A Message President and CEO Shawn Coughlin

It’s hard to believe it has been only 10 days since we decided to cancel the 2020 NABH Annual Meeting. It feels more like 10 years.

On behalf of our NABH team here in Washington, thank you for all you have done to provide excellent behavioral healthcare services during one of the most difficult and stressful times in our nation’s history. Through you, our members, we have learned and shared much in one week’s time. Ultimately, we hope to use the lessons we learn during the Covid-19 pandemic to help our members—and improve behavioral healthcare in the United States.

As we all navigate the pandemic, I want to highlight some actions NABH has taken to apprise our members of federal guidance, to inform relevant federal agencies and lawmakers about our recommendations, and to share best practices with each other.

First, please visit our Covid-19 webpage, which includes our weekly recommendations to the Centers for Medicare & Medicaid Services (CMS), guidance from relevant federal agencies, and other external resources that we think you and your teams will find useful. We will update that page regularly.

We will also continue to send NABH Alerts when we have crucial and/or urgent information to share. This week’s CEO Update includes the NABH Alerts we sent earlier this week, in case you missed those.

In addition, please remember to follow us on Twitter @NABHBehavioral and on LinkedIn, where we will post important information and share what our members are doing.

Finally, please keep us informed about the challenges you’re managing and processes that are working well. You can reach us at nabh@nabh.org.

Again, our thanks and very best wishes to each of you, your teams, and your families to stay healthy and safe.

Shawn Coughlin
President and CEO

NABH Sends Covid-19 Priority Recommendations to Vice President Pence, Hill Leaders

NABH on Friday sent a letter to top federal leaders outlining the association’s priority recommendations during the Covid-19 pandemic.

Congress is considering a legislative package to address Covid-19 issues, and NABH alerted Vice President Mike Pence and congressional leaders about the major challenges that NABH members are managing during the pandemic.

Click here for the full letter.
 
CMS Outlines Actions for Healthcare Providers During Covid-19 National Emergency

CMS this week released a fact sheet for healthcare providers and states following President Trump’s declaration of a national emergency due to Covid-19.

You can learn more from the agency’s news release about these actions.

Federal Agencies Offer Flexibility on Telehealth and HIPAA During Covid-19 Pandemic

Agencies within the U.S. Health and Human Services Department (HHS) as well as the U.S. Drug Enforcement Administration (DEA) on Tuesday released essential guidance allowing for expanded telehealth use during the Covid-19 pandemic. Also Tuesday, HHS’ Centers for Medicare & Medicaid Services (CMS) issued important information about waivers or modifications under section 1135 of the Social Security Act during the national public emergency. Please see below for information and related links.

Meanwhile, CMS released a virtual toolkit for its partners, which includes links to the websites of other federal agencies, as well as guidance for schools, workplaces, Medicare beneficiaries, clinicians, caregivers, and others.

The agency’s announcement on increased flexibility in telehealth for Medicare beneficiaries allows Medicare payment for professional services for patients in any healthcare facility and in patients’ homes – no longer limited to rural settings and certain types of facilities. See also the FAQs on this announcement.

• CMS so also released guidance about telehealth services in the Medicaid program.

• HHS’ OIG released a policy statement and a fact sheet about telehealth cost-sharing during the Covid-19 pandemic.

• HHS Office for Civil Rights announced guidance on a limited waiver of HIPAA sanctions and penalties related to telehealth during the Covid-19 national emergency.

• DEA issued information related to telemedicine and medication assisted treatment.

In addition, CMS has approved first Section 1135 waiver in Florida allowing, among other flexibilities:

• • Reimbursement of otherwise payable claims from providers not enrolled in Florida’s Medicaid program or Medicare if certain conditions are met;
  • Waiver to allow facilities, including nursing facilities, intermediate care facilities for individuals with intellectual and developmental disabilities (ICF/IDDs), psychiatric residential treatment facilities (PRTFs) and hospitals’ NFs to be fully reimbursed for services rendered during an emergency evacuation to an unlicensed facility (where an evacuating facility continues to render services);
  • Waiver for Pre-Admission Screening and Annual Resident Review (PASRR) Level I Level II Assessments for 30 days. All new admissions can be treated like exempted hospital discharges;
  • See CMS guidance, for more information on section 1135 authority that allows waiver of certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements.

SAMHSA Releases 42 CFR Part 2 Guidance During Covid-19

The Substance Abuse and Mental Health Services Administration (SAMHSA) on Thursday released 42 CFR part 2 guidance clarifying patient consent requirements during the Covid-19 pandemic.

SAMHSA’s announcement acknowledges that patients may not be able to sign written consents due to social distancing and increased telehealth services during the pandemic. To ensure that substance use treatment is not interrupted, the agency’s guidance reminds providers they may determine that a “bona fide medical emergency exists” under the existing “medical emergency exception.”

Please contact Sarah Wattenberg, NABH’s director of quality and addiction services, if you have questions.

Fact of the Week

SAMHSA this week released tips on taking care of your behavioral health during the Covid-19 pandemic.

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

CMS Announces Actions to Address Spread of Coronavirus

The Centers for Medicare & Medicaid Services (CMS) this week announced a series of actions intended to limit the spread of Coronavirus 2019 (COVID-19), starting with directing healthcare providers nationwide to ensure they are implementing their infection-control procedures, which providers are required to maintain at all times.

CMS also announced that until further notice, state survey agencies and accrediting organizations will focus their facility inspections exclusively on issues related to infection control and other serious health and safety threats, such as abuse allegations, starting with nursing homes and hospitals. Vice President Pence—who is leading the government’s response to COVID-19—said this shift in approach will allow inspectors to focus their energies on addressing the spread of COVID-19.

The agency also provided information on suspension of survey activities, guidance for infection control and prevention concerning COVID-19 and related FAQs, and guidance for infection control and prevention of COVID-19 in nursing homes.

As of noon ET on Friday, the Centers for Disease Control and Prevention reported a total of 164 COVID-19 cases and 11 deaths in the United States, with 19 states reporting cases. The Atlanta-based agency has also provided guidance for healthcare facilities and information about clinician outreach and activity. Click here for an overview and additional information.

NABH alerted 2020 NABH Annual Meeting participants on March 3 that the association is watching federal updates closely and will continue its plans for the Annual Meeting in Washington, D.C. from March 16-18.

Senators Manchin, Moore Capito Reintroduce Protecting Jessica Grubb’s Legacy Act

Senators Joe Manchin (D-W.Va.) and Shelley Moore Capito (R-W.Va.) this week reintroduced the Protecting Jessica Grubb’s Legacy Act, which would allow patients to opt in and share their addiction medical records.

The legislation would also make it easier to share addiction records for the purposes of treatment, payment, and healthcare operations, while allowing patients to remain in control. The bill would also provide new protections under 42 CFR Part 2, which was passed in the 1970s before the Health Insurance Portability and Accountability Act of 1996 and electronic medical records.

NABH has long supported reforming 42 CFR Part 2. Click here to read a summary of the bill from Sens. Manchin and Moore Capito.

NABH Supports Medicare Mental Health Inpatient Equity Act

NABH was one of 40 organizations in the Mental Health Liaison Group this week to support the Medicare Mental Health Inpatient Equity Act, which would eliminate Medicare’s 190-day lifetime limit for Medicare beneficiaries who require inpatient psychiatric hospital care.

“This lifetime limit does not apply to psychiatric units in general hospitals and there is no such lifetime limit for any other Medicare specialty inpatient hospital service,” the MHLG wrote in a letter to Sens. Susan Collins (R-Maine) and Tina Smith (D-Minn.) “Through passage of landmark legislation, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, Congress put coverage for mental health and substance use disorders on par with other medical disorders,” the letter continued. “Also, that year, Congress passed important legislation to phase-in equalization of the Medicare outpatient coinsurance for mental and physical health. We must now finish the parity job and finally give Medicare beneficiaries the full parity that other individuals now have.”

The MHLG also sent a letter to Reps. Paul Tonko (D-N.Y.), an NABH Behavioral Healthcare Champion, and Bill Huizenga (R-Mich.) regarding a companion bill in the House.

CMS Issues Guidance on Access to Mental Health and SUD Services for Children and Pregnant Women

CMS this week sent a letter to state health officials that describes a provision in the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act related to coverage of mental health services for children and pregnant women.

“While the SUPPORT Act builds on MHPAEA, it is different in two important ways,” Calder Lynch, deputy administrator and director for the Center of Medicaid and CHIP Services, wrote in the letter. “Unlike MHPAEA, the SUPPORT Act explicitly requires coverage of behavioral health services.”

ONDCP to Host Webinar on Building the Addiction Physician Expert Workforce

Office of National Drug Control Policy (ONDCP) Director James Carroll and HHS Assistant Secretary for Health Admiral Brett Giroir, M.D. will host the webinar Building the Addiction Physician Expert Workforce to promote understanding of the addiction physician’s role in meeting the needs for substance use disorder (SUD) prevention and treatment.

The hourlong session on Tuesday, March 10 at 2 p.m. ET will also provide information and resources for efforts to expand the addiction physician workforce. Click here to register.

NABH Welcomes Domestic Policy Council Director Joe Grogan as Annual Meeting Speaker

NABH is pleased to welcome Joe Grogan, assistant to President Trump and director of the Domestic Policy Council, as a speaker to kick off the Annual Meeting policy breakfast on Wednesday, March 18 at 8 a.m.

Grogan, who leads the Trump administration’s domestic policy agenda, served previously as associate director for health programs at the Office of Management and Budget, where he managed the allocation and budgeting of more than $1 trillion in federal spending.

In the private sector, Grogan has worked in management at leading biotechnology firms Gilead Sciences, Inc., and Amgen, Inc. During President George W. Bush’s administration, he served as both a civil servant and in policy-making roles for more than seven years.

Grogan has also served as executive director of the Presidential Advisory Council on HIV and AIDS (PACHA), senior advisor to the FDA commissioner, and special assistant in the Administration for Children and Families.

Learn more about our Annual Meeting speakers and preliminary program. We look forward to seeing you in Washington!

Fact of the Week

In 2018, estimated 27.2 million Americans age 18 and older reported they experienced an alcohol or other drug use problem in their lifetime and approximately 20.2 million Americans over 18 described themselves as being in recovery from a drug or alcohol problem or having recovered from one.

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

Insurers Sign Settlement with Massachusetts Attorney General Over Mental Health Parity

Five large Massachusetts health insurers and two behavioral healthcare companies on Thursday signed a settlement with Massachusetts Attorney General Maura Healey regarding allegations that the organizations violated the state’s mental health parity laws.

A statement from Healey’s office said a number of the state’s healthcare companies have under-reimbursed mental healthcare services; imposed unlawful barriers, including prior authorization requirements for behavioral health services that were not required for comparable physical health services and could not be justified under the Parity Act; and had inaccuracies in their provider directories. The companies will pay a combined $1 million for a fund to promote initiatives to broaden access to mental health.

The settlement involves Harvard Pilgrim Healthcare and its behavioral health management company United Behavioral Health, which does business as Optum, Fallon Health and its behavioral health management company Beacon Health Strategies, Always Health Partners, Blue Cross Blue Shield of Massachusetts, and Tufts Health Plan.

“Treatment for substance use disorder and access to therapy are vital to public health, but too many people are facing unlawful barriers to the care they need,” Healey said in the statement. “These companies are making substantial and unprecedented changes to help ensure patients don’t have to struggle to find behavioral health services in Massachusetts.”

DEA Eases Regulations for Mobile Methadone

The Drug Enforcement Administration (DEA) this week proposed a regulation that revises the Controlled Substances Act (CSA) to permit narcotic treatment programs (NTPs)—opioid treatment programs, detoxification services that use methadone, and compounders— to operate mobile components, or mNTPs, without separate registrations.

The rule also proposes requirements related to security, recordkeeping, reporting, and inventory. The purpose of the rulemaking is to address the opioid epidemic by expanding access to methadone treatment, especially for residents of rural and underserved communities.
Learn more here from the NABH Issue Brief about the proposed rule.

CDC Requests Information on Workplace Supported Recovery

The Centers for Disease Control and Prevention’s (CDC) National Institute for Occupational Safety and Health (NIOSH) is seeking feedback on a NIOSH plan to develop resources and conduct research on Workplace Supported Recovery.

Workplace Supported Recovery programs help workers and employers facing the nation’s opioid crisis and other substance use disorders.

Click here to learn more about the request for information.

CMS Requests Public Comments on Rural Maternal and Infant Healthcare

The Centers for Medicare & Medicaid Services (CMS) has released a request for information regarding rural maternal and infant healthcare to improve access, quality, and outcomes for women in rural communities before, during, and after pregnancy.

Click here to read the agency’s Issue Brief on maternal healthcare in rural communities, and here to learn more about CMS’ request for information.

NABH Endorses NSC’s National Plan to Address Opioid Misuse

NABH this week joined more than 50 other organizations to endorse the National Safety Council’s National Plan to Address Opioid Misuse, which is intended for any presidential candidate to adopt as a roadmap to tackle America’s opioid crisis.

The plan offers solutions for the entire lifecycle of addiction, from prevention to recovery. It also offers recommendations that address the role prescribers play and that improve training and education of the non-addiction specialist medical workforce, including primary care, emergency department, Acura Care, and nw ark health professionals.

Kirsten Beronio Joins NABH as New Director of Policy and Regulatory Affairs

NABH is pleased to welcome Kirsten Beronio as the association’s new director of policy and regulatory affairs, effective Feb. 24.

Kirsten comes to NABH with more than 20 years of experience developing mental health and substance use disorder policy in leadership positions she has held in the legislative and executive branches of the federal government and at Mental Health America.

“Kirsten’s background in developing, implementing, and advocating for policies that help people struggling with mental health and substance use disorder positions her well for this role, and we are thrilled to have her join our team,” NABH President and CEO Shawn Coughlin said in a Feb. 24 news release.

Most recently Kirsten served as the senior policy advisor for behavioral health in the Center for Medicaid and Children’s Health Insurance Program (CHIP) at the Centers for Medicare & Medicaid Services from 2016 to 2020.

Before that, Kirsten worked as the first division director for behavioral health and intellectual disabilities policy in HHS’ Office of the Assistant Secretary for Planning and Evaluation. In addition to developing this new division from its inception, Kirsten served as a subject matter expert focused on federal parity legislation and regulations, implementation of key provisions of the Affordable Care Act, and various healthcare financing policies in Medicaid, Medicare, and CHIP. Kirsten earned a B.A. from Princeton University and a J.D. from Georgetown University.

At NABH, Kirsten will oversee quality and regulatory issues and will serve as the staff liaison for the Youth Services and Quality Committees.

2020 NABH Online Membership Directory Now Available

NABH this week released its 2020 online Membership Directory to help clinicians, hospital admissions staff, employee assistance directors, school counselors, policymakers, journalists, patient advocates, and families identify systems and facilities that provide essential behavioral healthcare services.

This is the second year NABH has made the Membership Directory available online, and the first year it is available only in a digital format. 2020 also marks the first time NABH has made the directory available to the general public.

“We are eager to share this useful resource with the public at a time when the need for quality behavioral healthcare services has never been greater,” NABH President and CEO Shawn Coughlin said in a Feb. 26 news release. “We hope people will find it helpful and share it with others who are looking for mental health or substance use treatment in their area.”

Directory information includes each NABH system member’s name, leadership, address, phone number, and website, as well as the behavioral healthcare facilities that each system operates.

Please call NABH at 202-393-6700 or e-mail nabh@nabh.org if you have questions.

NIMH, CDC Leaders to Address Attendees at NABH 2020 Annual Meeting

NABH is pleased to welcome federal healthcare officials from the National Institute of Mental Health (NIMH) and the CDC at the Annual Meeting in Washington next month.

Please join us on Tuesday, March 17 at 8:30 a.m. to hear from Joshua Gordon, M.D., Ph.D., director of the NIMH, whose work has had direct relevance to schizophrenia, anxiety disorders, and depression. And on Wednesday, March 18 at 9 a.m., NABH will welcome Debra Houry, M.D., M.P.H., director of the CDC’s National Center for Injury Prevention and Control. Dr. Houry, who completed her residency training in emergency medicine, will discuss adverse childhood experiences, overdose, and suicide.

Learn more about Drs. Gordon and Houry and our other Annual Meeting speakers on our Annual Meeting Speakers page. We look forward to seeing you next month in Washington!

Fact of the Week

Despite the number of people in recovery, nearly 89% of the estimated 20.2 million Americans who met the criteria for a substance use disorder (SUD) in 2018 did not receive specialized treatment for their condition.

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