What to Expect for Behavioral Health in 2020
From funding for Certified Community Behavioral Health Clinics to state Medicaid waivers, 2020 is sure to be a whirlwind for behavioral health and for the health care system at large. While Congress remains split down party lines with Democratic control of the House and Republican control of the Senate, time will tell if any large changes will happen during this election year. Here is a preview of what is likely ahead in health policy in the first year of the new decade.
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CMS Proposes Rule to Modify Medicaid Supplemental Payments
On Tuesday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that aims to increase transparency and reporting on state supplemental payments and financing arrangements in Medicaid. In an accompanying fact sheet, CMS stated that the proposed rule will equip the agency with improved oversight and tracking tools, allowing regulators to end state financing arrangements they consider to be impermissible. While we do not expect that most mental health and addiction providers will be directly affected, ultimately, these changes could result in a decrease in overall Medicaid resources available to states.
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HHS Proposes Updates to Fraud and Abuse Laws
Earlier this month, the Department of Health and Human Services (HHS) released a pair of proposed rules aimed at modernizing and clarifying the Stark Law and the Anti-Kickback Statute (AKS), two health care fraud and abuse laws. These new proposed rules aim to ease provider compliance burden and improve certainty for providers in value-based arrangements and for those who provide coordinated care. The rules also provide protections for providers transferring electronic health records and coordinating local transportation.
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DHS Publishes Harmful Public Charge Final Rule
The Trump administration on Wednesday officially published a final rule from the Department of Homeland Security (DHS) that greatly expands the definition of “public charge” when considering immigrants’ applications to enter or become permanent residents of the United States. This rule has already had a chilling effect on lawfully present immigrants utilizing public assistance programs for which they are eligible, including Medicaid, for fear of being denied the chance to stay in the United States. The National Council stands strongly opposed to this rule, which will result in significant harm to the health and welfare of immigrant families.
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Medicaid Myths: Debunking Common Misconceptions of the Medicaid Program
Last week, the Partnership for Medicaid, a nonpartisan advocacy coalition including the National Council, hosted a congressional staff briefing to discuss and unravel some of the most common misconceptions about the Medicaid program and its beneficiaries. The briefing focused specifically on individuals who receive health care via Medicaid and its impact on their lives. The diverse panel of speakers provided an overview of how millions of Americans benefit from the Medicaid program and how Medicaid expansion has led to increases in coverage, access to care and improved health outcomes for beneficiaries.
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Advocates Storm Capitol Hill to Preserve CCBHCs
On Thursday, the National Council hosted nearly 100 advocates from 16 states to build support for legislation to extend and expand the Certified Community Behavioral Health Clinic (CCBHC) demonstration program in Medicaid. The Excellence in Mental Health and Addiction Treatment Expansion Act (S. 824/ H.R. 1767) would extend the demo in the original eight states for two years, while expanding the program to the other 11 that applied but were not originally selected. The CCBHC program will expire on June 30, 2019 without Congressional action.
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Tennessee to Seek Block Grant for Medicaid
Last week, the Tennessee legislature passed a bill that would make it the first state in the nation to transform its Medicaid program into a single lump sum block grant. The legislation was passed after continued promises from the Trump Administration to provide states greater flexibility in running their state Medicaid programs. The bill now heads to Governor Bill Lee’s desks for his review and approval.
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MACPAC Requests Public Comment on IMD Payment
This week, the Medicaid and CHIP Payment and Access Commission (MACPAC) issued a request for comments from stakeholders on requirements, standards, and payments for institutions for mental disease (IMDs) under Medicaid. This announcement builds on recent moves by Congress and the Centers for Medicare and Medicaid (CMS) to provide opportunities for states to waive the IMD Medicaid payment exclusion for mental health and addiction services delivered in IMD settings. Specifically, the request comes in response to a provision from the SUPPORT Act that requires MACPAC to issue a report on IMDs and the services furnished by such providers. Providers interested in commenting have until May 31st at 5:30pm ET to submit comments.
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Congress Extends CCBHC Demonstration in Oregon, Oklahoma
The Senate approved a bill by voice vote on Tuesday that extends the Certified Community Behavioral Health Clinic (CCBHC) demonstration program in Oregon and Oklahoma, among other Medicaid programs. H.R. 1839, which passed the House last week, provides both states with an additional three months of participation in the CCBHC initiative, funding them both through June 30, 2019. Oregon and Oklahoma were set to conclude their two-year demonstration and lose their funding on March 31, but this extension will align them with the other six CCBHC demonstration states that began the program three months after OR and OK in 2017.
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New Report Details How Opioid Crisis Funds Are Being Used
The Bipartisan Policy Center (BPC) has published the first comprehensive report reviewing the estimated $11 billion allocated by the federal government for 57 different federal programs to address the opioid epidemic in 2017 and 2018. Funding has been used for a wide array of state-based programs, but states have primarily focused on creating treatment networks for opioid use disorder (OUD), financing treatment for at-risk individuals, making naloxone accessible and bolstering the addiction workforce. Unsurprisingly, the report found that Medicaid and Medicaid expansion have been critical in addressing the opioid epidemic. BPC recommends the federal government focus on sustainability, transparency, improved coordination among federal offices, and increased flexibility for states to address their unique needs.
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CMS Releases Guidance on Work Requirement Waivers
The Trump Administration this week continued encouraging states to weave work requirements into their Medicaid programs by releasing guidance on implementing, monitoring, and evaluating such changes. The new tools from the Centers for Medicare and Medicaid Services (CMS) are meant to provide guidance on creating effective demonstrations under Medicaid waiver authorities, particularly for waivers permitting states to implement work requirements and other experimental eligibility and coverage policies. As the Administration moves toward approving such waivers in more states, the National Council remains vehemently opposed to these harmful policies as they restrict access to needed mental health and addiction services.
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Ohio Becomes 9th State to Receive Approval for Medicaid Work Requirements
The Centers for Medicare and Medicaid Services (CMS) has approved Ohio’s Medicaid waiver to enact work requirements, even with legal challenges still pending in Kentucky and Arkansas for similar programs. Starting in 2021, Medicaid beneficiaries in Ohio not meeting certain exemptions will need to report 80 hours of “community engagement” per month to maintain coverage. Estimates indicate that approximately 18,000 people, about half of all eligible Medicaid beneficiaries, could lose coverage due to these new work requirements. The National Council for Behavioral Health remains strongly opposed to work requirements and other barriers that restrict access to needed behavioral health services.
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President Trump Releases FY 2020 Budget Proposal
On Monday, President Trump unveiled his Fiscal Year (FY) 2020 budget request — calling for $4.7 trillion decrease in federal spending and detailing his Administration’s priorities for next year. The document revives efforts to block grant Medicaid and restrict eligibility, maintains spending to combat opioid addiction, and outlines other major health care priorities. As with most presidential budgets, this proposal stands little chance of being enacted into law as written. Instead, the President’s budget proposal will act more as a messaging tool to Congress, which is currently working to develop and pass a budget for FY 2020 over the next few months
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Tonko, Turner Reintroduce Bipartisan Addiction Treatment Bill
A bipartisan bill that would allow states to restart Medicaid coverage for eligible incarcerated individuals up to 30 days before their release from jail or prison was introduced this week by Representatives Paul Tonko (D-NY) and Michael Turner (R-OH). The Medicaid Reentry Act (H.R. 1329) is an important step toward improving access to much-needed mental health and substance use services for one of the most vulnerable populations in the country.
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National Council Urges CMS to Strengthen Network Adequacy Standards for Medicaid Managed Care
State Medicaid programs should work with managed care organizations to ensure beneficiaries have timely access to robust provider networks, the National Council urged the Centers for Medicare and Medicaid Services in comments submitted Monday. Our comments were submitted in response to a Notice of Proposed Rulemaking issued by CMS in November that proposed to roll back prior regulations on Medicaid and CHIP managed care. While CMS indicated the new proposed rules are intended to “increase state flexibility,” the National Council is concerned they would result in loss of access to mental health and addiction treatment providers.
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Trump Administration Approves Medicaid Work Requirements in Maine, Michigan
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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CMS Urges Efforts to Improve Care for Dually Eligible Population
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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National Council Files Comments Against Public Charge Rule
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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CCBHC Expiration Presents “A Looming Crisis” for Addiction Care
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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Law Enforcement & CCBHCs: Increasing Access to Treatment, Decreasing Recidivism
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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