September is National Recovery Month & National Suicide Prevention Month

This past week began National Recovery Month and National Suicide Prevention Month, which are intended to educate Americans about services, treatment, and resources available to those with mental health and substance use disorders and to promote suicide prevention.

Elinore McCance-Katz, M.D., Ph.D, assistant secretary for mental health and substance use at the Substance Abuse and Mental Health Services Administration (SAMHSA), helped kick off the month-long observances in a video message celebrating those in recovery and the recovery community’s work in the fight against addiction in the United States.

SAMHSA will host a webinar series throughout Recovery Month that will feature a different topic every Thursday. Upcoming topics include supported employment, communities supporting recovery, and the importance of integrating recovery support services.

Meanwhile, the National Action Alliance (Action Alliance) for Suicide Prevention has developed several resources to help build awareness about suicide prevention. Please see the Action Alliance’s #BeThere activities and use the hashtag #BeThere to educate your organization’s social media followers.

In addition, the group will host National AI/AN Hope for Life Day on Sept. 10. That event falls during Suicide Prevention Week from Sept. 6-12. Please see the Hope for Life Day toolkit and visit the Action Alliance’s #BeThere webpage for more information.
 
And please remember to follow NABH on Twitter and LinkedIn to learn what NABH members, federal agencies, and other organizations are doing to honor National Recovery Month and National Suicide Prevention Month.

AHRQ Seeks Comment on Strategies for Opioid Use and Misuse in Older Adults in Primary Care

The Agency for Healthcare Research and Quality (AHRQ) is working on a project to assess and describe the current prevalence, awareness, and management of opioid use, misuse, and abuse in older adults and identify gaps and areas of needed research.

The new project will support primary care practices in both developing and testing innovative strategies, approaches, and/or tools for opioid management within learning collaboratives and will culminate in a “Compendium of Strategies” for opioid management in older adults in primary care settings.

AHRQ mapped out its data collection method in the agency’s project description and is seeking public comments about that process. The notice was posted on Aug. 26, and AHRQ will accept comments for 30 days after that publication date.

Anthem-Affiliated Health Plans More than Doubled the Number of Consumers Receiving Whole-Person Treatment for OUD

After committing four years ago that it would ensure more consumers would receive both drug therapy and counseling treatment, health insurer Anthem announced this week that it increased the combined percentage of consumers in employer-based, individual, and Medicaid plans with opioid use disorder (OUD) to 36% from 18% in 26 plans nationwide.

The Indianapolis-based insurer released the announcement at the start of National Recovery Month and added that Medicaid plans alone increased to 55% from 24%.

Greg Williams, a national recovery advocate who helped launch the Surgeon General’s report Facing Addiction in America and who co-founded The Alliance for Addiction Payment reform, applauded Anthem for its efforts and said it’s more important than ever for health insurers to take on this leadership role.

“Medication for certain substance use disorders has the potential to save lives, but medication alone is not a panacea for long-term outcomes,” Williams said in a news release from Anthem. “The best way to promote sustained recovery is to combine the use of medication in treatment with evidence-based behavioral therapies and recovery support services.”

Click here to read Anthem’s Sept. 2 announcement.

JAMA Article Examines OUD Therapies in Residential Treatment Programs

A new article in JAMA explores the findings of research that investigated the OUD treatment that the nation’s residential treatment programs offer.

Published Aug. 25, the research letter notes that residential treatment programs are “a common, costly setting for treating opioid use disorder and are frequently promoted in policy proposals to improve access to care.” But concerns have arisen about the quality of care and a low use of evidence-based opioid agonist treatment in these settings.

Because data on these programs are based primarily on self-reported surveys, the researchers simulated patients calls to audit the treatments that these programs offer. Click here to read the research letter.

Georgetown Offers New Master’s Program in Addiction Policy and Practice

Georgetown University is offering a new master’s program in addiction policy and practice that is intended to build a national policy workforce that will respond to the chronic health condition of addiction.

The program will draw from the faculty and resources of the university’s schools, including the Graduate School of Arts and Science, the O’Neill Institute for National and Global Health Law at Georgetown University Law Center, Georgetown University Medical Center, the McCourt School of Public Policy, and the basic and social science departments of Georgetown College.

Applications for the one-year program will open this fall and the first class is scheduled to begin in July 2021. Click here to learn more.

Fact of the Week

A prevalence of depression symptoms in the United States was more than three-fold higher during Covid-19 compared with before the pandemic.

2020 NABH Annual Survey Opens Today!

Data collection for the 2020 NABH Annual Survey starts today, Friday, Aug. 28. Your participation in this survey will help NABH continue to provide an accurate, up-to-the-minute picture of the U.S. behavioral healthcare industry. This year NABH has added a few new questions related to substance use to help us better measure our membership’s activities.

NABH’s contractor, Dobson DaVanzo & Associates, will conduct the NABH Annual Survey again this year. Dobson DaVanzo & Associates brings extensive data-analysis experience and data-security expertise to this project. The firm has analyzed data for the last several NABH Annual Surveys.

Dobson DaVanzo will send personalized links to the survey instrument via e-mail directly to the CEOs of all NABH-member organizations. If you receive a request to participate in the survey, please respond as soon as possible.

The 2020 online entry form will provide a personalized, secure e-mail link for each facility. You will be able to enter, save, and review data— and review that data internally with others in your organization who have completed the survey—until you click “Done” on the survey’s last page. After you click “done,” you may not make changes.

The survey data are used in dozens of ways to help protect mental health and addiction treatment benefits; ensure fair and adequate payments; improve patient care; and communicate trends to the media, payers, benefit consultants, and the public.

Within your organization, you can also use the NABH aggregate data you will receive to measure how your facility compares with national trends. Because the survey collects the most current information about the field, it can provide a valuable perspective for administrative and clinical operations. The NABH Annual Survey Report is an invaluable strategic planning tool as well as a reference document every behavioral healthcare organization should have.

If you have any questions or suggestions about this survey, please contact Shawn Coughlin or
Kirsten Beronio.

Thank you for your time. We appreciate your help in making us stronger advocates for you and your teams!

HHS Extends Provider Relief Fund Phase 2 General Distribution Deadline to Sept. 13

The Department of Health and Human Services (HHS) has extended the deadline to apply for Phase 2 General Distribution Funding for Medicaid, Medicaid managed care, Children’s Health Insurance Program, dental providers, and certain Medicare providers until Sunday, Sept. 13.

This funding is through the Provider Relief Fund, which the federal government established in this year’s Coronavirus Aid, Relief, and Economic Security Act (CARES) and Paycheck Protection Program and Health Care Enhancement Act. These payments do not need to be repaid to the government if providers comply with terms and conditions.

HHS has extended this Phase 2 General Distribution Funding deadline before, with the latest deadline scheduled for Friday, Aug. 28. Providers now have a few extra weeks to apply.

Click here to read HHS’ six steps to applying for the Phase 2 General Distribution.

CMS Makes Covid-19 Data Collection a Requirement in Conditions of Participation

The Centers for Medicare & Medicaid Services (CMS) is requiring Covid-19 data collection and reporting as a condition of participation (CoP) for hospitals participating in the Medicare and Medicaid programs, including psychiatric facilities.

CMS added the requirement with other provisions in an interim final rule and said it will accept comments for 60 days. The rule noted the requirement will become effective when it is published in the Federal Register, although it did not list a specific date.

Under the new requirement, hospitals will need to report daily data, including—but not limited to—the number of confirmed or suspected Covid-19 positive patients, intensive care unit beds occupied, and the availability of supplies and equipment, such as ventilators and personal protective equipment.

CMS warned in the rule that if a hospital fails to comply with this new CoP, it could face possible termination from the federal healthcare programs.

NABH Supports ‘Eliminating the Provider Relief Fund Tax Penalties Act’

NABH is one of 29 healthcare advocacy organizations this week to support the Eliminating the Provider Relief Fund Tax Penalties Act, a bill that would offer some financial relief to healthcare providers during the Covid-19 pandemic.

Congress’ allocation of $175 billion in financial support to healthcare professionals through this year’s Public Health and Social Services Emergency Fund (PHSSEF) has done much to help the healthcare community provide critical services to patients. At the same time, PHSSEF assistance is taxable, which results in a reduction of 21% or more to the benefit for taxpaying healthcare professionals, compared with non-taxpaying healthcare professionals.

“This negative impact penalizes those who care for our nation’s most vulnerable,” the organizations wrote in a letter to House and Senate lawmakers. “The passage of H.R. 7819/S. 4525 would remove the negative tax implications for PHSSEF recipients by ensuring that all Provider Relief Fund assistance is not taxable, while maintaining that expenses tied to this assistance are tax-deductible.”

Urban Institute Study Examines Naloxone Products and Pricing in Medicaid, 2010-2018 

Medicaid enrollees’ naloxone options will remain limited—and could potentially worsen the nation’s overdose crisis—without new federal policies that regulate prices and/or promote robust price competition, according to new research from the Urban Institute.

For the study, researchers tracked changes in Medicaid spending from 2010-2018 on naloxone, its price per unit, and Medicaid-covered naloxone prescriptions for generic naloxone products, the brand-name Narcan nasal spray, and the Evzio autoinjector.

“We find dramatic increases in Medicaid prescriptions for and spending on naloxone between 2010 and 2018,” Senior Research Associate Lisa Clemans-Cope and her team concluded in the study. “This may partially owe to the new naloxone formulations that offer advantages in administration,” the study’s authors wrote, adding that needle-free naloxone nasal spray is highly effective and easy to use, while the quick-acting autoinjector naloxone works for people with nasal abnormalities, which make up a substantial share of those with opioid use disorder.

“Ideally, prescribers could write naloxone prescriptions suited to each Medicaid patient’s circumstances,” the researchers wrote. “However, we find that the autoinjector formulation was not offered in any state Medicaid program in 2018, likely because of their very high and variable prices per prescription in years prior and lack generic equivalents.”

SAMHSA Accepting Applications for Disaster Response State Grant Program

The Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting applications for its Disaster Response State Grant Program, which is meant to provide mental and substance use disorder treatment, crisis counseling, and other related supports for adults and or school-aged children affected by hurricanes, typhoons, wildfires, and earthquakes during 2018.

The agency said it plans to issue about 17 grants of up to $7 million per year for one year and will accept applications through Wednesday, Sept. 2. Click here to learn more.

SAMHSA Helpline Offers 24/7 Crisis Counseling Services

As Americans withstand the effects of Hurricane Laura and California’s wildfires, NABH reminds all members that SAMHSA’s Disaster Distress Helpline provides crisis counseling services 24 hours a day, seven days a week, 365 days a year.

NABH thanks its members for providing essential behavioral healthcare services in the nation’s disaster areas during an already difficult time.

Looking Ahead: September is Suicide Prevention Month

The National Action Alliance (Action Alliance) for Suicide Prevention has developed several resources to help build awareness about suicide prevention during Suicide Prevention Month in September.

To help in the effort, please see the Action Alliance’s #BeThere activities and use the hashtag #BeThere to educate your organization’s social media followers. In addition, the group has scheduled a #BeThere Twitter chat on Tuesday, Sept. 1 at 2 p.m. ET and will host National AI/AN Hope for Life Day on Sept. 10. That event falls during Suicide Prevention Week, which is Sept. 6-12.

Click here for the Hope for Life Day toolkit and visit the Action Alliance’s #BeThere webpage for more information.

Fact of the Week

In April, 64% of the U.S. population reported feeling “nervous on several or more days.” That increased by five percentage points to 69% by July, according to a Census Bureau survey.

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

HHS Sets New OUD Target in ‘Healthy People 2030’ Public Health Plan

The Health and Human Services Department (HHS) this week released Healthy People 2030, the federal government’s 10-year plan to address the nation’s most critical public health priorities and problems.

In it, HHS features 355 core, or “measurable,” objectives with 10-year targets, including one to reduce the proportion of persons with opioid use disorder (OUD) in the past year. Specifically, the plan notes a baseline of 0.7% of persons aged 12 years and older who reported an OUD (heroin or prescription pain reliever) in the 12 months of 2018. Healthy People 2030 sets a new target of 0.5%.

A federal advisory committee of 13 external leaders and a workgroup of subject matter experts from more than 20 federal agencies contributed to Health People 2030, which also incorporated public comments during the development process.

EEOC Releases Guidance for Healthcare Providers to Help Opioid Patients Stay Employed

The U.S. Equal Employment Opportunity Commission (EEOC) has released a fact sheet to help explain the healthcare provider’s role under the American with Disabilities Act of 1990 when a patient who uses opioids needs a reasonable accommodation or when questions surface about a patient’s ability to perform a job safely.

As the EEOC noted in its announcement, this information is not new; instead, it applies to principles established in the 30-year-old law and previously issued guidance. The new publication is meant to provide clarity under all existing requirements.

In the publication, the EEOC recommends medical documentation be written using plain language that explains the provider’s professional qualifications and details regarding the nature and length of the relationship with the employee; the nature of the employee’s medical condition; the extent to which the employee’s opioid use would limit a “major life activity” (such as walking, lifting, sleeping, or concentrating) without treatment; the need for reasonable accommodation; and suggested accommodations “without overstating the need for any one particular accommodation in case an alternative is necessary.”

Click here to learn more.

NABH Participates in CMS Stakeholder Listening Session

NABH members and staff participated in a call about OUD during the public health emergency with leaders of the Centers for Medicare & Medicaid Services (CMS) this week.

Kimberly Brandt, principal deputy administrator for policy and operations at CMS, hosted the call and NABH President and CEO Shawn Coughlin represented the association. Joe Pritchard, CEO of Pinnacle Treatment Centers, and Greg Marotta, CEO of CleanSlate, also participated. During the call, CMS reviewed previous Trump administration activities and asked stakeholders to comment on outstanding issues related to expanding access to treatment for individuals with opioid use disorders.

The topics discussed included streamlining provider credentialing, collaborating with the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration (DEA) on telemedicine rules, making all Covid telehealth flexibilities permanent; permitting methadone induction through telehealth, supporting state licensure reciprocity, covering services for incarcerated individuals prior to reentering the community, covering contingency management as an evidence-based practice for individuals with stimulant disorders, and targeting specific funds to behavioral healthcare providers.

For more information, please contact Sarah Wattenberg, NABH’s director of quality and addiction treatment services.

Atrium Health’s Behavioral Health to Host Webinar on Virtual Care Model Next Week

NABH member Atrium Health’s Behavioral Health will host the first webinar in its series “Delivering Behavioral Health Services in a Pandemic Environment” next Wednesday, Aug. 26 at 1 p.m. ET.

The webinar, Transitioning Outpatient Services to a Virtual Care Model, is open to all. Click here to join the meeting.

Looking Ahead: September is Suicide Prevention Month

The National Action Alliance (Action Alliance) for Suicide Prevention has developed several resources to help build awareness about suicide prevention during Suicide Prevention Month in September.

To help in the effort, please see the Action Alliance’s #BeThere activities and use the hashtag #BeThere to educate your organization’s social media followers. In addition, the group has scheduled a #BeThere Twitter chat on Tuesday, Sept. 1 at 2 p.m. ET and will host National AI/AN Hope for Life Day on Sept. 10. That event falls during Suicide Prevention Week, which is Sept. 6-12.

Click here for the Hope for Life Day toolkit and visit the Action Alliance’s #BeThere webpage for more information. #BeThere activities and created a Hope for Life Day toolkit.  

Fact of the Week

Among U.S. adults aged 18 and older, 5.1% engaged in heavy drinking, or the consumption of an average of more than 14 alcoholic drinks per week for men or more than 7 drinks per week for women.

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

HHS Releases Provider Relief Fund Step-by-Step Guide and Stakeholder Toolkit

The U.S. Health and Human Services Department (HHS) this week hosted a webinar to clarify issues related to the Coronavirus Aid, Relief, and Economic Security Act’s (CARES) Provider Relief Fund and released materials for providers navigating the system to receive federal funding during the Covid-19 pandemic.

On Thursday, HHS’ Health Resources and Services Administration (HRSA) hosted the webinar about the Provider Relief Fund’s Phase 2 General Distribution, in which providers may receive up to 2% of their reported revenue from patient care.

The agency later released the presentation slides, as well as a step-by-step guide about the fund and a stakeholder toolkit. These and other pandemic-related materials are posted to NABH’s Covid-19 resources page.

Milliman Study Shows Individuals with Behavioral and Physical Health Conditions Drive High Total Healthcare Costs

Individuals with behavioral health conditions in addition to physical health conditions drive high total healthcare costs even though spending for behavioral healthcare treatment among these patients is a small portion of that total spending.

That is the conclusion of a new study from actuarial and consulting firm Milliman, Inc. this week that analyzed claims data for 21 million commercially insured individuals. The Path Forward for mental health and substance use, a private-sector initiative to spur market-based improvements in behavioral health treatment, commissioned the study. The initiative receives funding from the Mental Health Treatment and Research Institute LLC, a tax-exempt subsidiary of The Bowman Family Foundation.

According to the report, 5.7% of the entire study population—high-cost patients with both behavioral and physical health conditions—accounted for 44% of all healthcare spending. Meanwhile 50% of patients with behavioral health conditions had less than $68 of total annual spending for behavioral treatment.

“This is a tragedy,” Henry Harbin, M.D., a psychiatrist and advisor to The Path Forward, said in news release about the study’s findings. “And now we know this population accounts for more than half of our total healthcare spending,” he continued. “Tremendous savings and improved outcomes are achievable if these individuals who deserve care are identified early and provided with prompt evidence-based behavioral treatment.”

The report is intended to provide a baseline for estimating the effects of Covid-19 on behavioral healthcare.

CDC Report Shows 93,000 Americans Died from Excessive Alcohol Use from 2011-2015

An average of 255 Americans die from excessive drinking every day, shortening their lives by an average of 29 years, according to the Centers for Disease Control and Prevention (CDC).

A recent Mortality and Morbidity Weekly Report, or MMWR, from the federal public health agency showed excessive alcohol use was responsible for about 93,000 deaths and 2.7 million “YPLL,” or years of potential lives lost, during 2011-2015. The majority of these alcohol-attributable deaths involved males, and about four in five deaths among adults aged 65 or older was nearly double that among adults aged 20-34 years, the findings showed.

The report noted some recommendations from the Community Preventive Services Task Force that could reduce both alcohol-attributable deaths and YPLL, such as increasing alcohol taxes and regulating the number and concentration of alcohol outlets.

GAO Examines Medicaid Coverage for SUD Peer Support Services and Eating Disorders in the Military

A recent study from the Government Accountability Office (GAO) found that 37 states covered peer support services for adults with substance use disorders (SUDs) in their Medicaid programs in 2018.

GAO researchers analyzed Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission data for the report. The findings noted that officials from the three states GAO reviewed—Colorado, Missouri, and Oregon—reported that their Medicaid programs offered peer support services as a complement, rather than an alternative, to clinical treatment for SUD.

Separately, GAO also released a report on eating disorders in the U.S. military, which reviewed how the U.S. Defense Department (DOD) screens and provides treatment for eating disorders. That report showed that with DOD health coverage, service members and their dependents can receive specialized care for eating disorders through civilian providers working in 166 eating disorder facilities across 32 states. Of those facilities, more than three-quarters provide treatment to both adult and child and adolescent populations.

Manatt Health Releases Tracking Tool for Telehealth Coverage After Public Health Emergency

Manatt Health this week released a federal and 50-state tracking tool that highlights policy, regulatory, and legal changes related to telehealth during the Covid-19 pandemic.

The research firm released this resource a week after the Centers for Medicare & Medicaid Services (CMS) announced in its physician fee schedule proposed rule that certain Medicare telehealth flexibilities during the pandemic would be made permanent, while others would be temporary. Manatt’s tracking tool includes a complete list of services that the proposed rule addresses.

RTI International Tracks Addiction Treatment Quality Across Time and States

A recent RTI International study found improvements in quality on most measures for addiction treatment between 2007 and 2017 but concluded that “performance on several measures remained low.”

The North Carolina-based research and technical services firm said the study’s objective was to track trends in the signs of higher-quality addiction treatment based on definitions from the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Addiction, and the Substance Abuse and Mental Health Services Administration.

According to the report, a greater percentage of U.S. addiction treatment facilities had attributes indicating higher quality in 2017 than in 2007, with most of the improvement occurring between 2011 and 2017.

“Nonetheless, in 2017 fewer than 50 percent of facilities offered medications for opioid use disorder; testing for hepatitis C, HIV, and STDs; self-help groups; employment assistance; and transportation assistance,” the study said.

JAMA Article Explores Outpatient Mental Health Services for Youth After Psychiatric Hospitalization

A new JAMA study found that mental health follow-up received within seven days of discharge was associated with a reduced risk of suicide among children and adolescents during the eight to 189 days after hospital discharge.

Researchers examined a cohort study of 139,694 child and adolescent inpatients in the Medicaid program and concluded that “shorter hospital stay, lack of prior mental healthcare, managed care, Black race, older age, and medical comorbidities were associated with delayed follow-up care.”

National Association of Mental Health Program Directors to Host Webinar Next Week

The National Association of Mental Health Program Directors will hold a two-part webinar series titled “Establishing and Building Bed Registry Systems” next week.

Part One will focus on understanding the essential elements of an effective statewide registry, while Part Two will highlight three different models for success in establishing and building statewide crisis service and bed registries.

Click here to register for Part One on Wednesday, Aug. 19 from 1:30 p.m. to 3 p.m. ET, and here  to register for Part Two on Thursday, Aug. 20, also from 1:30 p.m. to 3 p.m. ET.

Fact of the Week

 About 25% of young adults between the ages of 18 and 24 reported they have seriously considered suicide during the Covid-19 pandemic.

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