CMS Proposes 2.1% Payment Increase to Per-Diem Base Rate for IPFs in FY 2022

The Centers for Medicare & Medicaid Services (CMS) this week proposed a 2.1-percent, Medicare payment increase to the per-diem base rate for inpatient psychiatric facilities (IPF) for fiscal year (FY) 2022.
 
This adjustment would increase the per-diem base rate to $833.50 from $815.22 and the electroconvulsive therapy (ECT) rate to $358.84 from $350.97.

CMS proposed several changes for inpatient psychiatric care in 2022, such as aligning an IPF policy regarding displaced residents from IPF closures and closures of IPF teaching programs with the policy changes that the agency made final in its FY 2021 IPPS rule.
 
In its FY 2022 proposed rule, CMS recommended the following changes to the IPF Quality Reporting Program:

• Starting in FY 2023, the agency would add a requirement to report Covid-19 Vaccination Coverage Among Healthcare Personnel in the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network web portal;

• For FY 2024, CMS would substitute the Follow-up After Psychiatric Hospitalization (FAPH) measure for the Follow-up After Hospitalization for Mental Illness (FUH) measure. The FAPH includes patients with substance use disorders and also expands the provider types who can provide follow-up care to include primary care providers;

• For FY 2024, the agency would remove the three following measures:
  • Alcohol Use Brief Intervention Provided or Offered and Alcohol Use Brief Intervention Provided (SUB-2/2a),
  • Tobacco Use Brief Intervention Provided or Offered and Tobacco Use Brief Intervention Provided (TOB-2/2a), and
  • Timely Transmission of Transition Record -Discharges from an Inpatient Facility to Home/Self Care or Any Other Site of Care.

CMS is requesting information about how to develop a patient experience-of-care measure, as well as comments on including a patient-reported outcomes measure that assesses functional outcomes. The agency also wants feedback on measures either included in the IPFQRP now or that could be added that would be appropriate for digital data collection.

The agency is also seeking comment about how to modify reporting in a way that would improve collecting information on health disparities. CMS asked specifically for feedback on stratification of quality measure results by dual eligibility, race and ethnicity, improving demographic data collection, and potential creation of a facility equity score synthesizing results across multiple social risk factors.

CMS will accept public comments on the rule until June 7.

U.S. Labor Department Issues Guidance on Parity Compliance

The U.S. Labor Department (DOL) has issued guidance on new implementation requirements for the Mental Health Parity and Addiction Equity Act (MHPAEA) that the 2021 Consolidated Appropriations Act requires.

Enacted on Dec. 27, 2020, the 2021 Consolidated Appropriations Act requires group health plans and health insurance issuers offering group or individual health insurance to perform and document analyses of how they comply with MHPAEA in their application of non-quantitative treatment limits (NQTLs) to mental health/substance use disorder (MH/SUD) benefits, compared with their application of NQTLs to medical/surgical benefits.

As of Feb. 10, 2021, health plans and insurers must make these comparative analyses available upon request to three federal agencies that oversee MHPAEA implementation: DOL, the U.S. Department of Health and Human Services, and the U.S. Treasury Department.

The required NQTL analyses by health plans and insurance issuers must include the following information:

• A description of the NQTL, plan terms, and policies at issue;

• Identification of the MH/SUD and medical/surgical benefits to which the NQTL applies;

• The factors used in applying the NQTLs to MH/SUD benefits and medical or surgical benefits;

• The evidentiary standards used for these factors;

• The comparative analyses demonstrating that the processes, strategies, evidentiary standards, and other factors used to apply the NQTLs to MH/SUD benefits, as written and in operation, are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, and other factors used to apply the NQTLs to medical/surgical benefits in the benefits classification; and

• The specific findings and conclusions reached by the plan or issuer, including any results of the analyses that indicate that the plan or coverage is or is not in compliance with the MHPAEA requirements.

The new law also requires the federal agencies to share findings regarding these analyses of MHPAEA compliance with the state governments where the plans or issuers are located and submit an annual report to Congress on these findings.

The guidance provides additional detail regarding the following topics:

• What information plans and issuers must make available to support their comparative analyses demonstrating compliance with MHPAEA in their use of NQTLs;

• Examples illustrating when the federal agencies might determine that a comparative analysis of NQTLs is insufficiently specific and detailed;

• The types of documents that plans and issuers should be prepared to make available to the federal agencies to support their analyses and conclusions regarding their NQTL comparative analyses;

• What actions the federal agencies will take if they determine that a plan or issuer has not submitted sufficient information or is not in compliance with MHPAEA;

• Whether state agencies and plan participants and beneficiaries may request to see a plan or issuer’s comparative analysis of its use of NQTLs;

• Which specific NQTLs the federal agencies plan to focus on in the near term when requesting comparative analyses from plans and issuers for review, namely:

1. • Prior authorization requirements for in-network and out-of-network inpatient services,
   • Concurrent review for in-network and out-of-network inpatient and outpatient services,

• Standards for provider admission to participate in a network, including reimbursement rates, and

• Out-of-network reimbursement rates (plan methods for determining usual, customary, and reasonable charges).

New Federal Guidance Says Federal Grantees May Now Use Funds to Buy Fentanyl Test Strips

Guidance this week from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Disease Control and Prevention (CDC) says funding may now be used to purchase rapid fentanyl test strips (FTS) as a way to help curb the sharp rise in drug overdose deaths primarily from strong synthetic opioids, including fentanyl.

FTS can be used to determine if drugs have been mixed or cut with fentanyl, which will provide people who use drugs and communities with information about fentanyl in the illicit drug supply so they can work to reduce their risk of overdose.

“This is a major step forward in the ongoing and critical work to prevent overdose and connect people who have substance use disorders to evidence-based treatment options,” Acting Assistant Secretary for Mental Health and Substance Use Tom Coderre, interim leader at SAMHSA, said in an announcement. “This will save lives by providing tools to identify the growing presence of fentanyl in the nation’s illicit drug supply and – partnered with referrals to treatment – complement SAMHSA’s daily work to direct help to more Americans.”

AP Reports U.S. Suicides Fell Nearly 6% in 2020, Defying Global Pandemic Expectations

Citing preliminary government data, the Associated Press on Thursday reported the number of U.S. suicides dropped by about 6% in 2020, the largest annual decline in at least 40 years.

The CDC has not reported national suicide rates for 2020, nor has it provided a breakdown of suicides by state, age, or race and ethnicity.

The AP story quoted Christine Moutier, M.D., chief medical officer at the American Foundation for Suicide Prevention, as saying an increase in the availability of telehealth services and other efforts to address America’s suicide problem may have contributed to the decrease in the preliminary findings.

NABH and Other Organizations Offer to Work with OSHA to Ensure Safety and Quality of Care at Psychiatric Facilities

In a letter to the Occupational Safety and Health Administration (OSHA) this week, NABH and three other behavioral healthcare groups offered to work with the federal agency to develop well-informed policies that ensure the safety of patients and personnel at psychiatric facilities.

NABH, the National Association of State Mental Health Program Directors, the National Alliance on Mental Illness, and the National Council for Behavioral Health sent a letter to James Frederick, the principal deputy assistant secretary of Labor for Occupational Safety and Health, that expressed concern about certain OSHA policies and implementation actions that do not align with other requirements that inpatient psychiatric facilities must follow to ensure both patient safety and quality care. For instance, one OSHA requirement calls for fully enclosing nursing stations with plexiglass—a practice that prevents patient-staff interactions that are critical for quality behavioral healthcare.

“We recognize that regulatory entities face many difficulties in developing a consistent set of requirements intended to reduce hazards in the context of different treatment approaches and services offered by individual facilities, different patient populations, and various state regulatory requirements,” the letter said. “Therefore, we recommend that OSHA establish a collaborative process to gather input from leading psychiatric hospitals and units, state mental health agency officials, psychiatric providers, employee representatives, and representatives of mental healthcare consumers and their families regarding effective practices for ensuring the safety of inpatient psychiatric facilities without compromising the clinical care of patients.”
 
The Kennedy Forum to Start Three-Part Webinar for Employers Next Week

The Kennedy Forum next week will host the first in a three-part webinar series about what employers can do to accommodate the growing demand from employees for better access to mental health and addiction care.

The series will explore the effects of mental health and addiction in the workplace, the pros and cons of different internal support options, and ways to collaborate with insurers to ensure better access to treatment.

Part 1 is titled “Impact—There is No Health Without Mental Health” and will be hosted on Thursday, April 15 from 2 p.m. to 3 p.m. ET. Parts 2 and 3 will be held on April 29 and May 13, respectively, at the same time. Click here to learn more and to register.

Save the Date: NABH 2021 Annual Meeting

NABH will host its 2021 Annual Meeting from Wednesday, Oct. 6 – Friday, Oct. 8, 2021 at the Mandarin Oriental Washington, DC.

The association re-scheduled for this later date in 2021 due to the ongoing Covid-19 pandemic. We hope you can join us!

After 2021, NABH will host its subsequent Annual Meetings in June. Please save the date for these future NABH Annual Meetings:

• June 13-15, 2022

• June 12-14, 2023

We look forward to seeing you again in Washington!

Fact of the Week

More than one year into the global pandemic, 76% of frontline healthcare workers say they feel “hopeful” when going to work these days, a new Kaiser Family Foundation/Washington Post survey found.
For questions or comments about this CEO Update, please contact Jessica Zigmond

Biden Administration Releases Drug-Policy Priorities for Year One

The Biden administration on Thursday released a statement outlining its first-year, drug-policy priorities to address America’s overdose and addiction crises.

White House Office of National Drug Control Policy (ONDCP) Acting Director Regina LaBelle noted in an announcement that these priorities will complement President Biden’s American Rescue Plan, which includes an investment of nearly $4 billion in behavioral health services.

In the next year, the ONDCP will work across government to implement seven priorities:

• Expanding access to evidence-based treatment

• Advancing racial equity in our approach to drug policy

• Enhancing evidence-based harm reduction efforts

• Supporting evidence-based prevention efforts to reduce youth substance use

• Reducing the supply of illicit substances

• Advancing recovery-ready workplaces and expanding the addiction workforce

• Expanding access to recovery support services

The strategy identified several issues that NABH has discussed with the ONDCP, including, but not limited to, enforcing parity, improving reimbursement for services, permitting medications through telehealth without an in-person evaluation, and removing policy barriers to using contingency management and motivational incentives.

In addition, harm reduction appears to have a more visible role in the Biden administration than with previous administrations, as do issues related to workforce, recovery-ready workplaces, and recovery-support services.

Final Rule to Implement Cures Act Interoperability Requirements Takes Effect April 5

A regulation to implement interoperability requirements outlined in the 21^st Century Cures Act and prohibit “information blocking” takes effect Monday, April 5.

Information blocking is defined as a practice by a health information technology (IT) developer, health information network, health information exchange, or healthcare provider that is likely to interfere with access, exchange, or use of electronic health information. There are certain exceptions.

The Office of the National Coordinator for Health Information Technology (ONC) has posted information clarifying what qualifies as information blocking, as well as a number of exceptions.

CMS Alerts Providers that Repayment of Covid-19 Accelerated and Advance Began March 30

The Centers for Medicare & Medicaid Services (CMS) this week alerted Medicare-participating providers that the federal agency began recovering Covid-19 Accelerated and Advance Payments (CAAPs).

A special edition MLN (Medicare Learning Network) Matters article informed all Medicare providers and suppliers who requested and received CAAPs that the agency began recovering those payments as early as March 30, depending upon the one-year anniversary of when providers received their first payment.

“Please be sure your billing staff are aware that the recovery has begun, or will begin soon, but no sooner than 1 year from the date we issued the CAAP to you,” the article said.

Bipartisan Policy Center Report Urges Congress to Integrate Primary Care and Mental Health & SUD Services

The Bipartisan Policy Center on Thursday released Tackling America’s Mental Health and Addiction Crisis Through Primary Care Integration, a 124-page report with legislative and regulatory recommendations to integrate behavioral health into primary care.

“Even before the Covid-19 pandemic, the unmet need for mental health and substance use services in the United States was significant,” the report noted. “Alarmingly, less than half of adults with mental health conditions received services in 2019, and the percentage was even lower in Black and Latino communities,” it continued. “As for substance use, nearly 90% of people with a substance use disorder did not receive treatment.”

The report highlights these essential recommendations: establish core, minimum standards for integration; drive integration in new and existing value-based payment models; expand, train, and diversify the workforce for integrated care teams; and promote the use of EHRs, telehealth, and other technology to support integrated care.

“Broader use of EHRs is critical for improving coordination among the different levels of behavioral healthcare, including inpatient, residential, and outpatient providers of mental health and addiction treatment,” NABH President and CEO Shawn Coughlin said in a news release about the report from the Behavioral Health Information Technology Coalition, of which NABH is a member. “The lack of federal funding to help behavioral healthcare providers implement health information technology has contributed significantly to relatively lower EHR use by these providers compared with other healthcare providers.”

The Bipartisan Policy also developed infographics that highlight the recommendations outlined in the report.

Next Week’s Virtual Rx Drug Abuse & Heroin Summit to Feature President Biden

President Biden will deliver a recorded message to attendees at next week’s virtual Rx Drug Abuse & Heroin Summit on Monday, April 5 at 10:15 a.m. ET.

Featured during the conference’s opening plenary session, the president’s remarks will focus on the Biden administration’s efforts to reduce overdose rates and save lives.

Registration is still available for the 10^th annual conference, which will present more than 75 sessions across nine educational tracks and will cover topics ranging from prevention and treatment to public safety and technology.

NABH Director of Quality and Addiction Services Sarah Wattenberg will present with representatives from the Office of National Drug Control Policy, the U.S. Drug Enforcement Administration, and the Veterans Affairs Department in a session titled, “Federal and Private Sector Responses to Opioid Treatment Issues During the Covid-19 Pandemic.”

For additional information, download the conference brochure, and click here to register.

NIMH Issues Notice of Special Interest in Research to Examine Covid-19’s Mental Health Effects on Children

The National Institute of Mental Health (NIMH) has issued a Notice of Special Interest (NOSI) to highlight interest in research to understand the mental health effects of Covid-19 pandemic on school-aged children, specifically those between the ages of 3 and 12.

The NOSI said the NIMH is interested particularly in the potential impact of primary instruction setting disruptions, such as pre-school and elementary school, on the mental health, cognitive, social, and emotional development of children.

“Empirical data would aid in balancing health risks for various public health mitigation strategies affecting children in the current pandemic as well as inform how to both be prepared and respond to future public health emergencies, including pandemics and disaster scenarios,” the noticed said.

Applications are due starting June 5 and ending on Sept. 8, 2021. Click here to learn more.

Save the Date: NABH 2021 Annual Meeting

NABH will host its 2021 Annual Meeting from Wednesday, Oct. 6 – Friday, Oct. 8, 2021 at the Mandarin Oriental Washington, DC.

The association re-scheduled for this later date in 2021 due to the ongoing Covid-19 pandemic. We hope you can join us!

After 2021, NABH will host its subsequent Annual Meetings in June. Please save the date for these future NABH Annual Meetings:

• June 13-15, 2022

• June 12-14, 2023

We look forward to seeing you again in Washington!

Fact of the Week

From Jan. 20, 2021–Feb. 1, 2021, more than two in five adults aged 18 or older experienced symptoms of an anxiety or a depressive disorder during the past seven 7 days. Meanwhile, one in four adults who experienced these symptoms reported that they needed but did not receive counseling or therapy for their mental health.
For questions or comments about this CEO Update, please contact Jessica Zigmond