National Council for Behavioral Health

Malka Berro

Policy Associate

QUOTABLE “This hasty midnight regulation is a step against some of the most vulnerable people in our communities and the bipartisan lawmakers who have tirelessly defended the merits of Medicare’s protected classes policy. We look forward to working with the Biden administration and Congress to ensure we give people in our nation with the most […]

Read More on CMS Announces Medicare Part D Demonstration, Methamphetamine Use Disorder Breakthrough  View Comments of CMS Announces Medicare Part D Demonstration, Methamphetamine Use Disorder Breakthrough

Malka Berro

Policy Associate

BREAKING NEWS Dr. Elinore McCance-Katz resigned yesterday as the Assistant Secretary for Mental Health and Substance Use. The National Council sincerely thanks Dr. McCance-Katz for her service and contributions to the behavioral health community. Read her statement here.   CMS Guidance on End-of-Pandemic Medicaid Changes On December 22, the Centers for Medicare and Medicaid Services […]

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Malka Berro

Policy Associate

QUOTABLE “COVID-19 has accelerated and expanded our country’s mental health and substance use disorder crisis. Access to treatment – when and where people need it – remains the biggest challenge we face. Unfortunately, insurers have consistently fought to illegally deny equitable coverage and states have lacked the tools to hold them accountable. No longer.” – […]

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Malka Berro

Policy Associate

IN CASE YOU MISSED IT On Tuesday, the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices voted on their initial COVID-19 vaccine distribution recommendations. As written, it is unclear if behavioral health providers and organizations are included under the panel’s recommended Phase 1 vaccination distribution category. This also follows a new […]

Read More on FY2021 Appropriations, Finalized Physician Fee Schedule  View Comments of FY2021 Appropriations, Finalized Physician Fee Schedule

Shelley Starkey

Policy Associate

QUOTABLE “The addition of Kentucky and Michigan to the CCBHC Medicaid demonstration will lower barriers to access and allow more people in more communities to receive the treatment and services they need, like medication-assisted treatment, as they cope with the disruption caused by the pandemic. By extending the demonstration to Kentucky and Michigan, Congress has […]

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Shelley Starkey

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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Malka Berro

Policy Associate

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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Malka Berro

Policy Associate

Last week, President Trump issued an Executive Order directing the Department of Health and Human Services (HHS) to advance a series of changes for the Medicare program. These changes aim to provide more health plan options for Medicare beneficiaries, modify Medicare fee-for-service (FFS) payments, and reduce regulatory burden, among others.

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Wendolyn Ebbert

Intern, Policy & Practice Improvement

On Tuesday, the MAPRx Coalition, which includes the National Council, hosted a Congressional staff briefing featuring a panel of advocates representing the AIDS Institute, the American Cancer Society, the National Council on Aging and Avalere Health. Speakers provided an overview of how Medicare Part D offers access to prescription drugs and the need for legislation that would place a cap on out-of-pocket costs for these medications. Currently, costs for medications that treat life-threatening illnesses such as cancer, HIV/AIDS, autoimmune diseases, which often co-occur with mental illness and substance use disorder, amount to tens of thousands of dollars per year per person. If Congress does not act, these expenses are set to increase in 2020, having a devastating impact for over 1 million Medicare enrollees.

Read More on Health Groups Convene Briefing on Medicare Out-of-Pocket Caps  View Comments of Health Groups Convene Briefing on Medicare Out-of-Pocket Caps

Shelley Starkey

Both the House and Senate have released bipartisan proposals in the last week to lower out-of-pocket health care costs across the country. The Senate Health, Education, Labor, and Pensions (HELP) Committee has released a sweeping proposal to address surprise medical billing, increase transparency within the health care industry, and bring down drug costs. Meanwhile, leaders of the House Ways and Means and Energy and Commerce Committees are seeking input on draft legislation to cap out-of-pocket costs under Medicare Part D, the program’s prescription drug benefit.

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Shelley Starkey

The Centers for Medicare and Medicaid Services (CMS) released a final rule on Thursday aimed at addressing rising drug prices and out-of-pocket expenses under Medicare Part D and Medicare Advantage. Notably, the final rule did not include previously-proposed measures that would have provided exceptions to Medicare’s “six protected classes,” a policy that ensures beneficiaries with complex health conditions, including mental illness, have access to a full range of medication treatment options. The announcement comes after six months of opposition to the proposals from Members of Congress and patient and provider advocates, including the National Council for Behavioral Health.

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Michael Petruzzelli

, National Council for Behavioral Health

New bipartisan legislation in the House and Senate would create greater access to mental health care, particularly for rural areas. The bill – the Mental Health Access Improvement Act (H.R. 945/S. 286) – would allow marriage and family therapists (MFTs) and licensed mental health counselors to directly bill Medicare for their services. Similar legislation has been introduced in previous sessions of Congress and again has the strong support of the National Council.

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Stephanie Pellitt

, National Council for Behavioral Health

On Thursday, the Centers for Medicare and Medicaid Services (CMS) released its Medicare Advantage (MA) and Part D draft call letter for 2020, which outlines changes to Medicare plan policies and payments each year.

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Michael Petruzzelli

, 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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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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Stephanie Pellitt

, 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.

Read More on CMS Finalizes Changes to Medicare Physician Payment and Quality Policies  View Comments of CMS Finalizes Changes to Medicare Physician Payment and Quality Policies

Stephanie Pellitt

, 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

, 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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Stephanie Pellitt

, 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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Shelley Starkey

Following an action-packed week for opioid-related legislation in the House, multiple Senate committees took up the mantle this week, hosting hearings, releasing new bills and considering legislation ahead of the Memorial Day recess. As bills advance out of committees, the full Senate is expected to consider the large package of opioid legislation later this summer. Meanwhile, similar efforts in the House are expected to make it to the floor in the coming weeks. The collective work of both chambers of Congress seek to address the opioid crisis from a number of fronts including prevention, treatment and recovery.

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