Addictions News Now—October 2011

Dear Readers,

Last month, the Congressional Research Service, a legislative branch agency that provides policy and legal analysis to committees and Members of both the House and Senate regardless of party affiliation, released an analysis of the impact of the Affordable Care Act (ACA) on the financing and delivery of addiction and mental health services. In it, CRS states that the ACA “is expected to increase the number of people with [addiction and mental health disorders] who have health coverage, through 1) expansion of Medicaid eligibility, 2) market reforms for private health insurance, and 3) creation of health insurance exchanges.” And yet, the report acknowledges that simply changing health care financing does not ensure access to needed services. Thus, the ACA attempts to reform the delivery of services through workforce investments and promoting new care models, such as health homes and other integration efforts.

Perhaps you’re wondering – what does this mean for you as a community addiction provider? Many of the ACA provisions described in the CRS report have yet to have an impact on the health care system. Many provisions aren’t authorized to go into effect until 2014; however, the federal government and States are taking action now in order to move implementation forward. These actions include the U.S. Dept. of Health and Human Services releasing ACA-related regulations (see story below: “CMS Extends Comment Period for Exchange Regulations to Oct. 31, 2011) and an array of federal grant opportunities for consumers, providers, and other health care stakeholders (See story: “Affordable Care Act Prevention Grants Will Support SBIRT, Tobacco Cessation” on our blog.

We have much work to do. The National Council will continue to promote the interests of addiction providers on Capitol Hill and to our federal partners through advocacy and responding to comment opportunities. Through our partnership with Hazelden, we are pleased to bring you a new technical assistance opportunity (see story below: “National Council Invites Applications for a Co-Occurring Disorder Learning Community”).

We need your help.

• Stay informed by bookmarking the National Council’s blog.
  
• Respond to our action alerts to protect the public safety net through the current Congressional deficit reduction debate.
• Learn about the impact of the 2014 insurance expansion on your client population by running an analysis of income level of client admissions. How many of your clients are at 133% or less of Federal Poverty Level (estimated $14,484 or less for 1 person)? They will all have access to the Medicaid expansion. How many of your clients are between 133%-200% of FPL (estimated $14,485-$21,780 for 1 person)? They will have access to private insurance through the health insurance exchange, along with premium subsidies to make insurance more affordable. Knowing these numbers will help you to understand the impact that the insurance expansion will have on your agency’s payer mix.
• Take advantage of National Council webinars and other educational and training opportunities to help you provide high-quality, efficient services to your clients.

We welcome your thoughts and feedback and look forward to partnering with Hazelden to keep you informed of the latest news and updates in future issues of the Addiction News Now.

Sincerely,

Chuck Ingoglia
Vice President, Public Policy

Resources & Reminders

National Council Invites Applications for a Co-Occurring Disorder Learning Community
The National Council for Community Behavioral Healthcare, in partnership with MTM Services  and Hazelden, is pleased to announce the launch of the Co-Occurring Disorder Learning Community. This exciting initiative is an opportunity for mental health and substance use organizations to improve care for individuals with co-occurring mental health and substance use disorders. Through this learning community, participating organizations will enhance their ability to provide effective integrated and comprehensive care.

Key elements of the Co-Occurring Disorder Learning Community include:

• Access to curriculum and leading experts in the integrated treatment of co-occurring disorder treatment and organizational change management
• Baseline and follow-up administration of a co-occurring treatment capacity assessment: the Dual Diagnosis Capability in Addiction Treatment (DDCAT) and the Dual Diagnosis for Mental Health Treatment (DDCMHT)
• Implementation of a Rapid Cycle Change quality improvement process which will provide goals and action steps to address co-occurring disorder service delivery capacity needs

Organizations will be chosen for participation by the National Council through a competitive application process. Participating organizations will agree to contribute $5,000 per site. For more information, please review the application packet. Applications must be submitted to Laira Kolkin, lairak@thenationalcouncil.org, by 5:00 PM, Eastern Time on October 14, 2011. Please contact Laira Kolkin with any questions about the application process.

Integration of Drug Abuse Prevention in Primary Care
The National Institute on Drug Abuse 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. Read more.

In The News 

Hazelden Opens Innovative Recovery Residence for College-Aged Youth Adults
Hazelden has launched an innovative, first-of-its-kind recovery residence for college-aged young adults in the heart of New York’s Tribeca neighborhood.  The state-of-the-art facility, called “Tribeca Twelve,” serves young people 18 to 29 years old who are either in college or graduate school or are planning to return. 

New York City is home to some 500,000 college age students.  College students are particularly vulnerable to problems caused by the use of alcohol or other drugs, with statistics showing that nearly 4 in 5 college students consume alcohol.  Almost half of full-time college students binge drink use illegal drugs or misuse prescription medications, and emerging adults have the highest rates of illicit drug and heavy alcohol use.

To address the unique needs of young adults with co-occurring substance use and mental health disorders, Hazelden has partnered with Columbia University’s Department of Psychiatry. Together they have created a seamless continuum of integrated care and an unprecedented level of recovery support programming for young adults with co-occurring disorders.

Residents will likely come to Tribeca Twelve after treatment or an intensive detox program, and must be ready to live independently.  The community of recovery, with its safe, secure, supportive and sober living environment, will help reduce the likelihood of relapse and reinforce healthy behavior among students in recovery.

The facility welcomed its first students in August and will seek to fill all 30 spaces by January, 2012.

For more information: click here.

Doctors Urged to Take Lead in Reducing Alcohol Misuse
Experts from around the world have issued a call to doctors to lead the battle against alcohol abuse – which has become the third leading risk factor in preventable and premature disease, affecting an estimated 76.3 million people globally.  The statement, timed to coincide with September’s United Nations Summit on Non-communicable Diseases, emphasized that doctors, valued and trusted by patients, have a unique opportunity to lead and inform the needed effort.

Study Shows Promise of Web-Based Aftercare Support for Patients Leaving Addiction Treatment
A study conducted by Hazelden’s Butler Center for Research, in conjunction with the Treatment Research Institute and the University of Pennsylvania’s Department of Psychiatry, has found great promise in web-based recovery support programming for patients discharged from residential drug and alcohol treatment.  These patients were provided web access to tailored clinical information and support, delivered over 18 months post-treatment.  The web-based programming was supplemented by access to a recovery coach.  The study, published in the Journal of Substance Abuse Treatment, found those who engaged most fully in the web-based program had significantly higher abstinence rates in the year following treatment and consumed less alcohol than those who were less engaged or not engaged at all.

SAMHSA Awards First-Ever State Substance Abuse Prevention Planning Grants
Late last month, SAMHSA announced 46 grants totaling $22.5 million next year to assist states, territories and tribes to further develop their substance abuse prevention efforts.  SAMHSA said the new grants “will help states conduct planning activities for the future that focus on new emerging challenges in preventing substance abuse and new opportunities for enhancing data collection, analysis and reporting systems, coordinating services and providing technical assistance and training.”  SAMHSA Administrator, Pam Hyde, said these “new grants are designed to help states and better position communities to reach America’s young people before they become involved with alcohol, illegal drugs, tobacco and abuse of prescription drugs.”
 

ONC’S HealthIT.gov
The Office of the National Coordinator (ONC) has launched a new website focused on patients and families.  The website, HealthIT.gov, provides information on the basics and benefits of HIT, E-Health, protecting a patient’s privacy and security and more. Under the American Recovery and Reinvestment Act (ARRA) ONC provides a number of programs and resources dedicated to the widespread adoption of health information technology.

Data Spotlight

The following provides summaries of recently-released data and research findings:

• Data from the Centers for Disease Control show that in the first quarter of 2011, the percentage of adults between ages 19 and 25 without insurance fell 3.5 points, to 30.4%.  That means approximately 1 million additional people gained coverage from the previous year.  Researchers attribute the cause to the new provision in law allowing young adults to stay on their parents’ insurance plan until age 26.
• Deaths caused by drugs have now topped traffic-related deaths.  The rise in drug-related deaths is due in large part to an increase in overdoses from prescription drugs.  This is the first time drugs have caused more deaths than motor vehicles since the government started tracking drug-related deaths in 1979.  An estimated 37,485 Americans died from drug-related causes in 2009, double the rate of 10 years ago. Painkillers and anti-anxiety drugs are often involved in drug-related deaths, and are now the cause of more deaths than heroin and cocaine combined.
• New research shows there has been a sharp rise in the U.S. in recent years in the number of young children in emergency departments or admitted to hospitals because of accidental poisoning from taking a potentially toxic dose of medication.  The CDC says more than 70,000 emergency visits each year are due to unintentional overdoses among children under the age of 18.  Particularly high among the prescription medications most commonly swallowed accidentally by young children were opioids (frequently prescribed for pain), sedatives-hypnotics (mostly prescribed as sleep aids) and cardiovascular drugs.
• Hospital stays for overdoses involving both alcohol and drugs rose by 76% among young adults in the U.S. between 1999 and 2008, to 29,202, according to a new study by the National Institute on Alcohol Abuse and Alcoholism.
• According to the National Survey on Drug Use and Health (NSDUH), the rate of illicit drug use among young adults ages 18 to 25 continues to rise – from 19.6% in 2008 to 21.2% in 2009 and 21.5% in 2010.  The NSDUH is a scientifically conducted annual survey of approximately 67,500 people throughout the world ages 12 and older.
   

Government Affairs Update

House, Senate Committees Draft Competing 2012 Health and Human Services Budgets; Include Cuts to SAMHSA, Second Chance Act
The Senate Appropriations Committee has voted to approve its version of the 2012 Labor-HHS-Education budget bill, which includes a $27 million reduction to the Substance Abuse and Mental Health Services Administration (SAMHSA). Of note among the line items in the Senate committee-approved bill:

• Center for Substance Abuse Treatment: $2.194 billion (a $5 million increase from FY 11)
• Screening, Brief Intervention, and Referral to Treatment: $53.2 million
• Center for Substance Abuse Prevention: 186.3 million (level to FY 11)

Meanwhile, the House Appropriations Committee has issued a draft version of the Labor-HHS-Education bill. The draft would reduce SAMHSA funding by $283 million. This includes $2.16 billion for the Center for Substance Abuse Treatment ($34 million less than the Senate version), and $118.9 million for the Center for Substance Abuse Prevention ($67.4 million less than the Senate version). The draft has not been approved by the House Appropriations Committee but may offer a competing platform for negotiations as the House and Senate work to reconcile their budget bills.

In related FY 2012 budget news, the Senate Appropriations Committee has approved its version of the Commerce-Justice-Science budget bill, which includes the complete elimination of Second Chance Act funding. The Second Chance Act supports state and local programs that reduce recidivism and coordinate reentry services, including drug abuse treatment services. In contrast, the House-passed version of this appropriations bill includes $70 million for Second Chance Act programs. The National Council has signed on to a letter to Congress urging lawmakers to support to House level of appropriations for these programs. In addition, the Legal Action Center has issued an action alert urging individuals to contact their Members of Congress in support of Second Chance Act funding. Click here to view the alert and take action.

Last week, the House and Senate agreed to a short-term bill that will keep the government operating until both chambers are able to reach an agreement on all of the 2012 budget bills.

Deficit Committee Silent on Details of Talks; New Resources Available for Advocates
Members of the Joint Select Committee on Deficit Reduction this week refused to release details on the progress of their talks to produce $1.2-1.5 trillion in federal budget savings. After a closed meeting on Tuesday, Members would only say that they had received briefings from budget experts and that they were making progress. So far, the Committee has held three public meetings and four private ones. As the Capitol Hill publication Roll Call noted this week, the conventional wisdom around difficult congressional negotiations holds that the more lawmakers and aides keep quiet, the more productive the negotiations are.

If you have not already done so, click here to read the National Council’s full analysis of the impact that the deficit negotiations could have on behavioral health providers and find out what you can do today to prevent losses to behavioral health funding.  The consumer group Families USA has also released new resources for advocates in the ongoing deficit committee negotiations. Visit Families’ “Keeping an Eye on the Super Committee” website to view reports on the issues at play in the negotiations and sample advocacy activities that you can engage in to influence the outcome of the talks.

CMS Extends Comment Period for Exchange Regulations to Oct. 31, 2011
The Centers for Medicare and Medicaid Services this week announced it is extending the public comment period on its proposed rulemaking for the establishment of state health insurance exchanges. Under the Affordable Care Act (ACA), the exchanges must be operational by January 1, 2014. However, the ACA did not fully elaborate all federal requirements for the design and operation of exchanges.

The current proposed regulation comes after three previous opportunities for individuals and organizations to submit comments to the Department of Health and Human Services (HHS) on how the exchanges should be structured. This proposed rule: (1) Sets forth the Federal requirements that States must meet if they elect to establish and operate an Exchange; (2) outlines minimum requirements that health insurance issuers must meet to participate in an Exchange and offer qualified health plans; and (3) provides basic standards that employers must meet to participate in the Small Business Health Options Program. HHS stated that its intent with this proposed rule is to afford States substantial discretion in the design and operation of an Exchange. Click here to view the proposed regulation.

The National Council has reviewed the proposed Exchange regulation and is preparing comments. When our comments are finalized, we will disseminate them as a template for other interested organizations to use as their basis of their own comments. Stay tuned to the Public Policy Update and other National Council communications to see the comment template. Comments are  due by Oct. 31, 2011.

The National Council’s Addiction News Now is published monthly and is produced in partnership with Hazelden.