FCC Designates 988 as Three-Digit Number for National Suicide Prevention Hotline

The Federal Communications Commission (FCC) this week adopted rules to establish 988 as the new, nationwide, three-digit phone number for Americans in crisis to connect with suicide prevention and mental health crisis counselors.

All phone service providers are required to direct all 988 calls to the existing National Suicide Prevention Lifeline by July 16, 2022. During the transition period, Americans who need help should continue to contact the National Suicide Prevention Lifeline by calling 1-800-273-8255 (1-800-273-TALK) or through online chats.

Veterans and U.S. service members may reach the Veterans Crisis Line by pressing 1 after dialing, chatting online at www.veteranscrisisline.net, or texting 838255.

U.S. Drug Overdose Deaths Hit Record High of 71,000 in 2019

Nearly 71,000 Americans died of drug overdoses in 2019, according to preliminary data from the Centers for Disease Control and Prevention this week.

The record high number of overdose deaths predates the Covid-19 pandemic, which experts predict will increase the number of overdose deaths even higher.

Reports show that fentanyl and similar synthetic opioids—which accounted for about 36,500 overdose deaths—are driving the trend, while deaths involving cocaine and methamphetamine are also rising.

HHS Announces Changes to Covid-19 Daily Data Reporting Process Effective July 15 

HHS announced that as of Wednesday, July 15, the CDC’s National Healthcare Safety Network (NHSN) Covid-19 module is no longer an option for hospitals to fulfill the agency’s request for daily data reporting on bed capacity, utilization, personal protective equipment (PPE), and in-house laboratory testing data.

Instead, HHS has asked hospitals to use one of these four options to report that information:

• If your state has assumed reporting responsibility, submit all data to your state each day and your state will submit on your behalf. Your state can provide you with a certification if they are authorized to submit on your behalf.
• Submit data to TeleTracking™. All instructions about the data submission are on that site and the new and updated fields will be ready as of July 15.
• Authorize your health information technology (IT) vendor or other third party to share information directly with HHS.
• Publish to the hospital or facility’s website in a standardized format, such as schema.org.

For additional details about these options, please see page 9 in HHS’s updated guidance. This information is also posted to NABH’s Covid-19 resources page.

SAMHSA Updates Confidentiality of Patient Records in Final Rule

The Substance Abuse and Mental Health Services Administration (SAMHSA) this week issued a final rule to update the Confidentiality of Substance Use Disorder Patient Records known as 42 CFR part 2 (or “part 2”) regulations, further aligning the regulations with other healthcare delivery rules.

Key changes include:

• Part 2 programs may share information verbally with a non-part 2 provider without subjecting the non-part 2 record to the requirements of part 2, as long as the non-part 2 provider segregates specific substance use disorder (SUD) records.
• Patients may consent to disclosures without naming a specific individual to receive this information; the update provides instructions for disclosures to exchanges and research institutions and provides guidance on disclosures related to care coordination and case management.
• Non-part 2 providers are not required to redact information in their medical records and may redisclose information if the patient has signed a written consent, or if the disclosure is otherwise permitted under the regulations.
• Written consents expressly allow sharing information with 18 types of payment and healthcare operations, including for care coordination and case management.
• Non-opioid treatment providers have access to central registries if they have a treatment relationship to the patient.
• Opioid treatment programs have new permissions to disclose information to prescription drug monitoring programs.
• During medical emergencies, information may be shared among part 2 programs or other SUD treatment providers during state or federally declared natural and major disasters.
• Disclosures for conducting scientific research may be made to non-Health Insurance Portability and Accountability (HIPAA) covered entities and those who are not subject to the Common Rule.
• Permits federal, state, and local agencies to conduct audits and evaluations.
• Extends to 12 months the period of placement of undercover agents or informants, which may be further authorized by a new court order.

These changes do not include provisions that recently became law in the Coronavirus Aid, Relief and Economic Security Act (CARES Act). CARES Act provisions are effective March 27, 2021. The rule was published in the Federal Register on July 15.

For questions about this rule, please contact Sarah Wattenberg, NABH’s director of quality and addiction services, at sarah@nabh.org.

NABH Sends Telehealth Letter to Capitol Hill as Congress Considers Latest Covid-19 Relief Bill

NABH this week sent a letter to congressional health policy staff that highlights the ways telehealth is essential in providing access to critical behavioral health services.

“Shortly after the pandemic arose, our members rapidly adjusted their programs and services to implement telehealth technologies so they could continue providing critically needed mental health and addiction treatment services during these incredibly stressful times,” NABH President and CEO Shawn Coughlin said in the letter, which included preliminary data from some NABH members that show how crucial the increased coverage of services through telehealth has been during the Covid-19 pandemic.

Separately this week, Manatt released a comprehensive 50-state tracker for policy, regulatory, and legal changes related to telehealth during the Covid-19 pandemic.   

JAMA Examines Behavioral Health Parity Efforts Nationwide

Citing SAMHSA data, a new article in JAMA showed that less than two-thirds of patients with schizophrenia, bipolar disorder, or other more serious mental health conditions received care for their illness in 2018, while the same study showed only in five people with an opioid use disorder obtained treatment.

The findings attributed the reasons for these statistics to stigma, barriers to care due to cost and clinical resources, and the overall scarcity of clinicians treating patients with mental health and substance use orders.

“These factors compound the difficulty of finding a clinician willing to accept patients associated with only “in-network” payments for their services,” the article noted. “A 2014 study using data from the National Ambulatory Medical Care Survey found that in 2009-2010, nearly half of psychiatrists surveyed did not accept network commercial insurance payment or Medicare, and more than half did not accept Medicaid,” it continued, adding that psychiatrists have one of the lowest Medicaid participation rates among medical specialists.

Fact of the Week

According to ProPublica Illinois, more than 1,180 Cook County residents have died or are suspected to have died from opioid-related overdoses this year. Half of the confirmed opioid-related deaths have been among Black people, even though Black residents make up less than a quarter of the county’s population.

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

HHS Plans to Extend Covid-19 Public Health Emergency

HHS has signaled it will extend the Covid-19 public health emergency before it expires on July 25.

The news was reported via Twitter on June 29 from HHS spokesman Michael Caputo, who noted that the department has renewed the public health emergency once before.

After it is extended, the public health emergency will remain effective for an additional 90 days. This extension will help providers continue to use waivers and flexibilities that have been issued to help them address the global pandemic.

Kaiser Family Foundation Releases Analysis on Mental Health and SUD

A new analysis from the Kaiser Family Foundation (KFF) on Friday found that 36.5% of adults in the United States report symptoms of anxiety or depressive disorder, up from 11% in 2019.

Meanwhile, Louisiana (42.9%), Florida (41.5%), and Oregon (41.3%) have the highest shares reporting these symptoms, while Wisconsin (27.2%), Minnesota (30.5%), and Nebraska (30.6%) have the lowest, the analysis showed.

KFF reported the statistics in a series of state facts sheets, which also showed New Mexico, Montana, Wyoming, Alaska, and Idaho are the states with the highest rates of suicide.

Commonwealth Fund Report Says Covid-19 Highlights Gaps in Medicare Mental Health Coverage

A report from the Commonwealth Fund released this week shows gaps that remain in Medicare beneficiaries’ access to mental health services, including the federal healthcare program’s 190-day lifetime limit for inpatient psychiatric stays and limited coverage for telemental health services.

The article’s purpose was to offer an overview of Medicare beneficiaries’ needs and benefits, as well as the initiatives to improve both financing and mental health services delivery in Medicare.

According to the study, more than 112 million Americans live in areas of the country where healthcare providers are in short supply, and experts predict increasing shortages in psychiatrists, clinical and counseling psychologists, mental health social workers, mental health counselors, and other specialty mental health professionals through 2025.

“Policies to expand coverage of telemental health should be rigorously studied and potentially made permanent as a strategy to increase access to mental health services,” researchers noted in the report.

Separately, JAMA on July 1 published a new analysis that examines the trends in the prevalence of U.S. adults who screened positive for depression and the proportion who received treatment from 2007 to 2016, with consideration of health insurance coverage.

Today is the Deadline to Register for DOL Discussion on Parity Compliance

The U.S. Labor Department (DOL) will host a 90-minute virtual discussion titled “Parity Compliance: Progress and Challenges” next Thursday, July 16 at 1:30 p.m. ET.

As part of DOL’s Fiscal Year 2020 MH/SUD Enforcement Evaluation Program—published in the 2020 DOL MHPAEA Report to Congress— DOL’s Employee Benefits Security Administration (EBSA) announced it would host a listening session to gain feedback on the agency’s interpretive guidance and enforcement program. EBSA also noted that attendees could use the opportunity to comment on the MHPAEA self-compliance tool that EBSA proposed on June 19.

The last day to register for the event is today, July 10.

NAMI To Host First Virtual NAMICon Next Week

The National Alliance on Mental Illness (NAMI) has transitioned its in-person NAMICon to a virtual event on July 13 and 14.

The event’s plenary session will feature National Institute of Mental Health Director Joshua Gordon, M.D., Ph.D., who will discuss the challenges and opportunities of mental health research. The program will also explore the importance of diversity, inclusion, and cultural competence, and how to address issues such as identity, language, and demographics.

Click here to register for the event and here for the program’s two-day schedule.

NNED, SAMHSA to Host Roundtable Next Week on Addressing Covid-19 and Behavioral Health Needs in Communities of Color

The National Network to Eliminate Disparities in Behavioral Health (NNED) and the Substance Abuse and Mental Health Services Administration (SAMHSA) will host a host a virtual roundtable next week to address how the Covid-19 pandemic, the current economic crisis, and civil unrest from incidents of police brutality have worsened disparities in mental health.

The event—part of National Minority Mental Health Awareness Month this July—will highlight how faith-based NNED partner organizations are supporting mental health concerns of racial and ethnic minorities and providing opportunities to receive support and connection through faith-based practices and partnerships. Click here to register for the event on Thursday, July 16 at 3 p.m. ET.

And please remember to follow NABH on Twitter and LinkedIn for information and events related to National Mental Health Awareness Month.

BPC to Host Webinar on Covid-19’s Effect on Mental Health Access for People of Color

The Bipartisan Policy Center (BPC) will host a webinar titled “Covid-19’s Adverse Impact on Mental Health Access for People of Color” on Tuesday, July 21.

The BPC notes that as the Covid-19 pandemic has increased mental health and substance use problems, the situation is even worse for Black, Indigenous, and people of color populations, which have long experienced disparities in access to care. This 90-minute webinar will discuss this trend and how integrating behavioral health services with primary care can benefit these patient populations.

Click here to register for the event, which starts at 11:30 a.m. ET.

Fact of the Week

During the initial phase of the Covid-19 crisis in April 2020, the prevalence of serious psychological distress among adults age 55 and older was nearly double pre-COVID levels; among Hispanic and low-income adults, rates were more than triple.

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

FCC To Vote Next Month on Designating 988 as National Suicide Hotline Number

Federal Communications Commission (FCC) Chairman Ajit Pai this week presented his team with draft rules to establish 988 as the new, nationwide, three-digit phone number for Americans to connect with suicide prevention and mental health crisis counselors.

The Commission is scheduled to adopt the rules at its open meeting on July 16. If adopted, the rules would require all phone service providers to start directing all 988 calls to the existing National Suicide Prevention Lifeline by July 16, 2022. During the transition period, Americans who need help should continue to contact the lifeline by calling 800-273-8255 (TALK).

“988 will save lives. Helping Americans in crisis connect to counselors trained in suicide prevention is one of the most important things we can do at the FCC,” Chairman Pai said in a statement this week. “We believe that 988—which has an echo of the 911 number we all know as an emergency number—will help people access mental health services,” he continued.

“Establishing this special purpose number will also highlight the urgency of addressing rising suicide rates in America and reduce the stigma too often associated with seeking assistance from suicide prevention and mental health services.”

HHS Announces MENTAL Health Innovation Challenge to Combat Social Isolation and Loneliness

HHS this week said the Administration for Community Living and the Office of the Assistant Secretary for Health launched the MENTAL Health Challenge to fight social isolation and loneliness among older adults, people with disabilities, and veterans.

The White House Office of Science and Technology Policy is coordinating the Mobilizing and Empowering the Nation and Technology to Address Loneliness & social isolation (MENTAL) Health Innovation Challenge, and other federal partners include the FCC and the Veterans Affairs Department.

A total of $750,000 in prizes will be awarded for developing an easy-to-use online system that offers recommendations for programs, activities, and resources that can help users connect to others and engage in the community, based on their needs, interests, and abilities. HHS’ announcement said the winning system will be announced—and demonstrated—in January 2021 at CES, the Consumer Technology Association’s annual trade show. That winning system will then become the centerpiece of a national public awareness campaign.

“We need a multipronged public health approach to change the way we address social isolation, especially among our most at-risk populations,” U.S. Surgeon General VADM Jerome M. Adams, M.D., M.P.H. said in the announcement. “This approach must include the development of innovative solutions to combat the harmful physical and mental health effects of social isolation and the role technology has in promoting better connections for all.”

Nearly a quarter of Americans who are 65 or older have few social relationships or infrequent social contact with others, and more than 40% of people 60 and older report feeling lonely, according to HHS. The department also noted that the number of older adults is projected to nearly double by the year 2060, while the population of people with disabilities is growing and 22 veterans die by suicide every day. 

CMS Creates Office to Coordinate Administrative Burden Reduction Efforts 

The Centers for Medicare & Medicaid Services (CMS) this week announced it created the Office of Burden Reduction and Health Informatics to consolidate the agency’s efforts to reduce regulatory and administrative burden.

This new office is part of CMS’ Patients over Paperwork (PoP) initiative to eliminate duplicative, unnecessary, and costly federal requirements and regulations.

In addition to efforts that reduce administrative burden, the new office will focus on health informatics, which uses and applies health data and clinical information to provide better healthcare to patients.

“Fostering innovation through interoperability will be an important priority, and the office will leverage technology and automation to create new tools that allow patients to own and carry their personal health data with them seamlessly, privately, and securely throughout the health care system,” the agency’s announcement said.

Taskforce on Telehealth Policy Seeks Public Comment Through July 9

The Taskforce on Telehealth Policy is seeking public comments as it develops recommendations for policymakers on how to maximize telehealth services benefits while maintaining high quality and program standards.

The Alliance for Connected Care, National Committee for Quality Assurance, and the American Telemedicine Association convened the taskforce, which represents a broad range of providers, consumer advocates, payers, and health quality experts from the public, private, and not-for-profit sectors.

Click here to learn more about the taskforce and here to access the portal for submitting comments.

GAO Recommends Steps for U.S. Labor Department to Address SUD

The U.S. Labor Department (DOL) should clarify expectations of state workforce agencies and how funding from the 2014 Workforce Innovation and Opportunity Act (WIOA) can be used to address the needs of people with substance use disorders (SUD) and potential employers, the Government Accountability Office (GAO) recommended in a recent report.

DOL has awarded grants to states to address the nation’s opioid crisis after HHS declared the crisis a public health emergency in October 2017. The GAO was asked to investigate how WIOA-funded programs are addressing the employment and training needs of those affected by SUD.

For this report, the GAO interviewed officials in four of the 10 states that received DOL grants as of March 2019—Maryland, New Hampshire, Ohio, and Washington—and two that did not—Alabama and Arizona—as well as DOL officials and researchers.

“DOL officials said they support SUD-affected communities mainly by providing information to states that apply for and receive targeted grants,” the GAO report noted. “However, officials in two selected states expressed uncertainty about DOL’s expectations of states in serving the needs of SUD-affected job seekers and potential employers.”

The GAO noted that DOL agreed with GAO’s recommendations.

House Energy & Commerce Health Subcommittee to Examine Mental Health Bills Next Week

The House Energy and Commerce Health Subcommittee will hold a remote hearing next week to examine several bills intended to improve mental healthcare in the United States.

“As we confront a global pandemic, severe economic downturn, and systemic racism, we are faced with increased anxiety and stress,” House Energy and Commerce Chairman Frank Pallone, Jr. (D-N.J.) and Health Subcommittee Chairwoman Anna Eshoo (D-Calif.) said in a joint statement. “Mental health is an essential part of our nation’s health and and it is uniquely important during this time of unprecedented crisis—particularly for those with existing mental health conditions.”

The remote hearing will begin at 11 a.m. ET on Tuesday, June 30 and will examine more than 20 mental health-related bills.

Manatt Compares Presidential Campaign Healthcare Policy Positions in New Infographic 

Research firm Manatt this week has released an infographic that maps out the healthcare policy positions of President Donald Trump and Democratic presidential candidate and former Vice President Joe Biden during this 2020 election cycle.

The category “Increase Access to Treatment” shows President Trump would remove the Institutions for Mental Diseases (IMD) exclusion to allow residential treatment facilities with more than 16 beds to receive Medicaid reimbursements, and it shows former Vice President Biden would expand health insurance coverage, expand funding for mental health services and providers, and enforce mental health parity laws.

Fact of the Week

In 2018, national surveys from the Henry J. Kaiser Family Foundation, AARP, and Cigna examined the prevalence of loneliness, which they estimated to be 22%, 35%, and 47%, respectively. Using the same methodology as for its 2018 survey, in 2020 Cigna reported loneliness among Americans increased to 61% in 2019.

CEO Update Will Publish Next on Friday, July 10

NABH will not publish CEO Update next Friday, July 3 and will publish the next issue on Friday, July 10.

The NABH team wishes you and your families a happy and safe Independence Day weekend!

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