Capitol Connector

Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

The 116th Congress began on Thursday amid a government funding lapse that has shut down roughly 25 percent of the federal government. Democrats are set to lead the House chamber for the first time since 2010, while Republicans remain in control in the Senate. While legislation may be move less quickly in the new divided Congress, lawmakers will still face a number of “must-pass” bills that include health care priorities. Additionally, the Trump Administration will continue to shape the health care landscape with Medicaid waivers and potential payment reforms. Here is a preview of what’s ahead in health policy in 2019.

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Shelley Starkey

Policy & Advocacy Coordinator

The Centers for Medicare and Medicaid Services (CMS) approved waivers from Michigan and Maine last month that would allow the states to implement requirements for Medicaid enrollees to report work or “community engagement” activities each month or risk losing health coverage. Michigan and Maine join five other states that have had Medicaid work requirement waivers approved, while more than ten others are in the process of requesting similar changes to their Medicaid programs. The National Council stands strongly opposed to any provisions that create barriers to health coverage for individuals with mental health or substance use disorders, including Medicaid work requirements.

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

The Health Resources and Services Administration (HRSA) is currently accepting clinician applications for the National Health Service Corps (NHSC) Substance Use Disorder Workforce Loan Repayment Program. The program offers up to $75,000 in student loan repayment for clinicians who work at least three years providing substance use treatment at an approved site. Applicants that have a DATA-2000 waiver to prescribe buprenorphine to treat opioid use disorder, work in an opioid treatment program or are licensed or certified in substance use interventions, will receive priority. Applications will be accepted on or before February 21, 2019.

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Michael Petruzzelli

Manager, Policy and Advocacy, National Council for Behavioral Health

Late last month, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma sent a letter to state Medicaid directors describing ways states can improve care and reduce burdens for individuals who are dually-eligible for both Medicare and Medicaid. This population of individuals tends to have complex medical and behavioral health needs and accounts for a disproportionate share of federal spending for both programs. The letter outlines ten opportunities for states to improve care for the dually-eligible population in 2019.

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

Late last week, Judge Reed O’Connor found the Affordable Care Act (ACA) to be unconstitutional following Congress’ repeal of the individual mandate penalty in 2017. Most importantly, the law remains in effect pending what is likely to be a lengthy appeals process. Nonetheless, the ruling will likely have significant impacts on the health care debate in Washington and around the country. The decision is expected to be appealed to the Court of Appeals for the Fifth Circuit, which will likely consider it at some point in 2019, and the case could eventually be heard by the Supreme Court.

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

On March 25-27th, behavioral health’s premier conference, NatCon19, will kick off in Nashville, TN. NatCon19 is where the best in behavioral health gather to learn from industry experts, take in world-class entertainment, keep up on the most innovative products, and make new connections. Policy and advocacy are always a special focus at NatCon. This year, our NatCon19 Policy Track will help you gain understanding of the latest policy challenges and solutions and guidance on how you can influence policy to better support clinics and patients.

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

Earlier this week, the Senate and House both voted to pass the First Step Act, bipartisan legislation to reform the nation’s criminal justice system. Notably, the First Step Act includes a reauthorization of the Second Chance Act, a law that supports state and local reentry programs to reduce recidivism and provides people leaving prison with post-release supportive services, including mental health and addiction treatment. President Trump is expected to sign the measure into law on Friday (12/21).

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

Last week, the National Council for Behavioral Health submitted comments to the Department of Homeland Security (DHS) regarding the Trump Administration’s proposed rule that would allow legal immigrants to be denied lawful permanent residency if they enroll in Medicaid or other public benefits. The proposed rule would expand the definition of “public charge,” a test that determines if immigrants are likely to become dependent on government for subsistence, to include federal health, housing and nutrition programs. The National Council expressed strong opposition to the rule as it would deter legal immigrant families from seeking health care coverage, harming the health of millions of adults and children.

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

The Health Resources & Services Administration (HRSA) recently released national-level behavioral health workforce estimates for 2016 through 2030. The analysis, which was mandated by the 21st Century Cures Act, highlights how workforce shortages and an unequal distribution of providers have intensified access to care challenges for patients. HRSA reiterated that continued analysis on the behavioral health care workforce was essential to combatting the ongoing opioid crisis and noted that these findings aim to provide information on trends within the mental health and substance use disorder provider workforce.

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

On Wednesday, the Office of Civil Rights (OCR) for the Department of Health and Human Services (HHS) announced a widely anticipated request for information on how the current Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules may impede the transformation to coordinated, value-based health care. HHS is welcoming comments on “how the rules could be revised to promote these goals, while preserving and protecting the privacy and security of such information and individuals’ rights with respect to it.” The announcement suggests that the agency may be considering big changes to HIPAA. Responses to the RFI are due February 11, 2019.

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

In a few short weeks, Members of the 116th Congress will begin work on Capitol Hill. A new Congress equals new opportunities to improve the lives of individuals and families impacted mental illness and substance use disorders. To help prepare for the new Congress, the National Council’s Policy and Advocacy team recently surveyed National Council members to gather input on federal policy priorities for 2019 and beyond. Read more a for a summary of the results

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Shelley Starkey

Policy & Advocacy Coordinator

Earlier this week, the National Council for Behavioral Health submitted official comments to the Federal Communications Commission (FCC) urging the agency to designate a 3-digit phone code as a Behavioral Health and Suicide Crisis Lifeline. The National Council’s comments aim to address a public notice issued by the FCC soliciting public opinion on the implementation of the National Suicide Hotline Improvement Act. The Act, which was signed into law in August, tasks the FCC along with the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Department of Veterans Affairs (VA) with studying and reporting on the feasibility of replacing the current behavioral health crisis hotline, 1-800-273-TALK, with a memorable three-digit code such as 411 or 611.

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

Since launching in mid-2017, Certified Community Behavioral Health Clinics (CCBHCs) have dramatically improved access to community-based addiction care in the eight states where they operate, particularly opioid addiction services. CCBHCs have hired hundreds of new addiction-focused clinicians, expanded medication-assisted treatment (MAT) and other addiction services, and reduced patient wait times. However, with the CCBHC program set to end in mid-2019, access to lifesaving treatment could be lost. A new National Council report shows that the end of the CCBHC demonstration would result in massive program closures, staff layoffs and reduced addiction treatment access for patients. The National Council is calling on Congress to act quickly to extend the life of this critical program.

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Shelley Starkey

Policy & Advocacy Coordinator

The National Council for Behavioral Health, in partnership with Senators Debbie Stabenow (D-MI) and Roy Blunt (R-MO), hosted a Congressional staff briefing on Tuesday to highlight how Certified Community Behavioral Health Clinics (CCBHCs) are partnering with their local law enforcement to connect community members to timely addiction and mental health treatment and help officers to focus more of their time on their main duty: keeping their communities safe. The briefing brought together law enforcement officers and clinic leaders who urged Congress to act quickly to pass the Excellence in Mental Health and Addiction Treatment Expansion Act (S. 1905/H.R. 3931) to extend the CCBHC demonstration.

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

Late last week, the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced four new Section 1332 state innovation waiver concepts for states to make changes to their individual insurance markets (fact sheet). The new waiver concepts build on the recently issued CMS guidance on Section 1332 waivers, under which CMS aims to strengthen states’ authority to shape their health insurance markets. The Administrator stated in her keynote address at the States and Nation Policy Summit of the American Legislative Exchange Council (ALEC) that it was a mistake to federalize so much of health care policy under the Affordable Care Act (ACA), and that the new concepts are “designed to illustrate how states can waive certain ACA provisions under section 1332 of the law and develop alternatives to the ACA’s otherwise one-size-fits-all approach.”

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Mindy Klowden

Director,Training and Technical Assistance

The Centers for Medicare and Medicaid Services (CMS) recently issued final policy changes for Year 3 (2019) of the Quality Payment Program (QPP), as part of the final 2019 Medicare Physician Fee Schedule rule. The final rule updates payment rates and key policies applicable to physicians and other professionals under Medicare. Most notably, the rule expands the types of clinicians (including clinical psychologists) that are eligible to participate in the QPP through the Merit-based Incentive Payment System (MIPS).

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Shelley Starkey

Policy & Advocacy Coordinator

The Centers for Medicare and Medicaid Services (CMS) re-approved Kentucky’s request to add work requirements to the state’s Medicaid program last week, following a federal judge’s ruling earlier this year that overturned the first iteration of these requirements. These changes would require the population covered by Kentucky’s Medicaid expansion to report 80 hours of work or “work-related activities” each month, or face losing their coverage for a six-month lockout period. The approved 1115 waiver, which takes effect April 1, 2019, is almost identical to the state’s previously overturned application, and has been projected to result in at least 95,000 Kentuckians losing Medicaid coverage over the next five years.

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

The Centers for Medicare and Medicaid Services (CMS) has released a new proposed rule on prescription drug pricing in Medicare Part D and Medicare Advantage (MA). Most notably, the proposal would provide new exceptions to Medicare’s “six protected classes” policy, a policy that ensures beneficiaries with complex health conditions, including mental illness, have access to a full range of medication treatment options. The Partnership for Part D Access, a coalition headed by the National Council, immediately spoke out against these changes as harmful to patients’ health. Additionally, the proposal would permit Medicare Advantage plans to use step therapy for Part B drugs, provide physicians with real-time estimates of drug prices and alternatives and require the Part D Explanation of Benefits to include new drug pricing information.

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

The Centers for Medicare and Medicaid Services (CMS) has released a proposed rule to update the regulations governing Medicaid and Children’s Health Insurance Program (CHIP) managed care plans. The proposed rule would rollback many of the managed care standards established by the Obama Administration in 2016 that help ensure Medicaid beneficiaries have timely access to comprehensive health care. Now CMS intends to “increase state flexibility” by relaxing requirements that support network adequacy and provider pay. CMS is accepting comments on the proposed rule through January 14, 2019.

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Stephanie Pasternak

Policy Associate, National Council for Behavioral Health

This week the Centers for Medicare and Medicaid Services (CMS) announced a new opportunity for states to expand Medicaid coverage for mental health services, including treatment delivered in inpatient facilities with more than 16 beds known as institutions for mental disease (IMDs). In a letter, CMS explains how states can use Section 1115 waivers to “support innovative service delivery systems” for adults with serious mental illness (SMI) and children with serious emotional disturbance (SED). CMS emphasized the need for states to bolster early identification services, better integrate mental health and primary care, increase access to crisis services and expand the use of Certified Community Behavioral Health Clinics (CCBHCs).

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