You’re not alone. Call 988 to connect to the National Suicide and Crisis Lifeline.

President Biden Sends National Drug Control Policy to Congress

President Biden on Thursday sent his administration’s inaugural National Drug Control Policy to Congress with the goal of using a whole-of-government approach to combat the nation’s overdose crisis.

The comprehensive strategy focuses on the main drivers of the crisis—untreated addiction and drug trafficking—as it directs federal agencies to take actions that will expand access to evidence-based prevention, harm reduction, treatment, and recovery services, while also reducing the supply of drugs.

The plan comes as the nation continues to produce grim statistics: for the first time in America’s history, the country has passed the milestone of 100,000 deaths resulting from drug overdoses in a 12-month period. Meanwhile, since 1999, drug overdoses have killed approximately 1 million Americans.

A message from President Bident to Congress at the beginning of the strategy explains the Office of National Drug Control Policy led the effort to produce the strategy in close collaboration with the 18 national drug control agencies. In addition, the Biden administration involved more than 2,000 leaders and stakeholders, including Congress, all 50 Governors, and advocates representing public safety, public health, community groups, local governments, and Tribal communities.

An important component of the strategy is its emphasis on harm reduction, an approach that works with people who use drugs to prevent overdose and infectious disease transmission; improve the physical, mental, and social wellbeing of those served; and offer flexible options for accessing substance use disorder treatment and other health care services.

“We are changing how we help people when it comes to drug use, by meeting them where they are with high-impact harm reduction services and removing barriers to effective treatment for addiction,” Rahul Gupta, M.D., M.P.H., M.B.A., director of National Drug Control Policy, said in the document, “while addressing the underlying factors that lead to substance use disorder head on.”

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CEO Update 189

U.S. Preventive Services Task Force Issues Draft Recommendations on Screening for Anxiety, Depression, and Suicide Risk in Children and Adolescents

In a set of draft recommendations this week, the U.S. Preventive Services Task Force (USPTF) recommended screening children 12 and older for depression and children 8 and older for anxiety.

“There is not enough evidence to recommend for or against screening for anxiety and depression in younger children and screening for suicide risk in all youth,” the USPTF announced in a bulletin on April 12.

Both the American Academy of Pediatrics (AAP) and the American Foundation for Suicide Prevention (AFSP) expressed serious concerns about the panel’s conclusion that there is insufficient evidence to weigh the benefits and harms of screening asymptomatic children and adolescents for suicide risk. The AAP is urging clinicians to screen all adolescents for suicide risk despite the panel’s finding that more research is needed.

“Youth may keep suicidal thoughts to themselves and will not bring up the topic unless directly asked,” May Lau, M.D., M.P.H., a member of the AAP Section on Adolescent Health Executive Committee and a lead author of the Blueprint for Youth Suicide Prevention from AAP/AFSP, said in an article in AAP News. “By screening all youth for suicide, we can identify those that are at risk and connect them with the services they need.”

Meanwhile, Christine Moutier, M.D., chief medical officer at the AFSP, told the Associated Press this week that the report “may actually set the field back.”

“We have grave concerns that the recommendation citing ‘insufficient evidence’ to implement routine screening for suicide risk for any age youth is 1) flawed due to the incomplete data sources included in their review, and 2) may confuse the field just as major steps are being taken,” Moutier wrote in an e-mail message to NABH. Moutier added that the Blueprint for Youth Suicide Prevention recommends screening for youth ages 12 and older and outlines evidence-based care steps to take for youth who screen positive.

A public comment period for the USPTF’s draft recommendations is open until May 9. Click here for details.

HRSA Announces More Than $1.75 Billion in Provider Relief Fund Phase 4 Distribution Payments

HHS’ Health Resources and Services Administration (HRSA) said it is making available more than $1.75 billion in Provider Relief Fund (PRF) Phase 4 General Distribution payments to more than 3,680 providers nationwide this week.

According to HRSA, on April 13 providers received an email notification if their application was among those processed in this latest round, and the agency is working to process all remaining applications as quickly as possible.

Also this week, HHS Secretary Xavier Becerra extended the PHE for an additional 90 days after the current PHE expires on April 16.

HRSA Announces it Will Offer ‘Extenuating Circumstances’ Option to Providers for PRF Reporting Period 2

HRSA this week said healthcare providers will have the opportunity to submit a “Request to Report Late Due to Extenuating Circumstances for Reporting Period 2” if applicable. Last week, HRSA announced the “extenuating circumstances” option for Reporting Period 1, which lasts from April 11 through April 22.

The agency said providers will receive a notification regarding the process to submit a request for Reporting Period 2 in the coming weeks. For more information, visit the Request to Report Late Due to Extenuating Circumstances webpage, or call the Provider Support Line at (866) 569-352 from 9 a.m. to 11 p.m. CT, Monday through Friday.

The Kennedy Forum to Host Parity Webinar Featuring Leaders from HHS, SAMHSA, NABH, & AMA

NABH President and CEO Shawn Coughlin will join HHS Secretary Xavier Becerra and other healthcare leaders in a webinar about expanding access to mental health and addiction treatment coverage later this month.

The webinar on Tuesday, April 26 will also feature Assistant Secretary for Mental Health and Substance Use Miriam Delphin-Rittmon, Ph.D., former U.S. Rep. Patrick J. Kennedy, and American Medical Association President Patrice Harris, M.D.

Click here to learn more and register for the hour-long webinar, which will start at 2 p.m. ET.

AHA & IAHSS Release Toolkit to Help Mitigate Violence in Healthcare Settings

The American Hospital Association (AHA) and the International Association for Healthcare Security and Safety (IAHSS) have developed a toolkit for hospitals and health systems to establish procedures to prevent violence at all levels.

Creating Safer Workplaces is an 11-page resource that provides a framework to build a safer workplace environment; outlines what leaders should consider to promote physical safety and teamwork; highlights how leaders can mitigate risk; describes the role of hospitals in violence intervention; and more.

NPR Story Reports Most State Medicaid Programs Won’t Text Enrollees Despite Urgency to Renew Coverage

A National Public Radio (NPR) story this week cited a recent Kaiser Family Foundation report that found just 11 states said they would use text messaging to alert Medicaid recipients about the end of the Covid public health emergency, while 33 states will use the U.S. Postal Service and at least 20 will rely on individual or automated phone calls.

“It’s frustrating that texting is a means to meet people where they are and that this has not been picked up more by states,” Jennifer Wagner, director of Medicaid eligibility and enrollment for research group the Center on Budget and Policy Priorities, said in the story.

NPR also noted that officials at the Centers for Medicare & Medicaid Services (CMS) have told states they should consider texting—along with other methods of communication—when trying to contact enrollees about the end of the public health emergency (PHE), but many states don’t have the technology or information about enrollees to do so.

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

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

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

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

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

Deadline for 2022 NABH Exhibitor & Sponsor Guide Ads is Next Week

The deadline to submit an ad in NABH’s 2022 Exhibitor and Sponsor Guide is Tuesday, April 19. Be sure your organization is included in this year’s edition!

Please click here for details about advertising options, requirements, payment, and more.

We hope to see you in Washington in June!

Fact of the Week 

A recent National Institute of Mental Health-funded study showed that Stepped Care Trauma-Focused (TF) Cognitive Behavioral Therapy (CBT)—in which step one is a parent-led therapist-assisted treatment and step two provides therapist-led TF-CBT for children who did not benefit from step one and require more intensive treatment—can reduce costs by nearly 54%.

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

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CEO Update 188

HRSA Announces ‘Extenuating Circumstances’ Option for Provider Relief Fund Reporting

HHS’ Health Resources and Services Administration (HRSA) this week said it will allow healthcare providers to submit a Request to Report Late Due to Extenuating Circumstances for the Provider Relief Fund (PRF) Reporting Period 1 if one or more certain extenuating circumstances apply to their situations.

Starting Monday, April 11 and continuing through Friday, April 22 at 11:59 p.m. ET, providers who did not submit their PRF Period 1 report by the required deadline may request to submit a late Reporting Period 1 report, via a DocuSign form, if the following extenuating circumstances exist:

  • Severe illness or death: if a severe medical condition or death of a provider or key staff member responsible for reporting hindered the organization’s ability to complete the report during the reporting period
  • Impacted by natural disaster: if a natural disaster occurred during or in proximity to the end of the reporting period and damaged the organization’s records or information technology
  • Lack of receipt of reporting communications: if an incorrect email or mailing address on file with HRSA prevented the organization from receiving instructions prior to the reporting period deadline
  • Failure to click “submit”: if the organization registered and prepared a report in the PRF Reporting Portal, but failed to take the final step to click “submit” prior to deadline
  • Internal miscommunication or error: if an internal miscommunication or error regarding the individual who was authorized and expected to submit the report on behalf of the organization and/or the registered point of contact in the PRF Reporting Portal
  • Incomplete Targeted Distribution payments: if the organization’s parent entity completed all General Distribution payments, but a Targeted Distribution(s) was not reported on by the subsidiary

According to HRSA, requests to report late due to extenuating circumstances must indicate and attest to a clear and concise explanation, although the agency will not require supporting documents.

If HRSA approves an organization’s request, the organization will receive a notification to proceed with completing the Reporting Period 1 report. Providers will have 10 days from the date they receive the notification to submit a report in the PRF Reporting Portal.

Click here to learn more about reporting requirements, or call the Provider Support Line at (866) 569-3522 between 9 a.m. to 11 p.m. ET for additional information.

CMS Releases Two Sets of FAQ About ‘No Surprises Act’ Requirements

The Centers for Medicare & Medicaid Services (CMS) this week released two sets of frequently asked questions (FAQ) regarding requirements enacted in the No Surprises Act.

CMS issued an FAQ on April 6 that provides additional explanation about the law’s requirements and prohibitions, as well as clarification regarding the independent dispute resolution process and associated fees. A day earlier, CMS released an FAQ with additional information about developing good-faith estimates for uninsured or self-pay patients.

Thorn Run Partners Memo Highlights Medicare & Medicaid Flexibilities During the PHE

Thorn Run Partners, a bipartisan lobbying firm that works with NABH, recently highlighted a host of flexibilities in the Medicare and Medicaid programs during the ongoing Covid-19 public health emergency (PHE).

The 14-page memo includes information about recent guidance from CMS, PHE extensions, PHE-related policies in the $1.5 trillion omnibus spending package that President Biden recently signed into law, and more.

Click here to read the memo.

NABH Supports ‘Behavioral Health Information Technology Now Act’

NABH is pleased to support the Behavioral Health Information Technology Now Act, a new bill that would offer financial incentives to behavioral healthcare providers for health information technology adoption.

Reps. Doris Matsui (D-Calif.) and Markwayne Mullin (R-Okla.) introduced the bill in an effort to coordinate care between physical and mental healthcare—and also include behavioral healthcare providers from a key resource that they have been excluded from for years.

“The National Association for Behavioral Healthcare applauds Reps. Matsui and Mullin for recognizing that for far too long, behavioral healthcare providers have not received health information technology funding that other providers have benefited from,” NABH President and CEO Shawn Coughlin said in a news release about the legislation on April 6. “Their legislation would enable behavioral healthcare providers to coordinate care across behavioral healthcare service systems, primary care facilities, and specialty medicine providers more efficiently.”

Specifically, the bill would:

  • Finance behavioral health information technology (IT) adoption at $250 million
  • Condition funding allocations to providers based on: 1) acquisition of health IT systems that comply with 2015 certification standards, and 2) attestation of provider compliance with Trump Administration Interoperability and Data Blocking regulations
  • Direct the Office of the National Coordinator for Health Information Technology and the Substance Abuse and Mental Health Services Administration to develop voluntary behavioral health IT standards.

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

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

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

The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts.
Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Register Today for the 2022 Annual Meeting!

NABH will host its 2022 Annual Meeting—Shaping the Future of Behavioral Healthcare—from June 13-15 at the Mandarin Oriental Washington, DC.

Please remember to register for the meeting and reserve your hotel room today!

Fact of the Week

Veterans who take medications for opioid use disorder (OUD) for at least 15 days have more than a 50% decreased risk of dying by suicide compared with those not taking OUD medications, according to a study in the April issue of the American Journal of Psychiatry.

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

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CEO Update 187

CMS Proposes 2.7% Increase to Inpatient Psychiatric Facilities in 2023

The Centers for Medicare & Medicaid Services (CMS) on Thursday proposed increasing payment rates to the nation’s inpatient psychiatric facilities by 2.7% in fiscal year (FY) 2023, reflecting a 1.5% increase in payments, or about $50 million, relative to FY 2022.

According to the agency’s inpatient psychiatric facility prospective payment system (IPF PPS) proposed rule for FY 2023, the IPF PPS federal, per-diem base rate would increase to $856.80 from $832.94 and the electroconvulsive therapy payment rate would increase to $368.87 per treatment from $358.60 per treatment.

CMS said the increase is based on the proposed IPF market basket update of 3.1% less a 0.4% percentage point productivity adjustment.

For FY 2023 and subsequent years, CMS has proposed to apply a 5% cap on decreases in the IPF PPS wage index in order to mitigate instability in IPF PPS payments due to significant wage index decreases that may affect providers in any given year.

CMS did not propose any changes for the IPF Quality Reporting Program for FY 2023.

Meanwhile, the agency is seeking comments via a request for information (RFI) about what CMS should consider when advancing the use of measurement and stratification as tools to address healthcare disparities and advance healthcare equity.

Specifically, CMS would like comments related to goals and approaches for measuring disparities and using measure stratification across CMS Quality Reporting Programs; guiding principles for selecting and prioritizing measures for disparity reporting; principles for social risk factor and democratic data selection and use; identification of meaning performance differences; guiding principles for reporting disparity measures; and measures related to health equity.

CMS is considering and requesting comment about applying the following measures of health equity in the Inpatient Psychiatric Facility Quality Reporting Program: Health Equity Summary Score (HESS) and a structural measure assessing the degree of hospital leadership engagement in health equity performance data. Both of these measures are under consideration for the Medicare Inpatient Quality Reporting Program.

Please send any comments that your organization may have to Kirsten Beronio, NABH’s director of policy and regulatory affairs.

President Biden’s 2023 Budget Seeks to Transform U.S. Behavioral Healthcare Delivery

President Biden proposed new, mandatory investments totaling $51.7 billion over 10 years to enhance behavioral healthcare in America in the fiscal year (FY) 2023 budget proposal that he released on March 28.

Among the budget blueprint’s most notable behavioral health provisions is the president’s request of $697 million for the Substance Abuse and Mental Health Services Administration (SAMHSA) to ensure that 100% of contacts are answered for the new 988 behavioral health crisis hotline that will begin to operate in July. This is an increase of $590 million from what was enacted for fiscal year 2022.

Another significant provision is the president’s proposal for a new, $7.5 billion Mental Health System Transformation Fund through Medicaid to increase access to mental health services through workforce development and service expansion, including the development of non-traditional health delivery sites, the integration of quality mental health and substance use care into primary care settings, and the dissemination of evidence-based practices.

NABH is pleased to see President Biden’s 2023  budget proposal calls for improving compliance with behavioral health parity standards by requiring plans and issuers to use medical necessity criteria for behavioral health services that are consistent with the criteria developed by not-for-profit medical specialty associations. The proposal would also place limits on the consideration of profit in determinations of medical necessity.

The president’s budget would authorize the secretaries of the U.S. Health and Human Services, Labor, and Treasury Departments to regulate behavioral health network adequacy, and to issue regulations on a standard for parity in reimbursement rates based on the results of comparative analyses submitted by plans and issuers at a cost of $720 million over 10 years.

To learn more, please read the NABH Analysis that the association sent to members earlier this week.

Senate Finance Committee Releases ‘Mental Health Care in the United States: The Case for Federal Action’

In a bipartisan report released this week, the Senate Finance Committee concluded that “overwhelmingly, access to affordable, reliable, and high-quality behavioral health care escapes Americans when they need it most” and offered some potential solutions to address the nation’s myriad behavioral healthcare challenges.

The 36-page report is divided into eight chapters and examines behavioral health definitions, prevalence, and spending; workforce; children, adolescents, and young adults; access, integration, and coordination; mental health and substance use disorder (SUD) parity; telehealth; and next steps.

“As Chairman of the Senate Finance Committee, I am partnering with Ranking Member Mike Crapo on a major bipartisan effort to bring behavioral health care to the forefront of the U.S. health system by leveraging the programs under this Committee’s jurisdiction, including Medicare, Medicaid, and the Children’s Health Insurance Program,” Senate Finance Committee Chairman Ron Wyden (D-Ore.) said in a letter at the start of the report. Wyden added that 10 members of this committee, including five Democrats and five Republicans, are working on policy areas that Wyden deemed “vital for a path forward.”

The Center of Excellence for Protected Health Information Video Offers Guidance about SUD Personnel and 42 CFR Part 2

The Center of Excellence for Protected Health Information (CoE-PHI) has released a video that offers guidance about when identified SUD personnel within a general medical facility must follow the federal privacy protections for SUD treatment known as 42 CFR Part 2.

The Substance Abuse and Mental Health Services Administration funds CoE-PHI to help people and organizations understand and apply federal health privacy laws and regulations at work that are specific to certain tasks and roles. CoE-PHI also works to help patients and families understand their rights when seeking treatment for SUD and mental health.

MHA, American Psychological Association, and American Psychiatric Association to Host Webinar on Digital Therapeutics in Mental Health and SUD

Mental Health America, the American Psychological Association, and the American Psychiatric Association will host a webinar next Wednesday, April 6 that examines the role digital therapeutics have in addressing America’s mental health and SUD crises.

Participants will learn from Meena Seshamani, M.D., Ph.D., director of the Center for Medicare at CMS; Bakul Patel, director of the Digital Health Center of Excellence at the U.S. Food and Drug Administration; and other experts in the field.

The hourlong webinar will begin at 2 p.m. ET. Click here to register.

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

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

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

The portal allows members to submit individual examples of claim denials or upload multiple entries via Excel. It also includes sections on appeals and physician participation. In time, the tool could be a valuable resource for the NABH team’s advocacy efforts.
Please e-mail Emily Wilkins, NABH’s administrative coordinator, if you have questions about the portal.

Register Today for the 2022 Annual Meeting!

NABH will host its 2022 Annual Meeting—Shaping the Future of Behavioral Healthcare—from June 13-15 at the Mandarin Oriental Washington, DC.

Please remember to register for the meeting and reserve your hotel room today!

Fact of the Week 

Of the approximately 5.9 million adults living with severe bipolar disorder in the United States in 2020, about 51%, or 3 million adults, were untreated at any given time, the Treatment Advocacy Center reports.

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

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President Biden’s 2023 Budget Seeks to Transform U.S. Behavioral Healthcare Delivery

President Biden is proposing new, mandatory investments totaling $51.7 billion over 10 years to enhance behavioral healthcare in America in the fiscal year (FY) 2023 budget proposal he released Monday.

Among the budget blueprint’s most notable behavioral health provisions is the president’s request of $697 million for the Substance Abuse and Mental Health Services Administration (SAMHSA) to ensure that 100% of contacts are answered for the new 988 behavioral health crisis hotline that will begin to operate in July. This is an increase of $590 million from what was enacted for fiscal year 2022.

Another significant provision is the president’s proposal for a new, $7.5 billion Mental Health System Transformation Fund through Medicaid to increase access to mental health services through workforce development and service expansion, including the development of non-traditional health delivery sites, the integration of quality mental health and substance use care into primary care settings, and the dissemination of evidence-based practices.

President Biden’s budget also provides an investment of $397 million for the Health Resources and Services Administration’s (HRSA) Behavioral Health Workforce Development Programs, which is $235 million above FY 2022 enacted level. This funding is intended to increase training of new behavioral healthcare providers, including a track for health support workers such as peers and community health workers. The program also places an emphasis on team-based care.

This investment is meant to promote inclusive and equitable behavioral healthcare for youth and focus on the knowledge and understanding of children, adolescents, and youth at risk for a mental health disorder, serious emotional disturbance, or substance use disorder (SUD). The budget also includes increases in primary care training and enhancement and nurse education, practice, and retention to expand behavioral health services into primary care.

The FY 2023 budget provides $4.6 billion for SAMHSA’s mental health activities, an increase of $2.5 billion above the FY 2022 enacted level. These investments would provide a historic investment in the Behavior Health Crisis Services; expand access to crisis services; ensure access to early intervention and prevention services to the nation’s vulnerable populations; and invest in children’s mental health.

NABH is pleased to see President Biden’s budget calls for improving compliance with behavioral health parity standards by requiring plans and issuers to use medical necessity criteria for behavioral health services that are consistent with the criteria developed by not-for-profit medical specialty associations. The proposal would also place limits on the consideration of profit in determinations of medical necessity.

The budget would authorize the secretaries of the U.S. Health and Human Services, Labor, and Treasury Departments to regulate behavioral health network adequacy, and to issue regulations on a standard for parity in reimbursement rates based on the results of comparative analyses submitted by plans and issuers at a cost of $720 million over 10 years.

The budget proposes requiring all plans and issuers to cover three behavioral health visits and three primary care visits each year without charging a copayment, co-insurance or deductible-related fee.  And it would provide $125 million in mandatory funding over five years for grants to states to enforce mental health and SUD parity requirements.  Any funds not expended by states at the end of five fiscal years would remain available to the HHS secretary to make additional mental health parity grants.

It also proposes to eliminate the ability of self-insured non-federal governmental plans to opt out of parity, affording state and municipal employees the same consumer protections that apply to other employees with private health insurance.

In Medicare, the president’s budget would eliminate the 190-day lifetime limit and would require Medicare to cover up to three behavioral health visits per year without cost-sharing.

Also related to the Medicare program, current law requires the Centers for Medicare & Medicaid Services (CMS) to terminate psychiatric hospital participation in Medicare after six months of non-compliance with conditions of participation, even if the deficiency does not jeopardize patient health and wellbeing.  This provision does not apply to any other provider category. The president’s proposal would give CMS flexibility to allow a psychiatric hospital to continue receiving Medicare payments when deficiencies are not considered to immediately jeopardize the health and safety of its patients and where the facility is actively working to correct the deficiencies identified in an approved Plan of Correction.  This provision is considered budget-neutral and would not have cost implications.

Among other provisions, the White House budget proposal would also establish a Medicare benefit category for licensed professional counselors and marriage and family therapists that authorizes direct billing and payment under Medicare for these practitioners; remove limits on the scope of services for which Medicare can pay clinical social workers, licensed professional counselors, and marriage and family therapists; and allow these practitioners to bill Medicare directly for their mental health services for covered Part A qualifying Skilled Nursing Facility stays.

And the proposal would ensure that mental health and SUD benefits under Medicare do not face greater limitations on reimbursement or access to care relative to medical and surgical benefits.  The Medicare Payment Advisory Commission (MedPAC) would be required to issue a report to identify existing gaps in mental health and substance use disorder benefits to be addressed in the Medicare statute.

Specifically for SUD, President Biden has proposed $519 million, more than double the 2022 enacted level, for the Family Violence Prevention and Services program. This is the primary federal funding stream dedicated to the support of emergency shelter and related assistance for victims of domestic violence and their children.

The funding represents an increase of $292 million over FY 2022 enacted for the base program’s shelters and supportive services. This funding provides services to an estimated 1.3 million children and families to prevent family violence, domestic violence, and dating violence. This includes $250 million in cash assistance for domestic violence survivors and $30 million for the Safe Recovery Together demonstration grants. The demonstration grants will support families affected by domestic violence at the intersection of substance-use coercion, housing instability, and child welfare involvement.

President Biden’s FY 2023 budget also proposes:

  • $413 million to SAMHSA in FY 2023, and $4.1 billion over 10 years, for community health centers
  • A $238 million increase above the FY 2022 enacted level in funding for Certified Community Behavioral Health Center Expansion Grants
  • An increase in the amount of Mental Health Block Grant funds reserved for crisis intervention services to 10% from 5%
  • An investment of $11.4 billion, including $10.8 billion in discretionary funding, in programs addressing opioids and overdose-related activities across HHS.

After President Biden kicked off the federal budget process on Monday with his budget proposal, Office of Management and Budget Director Shalanda Young testified Tuesday before the House Budget Committee. Director Young will take more questions from the Senate Budget Committee on Wednesday.

Meanwhile, congressional appropriators will begin their work soon, starting with a House Appropriations Committee hearing this Thursday that will feature U.S. Health and Human Services Department (HHS) Secretary Xavier Becerra.

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CEO Update 186

Three-Judge Panel in 9th U.S. Circuit Court of Appeals Overturns Wit v. United Behavioral Health

In a blow to parity, a three-judge panel of the 9th U.S. Circuit Court of Appeals this week overturned a trial court’s Wit v. United Behavioral Health (UBH) decision, asserting that UBH’s interpretation that health insurance plans do not require consistency with generally accepted standards of care (GASC) “was not unreasonable.”

On Thursday, NABH sent its members an NABH Issue Brief that highlighted the following main points of the earlier decision from the trial court and the three-judge panel’s reversal of that decision in its seven-page ruling:

  • The original Witdecision determined that patients’ health and safety are protected when clinicians provide services consistent with GASC that are established by not-for-profit, professional associations, rather than insurance companies whose financial incentives often conflict with what is best for patients.
  • The three-judge panel said it is “not unreasonable” for health insurers’ coverage determinations to be inconsistent with GASC; however, the trial court’s decision, including two 100-page decisions, described how UBH made medical coverage decisions based on financial interests.
  • In its ruling, the appellate court’s three-judge panel did not cite one holding or one fact that the trial court concluded, despite the trial court’s exhaustive trial findings.
  • The trial court’s decision explained UBH’s misrepresentation to regulators that UBH used American Society of Addiction Medicine (ASAM) criteria when, in fact, the company modified and ultimately undercut the actual ASAM criteria.
  • The appellate court’s three-judge panel ruled that UBH is not obligated to cover treatment consistent with GASC if the treatment is not a covered benefit; however, the plaintiffs did not argue that UBH was obligated to cover all services consistent with GASC. Instead, the plaintiffs argued that if services—such as outpatient, intensive outpatient, and residential treatment—are covered benefits, UBH must make medical necessity determinations that are consistent with GASC.

This flawed ruling has the potential to worsen America’s mental health and addiction crises as the critical need for mental health and addiction treatment services continues to rise during the ongoing Covid-19 pandemic.

NABH will continue to fight for true mental health addiction treatment parity and expanded access to care for all who need it.

DEA Expands Access to Medication-Assisted Treatment for People with SUD

The U.S. Drug Enforcement Administration (DEA) on Wednesday announced a new option intended to broaden access for medication-assisted treatment (MAT) for people suffering from substance use disorder (SUD).

The new option applies to DEA-registered practitioners working in hospitals, clinics, or emergency rooms, and also for DEA-registered hospitals and clinics that allow practitioners to operate under their registration number. Under this new option, the DEA will grant requests for an exception to the one-day supply limitation in 21 CFR 1306.07(b) to allow for the dispensing of up to a three-day supply of narcotic drugs, including buprenorphine and methadone, “to a person for the purpose of relieving acute withdrawal symptoms when necessary while arrangements are being made for referral for treatment.” Adhering to The Further Continuing Appropriations Act of 2021 and Other Extensions Act, DEA will grant such exception requests while it works to amend 21 CFR 1306.07(b) that the law directs.

As part of this effort to save lives in the opioid overdose crisis, the DEA also announced that it is working to make permanent its Covid-19 public health emergency temporary regulations that allow for the initiation of buprenorphine to treat opioid use disorder via telemedicine.

Finally, the DEA said it is partnering with the U.S. Health and Human Services Department (HHS) to engage “in regular outreach with pharmacists and practitioners to express support for the use of medication-assisted treatment for those suffering from substance use disorder.”

Provider Relief Fund Reporting Period 2 Deadline is Next Week

The Health Resources and Services Administration’s (HRSA) Provider Relief Fund (PRF) reporting portal remains open for healthcare providers who need to report their use of PRF funds in Reporting Period 2 (RP2) by the deadline next Thursday, March 31.

According to HRSA, providers who received one or more payments totaling greater than $10,000 in the aggregate during a Payment Received Period must use the funds by the deadline and report for each application reporting period.

HRSA’s announcement also said that providers who received PRF payments exceeding $10,000 in the aggregate between July 1, 2020 and Dec. 2020 and who do not submit a report on use of the funds by 11:59 p.m. ET on March 31, 2022 will be required to return all funds.

HRSA said it will not grant grace periods or extensions. Click here to read HRSA’s PRF Reporting Non-Compliance fact sheet. 

BJA Announces Adult Drug Court Discretionary Grant Program Funding Opportunity

The U.S. Justice Department’s Bureau of Justice Assistance (BJA) is seeking applications to plan, implement, and enhance drug court services, including service coordination, management of drug court participants, and recovery support services.

Adult drug courts integrated evidence-based SUD treatment, mandatory drug testing, incentives, and sanctions, and transitional services in judicially supervised criminal court setting that have jurisdiction over persons with SUD treatment needs to reduce recidivism, increase access to treatment and support, and prevent overdoses.

City or township governments, county governments, federally recognized Native American tribal governments, special district governments, and state governments, and others are eligible to apply for this grant opportunity.

The deadline to apply is Friday, May 20. Click here to learn more and apply.

Commonwealth Fund Podcast Examines Closing the Mental Healthcare Gap for Black Teens

In its podcast The Dose, the Commonwealth Fund this week featured Boston Children’s Hospital psychiatrist Kevin Simon, M.D., who discussed how providers can work with families to help address the mental healthcare gap for Black and brown teenagers in America.

The Commonwealth Fund notes that in the current overwhelming demand for behavioral health services, the unmet need for Black and brown teenagers stands out. One reason is they are not getting the care they need due to a shortage of child and adolescent mental health providers—especially providers of color—in the United States. Worsening the problem are the racial stereotypes that exist in how school officials, healthcare providers, and others perceive Black and brown teens.

Simon suggests that the country diversify the mental healthcare provider workforce to correct the problem in the long term. In the short term, he adds, providers can work with families and teachers to strengthen the system and start by demonstrating “cultural humility” and a genuine curiosity about the lived experiences of Black and brown youth.

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

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

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

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

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

Register Today for the 2022 Annual Meeting!

NABH will host its 2022 Annual Meeting—Shaping the Future of Behavioral Healthcare—from June 13-15 at the Mandarin Oriental Washington, DC.

Please remember to register for the meeting and reserve your hotel room today!

Fact of the Week

Only 20% of U.S. adults received mental health treatment since the start of the Covid-19 pandemic, but 80% of those agreed they benefited from this care, the America Psychological Association reports.

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

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NABH Issue Brief: Details About 9th U.S. Circuit Court of Appeals Ruling to Overturn Wit v. United Behavioral Health Decision

In a blow to parity this week, a three-judge panel of the 9th U.S. Circuit Court of Appeals overturned a trial court’s Wit v. United Behavioral Health (UBH) decision, asserting that UBH’s interpretation that health insurance plans do not require consistency with generally accepted standards of care (GASC) “was not unreasonable.”

This NABH Issue Brief highlights brief background on the earlier decision from the trial court, as well as the main points of the three-judge panel’s reversal of that decision this week in its seven-page ruling:

  • The original Wit decision determined that patients’ health and safety are protected when clinicians provide services consistent with GASC that are established by not-for-profit, professional associations, rather than insurance companies whose financial incentives often conflict with what is best for patients.
  • The three-judge panel said it is “not unreasonable” for health insurers’ coverage determinations to be inconsistent with GASC; however, the trial court’s decision, including two 100-page decisions, described how UBH made medical coverage decisions based on financial interests.
  • In its ruling, the appellate court’s three-judge panel did not cite one holding or one fact that the trial court concluded, despite the trial court’s exhaustive trial findings.
  • The trial court’s decision explained UBH’s misrepresentation to regulators that UBH used American Society of Addiction Medicine (ASAM) criteria when, in fact, the company modified and ultimately undercut the actual ASAM criteria.
  • The appellate court’s three-judge panel ruled that UBH is not obligated to cover treatment consistent with GASC if the treatment is not a covered benefit; however, the plaintiffs did not argue that UBH was obligated to cover all services consistent with GASC. Instead, the plaintiffs argued that if services—such as outpatient, intensive outpatient, and residential treatment—are covered benefits, UBH must make medical necessity determinations that are consistent with GASC.

The deeply flawed ruling from the three-judge panel of the 9th U.S. Circuit Court of Appeals has the potential for worsening America’s mental health and addiction crises as the critical need for mental health and addiction treatment services continues to rise during the ongoing Covid-19 pandemic. NABH will continue to fight for true mental health addiction treatment parity and expanded access to care for all who need it.

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