Senate Readies Vote on Tax Reform Bill
Back from the Thanksgiving recess, the Senate is nearing a vote on its tax reform package – potentially by week’s end. The bill was approved out of committee along a party-line vote earlier this week and on Wednesday night, the Senate voted 52-48 to bring the bill to the floor and begin debate. The National Council has made clear its opposition to this package as it includes provisions that would be detrimental to community behavioral health organizations and Americans’ access to mental health and addiction care.
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National Council Opposes Proposal to Weaken Essential Health Benefits
On Monday, the National Council submitted comments to the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) regarding proposed changes to the Essential Health Benefits (EHB) for marketplace insurance plans. The proposed changes would allow states to choose less comprehensive coverage for mental health and substance use services, which would hurt patient care and raise their out-of-pocket costs. The National Council expressed strong opposition to this proposal and other EHB changes in addition to reiterating support for including prescription drug utilization in the Risk Adjustment Model.
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Nominee for HHS Secretary Testifies Before Senate HELP Committee
On Wednesday, the Senate Committee on Health, Education, Labor, and Pensions (HELP) held a hearing on the nomination of Alex Azar to serve as Secretary of the Department of Health and Human Services (HHS). Azar expressed his priorities if confirmed as Secretary, which include tackling the opioid epidemic, and was met with mixed feelings from committee members. Azar will sit for another hearing in front of the Senate Finance Committee, which will vote on advancing his nomination for a final confirmation vote on the Senate floor.
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Diverse Stakeholders Gather to Discuss Mental Health and Criminal Justice Reform
On November 9, 2017, the Association for Behavioral Healthcare and Massachusetts Association for Mental Health in partnership with the Behavioral Health + Economics Network (BHECON), hosted a forum to address the overwhelming number of individuals with mental health needs that encounter the criminal justice system in Massachusetts. The forum, entitled “The Intersection of Reform: Behavioral Health and the Criminal Justice System,” highlighted both national and local programs that are decreasing recidivism, or rearrests, and arrests for individuals with behavioral health disorders, increasing successful treatment outcomes, and saving money for counties and states.
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CMS Updates the Child and Adult Core Health Care Quality Measurement Sets
The Center for Medicaid & CHIP Services (CMCS) recently issued an informational bulletin outlining 2018 updates to the core sets of children’s and adult health care quality measures for beneficiaries in Medicaid and the Children’s Health Insurance Program (CHIP). The core sets are tools states can use, and may voluntarily report on, to monitor and improve the quality of health care provided under their Medicaid and CHIP programs. CMS plans to add new screening measures for mental health and substance use to the Child and Adult Core Sets, while retiring a few behavioral measures found in the Child Core Set.
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Senate Plans Vote on Repeal of Individual Mandate, Tax Reform
Senate Majority Leader Mitch McConnel (R-KY) has announced that the Senate will vote on its tax reform bill, which includes a repeal of the Affordable Care Act’s individual health insurance mandate, next week. The bill could negatively impact mental health and addiction organizations in numerous ways by increasing health care costs and narrowing coverage, reducing charitable giving, and eliminating the medical expense deduction. With members of Congress back home in their districts, now is a key time for advocates to voice their concerns about this harmful legislation.
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Indiana Seeks Solutions to Opioid Crisis
Earlier this month, community leaders from Indiana hosted a briefing on Capitol Hill to discuss recent statewide action to battle the opioid crisis. The meeting was centered around understanding the prevalence of opioid addiction, what funding and resources are currently available to combat addiction in the state, and the introduction of the Responding to the Addictions Crisis program, a $50 million commitment by Indiana University to find new solutions to address opioid addiction.
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House Passes Tax Reform, Senate Version Adds Health Care Provision
This week, the House of Representatives approved its version of tax reform legislation by a vote of 227-205. This House proposal is vastly different than the version the Senate is currently working on. On Tuesday, the Senate inserted a provision to repeal the Affordable Care Act’s individual health insurance mandate as a part of its proposal. The provision would zero out the penalty individuals face for not purchasing insurance beginning in 2019.
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Alex Azar Nominated to Lead HHS
President Trump, on Monday, nominated former pharmaceutical executive Alex Azar to be his next Secretary of Health and Human Services. Azar, who spent most of the last decade at Eli Lilly and Co., previously served for six years in the George W Bush administration – first as General Counsel for four years and then as Deputy Secretary for two years under President George W. Bush. The Senate will consider his nomination later this month.
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CMS Administrator Encourages Work Requirements in Medicaid’s New Direction
Last week, the Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma gave a speech that further elaborated on new guidelines and priorities for Medicaid waivers. The Administrator’s comments to State Medicaid Directors included encouraging states to submit Section 1115 waivers that include work requirements, using the term “community engagements” to describe work requirements for able-bodied adults.
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House Bill Aims to Increase Transparency, Research On Effective Opioid Crisis Responses
Last week, Representative Bob Latta (R-OH), along with three Republican cosponsors, introduced a bill that would create a public electronic database of information and strategies to combat the opioid crisis. The Indexing Narcotics, Fentanyl and Opioids (INFO) Act (H.R. 4284) would create a position of Federal Coordinator within the Department of Health and Human Services (HHS) to oversee the implementation and coordination of this public database in partnership with other government agencies.
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Medicare Payment Rule Finalized
The Centers for Medicare & Medicaid Services (CMS) recently released Final Rule Year 2 (Performance Year 2018) of Medicare’s Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The QPP, which went into effect on January 1, 2017, includes two paths to payment for eligible clinicians who bill Medicare using the Physician Fee Schedule: The Merit-based Incentive Payment System (MIPS), and Advanced Alternative Payment Models (Advanced APMs). Performance in the QPP each year impacts payments two years later; in other words, performance in 2018 will impact Medicare Part B payments in 2020. By moving from volume-based payment to payment for quality and value, both systems change the way behavioral health providers are reimbursed under Medicare Part B.
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House Tax Reform Plan Poses Risks to Health, Nonprofits
Last week, House Republicans unveiled a sweeping tax reform bill (H.R. 1), amounting to a massive tax cut for certain individuals and corporations. While the bill does not cut Medicaid, it would add $1.5 trillion to the federal deficit, which could threaten future health care spending as available federal dollars shrink. The bill also contains provisions that could lessen the charitable donations nonprofits receive and eliminate the medical tax deduction.
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CMS Proposes Insurance Marketplace Rules for 2019
Last month, the Centers for Medicare and Medicaid Services proposed new marketplace rules for the 2019 open enrollment period. The rule reflects an executive order signed by President Trump earlier in his administration to roll back regulatory requirements on insurance agencies and states. Of importance, the rules would allow for states to tinker with the essential health benefits benchmark every year.
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CMS Issues Guidance to States on Improving Medicaid Waiver Process
Earlier this week, the Centers for Medicare & Medicaid Services (CMS) released guidance to streamline approvals of Medicaid waivers and state plan amendments. These tools are used by states to alter Medicaid benefits, eligible populations, and service delivery. While the Administration’s stated goal is to ensure Medicaid’s long-term fiscal sustainability and promote beneficiary independence, advocates should be aware of state proposals that could limit beneficiaries’ participation in the Medicaid program.
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National Council Joins Commitment to Improve Access and Quality of Addiction Treatment
On Wednesday, 16 health care payers representing more than 245 million lives adopted eight National Principles of Care for the treatment of addiction. As a result, the payers have agreed to identify, promote and reward substance use disorder treatment that aligns with the National Principles of Care. The principles emphasize universal screening, personalized treatment planning and access to evidence-based treatment and recovery support services. This initiative is part of the Substance Use Disorder Treatment Task Force, launched in April 2017 by Shatterproof and includes the National Council as a member.
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House Bill Seeks to Increase Access to Medication-Assisted Treatment
In September, Representatives Paul Tonko (D-NY) and Ben Ray Luján (D-NM) introduced a bill that would expand access to medication-assisted treatment (MAT) for opioid use disorders. The Addiction Treatment Access Improvement Act (H.R.3692) would allow new provider types to prescribe buprenorphine, a medication utilized in MAT, and would increase the number of patients that qualified physicians could treat.
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Opioid Commission Recommends More Treatment in Final Report
On Thursday, the White House Commission on Combating Drug Addiction and the Opioid Crisis published its final report. It calls for a dramatic expansion of addiction treatment capacity, but fails to make any specific recommendations for new funding. Without additional funding, it is extremely unlikely that any of the Commission’s 56 recommendations can be realized.
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CMS Issues New Guidance on Waivers of IMD Rule
On Thursday, the Centers for Medicare and Medicaid Services (CMS) issued a letter to State Medicaid Directors outlining a new waiver process to allow Medicaid payment of a broad range of services for opioid and other substance use disorders (SUD), including residential treatment. The letter, issued in response to President Trump’s declaration of an opioid public health emergency, promises states a “more flexible, streamlined” 1115 Medicaid waiver approval process to accelerate state’s ability to respond to the opioid epidemic. While this move could present an opportunity for states to expand their continuum of care for addiction, strict budget neutrality requirements and heightened state reporting requirements may prove too burdensome for states to realistically pursue this option.
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Senate Democrats Introduce Bill to Combat Opioid Crisis
Last week, Senators Bob Casey (D-PA) and Ed Markey (D-MA) introduced the “Combating the Opioid Epidemic Act.” The bill calls for Congress to invest $45 billion toward prevention, detection, surveillance, and treatment of opioid addiction. This legislation seeks to combat an epidemic that took the lives of over 33,000 Americans in 2015. The National Council applauds the Senators for their leadership on this issue, and looks forward to supporting their efforts to see this bill through Congress.
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