Capitol Connector

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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Michael Petruzzelli

Manager, Policy and Advocacy, National Council for Behavioral Health

Last week, the National Council submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding Kentucky’s Medicaid proposal to impose work requirements on Medicaid beneficiaries. In July, a district court judge blocked the state’s waiver request and required the agency to reevaluate the waiver application and analyze its impact on beneficiaries. This legal decision only applies to Kentucky and has no bearings on work requirements being imposed in other states.

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Shelley Starkey

New guidance from the Centers for Medicare and Medicaid Services (CMS) reports updated policies and procedures around state plan amendments (SPAs), 1115 waivers and 1915 waivers in states’ Medicaid programs. Two informational bulletins released within the past week outline the agency’s efforts to streamline approval processes and provide clarity around these options that are meant to give states flexibility in how they administer their Medicaid programs. These updates are part of CMS’s ongoing efforts to address concerns from states and federal policymakers around long administrative approval times and lack of transparency and oversight.

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Shelley Starkey

Many states across the country are pushing back against the Trump Administration’s recent expansion of short-term health plans, which would make bare-bones plans that are exempt from critical coverage provisions of the Affordable Care Act more widely available in the individual market. Officials in California, Illinois, Vermont, and Hawaii are seeking varied solutions to limit the effects of the change. The National Council strongly opposes the recent federal ruling to expand short-term health plans.

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Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

CMS is planning significant changes to a value-based payment model known as Accountable Care Organizations (ACOs) in a sweeping rule proposed last week. The rule would give new ACOs just two years before they must start sharing savings and losses with the agency. The proposal has drawn criticism from hospital groups and ACO stakeholders, who say the plan will cause many ACOs to leave the program. Comments on the proposed rule are due by October 16, 2018.

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Katiri Zuluaga

Manager, State Initiatives

As states move more Medicaid services to managed care, the National Council for Behavioral Health has released Medicaid Managed Care Contracting, an advocacy guide to ensure mental health and addiction care is protected under managed care arrangements. Behavioral health providers are often subject to practices that restrict reimbursement and reduce patients’ options. The guide offers community behavioral health providers and associations talking points and sample contract language they can use with their state Medicaid agency to ensure Medicaid managed care will enhance behavioral health access.

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Shelley Starkey

Beginning in October, bare-bones, short-term health plans that are exempt from critical coverage provisions of the Affordable Care Act (ACA), will become more widespread in the insurance market. A final rule issued this week by the Departments of Health and Human Services (HHS), Labor and Treasury would permit the sale of limited health coverage plans that expose consumers to more risks and potentially larger medical bills when seeking critical care. The National Council strongly opposes any moves that undermine the availability of comprehensive coverage, including mental health and addiction benefits offered at parity.

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Shelley Starkey

A new bill would establish a loan repayment program for mental health care providers that commit to working in designated high-needs communities. Representatives John Katko (R-NY) and Grace Napolitano (D-CA) introduced the bipartisan legislation, called the Mental Health Professionals Workforce Shortage Loan Repayment Act of 2018 (H.R.6597), to address a critical shortage in the number of mental health care providers across the country.

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Katiri Zuluaga

Manager, State Initiatives

The Trump Administration intends to continue approving states’ requests to institute work requirements on Medicaid enrollees, despite a recent court ruling that set such efforts back. In an address last week, Health and Human Services (HHS) Secretary Alex Azar said the administration is ‘undeterred’ after a federal judge blocked Kentucky’s Medicaid work requirements last month. This move invalidated the Centers for Medicare and Medicaid Services’ (CMS) approval of an 1115 Medicaid waiver to redefine eligibility for the public program in Kentucky.

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Shelley Starkey

Implementation of the 21st Century Cures Act’s mental health provisions was the topic of a Congressional hearing last week. Lawmakers sought updates on the Administration’s progress in strengthening the behavioral health workforce and mental health parity enforcement. Dr. Elinore McCance-Katz, head of the Substance Abuse and Mental Health Services Administration (SAMHSA), testified to her agency’s progress in addressing these initiatives as well as other pressing mental health and addiction issues.

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Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

The House has passed the National Suicide Hotline Improvement Act, a bill that could spur the development of a three-digit code (like 411 or 611) to act as a national suicide prevention hotline. The National Council for Behavioral Health and other bill supporters say a new three-digit code, specifically catered toward mental health crises, would help divert individuals from the unnecessary use of 911 emergency services. After passing the House overwhelmingly, the bill now heads to the Senate for consideration.

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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 proposed rules for the 2019 Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP). The proposed rules update payment rates and key policies applicable to physicians and other professionals under Medicare. Among the key changes, the proposed rule would reduce billing documentation requirements, expand telehealth options and potentially create a bundled payment for the care and management of substance use disorders (SUD) in Medicare.

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Michael Petruzzelli

Manager, Policy and Advocacy, National Council for Behavioral Health

The 2018 Midterm Elections are fast approaching, NOW is the time to get out the vote!

In political advocacy, the first and most important step is deciding who will represent you and your community in Washington, D.C. The National Council for Behavioral Health is committed to helping increase voter engagement among Americans living with mental illness and addiction and their families. To this end, National Council is calling on its members to get out the vote and run Voter Registration drives in their organizations this summer and fall.

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Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

On June 29th, a district court judge blocked Kentucky’s waiver request to require Medicaid enrollees to work or participate in a job-related activity for at least 80 hours per month or lose their health coverage. The court ruled that the Centers for Medicare and Medicaid Services (CMS) had not properly considered whether the initiative would violate Medicaid’s central objective of providing medical assistance to the state’s citizens. The decision could have broad implications for other states hoping to limit Medicaid enrollment through work requirements.

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Shelley Starkey

Just before the July 4th recess, the Senate Appropriations Committee advanced 12 bills as a first step to setting funding levels across the federal government for Fiscal Year 2019, including a package for key health, education, and labor programs. A key focus in the proposal is combating opioid addiction, which marks a 1,275% increase in funding over the past 4 years for prevention, treatment, recovery, and research programs. As currently written, the National Institutes of Health and the Substance Abuse and Mental Health Services Administration would see significant increases in their topline budgets.

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Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

The House Appropriations Committee approved its Labor-HHS budget for fiscal year 2019, funding key federal health, education and labor programs for the year ahead. The Substance Abuse and Mental Health Services Administration (SAMHSA) saw increases of more than $400 million to its programming, though several key programs maintained level funding to prior years, and a fund to support the expansion of Certified Behavioral Community Health Clinics (CCBHCs) faces elimination.

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Shelley Starkey

After months of work on the topic, the House of Representatives last Friday passed a wide-ranging package of legislation aimed at addressing various facets of the opioid crisis. The bipartisan Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act (H.R. 6) combines 58 individual previously-passed bills that focus on topics ranging from expanding access to opioid addiction treatment to encouraging the adoption of alternative forms of pain management and more. Attention now turns to the Senate as legislators are building their own version of an opioid package, which will need to be reconciled with the House version before being signed into law by the president.

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Stephanie Pellitt

Policy Associate, National Council for Behavioral Health

Congress’ investment of $1 billion for opioid addiction services is now available for states to access through a grant application with the Substance Abuse and Mental Health Services Administration (SAMSHA). This funding was allocated in the recent omnibus budget agreement and is in addition to the $500 million provided in the Opioid State Targeted Response (Opioid STR) grants for FY 2018. State agencies will have until August 13th to submit an application to SAMHSA detailing how they will use the funds to support current state efforts to combat opioid abuse. While providers cannot apply for the funds directly, they should engage with their state officials to discuss addiction services that could be strengthened in their community.

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