Capitol Connector

Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

With historic levels of voter turnout, Tuesday’s midterm election results saw Democrats regain control of the House of Representatives, while Republicans strengthened their majority in the Senate. Health care emerged as a clear priority for voters and Medicaid expansion proved to be a big winner on election night. With power now divided in Congress, the next two years could feature intense political gridlock or force bipartisan compromise. Right now, one thing is clear – the 2018 midterms will send one of the largest classes of freshmen Members to Washington in recent history – and with them come new advocacy opportunities for the National Council and its members.

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Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

Last week, the Centers for Medicare and Medicaid Services (CMS) released its final rule for the 2019 payment year under Medicare. The rule finalizes policies around reducing provider burden, increasing electronic health record (EHR) interoperability, coverage expansions for telehealth, virtual care, and substance use disorder treatment. Notably, CMS decided to modify its original proposal to significantly change the payment and documentation requirements for traditional outpatient, office-based visits by modifying some elements to address concerns raised by provider groups like the National Council and other stakeholders.

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Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

On Wednesday, the Centers for Medicare and Medicaid Services (CMS) approved Wisconsin’s request to enact a series of restrictions that would limit Medicaid eligibility and restrict enrollees’ use of Medicaid benefits. The newly-approved Section 1115 waiver will require certain adult beneficiaries to work 80 hours per month to maintain health coverage, institute premiums and subject applicants to drug use screening questions. This decision is the latest in a series of work requirement approvals, however, Wisconsin is the first non-Medicaid expansion state to receive permission from CMS to impose work requirements.

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Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

The Trump Administration has issued new guidance to states that would relax requirements around 1332 waivers, the Affordable Care Act’s (ACA) vehicle for states to make changes to their individual insurance markets. The guidance tracks closely with the Administration’s stated goal of providing flexibility for states to offer cheaper insurance options outside of the ACA marketplaces. In short, the new guidance encourages states to utilize association health plans (AHPs) and short-term health plans as alternatives to current ACA marketplace plans.

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Shelley Starkey

Results from a new survey suggest that state Medicaid programs have seen stagnant enrollment over the past year while combined federal and state spending continued to grow similarly to the previous year. Additionally, states have reported a shifting focus toward prioritizing improvements in outcomes and value through delivery system changes and managed care requirements. The Kaiser Family Foundation (KFF) and Health Management Associates (HMA) included these results from their 18th annual survey of state Medicaid directors in two reports, released last week.

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Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

On Wednesday, President Trump signed into law a sweeping bipartisan opioid package (H.R. 6) passed by the House and Senate earlier this year. The SUPPORT for Patients and Communities Act (SUPPORT Act) promotes many National Council priorities, including expanding access to treatment, strengthening the behavioral health workforce and supporting behavioral health information technology. While the SUPPORT for Patients and Communities Act is an important step toward curbing the opioid epidemic, a more comprehensive response that invests in the full continuum of addiction services is needed to address the nation’s addiction crisis.

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Shelley Starkey

Certified Community Behavioral Health Clinics (CCBHCs), a new comprehensive mental health and addiction treatment model that is currently active in eight states, have been transforming care across the country since they launched in mid-2017. As required by the legislation that gave rise to CCBHCs, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued its first annual report to Congress on the status of the program late last week. The report outlines the genesis of the CCBHC program, the process that clinics have undergone to become CCBHCs, the current status of the program’s implementation, and long-term sustainability efforts.

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Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

This week, the Trump Administration formally published a 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 strongly opposes the rule as it would deter immigrant families from seeking health care coverage, harming the health of millions of adults and children. The proposed rule is subject to a 60-day comment period, meaning comments on the rule will be accepted until December 10.

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Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

A newly released report evaluates the strength and quality of state laws created to ensure that health insurers treat illnesses of the brain, such as depression and substance use disorders, the same way they treat illnesses of the body, such as diabetes and cancer. The report assigns failing grades to 32 states, while the state of Illinois is identified as having a model state statute. The report offers recommendations for how states can improve their parity laws to ensure equal access to mental health and substance use disorder treatment.

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Shelley Starkey

New provisions that would expand access to medication-assisted treatment (MAT) via telemedicine were included in the sweeping package of opioid legislation (H.R. 6) that has been passed by Congress and now awaits the President’s signature. The National Council for Behavioral Health applauds Congress for acting on this issue and taking up our recommendations, and remains committed to further expanding access to these evidence-based treatments through telemedicine.

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Michael Petruzzelli

Manager, Policy and Advocacy, National Council for Behavioral Health

Last month, the Department of Health and Human Services and the Drug Enforcement Administration (DEA) jointly released guidance on telemedicine and the prescribing of opioids for treatment of opioid use disorder. The National Council has long been advocating for changes to be made to DEA regulations restricting how behavioral health medications that are controlled substances can be prescribed via telemedicine. While the guidance is meant to promote the use of telemedicine during the opioid crisis, it offers little “new” information and instead reiterates what is and is not permitted under current law.

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Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

This week, House and Senate leaders announced an agreement on legislation to address the nation’s opioid addiction crisis. The bipartisan agreement (H.R. 6) supports many National Council priorities, including expanding access to treatment, strengthening the behavioral health workforce and supporting behavioral health information technology. The package also reveals the fate of controversial measures on the Institutions for Mental Disease (IMD) rule and the privacy of substance use disorder (SUD) treatment records that Congressional lawmakers and staff have worked through over the last several weeks.

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Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

On Wednesday, the House overwhelmingly passed a bipartisan “minibus” package for fiscal year 2019 Defense-Labor, Health and Human Services, Education (Labor-HHS) appropriations bills, which include funding for federal mental health and addiction programs. Notably, the bill (H.R. 6157) would increase funding for some mental health and addiction programs as well as provide around $3.8 billion to specifically to address the opioid addiction crisis. The “minibus” also included a stopgap spending measure to fund the rest of the government into early December. With the Senate having passed the bill last week, the bill now heads to President Trump, who has said that he will sign the measure by September 30th to avert a government shutdown.

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Michael Petruzzelli

Manager, Policy and Advocacy, National Council for Behavioral Health

Last week, the Office of the U.S. Surgeon General and the Substance Abuse and Mental Health Services Administration (SAMHSA) released the jointly developed Spotlight on Opioids, aiming to provide an update on opioid use and amplify discussion about substance use disorders (SUD) generally. In a statement announcing the report, Health and Human Services (HHS) Secretary Alex Azar expressed support for medication-assisted treatment (MAT), while the Surgeon General and the Assistant Secretary for Mental Health and Substance Use, called out several challenges impacting efforts to curb the crisis, including persistent societal stigma, workforce shortages and a lack of workforce supports.

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Shelley Starkey

The Senate passed its version of a sweeping legislative package to address the opioid crisis on Monday in a 99 to 1 vote. The bipartisan Opioid Crisis Response Act (S. 2680) supports many National Council priorities, including expanding access to treatment, strengthening the behavioral health workforce and supporting behavioral health information technology. The House and Senate will now need to reconcile the differences between the two different versions of legislation to finalize a bill for the President’s signature.

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Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

This week, the Senate overwhelmingly passed a bipartisan “minibus” package for fiscal year 2019 Defense-Labor, Health and Human Services, Education (Labor-HHS) appropriations bills, which include funding for federal mental health and addiction programs. Notably, the bill (H.R. 6157) would increase funding for some mental health and addiction programs as well as provide around $3.8 billion to specifically to address the opioid addiction crisis. With the House expected to vote on the package next week, Congress hopes to finalize the federal health care budget and avoid a government shutdown before the September 30th spending deadline.

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Michael Petruzzelli

Manager, Policy and Advocacy, National Council for Behavioral Health

Last week, the Substance Abuse and Mental Health Services Administration (SAMHSA) released the 2017 National Survey on Drug Use and Health (NSDUH), providing the nation with a snapshot of the ongoing opioid epidemic and mental health update across the country. The report found that 1 in 12 American adults (18.7 million) had a substance use disorder (SUD) and that 1 in 5 (46.6 million) had a mental illness. More than 8.5 million, though, were found to have both a SUD and mental illness.

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Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

Senate leaders have finalized a sweeping legislative package aimed at addressing the opioid epidemic, clearing the way for a Senate vote next week. The Senate had hoped to vote on the measure on Thursday, but inclement weather from Hurricane Florence caused the vote to be cancelled. The bipartisan Opioid Crisis Response Act (S. 2680) comprises more than 70 bills reported out of five Senate committees and touches on many elements of the epidemic. The bill’s provisions support many National Council priorities including expanding access to addiction treatment, strengthening the addiction treatment workforce, improving behavioral health information technology and more.

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Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

This week the National Council for Behavioral Health submitted comments to the Centers for Medicare and Medicaid Services (CMS) on its proposed rules for the 2019 Medicare Physician Fee Schedule (MPFS). The proposed rules update payment rates and key policies applicable to physicians and other professionals under Medicare. Among the key changes supported by the National Council were initiatives to reduce billing documentation requirements for Evaluation and Management (E/M) services, base reimbursement for office visits on the level of medical decision-making required, allow for same-day visits and create a bundled payment for the care and management of substance use disorders (SUD) in Medicare.

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Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

Last week, the Senate overwhelmingly passed a joint Defense and Labor-HHS appropriations bill that would increase federal health spending in the upcoming fiscal year. Notably, the bill would increase funding for some mental health and addiction programs as well as provide around $3.7 billion to specifically to address the opioid addiction crisis. House and Senate members now face a time crunch to reconcile their appropriations bills before a September 30th funding deadline and potential government shutdown.

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