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Your source for the latest updates from Capitol Hill. We translate policy into practice so you can learn how policy trends will affect your work and how best to prepare.

CMS Releases Medicare Part D and MA Drug Pricing Proposal

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Stephanie Pellitt

, National Council for Behavioral Health

The Centers for Medicare and Medicaid Services (CMS) has released a new proposed rule on prescription drug pricing in Medicare Part D and Medicare Advantage (MA). Most notably, the proposal would provide new exceptions to Medicare’s “six protected classes” policy, a policy that ensures beneficiaries with complex health conditions, including mental illness, have access to a full range of medication treatment options. The Partnership for Part D Access, a coalition headed by the National Council, immediately spoke out against these changes as harmful to patients’ health. Additionally, the proposal would permit Medicare Advantage plans to use step therapy for Part B drugs, provide physicians with real-time estimates of drug prices and alternatives and require the Part D Explanation of Benefits to include new drug pricing information.

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CMS Proposes Overhaul of Medicaid Managed Care Rules

November 16, 2018 | Medicaid | Comments
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Stephanie Pellitt

, National Council for Behavioral Health

The Centers for Medicare and Medicaid Services (CMS) has released a proposed rule to update the regulations governing Medicaid and Children’s Health Insurance Program (CHIP) managed care plans. The proposed rule would rollback many of the managed care standards established by the Obama Administration in 2016 that help ensure Medicaid beneficiaries have timely access to comprehensive health care. Now CMS intends to “increase state flexibility” by relaxing requirements that support network adequacy and provider pay. CMS is accepting comments on the proposed rule through January 14, 2019.

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CMS Announces New Opportunities to Expand Mental Health Services

November 15, 2018 | Medicaid | Mental Health | Comments
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Stephanie Pellitt

, National Council for Behavioral Health

This week the Centers for Medicare and Medicaid Services (CMS) announced a new opportunity for states to expand Medicaid coverage for mental health services, including treatment delivered in inpatient facilities with more than 16 beds known as institutions for mental disease (IMDs). In a letter, CMS explains how states can use Section 1115 waivers to “support innovative service delivery systems” for adults with serious mental illness (SMI) and children with serious emotional disturbance (SED). CMS emphasized the need for states to bolster early identification services, better integrate mental health and primary care, increase access to crisis services and expand the use of Certified Community Behavioral Health Clinics (CCBHCs).

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BHECON’s 2018 Themes Show Key Issues Faced by State Behavioral Health Associations

November 15, 2018 | Justice | Mental Health | Parity | Workforce | Comments
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Katiri Zuluaga

Manager, State Initiatives

The Behavioral Health + Economics Network (BHECON), an initiative led by the National Council, is winding down on its second year of activities. BHECON partners with National Council state provider associations to transform the behavioral health delivery system by increasing their advocacy capacity and breaking down silos that create barriers to services for individuals with serious mental illness and co-occurring conditions. In its second year, BHECON translated the key state issues identified by stakeholders in year one, including mental health parity, workforce and increasing access to behavioral health services, into specific policy solutions in each of the nine states currently participating in the program.

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Health Care Emerges as Top Issue in Midterms

November 8, 2018 | ACA | Medicaid | Mental Health | Comments
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Stephanie Pellitt

, 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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CMS Finalizes Changes to Medicare Physician Payment and Quality Policies

November 8, 2018 | Medicare | Quality | Comments
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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.

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Wisconsin Waiver Adds Medicaid Work Requirements, Drug Screens

November 1, 2018 | Medicaid | Waivers/SPAs | Comments
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Stephanie Pellitt

, 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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Trump Administration Loosens Requirements for ACA 1332 Waivers

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Stephanie Pellitt

, 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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Kaiser Family Foundation Survey Outlines Medicaid’s Future

November 1, 2018 | Medicaid | Comments
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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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President Trump Signs Opioid Package into Law

October 25, 2018 | Opioid and Heroin Epidemic | Comments
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Stephanie Pellitt

, 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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SAMHSA Releases First Annual CCBHC Report to Congress

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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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New Rule Would Limit Immigrants’ Medicaid Access

October 11, 2018 | Medicaid | Take Action | Comments
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Stephanie Pellitt

, 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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32 States Get A Failing Grade on Parity

October 4, 2018 | Parity | Comments
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Stephanie Pellitt

Policy and Advocacy Associate

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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Opioid Package Expands Telemedicine for Behavioral Health

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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 Mental Wellbeing 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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Latest DEA Guidance Offers Little “New” Information for Community Behavioral Health Providers

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Michael Petruzzelli

, National Council for Mental Wellbeing

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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Congress Reaches Final Opioid Crisis Deal

September 27, 2018 | Opioid and Heroin Epidemic | Comments
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Stephanie Pellitt

, 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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House Passes Huge Health Spending Bill

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Stephanie Pellitt

, 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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Surgeon General, SAMHSA Release Updated Report on Challenges Fighting Opioid Epidemic

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Michael Petruzzelli

, National Council for Mental Wellbeing

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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Opioid Legislation Nearing Finish Line Following Passage of Senate Bill

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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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Senate Passes Massive Health and Defense Spending Bill

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Stephanie Pellitt

, 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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