
Restricting benefits may also lead to greater out-of-network use, as many important behavioral healthcare services are not mandatory benefits in Medicaid, including residential and inpatient behavioral healthcare, most psychiatric medications, targeted case management, and various other clinical services.[13]
Accordingly, each of the Medicaid policy changes could result in individuals incurring greater out-of-pocket expenses, which, according to the Congressional Budget Office (CBO), could “possibly [lead] to a significant increase in medical debt and bankruptcies.”[14] Otherwise, more individuals could delay or forgo care due to unaffordability, which could result in worsened symptoms that necessitate more intensive care than if treated earlier.
These risks are magnified for Medicaid beneficiaries who lose coverage, as a portion of them may be unable to enroll in other plans (e.g., employer-sponsored, Marketplace). If FFP caps are implemented, CBO and Joint Committee on Taxation staff estimate that about 65% of people who lose Medicaid coverage would become uninsured.[15]
Work Requirements Must Include Behavioral Health Exceptions
Beyond financing, other proposals have been made to implement work requirements for Medicaid beneficiaries (also called “community engagement requirements”), whereby adults’ Medicaid eligibility is conditioned on continued participation in work or other qualifying activities (e.g., educational activities, volunteer programs).4 If pursued, work requirements must incorporate sufficient exceptions to ensure that individuals whose mental or substance use disorders prevent them from satisfying the requirements remain eligible for Medicaid enrollment and are not terminated.
These exceptions should reflect the enormous challenges that people with behavioral health conditions face, many of whom need treatment but cannot access it. Therefore, exceptions should not be limited to people actively enrolled in treatment. Additionally, while some people with behavioral health conditions may qualify for a disability exception, these determinations are often complex and do not capture everyone with significant impairment, so relying on disability exceptions alone risks people who cannot work because of their condition losing coverage. Further, some people with behavioral health conditions experience diminished mental capacity that interferes with their ability to complete administrative processes such as verifying exception eligibility or work requirement compliance, so processes must be designed to accommodate these circumstances. Finally, some people who are not working due to their behavioral health condition may be able to obtain employment if they receive appropriate treatment and recovery supports, so continued Medicaid coverage could actually help facilitate people getting employed.
Importance of Medicaid for the Behavioral Healthcare System
With Medicaid beneficiaries having a disproportionately high prevalence of behavioral health conditions,[16] Medicaid is critical to the delivery of services that people with mental and substance use disorders rely upon to treat their conditions. Therefore, the proposed Medicaid policy changes pose significant risks to behavioral healthcare organizations, which already are stretched thin by low reimbursement and uncompensated care amounting to billions of dollars per year.[17] These changes could necessitate cuts to service availability, leading to decreased access for patients amidst unprecedented need for services.
For OTPs, Medicaid funding enables them to be at the front line of the national response to the overdose crisis. OTPs deliver evidence-based treatment that promotes long-term recovery from opioid use disorder and prevents overdose deaths, and their efforts have transformed the lives of countless Medicaid beneficiaries, especially considering that Medicaid beneficiaries have an overdose death rate that is twice as high as the overall rate in the United States.[18] With 86% percent of OTPs accepting Medicaid in 2023[19] – more than any other insurance type – less funding from Medicaid could threaten the sustainability of OTPs and undermine the recent progress made to reduce overdose deaths.
Beyond the essential care that behavioral healthcare organizations provide, these facilities also have tremendous positive impacts on the economy. For example, one study found that the national economic impact of inpatient psychiatric facilities is nearly three times higher than expenditures, and these facilities alone create almost half a million jobs.[20] If Medicaid expenditures are reduced, we could expect even greater decreases in economic output attributable to behavioral healthcare facilities.
Recommended Actions
The 119th Congress and Trump administration have several major opportunities to reduce burden on behavioral healthcare organizations and better support them as they work to combat the nation’s behavioral health crisis. With respect to Medicaid, NABH recommends the following immediate actions to expand access to treatment:
- Eliminate the Institution for Mental Diseases exclusion, which blocks access to treatment for millions of Americans with severe mental and substance use disorders.
- Align mental health parity requirements for Medicaid managed care plans with the recent final rule for commercial markets, which was a major step forward in expanding access to care.
- Promote adequate Medicaid reimbursement of behavioral healthcare services to match the cost of delivering those services and the value they provide to patients.
Conclusion
For too long, payment and coverage inadequacy has inhibited the availability of behavioral healthcare services. Proposed changes to Medicaid financing and eligibility could have devastating impacts on Medicaid beneficiaries’ access to behavioral healthcare and the organizations that deliver these services. Congress and the Trump administration should undertake policy efforts that promote access to care for the millions of Americans with mental and substance use disorders.
References
[1] Guth M, Saunders H, Corallo B, Moreno S. Medicaid coverage of behavioral health services in 2022: findings from a survey of state Medicaid programs [Internet]. Kaiser Family Foundation; 2023 Mar 17 [cited 2025 Jan 17]. Available from: https://www.kff.org/mental-health/issue-brief/medicaid-coverage-of-behavioral-health-services-in-2022-findings-from-a-survey-of-state-medicaid-programs
[2] Medicaid and CHIP Payment and Access Commission. Behavioral health [Internet]. Medicaid and CHIP Payment and Access Commission; [cited 2025 Jan 17]. Available from: https://www.macpac.gov/topic/behavioral-health
[3] Congressional Budget Office. Options for reducing the deficit: 2025 to 2034 [Internet]. Congressional Budget Office; 2024 Dec [cited 2025 Jan 17]. Available from: https://www.cbo.gov/system/files/2024-12/60557-budget-options.pdf
[4] Limit, Save, Grow Act of 2023, H.R. 2811, 118th Cong., 1st Sess. (2023). Available from: https://www.congress.gov/bill/118th-congress/house-bill/2811
[5] Meiselbach MK, Ettman CK, Shen K, Castrucci BC, Galea S. Unmet need for mental health care is common across insurance market segments in the United States. Health Aff Sch. 2024 Mar 8;2(3):qxae032. doi: 10.1093/haschl/qxae032. PMID: 38756925; PMCID: PMC10986235. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10986235
[6] Substance Abuse and Mental Health Services Administration. 2023 NSDUH Detailed Tables [Internet]. Substance Abuse and Mental Health Services Administration; 2024 Jul 30 [cited 2025 Jan 17]. Available from: https://www.samhsa.gov/data/report/2023-nsduh-detailed-tables
[7] Mark TL, Parrish W. Behavioral health parity – pervasive disparities in access to in-network care continue [Internet]. RTI International; 2024 Apr 17 [cited 2025 Jan 17]. Available from: https://dpjh8al9zd3a4.cloudfront.net/publication/behavioral-health-parity-pervasive-disparities-access-network-care-continue/fulltext.pdf
[8] Biener AI, Selden TM. Public and private payments for physician office visits. Health Aff. 2017 Dec;36(12):2160-2164. doi: 10.1377/hlthaff.2017.0749. PMID: 29200346. Available from: https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0749
[9] Zhu JM, Renfro S, Watson K, Deshmukh A, McConnell KJ. Medicaid reimbursement for psychiatric services: comparisons across states and with Medicare. Health Aff. 2023 Apr;42(4):556-565. doi: 10.1377/hlthaff.2022.00805. PMID: 37011308; PMCID: PMC10125036. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10125036
[10] Appendix 1: supplementary data tables. Trends in the overall health care market [Internet]. American Hospital Association; [cited 2025 Jan 17]. Available from: https://www.aha.org/system/files/media/file/2020/10/TrendwatchChartbook-2020-Appendix.pdf
[11] Office of the New York State Attorney General. Inaccurate and inadequate: health plans’ mental health provider network directories [Internet]. Office of the New York State Attorney General; 2023 Dec 7 [cited 2025 Jan 17]. Available from: https://ag.ny.gov/sites/default/files/reports/mental-health-report_0.pdf
[12] Zhu JM, Charlesworth CJ, Polsky D, McConnell KJ. Phantom networks: discrepancies between reported and realized mental health care access in Oregon Medicaid. Health Aff. 2022 Jul;41(7):1013-1022. doi: 10.1377/hlthaff.2022.00052. PMID: 35787079; PMCID: PMC9876384. Available from: https://www.healthaffairs.org/doi/10.1377/hlthaff.2022.00052
[13] Medicaid and CHIP Payment and Access Commission. Behavioral health services covered under state plan authority [Internet]. Medicaid and CHIP Payment and Access Commission; 2021 Jan 11 [cited 2025 Jan 17]. Available from: https://www.macpac.gov/subtopic/behavioral-health-services-covered-under-state-plan-authority
[14] Congressional Budget Office. Options for reducing the deficit: 2023 to 2032 [Internet]. Congressional Budget Office; 2022 Dec [cited 2025 Jan 17]. Available from: https://www.cbo.gov/system/files/2022-12/58164-budget-options-large-effects.pdf
[15] Congressional Budget Office. Establish caps on federal spending for Medicaid [Internet]. Congressional Budget Office; 2022 Dec 7 [cited 2025 Jan 17]. Available from: https://www.cbo.gov/budget-options/58622
[16] Saunders S, Rudowitz R. Demographics and health insurance coverage of nonelderly adults with mental illness and substance use disorders in 2020 [Internet]. Kaiser Family Foundation; 2022 Jun 6 [cited 2025 Jan 17]. Available from: https://www.kff.org/mental-health/issue-brief/demographics-and-health-insurance-coverage-of-nonelderly-adults-with-mental-illness-and-substance-use-disorders-in-2020
[17] Government Accountability Office. States’ use and distribution of supplemental payments to hospitals [Internet]. Government Accountability Office; 2019 Jul [cited 2025 Jan 17]. Available from: https://www.gao.gov/assets/gao-19-603.pdf
[18] Mark TL, Huber BD. Drug Overdose Deaths Among Medicaid Beneficiaries. JAMA Health Forum. 2024 Dec 6;5(12):e244365. doi: 10.1001/jamahealthforum.2024.4365. PMID: 39641942; PMCID: PMC11624576. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11624576/
[19] Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. National Substance Use and Mental Health Services Survey (N-SUMHSS), 2023: annual detailed tables [Internet]. Substance Abuse and Mental Health Services Administration; 2024 [cited 2025 Jan 17]. Available from: https://www.samhsa.gov/data/sites/default/files/reports/rpt53013/NSUMHSS-Annual-Detailed-Tables-23.pdf
[20] Dobson A, DaVanzo JE, Heath S, Berger G, El-Gamil A. The economic impact of inpatient psychiatric facilities: a national and state-level analysis. National Association for Behavioral Healthcare; 2010 Feb 19 [cited 2025 Jan 17]. Available from: https://www.nabh.org/wp-content/uploads/2018/06/NAPHS-Final-Report-2-19-10.2.pdf
DEA & HHS Extend Telehealth Flexibilities for Controlled Substances
The U.S. Drug Enforcement Administration (DEA) and U.S. Department of Health and Human Services (HHS) on Wednesday proceeded with rulemaking related to the prescribing of controlled substances via telehealth without ever having conducted an in-person medical evaluation, which would partially extend current flexibilities that have been in place since the COVID-19 pandemic.
In particular, (1) DEA and HHS issued a final rule focused on buprenorphine for the treatment of opioid use disorder (OUD), and (2) DEA issued a notice of proposed rulemaking (NPRM) for special registrations focused on all Schedule II-V controlled substances.
The final rule will allow practitioners to prescribe Schedule III-V controlled substances for OUD (i.e., buprenorphine) for up to six months via audiovisual or audio-only telehealth before conducting an initial in-person medical evaluation, after which the practitioner must conduct an in-person medical evaluation or engage in other telehealth practices permitted by regulation to continue prescribing. The final rule also includes requirements related to prescription drug monitoring program (PDMP) review and pharmacist verification of patient identify. It is estimated that this rule will become effective on Feb. 16, 2025.
The NPRM would create multiple special registrations for practitioners and online telemedicine platforms (i.e., entities that facilitate connections between patients and practitioners) to prescribe controlled substances via telehealth indefinitely. For practitioners, there would be a Telemedicine Prescribing Registration covering Schedules III-V; and an Advanced Telemedicine Prescribing Registration covering Schedules II-V, which would be limited to practitioners who specialize in psychiatry, hospice care, palliative care, pediatrics, or neurology (unrelated to pain management), and practitioners in long-term care facilities.
Online telemedicine platforms would be eligible for a Telemedicine Platform Registration if they provide oversight of practitioners’ prescribing practices and undertake efforts to promote patient safety and prevent misuse and diversion. In addition to obtaining one of these three special registrations, entities would generally be required to obtain a State Telemedicine Registration for each state in which patients who receive special registration prescriptions are located.
Other requirements for practitioners include maintaining photographic records on patient identity, maintaining all special registration records at a single location, including a special registration number on applicable prescriptions, and annual reporting to DEA of special registration prescriptions for all Schedule II and select Schedule III-V controlled substances (pharmacies would also be required to report similar data monthly). For Schedule II controlled substances, additional limitations are proposed, including that special registration prescriptions could only be issued to treat conditions within the practitioner’s specialty, pediatric specialists could only issue prescriptions to patients up to age 18 and when a parent/guardian is in the same room, practitioners must be physically located in the same state as a patient when issuing a prescription, and the number of special registration Schedule II prescriptions must be less than 50% of the total number Schedule II prescriptions issued in a calendar month.
In addition, DEA proposes that for the first three years after implementation, practitioners would need to check the PDMPs of the state where the patient is located, the state where the practitioner is located, and any states with which each of the previous states have reciprocity agreements. After three years, practitioners would need to conduct a nationwide PDMP check. If that is not possible, however, practitioners would follow the prior requirements.
Finally, all telehealth encounters would need to be conducted using audiovisual technology, except audio-only technology would be permitted for the prescribing of Schedule III-V narcotic-controlled substances to treat OUD (i.e., buprenorphine) after a telehealth evaluation is conducted using audiovisual technology.
NABH staff will coordinate with relevant NABH committees to develop a response to the NPRM. We expect that comments will be due by March 18, 2025.
Dan Schwartz Joins NABH as Director of Quality and Addiction Services
WASHINGTON, Dec. 10, 2024 /PRNewswire/ — The National Association for Behavioral Healthcare (NABH) is pleased to welcome Dan Schwartz as the association’s director of quality and addiction services.
Dan brings to NABH a range of experiences in federal agencies related to addiction services, including most recently in his role as a senior behavioral health policy analyst in the Office of the Assistant Secretary for Planning and Evaluation (ASPE) at the U.S. Department of Health and Human Services (HHS).
In that role, Dan engaged in federal policymaking efforts by providing subject matter expertise about the delivery, financing, and regulation of behavioral health services, with an emphasis on the substance use disorder care continuum, controlled substances, and various mental health topics.
Dan also served as the staff lead for the HHS Workgroup on Implementation Strategies for Contingency Management; co-led a workgroup that supported developing legislative proposals related to behavioral health; and was a lead analyst for developing and implementing the HHS Overdose Prevention Strategy.
“We are excited to have Dan join our team,” said NABH President and CEO Shawn Coughlin. “He brings energy, experience, and enthusiasm to a critical role in our association.”
Prior to working at ASPE, Dan worked at the White House Office of National Drug Control Policy and the Substance Abuse and Mental Health Services Administration.
Dan earned a master’s degree in public health from Johns Hopkins University, where he was a Bloomberg Fellow in Addiction & Overdose, and a bachelor’s degree in public health from George Washington University.
About NABH
The National Association for Behavioral Healthcare (NABH) represents provider systems that treat children, adolescents, adults, and older adults with mental health and substance use disorders in inpatient behavioral healthcare hospitals and units, residential treatment facilities, partial hospitalization and intensive outpatient programs, medication assisted treatment centers, specialty outpatient behavioral healthcare programs, and recovery support services in 49 states and Washington, D.C. The association was founded in 1933.
SOURCE National Association for Behavioral Healthcare
NABH Responds to The New York Times story on Opioid Treatment Programs
Washington, Dec. 7, 2024—A story published in The New York Times on Dec. 7 has prompted NABH to clarify the purpose and critical need for opioid treatment programs (OTPs) in the United States.
NABH is concerned the article’s incomplete picture of how OTP treatment works could contribute to what is already a stigmatized disease in an environment where patients should be encouraged to seek the care they need desperately. OTPs are among the most regulated facilities in the healthcare system and provide lifesaving care every day.
Millions of Americans struggle with opioid addiction, and the Centers for Disease Control and Prevention reports more than 81,000 Americans died from an opioid-related overdose in 2023.
NABH member facilities, including those that Acadia Healthcare operates, provide a lifeline to those in need. Opioid treatment programs provide medication-assisted treatment (MAT), which combines U.S. Food and Drug Administration (FDA)-approved medications, behavioral therapies, and wraparound support services. MAT is the most effective intervention to treat opioid use disorder and is proven to reduce overdose fatalities by up to 60%.[1] Meanwhile, the U.S. Surgeon General has called MAT the “gold standard” for treating opioid use disorder (OUD).[2] OTPs provide MAT while addressing patients’ unique needs, reducing barriers to care, and implementing safeguards that support long-term recovery and sustained treatment engagement.
It is important to understand that treatment at OTPs is voluntary, and staff members see patients only after patients make the decision to seek treatment. Patients benefit from the expertise of a multidisciplinary team including physicians, nurses, counselors, clinicians, peer recovery specialists, and case managers, and patients can choose to start or complete treatment based on their own decisions and unique circumstances.
In addition, OTPs are subject to strict regulations and are required by law to employ a licensed physician who oversees all medical services provided to patients based on rigorous clinical guidelines. OTPs are also accredited and regularly inspected to uphold high standards of care, and, in many cases, our members exceed the state and federal regulatory requirements needed to maintain their licenses. These providers invest heavily in staff, training and medical care, counseling, case management and wraparound support— services that often exceed what insurance will reimburse.
Our members see firsthand the growing lethality of drug use and the severe ramifications of individuals not being able to receive needed treatment right away. Yet only 1 out of 5 people living with OUD are receiving needed treatment.[3] Early intervention is critical, with scientific research showing significantly better outcomes for patients who receive comprehensive care compared with those who don’t.
NABH strongly supports the potential of recent federal efforts to expand access to care through telehealth services, expanded methadone take-home privileges, and other flexibilities offered through regulatory revisions. However, we continue to express serious concerns regarding the Modernizing Opioid Treatment Access Act (MOTAA) due to the potential unintended consequences and harms that may result from legislation proposing such abrupt and expansive regulatory changes.
And we are not alone. Other stakeholders have also expressed significant concerns, including six of the nation’s largest law enforcement organizations. For more information about this issue, please see NABH’s letter to House and Senate leaders on Dec. 4, 2024.
OTP facilities play a vital role in addressing the nation’s opioid and addiction crises, and it is imperative that we continue to support providers who do this important work so people in need can immediately access the personalized care, treatment options, and ongoing support services they need to achieve long-term recovery.
About NABH
The National Association for Behavioral Healthcare (NABH) represents provider systems that treat children, adolescents, adults, and older adults with mental health and substance use disorders in inpatient behavioral healthcare hospitals and units, residential treatment facilities, partial hospitalization and intensive outpatient programs, medication assisted treatment centers, specialty outpatient behavioral healthcare programs, and recovery support services in 49 states and Washington, D.C. The association was founded in 1933.
SAMHSA Updates OTP Regulations
SAMHSA Updates OTP Regulations
Updated Feb. 2, 2024 The Substance Abuse and Mental Health Services Administration published Medications for the Treatment of Opioid Use Disorder late yesterday for public inspection. The final rule was published earlier today and becomes effective on April 2, 2024, with compliance by October 2, 2024. [Please note that this is a correction of the compliance date of October 2, 2026 that was published yesterday in the public notice.] NABH provided comments on the Notice of Proposed Rule Making that was issued in December 2022 calling for greater regulatory flexibility for opioid treatment programs (OTPs). The final regulations align closely to NABH recommendations and herald greater deference to clinical decision-making in the nation’s (OTPs). Among the provisions, the regulations:- Make permanent the Covid-era take-home schedule;
- Permit methadone for new patients via audio-visual telemedicine with the dispensing of medication at the OTP (not audio-only).
- Permit audio-only telemedicine when the patient is in the presence of a practitioner who is registered to prescribe SII, including dispensing.
- Clarify (in response to NABH off-line discussion and official comments) that the prescription of methadone to community pharmacies is NOT permitted;
- Change the requirement for a one-year history of OUD for eligibility so that now either the patient must a) meet diagnostic criteria for moderate-severe OUD, or b) be in OUD remission, or c) at high risk for overdose;
- Remove the requirement for two treatment failures for people under 18 to be eligible for services;
- Remove requirement for a one-year history of OUD for people recently released from a correctional facility, pregnant patients, or previously enrolled individuals;
- Allow medication units to provide all OTP services;
- Decouple medication and attendance at counseling services;
- Permit interim treatment for 180 days, including at for-profit OTPs;
- Permit mid-levels (“…those appropriate licensed by the state”) to prescribe without exemption;
- Clarified accreditation standards to reduce potential for a burdensome increase in less-than 3-year accreditations;
- Permit buprenorphine prescribing in an OTP via audio-only and audio-visual without an in-person evaluation; and
- Update terminology to reflect contemporary, non-stigmatizing language.
Andrew Dodson Joins NABH as Director of Congressional Affairs
WASHINGTON, Aug. 17, 2023 /PRNewswire/ — The National Association for Behavioral Healthcare (NABH) is pleased to welcome Andrew (Andy) Dodson as the association’s director of congressional affairs, effective Aug. 16.
Andy brings to NABH more than 20 years of legislative and regulatory advocacy experience in senior government affairs positions with several national trade associations and a multi-client government affairs consulting firm.
He has advocated for companies and associations in the insurance, technology and telecommunications, real estate, and business aviation industries, and he is eager to represent behavioral healthcare providers.
“We are very excited that Andy has joined our team because he brings with him a keen understanding of Capitol Hill, extensive lobbying experience, and a strong background in regulatory affairs,” said NABH President and CEO Shawn Coughlin. “He is what NABH needs, and we know he will enhance and strengthen our advocacy efforts.”
Most recently Andy led the American Wood Council’s federal, state, and local advocacy efforts, where he developed and implemented successful political campaigns and government relations initiatives.
Andy began his political career working in the Texas legislature and on several statewide political campaigns before he moved to Washington, D.C., where he worked for House Majority Leader Richard Gephardt (D-Mo.) and several Texas lawmakers. He also worked as a regional fundraising director for the Democratic Congressional Campaign Committee and the Clinton/Gore Re-Election Committee.
Andy is a graduate of the University of Texas at Austin. He lives Bethesda, Md. with his wife and two sons.
About NABH
The National Association for Behavioral Healthcare (NABH) represents provider systems that treat children, adolescents, adults, and older adults with mental health and substance use disorders in inpatient behavioral healthcare hospitals and units, residential treatment facilities, partial hospitalization and intensive outpatient programs, medication assisted treatment centers, specialty outpatient behavioral healthcare programs, and recovery support services in 49 states and Washington, D.C. The association was founded in 1933.
SOURCE National Association for Behavioral Healthcare
CMS Final Rule Estimates Overall IPF Payments to Increase by 2.3% in 2024
The Centers for Medicare & Medicaid Services (CMS) on Thursday released its Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) final rule for Fiscal Year (FY) 2024, which is estimated to increase overall payments to IPFs by 2.3%, or $70 million, relative to FY 2023.
While the agency’s final FY 2023 payment update is larger than its earlier proposed 1.9% increase, NABH will continue to push policymakers to recognize fully the high costs that our association’s members face.
The FY 2024 update includes increases in the federal per-diem base rate to $895.63 from $865.63, and in the outlier threshold to $33,470 from $24,630, which will reduce the number of cases that qualify for an outlier payment.
CMS released a fact sheet with the final rule. The NABH team is currently reviewing the rule and will share a more detailed summary in tomorrow’s CEO Update.
HHS, DOL and Treasury Release Proposed Rules to Strengthen MHPAEA
The U.S. Health and Human Services (HHS), Labor (DOL), and Treasury Departments on Tuesday released proposed rules to bolster the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 and remove obstacles to behavioral healthcare access.
The rules propose several amendments to the 2013 MHPAEA final regulations, as well as provisions that would establish the content requirements of the Non-Qualitative Treatment Limitations, or NQTL, comparative analyses required under amendments to MHPAEA included in the Consolidated Appropriations Act, 2021 (CAA, 2021).
“Today’s rules show the Biden administration’s continued effort to implement the landmark parity law,” said NABH President and CEO Shawn Coughlin. “We’re hopeful these changes will do much to eliminate the illegal restrictions and barriers to behavioral healthcare that exist today, nearly 15 years after the law passed.”
The three departments also released a Technical Release on NQTLs that outlines principles and seeks public comment to inform future technical guidance about the application of proposed data collection and evaluation requirements to NQTLs related to network composition that the rule proposes.
Along with the proposed rules, the departments released the 2023 MHPAEA Comparative Analysis Report to Congress that the CAA, 2021 requires. The report includes information about the agencies’ enforcement efforts and identifies plans and issuers that received final determinations of non-compliance with MHPAEA.
The White House released a fact sheet about the rule and DOL’s Employee Benefits Security Administration posted all the related documents here.
NABH will seek feedback from members and submit comments about the proposed rules and Technical Release.
CMS Coverage for PHP Telehealth Services Set to End After May 11
As the COVID-19 Public Health Emergency (PHE) draws to a close at the end of Thursday, May 11, the Centers for Medicare & Medicaid Services (CMS) has shared with NABH and other stakeholders the agency’s plans to end telehealth coverage for partial hospitalization program (PHP) services implemented during the PHE.
In addition, CMS has explained that telehealth coverage will continue through December 2024 for Intensive Outpatient Program (IOP) services that qualify under the outpatient prospective payment system as “remote mental health services.”
NABH continues to communicate with key Members of Congress to clarify the legislative intent behind the telehealth coverage extensions that were authorized in the Consolidated Appropriations Act, 2023 last December. The NABH team understands that some Members of Congress intended for the telehealth coverage extension to include PHP services.
Given the persistent confusion on these matters, NABH has urged CMS to issue clarification in writing. NABH will keep members apprised of our efforts to extend telehealth coverage for PHP services.
DEA Extends COVID-19 Telehealth Flexibilities for Prescription of Controlled Medications for Now
The U.S. Drug Enforcement Administration (DEA) on Wednesday said it will extend its COVID-19 telemedicine flexibilities for prescription of controlled medications as the agency works to determine how to move forward in a way that gives Americans access to needed medicine with the appropriate safeguards.
An announcement from DEA noted the agency received a record number of comments on its proposed telemedicine rules, which prompted DEA and HHS to submit a draft temporary rule to the Office of Management and Budget requesting an extension. NABH submitted comments on this matter (see CEO Update, April 28, 2023).
“Further details about the rule will become public after its full publication in the Federal Register,” the announcement said.
NABH Education & Research Foundation Webpage Now Features Grants & Funding Opportunities
The NABH Research and Education Foundation has updated its webpage with a section devoted to potential funding resources and opportunities for behavioral healthcare organizations and their employees.
To access the Foundation’s webpage, visit NABH’s homepage and locate the “NABH Foundation” tab in the navigation menu. From there, hover over the tab to find a drop-down menu with the following sections: About, Grants & Funding Opportunities, Resources, and Contribute.
We urge you to visit the page and search for potential funding opportunities, which NABH also includes in CEO Update, the association’s weekly e-newsletter.
Please contact foundation@nabh.org if you have a grant or other funding opportunity to share. Thank you!
CBO Report: Budgetary Effects of Modifying or Eliminating the IMD Exclusion
CBO Report: Budgetary Effects of Modifying or Eliminating the IMD Exclusion
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FDA Approves First Over-the-Counter Naloxone Spray
The U.S. Food and Drug Administration (FDA) today approved Narcan, 4 mg. naloxone hydrochloride nasal spray for over-the-counter (OTC), non-prescription use, making it the first naloxone product approved to use without a prescription.
Naloxone is a medication that reverses the effects of opioid overdose rapidly and is the standard treatment for opioid overdose. The FDA’s action today clears the way for this life-saving medication to be sold directly to consumers in drug stores, convenience stores, grocery stores, gas stations, and online.
The move comes at a time when the Centers for Disease Control and Prevention released provisional data this month that showed 101,751 reported U.S. fatal overdoses in the 12-month period ending in October 2022, while the predicted number of fatal doses for that period is even higher at 107,689.
“Today’s approval of OTC naloxone nasal spray will help improve access to naloxone, increase the number of locations where it’s available, and help reduce opioid overdose deaths throughout the country,” FDA Commissioner Robert M. Califf, M.D said in today’s announcement. “We encourage the manufacturer to make accessibility to the product a priority by making it available as soon as possible and at an affordable price.”
According to the FDA, the manufacturer determines the timeline for availability and price of this OTC product. Click here to learn more.
President Biden to Outline Approach for Addressing Nation’s Mental Health & Opioid Crises in State of the Union
In tonight’s State of the Union address, President Biden is expected to mention specific ways his administration will address America’s mental health crisis, beat its opioid overdose epidemic, and ensure parity.
In a fact sheet about the speech, “mental health” is mentioned 32 times, and “fentanyl” 23 times, signaling the Biden’s administration commitment to tackling two of the nation’s toughest domestic problems. The White House will also discuss these issues in a briefing on Wednesday, Feb. 8 at 2:30 p.m. ET. Click here to register for the webinar.
In a boost for parity, President Biden is expected to say that this administration will propose new rules this spring to ensure that insurance plans do not impose inequitable barriers to care and that mental healthcare providers are being paid by health plans on par with other healthcare professionals.
President Biden is also expected to provide details on how his administration will help expand access to mental healthcare services for all who need it, such as expanding peer support specialists for veterans; creating healthy environments for children, adolescents, and teens; and supporting the nation’s mental healthcare workforce.
The Biden administration also intends to improve the capacity of the 988 lifeline by investing in expanding the nation’s crisis care workforce; scaling mobile intervention services; and developing additional guidance on best practices in crisis response. To enhance telehealth services, HHS will triple resources dedicated to promoting interstate license reciprocity to deliver mental health services across state lines, according to the White House.
Meanwhile, Congress and the nation can expect to hear about this administration’s aggressive plans to combat the nation’s ongoing opioid crisis. News reports Tuesday quoted Office of National Drug Control Policy (ONDCP) Director Rahul Gupta, M.D. as saying President Biden will apply a “forceful approach” for going after fentanyl and expanding public health efforts to reduce overdose deaths. Such measures will include disrupting the trafficking, distribution, and sale of fentanyl. Tonight the president is expected to announce that his administration will add 123 new, large-scale scanners at land points of entry along the nation’s Southwest border by 2026, and also lead a sustained, diplomatic push to address fentanyl and its supply chain abroad.
The president is also supposed to announce a commitment to expanding access to evidence-based prevention, harm reduction, treatment, and recovery. In the last year, the Biden administration has permitted using $50 million for local public health departments to purchase naloxone; released guidance making it easier for programs to obtain and distribute naloxone to at-risk populations; and prioritized reviewing over-the-counter naloxone applications.
President Biden will deliver his State of the Union address at 9 p.m. ET.
NABH Education and Research Foundation Partners with Manatt to Produce Issue Brief on Telehealth Services in PHP and IOP
NABH is pleased to announce that the NABH Education and Research Foundation today 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.
SAMHSA Proposed Rule Permits Methadone Prescribing for New Patients via Telemedicine
The Substance Abuse and Mental Health Services Administration (SAMHSA) on Tuesday 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.
Biden Administration Launches Opioid Overdose Dashboard
The Biden Administration on Thursday unveiled a new website featuring the Office of National Drug Control Policy’s (ONDCP) new Opioid Overdose Tracker to track 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.
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.
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.
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.
Rochelle Archuleta Joins NABH as Executive Vice President for Government Relations and Public Policy
Rochelle Archuleta has joined the National Association for Behavioral Healthcare (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.