Former U.S. Rep. Jim Ramstad (R-Minn.), Addiction Recovery Champion, Dies at 74

Former U.S. Rep. Jim Ramstad (R-Minn.), a champion for addiction recovery, died Thursday at the age of 74.

Ramstad, who had been ailing from Parkinson’s Disease, channeled his personal battle with addiction to become a strong advocate for recovery. He represented Minnesota’s third district in the U.S. House of Representatives for nine terms before he retired in 2009.

The Minnesota Republican was the chief sponsor for the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, the bill that opened access to treatment for millions of Americans suffering from mental illness or chemical addiction.

News outlets reporting Ramstad’s death described how the former congressman’s personal battle with alcoholism spurred him to help others battling addiction. The stories also mentioned Ramstad’s arrest for disorderly conduct while he served in the Minnesota state legislature, the event that caused him to give up drinking.

“If I had not wound up in that jail cell, I would not have sought treatment,” Ramstad told The New York Times in 2006.

Ramstad celebrated his 39^th year of sobriety at his death, according to news reports.

Federal Court Orders Class-Wide Remedies in Wit v. United Behavioral Health

NABH legal consultant and psychotherapist Meiram Bendat, Ph.D., J.D., sent the following summary to NABH this week regarding the remedies in the Wit v. United Behavioral Health case:

In its 99-page ruling, the court explained the need for: (1) a 10-year injunction requiring UBH to exclusively apply medical necessity criteria developed by non-profit clinical specialty associations; (2) appointment of a special master; (3) training of UBH in the proper use of court-ordered medical necessity criteria; and (4) reprocessing of nearly 67,000 mental health and substance use disorder benefit claims denied during the class period.

Today’s ruling stems from two consolidated class actions, Wit et al. v. United Behavioral Health. and Alexander et al. v. United Behavioral Health, brought by Psych-Appeal, Inc. and Zuckerman Spaeder LLP under the Employee Retirement Income Security Act of 1974 (“ERISA”) in 2014, certified in 2016, and tried in October 2017. While nearly 50,000 ERISA insureds will be eligible for class-wide relief in this case, non-ERISA insureds (such as governmental employees) adversely impacted by UBH’s defective guidelines must rely on state and federal regulators to intervene on their behalf.

I trust that you recognize the significance of today’s ruling as much as we do.

 -Meiram Bendat, Ph.D., J.D., Founder and President, Psych Appeal

DEA Publishes Regulations to Implement the Controlled Substances Act and the Preventing Drug Diversion Act

The Drug Enforcement Administration (DEA) this week published regulations to implement amendments that the 2018 SUPPORT Act made to the Controlled Substances Act. The regulations became effective on Friday, Oct. 30 and appeared in the Federal Register on Nov. 2.

The updated regulations:

• Allow a practitioner to treat up to 100 patients if a practitioner meets additional credentialing requirements, or if the practitioner provides covered medications (MAT) in a qualified practice setting, and up to 275 patients if the practitioner meet specific additional requirements (42 CFR 8.610-8.655);
• Permanently include nurse practitioner or physician assistant in the definition of ”qualifying other practitioner,” and temporarily expand the definition (until Oct. 1, 2023) to include a clinical nurse specialist, certified registered nurse anesthetist, or a certified nurse midwife who meets certain qualifications;
• Provide an additional option for a physician to be considered a ”qualifying physician” if the physician graduates in good standing from an accredited school of allopathic medicine or osteopathic medicine in the United States five years prior to notifying HHS of his or her intention to dispense narcotic drugs for maintenance or detoxification treatment. This does not eliminate the SUPPORT Act’s eight-hour opioid training requirement; rather, it permits the training to be completed in medical school or residency, not just through post-residency continuing medical education; and
• Permit pharmacies to deliver a controlled substance to a prescribing practitioner’s location for the purpose of administering the medication (through implantation or injection) to the patient or research subject, as previously permitted under a DEA exception. This permits administration directly in the provider’s office without requiring a trip to the pharmacy.

In separate rulemaking, the DEA proposed its intention to amend the Preventing Drug Diversion Act of 2018 related to the identifying and reporting of suspicious orders by DEA registrants. The proposal offers a two-option framework for reporting suspicious orders, establishes a centralized database for reporting, defines four terms: “due diligence,” “order,” “order received under suspicious circumstances,” and

“suspicious order,” and requires registrants to design and operate privacy-law-compliant systems.

The provisions are intended to clarify procedures for registrants and address a lack of uniformity in reporting suspicious orders. Comments are due by Monday, Jan. 4, 2021.

HHS Extends Compliance Deadline for Information Blocking and Health IT Certification

The U.S. Health and Human Services Department (HHS) recently released an interim final rule that gives healthcare providers and vendors an additional five months to comply with healthcare information blocking and interoperability regulations by April 5, 2021.

In March, HHS’ Office of the National Coordinator for Health IT (ONC) released a 21^st Century Cures Act final rule that established exceptions to the Cures Act’s information blocking provision and adopted new health information technology (health IT) certification requirements to improve patients’ smartphone access to their health information at no cost through application programming interfaces.

The new interim final rule extends dates in the information blocking provisions—including a November compliance deadline for providers—as well as dates for the Conditions and Maintenance of Certification provisions that require electronic health records platforms to be interoperable. This is the second time HHS has extended the compliance deadline due to the Covid-19 pandemic.

“We are hearing that while there is strong support for advancing patient access and clinician coordination through the provisions in the final rule, stakeholders also must manage the needs being experienced during the current pandemic,” Don Rucker, M.D., national coordinator for health IT, said in an announcement. “To be clear, ONC is not removing the requirements advancing patient access to their health information that are outlined in the Cures Act final rule,” he continued. “Rather, we are providing additional time to allow everyone in the health care ecosystem to focus on Covid-19 response.”

The rules require that various types of clinical notes be shared with patients, although the rules do not apply to “psychotherapy notes recorded in any medium by a healthcare provider who is a mental health professional documenting or analyzing the contents of a conversation during a private counseling session or a group, joint, or family counseling session and that are separate from the rest of the individual’s medical record,” according to a summary.

Reminder: DOL’s Rural Healthcare Workforce Training Grant Applications Due Nov. 13

The U.S. Labor Department’s Employment and Training Administration (ETA) will accept applications for its H-1B Rural Healthcare Grant Program until next Friday, Nov. 13.

Earlier this fall, ETA announced $40 million in available grant funding for employment and training programs in healthcare occupations—including behavioral and mental healthcare—that serve rural populations.

According to the announcement, employment and training programs through this funding can propose a wide range of models, including Registered Apprenticeship Programs and Industry-Recognized Apprenticeship Programs. Pre-apprenticeships are permitted only “as on-ramps” to apprenticeship programs proposed as a response to the funding notice and must lead to apprenticeships during the life of the grant.

Click here to learn more about the training programs and here to learn how to apply for the funding.

Bipartisan Policy Center to Host Telehealth Webinar Next Week

Sen. Angus King (I-Maine), Maine healthcare providers, and Bipartisan Policy Center experts will lead a webinar about the future of telehealth next Friday, Nov. 13 at noon ET.

The webinar will address the investments and changes that both policymakers and healthcare providers need to make to sustain access to quality healthcare through telehealth.

Click here to learn more and to register.

NABH to Host Next Annual Meeting in October 2021

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

Individuals with a serious mental illness have an average life expectancy 10 to 25 years lower than the rest of the population.

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

Presidential Executive Order Establishes Coronavirus Mental Health Working Group

The White House last week issued an executive order to create a Coronavirus Mental Health Working Group that is expected to develop a plan that addresses Covid-19’s mental health effects on Americans and calls for agencies to maximize support for behavioral healthcare treatment.

President Trump’s Saving Lives Through Increased Support for Mental—and Behavioral-Health Needs executive order notes that the working group’s efforts will consider the mental and behavioral health conditions of the vulnerable populations that the pandemic has affected, including minorities, seniors, veterans, small business owners, children, individuals potentially affected by domestic violence or physical abuse, persons living with disabilities, and individuals with substance use disorder (SUD).

“We know that the Covid-19 pandemic has created or exacerbated serious behavioral health challenges for many Americans, both adding new stresses and disrupting access to treatment,” U.S. Health and Human Services (HHS) Secretary Alex Azar said in a statement.  “The president’s executive order is a welcome opportunity to increase efforts to address the mental health effects of the pandemic, which have already included hundreds of millions of dollars in grants and historic flexibilities to ensure Americans can continue to receive treatment for mental illness and substance use disorders.”

Azar will co-chair the new working group with Brooke Rollins, acting director of the U.S. Domestic Policy Council.

U.S. Congress Joint Economic Committee Examines Covid-19’s Toll on Americans’ Mental Health

The United States Congress Joint Economic Committee has released a report that examines how Covid-19’s health and economic repercussions have led to “an unprecedented mental health crisis” in America.

The 13-page report summarizes earlier surveys and studies that have found two-thirds of Americans fear that they or their loved ones will be exposed to the virus; more than 12 million Americans are unemployed, and, since February, more than 5 million have given up looking for work; and that nearly one-third of adult Americans are having trouble paying for typical household expenses.

“There is yet no clear end in sight for the coronavirus pandemic, which will continue to have devastating effects on public health and on the economy,” the report said. “The Institute of Health Metrics and Evaluation projects more than 360,000 deaths by the end of 2020 under current circumstances, and upward of 430,000 if mandates continue to be eased,” it continued. “The Federal Reserve expects the unemployment rate to remain above pre-pandemic levels until at least the end of 2021. These intense stresses likely will have a growing and lasting impact on Americans’ mental health.

CMS Corrects Announcement to Say Providers Cannot Use PRF When Repaying Medicare Loans

The Centers for Medicare & Medicaid Services (CMS) corrected a misstatement in its Oct. 8 news release to say the nation’s healthcare providers and suppliers cannot use Provider Relief Funds (PRF) to repay Medicare loans the agency has made during the Covid-19  public health emergency.

The correction first appeared in an FAQ on Oct. 9. CMS subsequently corrected its original release.

AAAP Releases Buprenorphine Provider Survey Report to Inform Policymakers

The American Academy of Addiction Psychiatry (AAAP) this week released the findings from a new survey that found 80% of X-waivered physicians, physician assistants, and nurse practitioners who treat patients with opioid use disorder (OUD) want telehealth options to continue after the Covid-19 public health emergency. The X-waiver permits office-based clinicians to prescribe Suboxone (buprenorphine/naloxone) for OUD patients.

The AAAP led the project with help from other organizations, including the American Psychiatric Association, the American Society of Addiction Medicine, Boston Medical Center, Boston University, and the Yale Program in Addiction Medicine.

According to the survey, 78% of respondents said the Covid pandemic has caused them to put on hold or reduce in-person visits. Meanwhile, 75% of physicians and other healthcare professionals said they have used virtual visits to help maintain medication to treat OUD, and 48% reported they used telehealth to initiate medication to help treat OUD.

“During the pandemic, physicians and other health care professionals have adapted to quickly provide high-quality, evidence-based care, but this was only possible due to new flexibilities in telehealth rules,” the survey said.

National Addiction Treatment Week Begins Monday, Oct. 19

Monday kicks off National Addiction Treatment Week to build awareness that addiction is a disease, evidence-based treatment is available, and recovery is possible. The week is also meant to encourage people to enter the field of addiction treatment.

The American Society of Addiction Medicine (ASAM) launched National Addiction Treatment Week three years ago with partner organizations. Partners include the National Institute on Drug Abuse, the American Medical Association, and the National Association of Addiction Treatment Providers. Click here for ASAM’s schedule of the week and toolkit.

Separately, ASAM released an updated cannabis policy statement on Oct. 10.

Please Complete the 2020 NABH Annual Survey!

The 2020 NABH Annual Survey will close on Saturday, Oct. 31.

NABH members should have received personalized links to the survey from consulting firm Dobson DaVanzo. If you have not received a link, please click here and follow the instructions to submit your survey today. Your feedback will help inform and improve NABH’s advocacy efforts.

Thank you for your time!

Fact of the Week

The rate of domestic violence that women with serious mental illness experience throughout their adulthood was more than double than that of the general population: 69% versus 33%. Men with serious mental illness showed a similar trend when compared with the general population: 49% versus 17%, respectively.

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

CMS Gives Medicare Part A & B Providers One More Year to Repay AAP Loans

The Centers for Medicare & Medicaid Services (CMS) said Thursday it will give Medicare Part A and B providers and suppliers an additional year to repay loans the agency made to them during the Covid-19 public health emergency (PHE).

CMS had advanced payments to Medicare Part A and B providers and suppliers through the Accelerated and Advance Payment (AAP) program to help cover costs as the PHE disrupted healthcare services this year. Initially CMS had required providers to start making repayments in August 2020.

“CMS’ advanced payments were loans given to providers and suppliers to avoid having to close their doors and potentially causing a disruption in service for seniors,” CMS Administrator Seema Verma said in an announcement. “While we are seeing patients return to hospitals and doctors providing care we are not yet back to normal,” she added.

According to the agency’s new terms, after that first year, CMS will automatically recoup 25% of Medicare payments otherwise owed to the provider or supplier for 11 months. After that period, CMS will increase the recoupment amount to 50% for another six months.

CMS said it will send letters to providers who have any outstanding balances after the entire period—a total of 29 months— informing them that repayment will be subject to a 4% interest rate. Those letters will also include guidance on how to request an Extended Repayment Schedule (ERS) due to financial hardship. The agency’s announcement urged providers and suppliers to contact their Medicare Administrative Contractor for information about how to request an ERS.

An ERS will allow a provider or supplier to repay these debts over the course of three to five years. CMS also said providers and suppliers may use Provider Relief Funds to repay these Medicare loans.

CMS said it will communicate with each provider and supplier about the amount they owe and all applicable terms in the coming weeks.

New CMS Guidance Requires Psychiatric Hospitals to Report Covid-19 Data Weekly

CMS has released guidance that requires Medicare- and Medicaid-participating psychiatric hospitals to report Covid-19 data to the agency on a weekly basis.

CMS published an interim final rule in early September that said hospitals would be required to submit Covid-19 data during the public health emergency in a frequent, standardized way that the U.S. Health and Human Services Department (HHS) secretary specified.

This week’s awaited guidance makes it clear that the nation’s psychiatric hospitals—along with rehabilitation hospitals—need to report their data weekly, and not on a daily basis as other hospital types are required to do. NABH advocated for CMS to lessen the reporting frequency for psychiatric hospitals and is pleased with the change.

The agency listed the required data in new guidance and also developed an infographic that highlights when the agency plans to alert hospitals about gaps in reporting and compliance. These materials are also available on NABH’s Covid-19 resources webpage.

HRSA Releases Provider Relief Fund Phase 3 Distribution Guide and Fact Sheet

HHS’ Health Resources and Services Administration (HRSA) has released a 12-page provider guide and separate fact sheet to help the nation’s healthcare providers navigate the third phase of the Provider Relief Fund (PRF) distribution during the Covid-19 pandemic.

The guide includes specific details on eligibility requirements, application requirements, and reporting guidelines, while the fact sheet condenses the guide’s information and also provides links.

HHS announced an additional $20 billion in additional funding last week and encouraged behavioral healthcare providers to apply. The department also developed a list of providers eligible for the funding, including addiction counseling centers, mental health counselors and psychiatrists.

The Phase 3 Distribution application process opened this past Monday, Oct. 5, and the application deadline is Friday, Nov. 6.

HRSA has scheduled an informational webinar to learn more about the Phase 3 Distribution process next Thursday, Oct. 15 at 3 p.m. ET. Click here to register.

HHS has scheduled a webinar about the Phase 3 Distribution process specifically for behavioral healthcare providers and the associations that represent them for Friday, Oct. 16 at 3 p.m. ET. Click here to register.

NABH Submits Comments to CMS on 2021 Physician Fee Schedule Proposed Rule

NABH on Oct. 2 provided feedback to CMS on the telehealth services and substance use disorder (SUD) provisions in the agency’s 2021 physician fee schedule (PFS) proposed rule.

In a letter to CMS Administrator Seema Verma, NABH said it supports the proposed rule’s provisions that would continue some of the expanded Medicare coverage of services provided via telehealth, including provisions to extend permanently Medicare coverage for group psychotherapy and psychological testing.

The association also said it supports those provisions clarifying that clinical social workers and clinical psychologists and therapists can furnish online assessment and management services, virtual check-ins, and remote evaluations.

“We urge you to continue covering evaluation and management services and behavioral health counseling as well as opioid/addiction treatment program counseling and periodic assessment services provided via audio-only technology, i.e., telephone,” the letter said. “Furthermore, we recommend continuing to pay for these services at the same or comparable rates as in-person care—as well as paying for administrative fees to help cover the costs of this technology.”

NABH also provided comments on the Opioid Treatment Program (OTP) bundled payment regulations, emphasizing more equitable reimbursement for naloxone and community education for naloxone, as well as reduced limitations on the frequency of reimbursement to align with medical necessity determinations.

In addition, NABH’s letter said the association supports continued coverage of periodic telehealth assessments beyond the PHE (including audio-only), and to be reimbursed every 60-90 days, consistent with many state requirements to perform such assessments.

The association encouraged CMS to continue the simple, one-bundle structure that has been used successfully to date and reiterated NABH’s recommendation from last year that CMS provide a 17% adjustment to encourage the development of rural OTPs. And NABH underscored the importance of continuing to permit greater flexibility in take-home medications, as well identifying the need to permit reimbursement for OTPs who are under a Substance Abuse and Mental Health Services-provisional certification.

Finally, NABH supported the agency’s proposal to expand the PFS bundled payments for Opioid Use Disorder to all SUDs.

U.S. Labor Department to Provide $40 Million in Rural Healthcare Workforce Training Grants 

The U.S. Labor Department’s Employment and Training Administration has announced about $40 million in available grant funding for employment and training programs in healthcare occupations—including behavioral and mental healthcare—that serve rural populations.

According to the announcement, employment and training programs through this funding can propose a wide range of models, including Registered Apprenticeship Programs and Industry-Recognized Apprenticeship Programs. Pre-apprenticeships are permitted only “as on-ramps” to apprenticeship programs proposed as a response to the funding notice and must lead to apprenticeships during the life of the grant.

The deadline to apply is Friday, Nov. 13. Click here for additional information and how to apply.

U.S. Justice Department to Develop Guidelines to Manage Substance Withdrawal in Jail-based Settings

The U.S. Justice Department’s Bureau of Justice Assistance (BJA) and the National Institute of Corrections is seeking feedback to develop evidence-based, clinical guidelines and protocols that will help jail administrators, correctional officers, and jail-based clinicians identify and safely manage substance withdrawal in jail-based settings.

According to an announcement, the guidelines will address a host of issues, including, but not limited to, rapid withdrawal from opioids, benzodiazepines, alcohol, methamphetamine, and cocaine individually or in combination, including specification of persons who exhibit withdrawal symptoms or report histories or information from other sources that indicate the necessity of immediate referral to medical facilities outside of the jail; screening for risk of suicide, specifically opioid withdrawal-potentiated suicides; and medication maintenance for entering detainees with prescriptions for opioid or antipsychotic medications.

The BJA will select one applicant for a 10-month award to create a document that outlines the guidelines and protocols. Applications are due by Wednesday, Oct. 28. Click here for more information.

Joint Commission to Host Virtual Behavioral Health Care and Human Services Conference

The Joint Commission will host its Behavioral Health Care and Human Services conference in a virtual format on Friday, Oct. 28.

This year, attendees will have the option to choose from two tracks: Track A, designed for organizations accredited under the Behavioral Health Care Accreditation Manual, and Track B, intended for those accredited under the Hospital Accreditation Manual and supplemented with the Behavioral Health Care Manual.

Click here for more information and to register.

Today is the Deadline to Submit Recommendations for the 2021 NABH Board of Trustees

The deadline is today, Friday, Oct. 9, to submit nominees for NABH’s Board Chair-Elect and three NABH Board of Trustees seats that will become available in 2021.

NABH’s Selection Committee is particularly interested in identifying senior managers who represent broad diversity within the NABH membership, including various levels of care, organizational structures, and size.

If you have not done so yet, please download a nomination form to share your recommendations of individuals you would like to see included in the single-slate ballot for 2021. Please be sure to attached a curriculum vitae (CV) for each individual you recommend, which will help the Selection Committee in its deliberations. You are welcome to recommend yourself.

Please send your completed form and all candidate CVs to NABH Director of Operations Maria Merlie. Thank you for your time!

Please Complete the 2020 NABH Annual Survey! 

The 2020 NABH Annual Survey opened in late August and NABH members should have received personalized links to the survey from consulting firm Dobson DaVanzo.

If you have not received a link, please click here and follow the instructions to submit your survey today. Your feedback will help inform and improve NABH’s advocacy efforts.

The survey closes on Saturday, Oct. 31. Thank you for your time!

Fact of the Week

In the first half of 2019, just more than one in 10 adults (11%) reported symptoms consistent with a diagnosable anxiety or depressive disorder. By July 2020, during the Covid-19 pandemic, that number had increased to 40%.

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