Congress Works to Complete Covid-19 Relief Bill as Federal Funding Deadline Nears

Federal lawmakers on Friday continued to work on a $900 billion Covid-19 funding relief bill to avert a government shutdown before federal funding expires at midnight.

Congress has already agreed on a $1.4 trillion omnibus bill, the legislative vehicle for the $900 billion economic relief package that lawmakers still need to complete.

NABH has learned the Covid-19 relief bill is likely to include about $700 million for the U.S. Health and Humans Services Department (HHS) to use for additional research and procurement and medical supply needs, such as personal protective equipment, and about $35 billion for the Provider Relief Fund.

The bill is also likely to provide about $3.15 billion to the Substance Abuse and Mental Health Services Administration (SAMHSA) for the Substance Abuse Prevention and Treatment Block Grant, the Community Mental Health Services Block Grant, tribal programs, emergency relief, and peer recovery programs and suicide prevention efforts at the Centers for Disease Control and Prevention (CDC); about $1.3 billion to State Opioid Response Grants, and about $150 million to the Certified Community Behavioral Health Centers Program.

Meanwhile, the bill’s addiction and mental health provisions would also expand access to medication-assisted treatment (MAT) through a limited extension of Centers for Medicare & Medicaid Services (CMS) and Drug Enforcement Administration (DEA) telehealth waivers. It would also eliminate the requirement that practitioners apply for a waiver through the DEA in order to prescribe buprenorphine for substance use disorder treatment to the end of the public health emergency or to Dec. 31, 2021, under the conditions of appropriate state oversight and a follow-up study on buprenorphine diversion.

NABH staff is tracking congressional developments and will keep members apprised of the legislation’s effects on behavioral healthcare providers.

HHS Starts Distributing $24.5 Billion in Phase 3 Covid-19 Provider Relief Funding

HHS announced Dec. 16 that it has increased and started to distribute $24.5 billion in the Provider Relief Fund’s (PRF) third phase.

The announcement from HHS said the department completed its review of Phase 3 applications from the PRF and will distribute the funding to more than 70,000 providers. HHS also said the sum is greater than the $20 billion that was planned originally, with $4.5 billion being used “to satisfy close to 90% of each applicant’s reported lost revenues and net change in expenses” that the coronavirus pandemic caused during the first half of 2020.

Click here to view HHS’ first set of Phase 3 payments by state.

Mental Health and Addiction Organizations Urge HHS to Include Behavioral Healthcare Providers Among Covid-19 Vaccine Priority Groups 

NABH is one of nearly 50 mental health and addiction treatment advocacy groups that sent a letter Friday to HHS Secretary Alex Azar urging him to direct the CDC to issue guidance advising states to include mental health and addiction treatment providers among the prioritized groups for receiving the Covid-19 vaccines.

The letter notes this group includes the behavioral healthcare practitioners and staff that the U.S. Homeland Security Department deems as critical essential workers; recovery support providers; and patients in inpatient psychiatric and residential treatment and community-based treatment settings.

“The Covid-19 pandemic is having a significant impact on the behavioral health of children and adolescents,” the letter said. “According to another recent CDC report, the proportion of children’s visits to emergency departments for mental health reasons increased dramatically starting in April 2020 and continuing through October of 2020.”

CEOs from 14 Mental Health Groups Release ‘Unified Vision’ to Address U.S. Mental Health Crisis

The chief executives of the country’s 14 leading mental health advocacy organizations and professional associations this week announced they have formed a unified coalition to engage federal and state officials nationwide to introduce a plan for accelerating effective mental health and substance use care as America manages the global Covid-19 pandemic.

NABH President and CEO Shawn Coughlin represents the association in the coalition, which also includes the American Psychiatric Association, American Psychological Association, Massachusetts Association for Mental Health, Meadows Mental Health Policy Institute, Mental Health America, National Alliance for Mental Illness, National Council for Behavioral Health, One Mind, Peg’s Foundation, Steinberg Institute, Kennedy Forum, Treatment Advocacy Center, and Well Being Trust.

“The lesson of the Covid pandemic is not simply about lack of preparedness,” Kennedy Forum founder and former U.S. Rep. Patrick Kennedy (D-R.I.) and Thomas Insel, M.D. wrote in a joint op-ed about the coalition in The Newark Star-Ledger. “It is also about our resourcefulness as a society to mobilize public-private partnerships that could develop treatments and vaccines at unprecedented speed and scale.”

The coalition’s vision statement provides “pathways for success” across seven critical policy areas: early identification and prevention, especially for families and young people; rapid deployment of emergency crisis response and suicide prevention; leveling inequities in access to care; establishing integrated health and mental health care to ensure “whole-person” well-being; achieving parity in payment by health plans for mental health and substance-use coverage; assuring evidence-based standards of treatments and care; and, engaging a diverse mental health care workforce, peer support and community-based programs.

Visit the Unified Vision homepage to learn more.

HHS-OIG Requests Recommendations for New or Updated Safe Harbor Provisions

HHS’ Office of Inspector General (OIG) this week requested proposals and recommendations to develop new, or to modify existing, safe harbor provisions under the Social Security Act’s federal anti-kickback statute.

The statute applies criminal penalties for whoever knowingly—and willingly—offers, pays, solicits, or receives money to induce or reward the referral for, or purchase of, items and services that are reimbursed under any federal healthcare program. Because of the statute’s broad reach, there was concern that the statute included relatively harmless business arrangements.

This has had an especially negative effect on implementing “contingency management/motivational incentive treatment” practices in which individuals receive small rewards for improving treatment outcomes. Contingency management is an evidence-based practice that the National Institute on Drug Abuse and the SAMHSA developed as a joint initiative in 2001.

This treatment intervention is especially critical for individuals with stimulant use disorders, for which there are no effective treatment medications. According to the CDC, drug overdoses involving psychostimulants increased 33.3% between April 2019 and April 2020, the highest percentage increase of all categories of drugs involved in overdoses for that time period.

Healthcare providers and others could comply with safe harbor conditions so that they are not subject to the federal anti-kickback statute.

The OIG will accept comments on the proposed rule until Tuesday, Feb. 16, 2021. Click here to learn how to submit recommendations.

SAMHSA Announces Mental Health and SUD Grant Funding Opportunities 

SAMHSA this week announced it is accepting applications for more than a dozen grant funding opportunities in behavioral healthcare.

The programs cover topics related to mental health, recovery, suicide, traumatic stress for children, and more. Click here to read about the program opportunities and application deadlines.

Center for Connected Health Policy to Host Telehealth Policy Webinar on Feb. 5

The Center for Connected Health Policy will host Telehealth & Medicaid: What’s Next? A Roadmap for Telehealth Beyond the Pandemic on Friday, Feb. 5, 2021 at 2 p.m. ET.
 
The webinar will feature experts in a panel discussion about what the future looks like for telehealth policy in Medicaid. Attendees will hear from high-level administrators and policy staff from the Medicaid and CHIP Payment Advisory Commission (MACPAC), the Arizona Health Care Cost Containment System, the Colorado Department of Health Care Policy and Financing, and the Oregon Health Authority.

Click here to learn more and to register.

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

NABH has e-mailed members NABH Board of Trustees candidate profiles and a ballot to elect new members to the 2021 Board.

If you have not done so, please vote for the open Board Chair-Elect position and three available Board seats; sign the ballot (it is not valid without a signature); and return it to NABH. You can do this by scanning your completed ballot and e-mailing it nabh@nabh.org, or faxing it to 202-783-6041.

NABH must receive all ballots no later than Thursday, Dec. 31, 2020. New Board members and the Board Chair-elect will take office in January 2021.

Save the Date: NABH 2021 Annual Meeting 

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

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

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

• June 13-15, 2022

• June 12-14, 2023

We look forward to seeing you in Washington next year!

Fact of the Week 
A recent JAMA Psychiatry study examining the pandemic’s effects on mental health found that among Black residents, suicide deaths appeared to double the recent historical average from March 5, the date Maryland declared a state of emergency and shut down, until May 7, when the first public spaces reopened. While the researchers highlighted the study’s limitations, they concluded that “…policy interventions and targeted resource allocation may be warranted to mitigate disparities impacting Black individuals.”

Happy Holidays from NABH!

NABH will not publish CEO Update for the next two weeks and will resume on Friday, Jan. 8, 2021. The entire NABH team wishes you, your teams, and your families a very happy, healthy, and safe holiday season!

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

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

In guidance released this week, the U.S. Health and Human Services Department (HHS) said hospitals, hospital laboratories, and acute-care facilities will be required to include incidences of patients with influenza in their Covid-19 data reporting data as of Dec. 18.

The new influenza fields were added as optional elements to the Covid-19 data reporting set in October and will be mandatory starting next week.

In addition, the new reporting requirements include weekly reporting on inventory and use of Covid-19 therapeutic medications.

Please note the relevant new provisions highlighted in this week’s guidance, which is also available on NABH’s Covid-19 resources webpage.

CMS Hospital Price Transparency Final Rule Presentation Now Available

The Centers for Medicare & Medicaid Services (CMS) has provided slides from the agency’s Dec. 8 webinar about the hospital price transparency final rule.

Beginning Jan. 1, all U.S. hospitals will be required to provide transparent and accessible pricing information online about the items and services they provide. According to CMS, hospitals will be required to do this in two ways: first as a comprehensive, machine-readable file that notes all items and services, and second as a display of shoppable services in a consumer-friendly format.

The webinar identified who must comply with the rule, defined hospital “standard charges,” and outlined what items and services must be included.

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

President-elect Joseph Biden has selected California Attorney General Xavier Becerra as his nominee to lead HHS and internist Vivek Murthy, M.D. to reprise his earlier role as U.S. surgeon general.

Becerra, who represented California in the U.S. House of Representatives from 1993 to 2017, was chairman of the House Democratic Caucus from 2013 to 2017 and served on the powerful House Ways and Means Committee. He earned both his bachelor and law degrees from Stanford. If confirmed, Becerra would be the first Latino to lead HHS.

A fierce champion of the Patient Protection and Affordable Care Act, Becerra is leading 20 states and Washington, D.C.  to protect the seminal 2010 healthcare law from being dismantled. Becerra would oversee the department at a critical time during the Covid-19 pandemic, as caseloads surge and a massive vaccination effort is set to launch soon.

Murthy served as the nation’s 19th U.S. surgeon general during the Obama administration from December 2014 until January 2017. Murthy completed his internal medicine residency at Brigham and Women’s Hospital and Harvard Medical School, and also led and managed medical teams as a faculty member.

Biden also named Rochelle Walensky, M.D., M.P.H., chief of infectious diseases at Massachusetts General Hospital, to lead the Centers for Disease Control and Prevention in Atlanta. Walensky also serves as professor of medicine at Harvard Medical School and is an expert on AIDS and HIV.

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

Well Being Trust and the Institute for Healthcare Improvement (IHI) have released two resources to help healthcare providers, payors, and community partners implement strategies to help save lives from overdose and suicide, and care for front-line health workers during the Covid-19 pandemic.

A Guide for Health Systems to Save Lives from “Deaths of Despair” and Improve Community Well-Being is a 37-page resource that explores the role of healthcare systems in improving health and well-being and proposes an approach that identifies who the population is, how to implement methods, and what interventions to use in communities.

The shorter of the two resources, A Guide to Promoting Health Care Workforce Well Being During and After the Covid-19 Pandemic defines key concepts, such as “moral injury,” “psychological first-aid,” and “grief leadership,” and then offers applicable steps that healthcare organizations can take to build on existing support systems.

SAMHSA Releases Treatment Guide on Youth Suicide

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released Treatment for Suicidal Ideation, Self-harm, and Suicide Attempts Among Youth, a 57- page guide that provides interventions to treat suicidal ideation, self-harm, and suicide attempts among youth.

Elinore McCance-Katz, M.D., Ph.D., assistant secretary for mental health and substance use, noted in a foreword that the guide is part of SAMHSA’s response to the 21^st Century Cures Act’s requirement to disseminate information on evidence-based practices and service delivery models. McCance-Katz also wrote that suicide is the second leading cause of death for youth in the United States. The suicide rate for youth aged 10 to 24 increased 56% to 10.6 per 100,000 people in 2017 from 6.8 per 100,000 people in 2007.

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

NABH this week e-mailed system members the NABH Board of Trustees candidate profiles and a ballot to elect new members to the 2021 Board.

If you have not done so, please vote for the open Board Chair-Elect position and three available Board seats; sign the ballot (it is not valid without a signature); and return it to NABH. You can do this by scanning your completed ballot and e-mailing it nabh@nabh.org, or faxing it to 202-783-6041.

NABH must receive all ballots no later than Thursday, Dec. 31, 2020. New Board members and the Board Chair-elect will take office in January 2021.

Save the Date: NABH 2021 Annual Meeting 

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

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

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

• June 13-15, 2022

• June 12-14, 2023

We look forward to seeing you in Washington next year!

Fact of the Week

A new Morning Consult poll found that 36% of Americans reported their mental health has suffered during the Covid-19 global pandemic, while 19% said their physical health has worsened.

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

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

Centers for Disease Control and Prevention (CDC) Director Robert Redfield, M.D. on Thursday approved a CDC committee’s recommendation that healthcare personnel and long-term care facility (LTCF) residents be offered the Covid-19 vaccine in the vaccination program’s initial phase.

The agency’s Advisory Committee on Immunization Practices (ACIP) Covid-19 Vaccines Work Group earlier this week outlined a phased allocation for the vaccines that highlighted the committee’s scientific and ethical considerations. The ethical principles include maximizing benefits, minimizing harm, promoting justice, and mitigating health inequities.

ACIP members defined LTCF residents as “adults who reside in facilities that provide a variety of services, including medical and personal care, to persons who are unable to live independently,” and a footnote on slide 12 of the presentation includes psychiatric facilities in the LTCF definition.

As part of this effort, NABH sent a letter to the National Governors Association that asked governors to prioritize behavioral healthcare providers in the first round of the Covid-19 vaccine distribution. In the letter, NABH President and CEO Shawn Coughlin emphasized that demand for mental health and addiction services has increased during the global pandemic, while challenges such as personal protective equipment shortages and reduced staff availability have placed additional burdens on behavioral healthcare providers.

“It is critical that we preserve and even increase access to behavioral healthcare as a key component of the response to Covid-19,” Coughlin wrote. “Since the onset of the pandemic, our members have been intensely focused on implementing many new practices and protocols to address the increased demand for behavioral healthcare while preventing the spread of the coronavirus,” he added. “They have developed and implemented new screening and infection- control measures. Unfortunately, some of these measures, such as quarantine rooms, reduce their capacity to provide care.”

CMS Maintains Some Telehealth Provisions in 2021 Medicare Physician Fee Schedule 

In the Calendar Year (CY) 2021 Medicare Physician Fee Schedule rule released this week, the Centers for Medicare & Medicaid Services (CMS) said it will maintain some of the telehealth service coverage it authorized during the Covid-19 pandemic, including telehealth coverage for group psychotherapy and psychological and neurological testing.

CMS said it will decline to continue covering evaluation and management services via audio-only technology, and instead will provide coverage on an interim basis during CY 2021 for an extended, audio-only assessment service to determine whether an in-person visit is needed.

This rule also finalized regulations to allow Medicare coverage of telehealth services provided to existing patients while at home, regardless of where they live for treatment of substance use disorders and co-occurring mental health conditions. The Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) authorized this exception to the Medicare rules that do not generally cover telehealth services that originate from the patient’s home and limit coverage of telehealth to certain geographic areas.

CMS Includes PHP Payment Rates in 2021 OPPS Rule

CMS this week included payment rates for partial hospitalization programs (PHPs) in the CY 2021 Outpatient Prospective Payment System (OPPS) final rule the agency released on Dec. 3.

In the rule, CMS made final its August proposal to use its existing methodology for calculating the CY 2021 geometric mean per diem cost using the most recent updated claims and cost data. Based on available data at that point, the proposed per diem rates were $243.94 for hospital-based PHPs and $121.62 for community mental health centers (CMHCs). Using the most recent updated claims and cost data as proposed, the final CY 2021 hospital-based PHP geometric mean per diem cost is $253.76 and the final CMHC geometric mean per diem cost is $136.14.

CMS also finalized the proposed payment rate for Level 2 Health and Behavior Services (Ambulatory Payment Classification 5822) at $78.54, based on existing claims data.

CMS Announces RFA for the Value in OUD Treatment Initiative

CMS has announced a request for application (RFA) for a new initiative intended to increase access to opioid use disorder (OUD) treatment services to eligible Medicare fee-for-service beneficiaries and those dually eligible for Medicare and Medicaid.

Funded through the SUPPORT Act, the Value in Opioid Use Disorder Treatment is a four-year demonstration that creates two new payments to participating providers: 1) a per-beneficiary, per-month, care-management fee, and 2) a performance-based incentive payment. The SUPPORT Act makes available $10 million each of the fiscal years 2021-2024 for demonstration payments. According to CMS, these payments will be made in addition to the OUD treatment services Medicare covers already.

The demonstration is open to a range of participants, including opioid treatment programs, certified community behavioral health clinics, and community mental health centers. CMS will accept applications through Jan. 3, 2021, and selected participants are expected to implement the demonstration by April 1, 2021, at which time payments will begin.

Click here to learn more and apply.

CMS to Host Hospital Price Transparency Webcast on Dec. 8

CMS will host a Hospital Price Transparency Webcast on Tuesday, Dec. 8 to provide a more detailed overview of the resources the agency outlined in an Open Door Forum late last month.

Before Thanksgiving, CMS hosted a Rural Health Open Door Forum to highlight hospital price transparency resources to help providers prepare for complying with the agency’s Hospital Price Transparency Rule that takes effect on Jan. 1, 2021.

Next week’s webcast will also provide a question-and-answer session after the presentation. Click here to register for the hourlong webcast, which will begin at 2 p.m. ET on Dec. 8.

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

U.S. policymakers should consider increasing the mental health provider workforce and investing in telehealth as the global pandemic’s mental health repercussions are likely to grow, according to a new report from The Commonwealth Fund.

The report cites modeling estimates from the Well Being Trust that show the Covid-19 pandemic could lead to more than 75,000 additional deaths from alcohol and drug misuse and suicide. Meanwhile, the report notes that the pandemic’s effect on social determinants of health—such as employment, income levels, housing and food security—have “threatened basic survival,” and that nearly one-quarter of adults surveyed in early November reported they had not received needed care in the past four weeks.

In addition to their mental health workforce and telehealth recommendations, researchers also suggested that states examine their respective insurance laws to ensure that mental health parity or equal treatment of mental health and substance use disorders is enforced, and enact plans to help children access the mental health resources they received previously in schools.

Learn about Prime Healthcare in Our NABH Member Profile!

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

Save the Date: NABH 2021 Annual Meeting

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

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

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

• June 13-15, 2022

• June 12-14, 2023

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

Fact of the Week

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

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