Addiction News Now - June 2011

As the SAMHSA-HRSA Center for Integrated Health Solutions (CIHS), operated by the National Council for Community Behavioral Healthcare, continues to expand its capacity to provide training and technical assistance in support of integrated primary and behavioral health services, we wanted to share a brief update with you on some of CIHS' recent activities:

•  On May 1, CIHS hosted a Integration Leadership Summit, which brought together key thought leaders among the memberships of the State Association of Addiction Services (SAAS)/NIATx, the National Association of Community Health Centers (NACHC) and the National Council for Community Behavioral Healthcare (National Council) for an intensive day of information sharing and strategy development to support integration efforts in the field. You can see a full agenda, list of participants and speakers, and handouts online. Follow-up discussions from this meeting will continue over the next few months, including a small, focused group discussion to identify areas of commonality between the three associations in the hopes that they can work together to support integration efforts among respective memberships.
• CIHS is pleased to announce several additions to its staff, including Aaron Williams, who will be serving as the Director of Training and Technical Assistance for Substance Abuse. Prior to joining us, Mr. Williams served as a member of the senior staff for the with the Central East Addiction Technology Transfer Center (Central East) and has managed several training and technical assistance projects supported by various agencies and foundations, including the National Institute on Drug Abuse and the Open Society Foundation. You can learn more about CIHS' staff here.

As part of its services, CIHS provides training and technical assistance to community health centers and other primary care and behavioral health organizations. Technical assistance areas include workforce, health information technology, wellness and health promotion, substance use, peer support, among others. To learn more about our services or to request technical assistance, please e-mail integration@thenationalcouncil.org or call 202-684-7457, ext. 251. Stay tuned to the National Council's Addiction News Now for highlights about addictions-related resources and announcements from CIHS and the National Council!

Sincerely,

Kathleen Reynolds, LMSW, ACSW
Center Director 

Resources and Reminders

Integration of Drug Abuse Prevention in Primary Care
The National Institute on Drug Abuse (NIDA) is requesting applications for an implementation research project to identify effective strategies and service delivery models for integrating existing evidence-based approaches to drug abuse prevention and treatment into primary care settings. Selected applicants will be awarded up to $500,000. Eligible applicants include government agencies, for profit and not-for-profit organizations. Deadline to apply is October 31, 2011. Read more.

Public Prevention Health Fund: Community Transformation Grants
HHS has announced the availability of $100 million for the current fiscal year for up to 75 Community Transformation Grants to support the implementation, evaluation, and dissemination of evidence-based community preventive health activities to achieve reductions in death or disability. Recipients may address several focus areas including substance abuse and mental health disorders. Eligible applicants include state and local non-profit organizations. The deadline to apply is July 15, 2011. Read more.

New Resource from SAMHSA: Become a TRICARE provider
TRICARE is the healthcare entitlement that reimburses for medical and behavioral health services outside the confines of a military treatment facility. TRICARE, which is part of the Military Health System, under the auspices of the Assistant Secretary of Defense for Health Affairs, covers an ever growing 9.6 million beneficiaries that include active duty members and families of the Army, Navy, Marine Corps, Air Force, and Coast Guard, as well as retirees from each of the above services and their families.

The SAMHSA technical assistance packet for becoming a TRICARE approved behavioral health provider supports increased access to community services for military families. To access more information, please click here.

SAMHSA Releases Two New Substance Abuse Treatment Resources:

• SA Treatment Admissions for Abuse of Benzodiazepines (Report): "Examines characteristics of substance abuse treatment admissions reporting any abuse of benzodiazepines based on 2008 data. Discusses demographics, prior use and treatment history, and abuse of benzodiazepines in conjunction with other drugs."
• Shaping the Future of Behavioral Health: Understanding Drivers Challenges and Opportunities (Presentation) "Explores the changes underway in the behavioral health field and the challenges and opportunities that lie ahead. Discusses the principles of recovery and considers health disparities, budget, block grants, approaches to improving practices, and communication."

Fight for Our Future at Hill Day, July 19-20
On July 19-20, 2011, join hundreds of your colleagues in Washington, D.C. for our field's premiere public policy and networking event! The National Council's Annual Public Policy Institute and Hill Day brings together addictions and mental health providers, administrators, board members, consumers, and community stakeholders from across the country. Participants come to D.C. for a full day of sessions and workshops on federal behavioral health policy - followed by visits with their elected officials on Capitol Hill to advocate for our field's priorities.

This year, Congress is under intense pressure to slash the Federal discretionary funding that is so vital to supporting mental health and addictions services. There's no more important time to fight for our future! Hill Day gives you the opportunity to influence policy and make your voice heard on Capitol Hill. Click here to see how last year's attendees made a difference.

Free Registration is now open for the 7th Annual Public Policy Institute and Hill Day. Thanks to the feedback we received from last year's attendees, the National Council is planning several enhancements and improvements to our Hill Day 2011 events - stay tuned to learn the details.

Save the Date for the "Get Ready for Hill Day" webinar on July 7 at 2pm EST. In this webinar, we'll cover essential information to help Hill Day attendees get ready for the trip to Washington including our policy asks for Hill Day and how to prepare for Hill visits. You can register online now.

Participating in Hill Day is easy. Visit our website to learn the details and view a tentative schedule of events. Questions? Contact Rebecca Farley at RebeccaF@thenationalcouncil.org or 202-684-7457, ext 235.

Register Now for Upcoming National Council Live Webinars on New Insurance Coverage Opportunities

A New Insurance Opportunity for Your Uninsured Clients Wednesday, July 3, 12:30pm EDT | REGISTER NOW

The Affordable Care Act created the Pre-Existing Condition Insurance Plan (PCIP) - a high risk insurance pool to provide insurance for individuals with pre-existing conditions through 2014, when the Medicaid and private insurance expansions begin. PCIP provides a potential opportunity for individuals with chronic health issues, including substance use and mental health disorders, to access insurance coverage not otherwise available to them due to their pre-existing health issues.

Recently, the U.S Department of Health and Human Services announced new eligibility standards and lower premiums in some states. These critical changes went into effect as of July 1, 2011. Join this webinar to learn more about PCIP and how it could potentially benefit your uninsured clients from a leading expert within the federal government.

Our webinar guest, Jay Angoff, is Senior Advisor to U.S. Department of Health and Human Services Secretary Kathleen Sebelius. He also served as the first Director of the Office of Consumer Information and Insurance Oversight, the Office responsible for implementing the insurance reform provisions of the Affordable Care Act, which is now part of the Centers for Medicare and Medicaid Services (CMS). Prior to joining HHS, Mr. Angoff held several state-level positions, including Insurance Commissioner of Missouri and chair of Missouri's Commission on Health Insurance Reform. Mr. Angoff began his career as an antitrust lawyer with the Federal Trade Commission. He is a graduate of Oberlin College and Vanderbilt Law School.

Health Insurance Exchanges & Behavioral Health Providers July 27 at 2:00pm EDT | REGISTER NOW 

The Affordable Care Act calls for the creation of private health insurance exchanges designed to provide individuals/families and small businesses access to affordable health insurance plans. As 2014 approaches, states will be working to design, implement, and run these private insurance exchanges, for which consumers could qualify for subsidies. Behavioral health providers have a stake in understanding the purpose and function of these new insurance exchanges since their creation, paired with an expansion of Medicaid eligibility to 138% federal poverty level (FPL), will soon introduce more insured patients into behavioral health care facilities.

Our webinar speaker, Jennifer McGuigan Babcock, serves as Vice President for Exchange Policy and Director of Strategic Operations at the Association of Community Affiliated Plans (ACAP). Having recently worked within the Office of Health Insurance Exchanges in the Department of Health and Human Service's new Center for Consumer Information and Insurance Oversight (CCIIO, now located in CMS), Ms. Babcock has investigated on the interplay between Medicaid and Exchange coverage in terms of eligibility and enrollment.

Watch the National Council's "Compliance 101" Webinar with Uri Bilek

The Affordable Care Act strengthens the government's ability to pursue fraud and abuse and, for the first time, requires all Medicare and Medicaid providers to have a compliance program. This webinar will outline the major provisions in health reform related to fraud and abuse enforcement, identify key legal risks, and recommend steps to update and enhance the effectiveness of your organization's corporate compliance program.

Uri Bilek is an associate in the health law and federal grants law practice groups at Feldesman, Tucker, Leifer, Fiddell, LLP in Washington, DC. He counsels clients on evaluating, developing, and implementing healthcare corporate compliance programs.

Listen to this webinar to hear how these compliance requirements impact addition-only organizations. Compliance 101: Presentation (PDF) | Webinar Recording (originally recorded Jun 16, 2011)

In The News

Women Prisoners Not Enrolled In Treatment Program After Release Much More Likely to Return
A new article published in The American Journal of Public Health concludes that women prisoners not enrolled in substance abuse treatment would be ten times more likely to return to prison within a year, most within the first six months. The study, conducted in Canada by Flora I. Matherson et al., tested the Community Relapse Prevention and Maintenance (CRPM) program, which works with women on parole from prison to follow recommendations outlined in the Declaration on Women's Health in Prison published by the World Health Organizations (WHO) and the United Nations Office on Drugs and Crime (UNODC)' in 2009. Matheson et al., conclude: "Aftercare is a critical component of a woman's support system after she leaves prison. Strategies that improve access to community aftercare are imperative for improving the life chances and health of these women."

For a full summary, click here.

Study Indicates that 90% of Individuals with Addiction Started Smoking, Drinking, or Using Other Drugs Before Age 18
A study released by The National Center on Addiction and Substance Abuse (CASA) at Columbia University found that nine out of 10 Americans who meet the medical criteria for addiction started smoking, drinking, or using other drugs before age 18. "Adolescent Substance Abuse: America's #1 Public Health Problem" also found that 1 in 4 Americans who began using any addictive substance before age 18 are addicted, compared to 1 in 25 Americans who started using at age 21 or older. You can read a press release and the full report online.

SAMHSA: 55 Percent Increase in Drug-Related Suicide ER Visits, 2005-2009
This month, SAMHSA released a new, national study that illustrated a 55 percent "increase in emergency department visits for drug related suicide attempts by men aged 21 to 34" with data from 2005-2009, going from 19,024 visits in 2005 to 29,407 visits in 2009. Antidepressants, among other pharmaceutical drugs, emerged as key concerns as visits among males aged 21 to 34 involving antidepressants increased by 155 percent and anti-anxiety and insomnia medications increased by 93 percent.

For the full report, click here.

NIDA Director Focuses on Prescription Drug Abuse Rates, Supports Upcoming NIH merger
The New York Times published an interview with Dr. Nora D. Volkow, director of The National Institute on Drug Abuse, this week where she discussed the toll soaring rates of prescription drug use starting to largely dwarf illegal use. As the Times reports, "Hospitalizations related to prescription drugs are up fivefold in the last decade, and overdose deaths up fourfold. More high school seniors report recreational use of tranquilizers or prescription narcotics than heroin and cocaine combined." In response to these trends, Dr. Volkow offers, "The challenges we face are much more complex, because we need to address the needs of patients in pain, while protecting those at risk for substance use disorders." She went on to express support for the recent plan for NIDA to merge with the National Institute on Alcohol Abuse and Alcoholism, calling the current siloed structure as "an artificial division with many missed opportunities."

For the full article, click here.

Drawing Links Between HIV/AIDS and Substance Abuse on 30th Anniversary of AIDS Discovery
In light of the 30th anniversary of the discovery of AIDS, The National Center for Drug Abuse has launched an interactive website that highlights the link between HIV-AIDS and substance abuse. The website is user-friendly and aimed mostly at teens, parents and teachers, and the media with research and news updates. The website includes a variety of fact sheets, resources, videos, and an advocacy center for people to share what they learn about the link between substance abuse and HIV-AIDS.

Check out the website by clicking here. The website resource is also available en Español.

For more information about HHS' commemoration of the thirty-year mark, visit aids.gov/thirty-years-of-aids.

Substance Abuse Prevention included in HHS's New National Prevention Strategy

On June 16, U.S. Surgeon General Regina Benjamin and members of the National Prevention, Health Promotion, and Public Health Council released the nation's first ever National Prevention Strategy. The National Prevention Council, created in June of 2010 and made up of the leadership of 17 federal agencies with input from the public and interested stakeholders, is charged with providing coordination and leadership at the federal level with respect to prevention, wellness and health promotion practices. The newly released National Prevention Strategy presents a vision, goals, recommendations and action items that public, private, nonprofit organizations and individuals can take to reduce preventable death, disease and disability in the United States. Three of the seven priorities identified in the prevention strategy include: Preventing Drug Abuse and Excessive Alcohol Use, Mental and Emotional Well-being, and Tobacco Free Living.

The prevention strategy provides evidence-based recommendations that have the potential to reduce the burden of the leading causes of preventable death and major illness. The recommendations include actions that the federal government, state and local governments, businesses, insurers, clinicians, schools, non-profit organizations, and individuals can take to improve wellness in each of the identified priorities. The strategy also promotes the use of screening, brief intervention, and referral to treatment (SBIRT) as a means for reducing substance abuse and improving mental and emotional well-being.

On the Hill

Congress Continues Negotiations on Budget and Debt Limit; Outcome Could Affect Long-term Medicaid Outlook

Negotiations over proposals to reduce federal spending continue, with Vice President Joe Biden leading talks among key Republicans and Democrats from both chambers. President Obama this week joined the effort, holding separate talks with House Republicans and House Democrats. A consistent sticking point in negotiations is Republicans' and Democrats' failure to agree over what means should be used to produce budget savings: Republicans have consistently advocated for trillions of dollars in cuts to federal spending, including major cuts to entitlement programs; while Democrats have urged combining spending cuts with revenue raising initiatives.

U.S. Treasury Secretary Tim Geithner has warned that Congress must enact a debt limit increase by Aug. 2, to prevent the nation from going into default. Although House Speaker John Boehner has urged Congress to reach a solution by the end of June, other fiscal conservatives have questioned the need for such quick action. 23 Republican Senators last week sent a letter to President Obama urging him to develop a contingency plan for a 2012 budget that does not include any borrowing authority. Meanwhile, other Republican leaders have written a letter warning Geithner that in the absence of a deal before Aug. 2, he may have to resort to even further extraordinary measures to keep the government solvent.

The unfolding debt limit debate - particularly the question of whether and how deeply to cut entitlement programs - will have a profound impact on Medicaid and other programs that fund safety net addictions and mental health services. The National Council encourages all of our members to attend Hill Day, July 19-20, to speak up for the importance of these programs and fight to protect funding for behavioral health. See more details below.

Putting Medicaid and Federal Deficit Reduction into Context: Funding Cuts Could Take Any of Several Guises
By Chuck Ingoglia, Vice President, Public Policy, National Council

As Congress continues to debate both the debt ceiling increase and the Fiscal Year 2012 budget, several proposed methods of reducing federal spending could have a substantial impact on the future of the program. Behavioral health providers should be aware of the ripple effect that these proposals - often couched only in terms of fiscal responsibility - may have on Medicaid.

Global Spending Cap: The notion of a global spending cap has been promoted by fiscal conservatives as a long-term solution to reducing federal spending. Under this scenario, both discretionary programs (such as the Mental Health Block Grant and Substance Abuse Prevention and Treatment Block Grant) and entitlement programs (like Medicaid) would undergo steep cuts to bring total federal spending to within a certain percentage of Gross Domestic Product. In future years, if spending grew above this limit, automatic, mandatory, across-the-board cuts would be imposed on all federal programs, including Medicaid. This scenario would likely force Medicaid to be converted to a block grant, since the program as currently designed could not support such funding reductions.

Health Spending Caps or Entitlement Spending Caps: Proposals to set a cap only on federal health spending or only on entitlement programs could have the same effect on Medicaid as a global spending cap: mandatory reductions to program funding and the potential for Medicaid to be converted to a block grant.

Medicaid Maintenance of Effort Repeal: This proposal, suggested both as stand-alone legislation and as a rider to the debt limit bill, would repeal the requirement under health reform that states maintain 2010 eligibility levels until 2014, when the Medicaid expansion and state health insurance exchanges take effect. Given the current budget shortfalls many states are facing, a MOE repeal would likely result in 300,000 Americans losing Medicaid coverage, according to a recent report.

Current Status of these Proposals: Many of the negotiations on the budget are taking place in secret, meaning that information about how Medicaid fares in any compromise deal may not be available until the deal is announced. At this point, it appears likely that the debt ceiling debate will include tens of billions of dollars - if not more - in spending cuts, and Medicaid is a likely target. Support for a MOE repeal appears to be growing in both the House and the Senate, and a vote on the proposal could come as soon as this month.

What does this mean for addiction providers? Currently, addiction providers seek reimbursement for services through private insurance, general fund dollars/SAPT block grant, or self-pay. With a robust expansion of Medicaid coverage to low-income populations up to 138% Federal Poverty Level (FPL) and the creation of state health insurance exchanges, addiction providers will likely see more Medicaid-eligible clients. SAMHSA recently estimated that 90-95% of those seeking treatment would qualify for some form of health insurance coverage. The current debate around discretionary spending and Medicaid, however, remains crucial to the vitality of publicly-funded substance abuse disorder treatment for a variety of reasons. The level of coverage offered to those newly eligible Medicaid beneficiaries and the size and livelihood of the Substance Abuse Prevention and Treatment Block Grant are among our many considerations moving forward in advocating for addiction providers.

What You Can Do to Fight for Discretionary Spending and Medicaid: You can write to your legislators today about opposing budget cuts to safety net programs by clicking this link. The National Council will use the Public Policy Update and our Action Alert network over the coming weeks to notify members of additional opportunities to contact your legislators in support of Medicaid. If you have not already subscribed to our Action Alerts, we encourage you to do so.

In addition, we strongly encourage all members to attend Hill Day in Washington, DC, July 19-20, where you'll have the opportunity to speak to your legislators and their staff face-to-face about the impact that cuts to Medicaid would have on you, your community, and the individuals you serve. The National Council is working hard in Washington to fight against these proposed cuts to Medicaid - but it is communications from constituents like you that typically can have the most sway over legislators' votes.

Members of Congress Urge Administration to Issue Final Parity Regulations

Forty Members of Congress have signed on to a letter to the Departments of Labor, Treasury, and Health and Human Services urging the agencies to issue final guidance on the Mental Health Parity and Addictions Equity Act of 2008. In January of 2010, the agencies issued interim final regulations outlining how insurance plans and employers should implement the terms of the law. This guidance went into effect for most insurance plans in January 2011; however, many questions remain that require clarification through additional regulatory guidance.

In their letter, the Members of Congress express concern that plans could eliminate intermediate levels of behavioral healthcare without further clarification of the regulation's scope of service requirements. The legislators also address the need for additional guidance on the law's requirement that insurance plans disclose their medical necessity criteria to consumers upon request, indicating that they have received reports that many plans are not complying with the informal (and non-binding) guidance that the Department of Labor has issued on this topic. Finally, the legislators request specific guidance on enforcement of "non-quantitative treatment limitations," which refer to restrictions insurance companies place on such things as fail-first policies for particular therapies or processes for deciding whether a drug is considered experimental. To learn more about the details of current guidance on these topics, please visit the Parity page of our website.