DC Update

July 17, 2014

News from the States

Pennsylvania releases physician guidelines for prescription opioids

Around the Agencies

CMS awards health care innovation grants
SAMHSA developing app to help parents and caregivers talk to their kids about underage drinking
HHS announces Medicaid Innovation Accelerator Program

Capitol Hill News

NASADAD attends briefing hosted by Coalition for Health Funding on the effects of sequestration on health
Sens. Booker and Paul introduce legislation to improve employment opportunities for adult non-violent offenders

Events

NASADAD attends town hall meeting hosted by Non-Defense Discretionary coalition on potential threats to discretionary spending
Alliance for Health Reform hosts briefing on health insurance marketplaces
National Academy for State Health Policy hosting webinar on Medicaid treatment services for children and adolescents

In the News

Avalere Health releases observations on essential health benefits package
New York Times publishes article on the IMD exclusion

Resources

Medicaid Directors and Mental Health Program Directors send comments to SAMHSA regarding 42 CFR Part 2
Commonwealth Fund study finds uninsured rate falls to 15%
Association of Drug Court Professionals releases brief report on the ACA
PDMP Center for Excellence releases report on State experiences with mandating provider participation in PDMPs
State Budge Officers release report on using performance data to inform State budgets

News from the States

Pennsylvania releases physician guidelines for prescription opioids

The newly released guidelines were a collective effort between the Pennsylvania Department of Drug and Alcohol Programs (led by Gary Tennis, NASADAD Board Member), the Department of Health, and Governor Tom Corbett’s Administration and were adopted by the State Medical Society. The guidelines are voluntary and encourage providers to consider a number of identified evidence-based practices for treating patients receiving opioids for chronic, non-cancer pain. Those identified practices include discussing the benefits and risks associated with opioid therapy, individualizing opioid selection and dosing, monitoring and reassessing patients periodically, and others. The Pennsylvania Chapter of the American College of Emergency Physicians (PaACEP) also adopted voluntary guidelines for treating pain in the emergency department.

Around the Agencies

CMS awards health care innovation grants

The Centers for Medicare and Medicaid Services (CMS) announced the recipients of the Health Care Innovation Awards. The $360 million in 3-year grant funds will be awarded to 39 recipients in 27 States and the District of Columbia to test innovative care models. According to U.S. Department of Health and Human Services (HHS) Secretary Sylvia Burwell, “The Health Care Innovation Awards support our ongoing work to drive down health care costs while providing high quality care to CMS beneficiaries. These awards advance innovative solutions in delivering and improving care from all across our nation” (HHS press release). Award recipients will be testing models in a number of areas of health care including improving emergency care, promoting better rural care coordination and telehealth, and promoting better care for people living with HIV/AIDS.

SAMHSA developing app to help parents and caregivers talk to their kids about underage drinking

The Substance Abuse and Mental Health Services Administration (SAMHSA) is developing the app as part of their “Talk. They Hear You.” campaign. SAMHSA previously released a successful online simulation tool that helps parents and caregivers talk to their kids about the risks of underage drinking. The newest version will include a mobile app for Android, Apple, and Windows devices to reach parents on-the-go. The tool uses virtual humans or “avatars” to educate parents and caregivers about how to effectively communicate with their child about alcohol use. Parents will be able to use the avatars to have practice conversations and get help from coaches based on the Motivational Interviewing Model.

HHS announces Medicaid Innovation Accelerator Program

The U.S. Department of Health and Human Services (HHS) announced the program which will provide more than $100 million in funding for technical support to help States improve health, improve care, and reduce costs for Medicaid beneficiaries. The letter sent to Medicaid Directors regarding the program specifically highlighted the need for additional investment in addiction and substance use disorder services. “While complementing other federal-state delivery system reform efforts such as the State Innovation Models initiative, this new initiative will help jumpstart innovation by providing federal tools and resources to support states in advancing Medicaid-specific delivery system reform. The Medicaid Innovation Accelerator Program will develop Medicaid specific resources to support state-based innovative health care reform efforts by identifying and advancing new Medicaid service delivery and financing models to improve patient care by providing data analytics, improving quality measurement and rapid cycle evaluation capabilities, and advancing effective and timely dissemination of best practices and learning among states” (HHS release).

Also check out an informational bulletin from the Center for Medicaid and CHIP Services (CMCS) on medication-assisted treatment.

Capitol Hill News

NASADAD attends briefing hosted by Coalition for Health Funding on the effects of sequestration on health

Rob Morrison, Executive Director and Colleen Haller, Public Policy Associate attended the Senate briefing, Faces of Austerity: How Budget Cuts Hurt America’s Health, hosted by the Coalition for Health Funding on July 15^th. The Coalition for Health Funding is made up of a wide range of national organizations, including NASADAD, National Association of County and City Health Officials, American Public Health Association, National Association of Community Health Centers, and many more whose collective missions and members depend on federal funding to meet the health care and wellness needs of vulnerable populations. The panel of speakers came from varying health sectors and discussed how sequestration and other budget cuts have affected their ability to meet the health care needs of their communities. The reductions in funding have had wide ranging effects on the delivery of services, research and innovation, public health infrastructure, and individual health.

Panelists:

Eve Anthony, Athens Community Council on Aging, Athens, GA
Dr. Shobna Ghosh, Virginia Commonwealth Medical Center, Richmond, VA
Dr. Glen Mays, University of Kentucky, Lexington, KY
Tim Starkey, Great Salt Plains Health Center, Cherokee, OK
Paulette Valentine, Southwest Utah Public Health Department, Saint George, UT

Sens. Booker and Paul introduce legislation to improve employment opportunities for ex- offenders

Senator Cory Booker (D-NJ) and Senator Rand Paul (R-KY) introduced the bill, The Record Expungement Designed to Enhance Employment Act of 2014 (REDEEM Act), in July 2014. The Act would create a pathway for nonviolent offenders, both adult and juveniles, to have their records sealed or expunged under certain circumstances. The REDEEM Act would also offer States incentives to raise the age of adult criminal activity to 18 years old, restrict room confinement of juveniles, lift the lifetime bans on some ex-offenders to receive benefits under the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF), and improve the accuracy of the FBI background check system.

Events

NASADAD attends town hall meeting hosted by Non-Defense Discretionary Coalition on threats to discretionary spending

Colleen Haller, Public Policy Associate attended the town hall, Continued Threats to Discretionary Spending (and What to Do About It) on July 8^th. The Non-Defense Discretionary (NDD) Coalition is made up of groups representing a wide range of non-defense related public interests that rely on discretionary or non-mandatory funding during the federal budget process. These groups represent issues including public health, education, housing, public safety, scientific research, and others. The meeting featured presentations by the Center on Budget and Policy Priorities (CBPP) on the repercussions of a national balanced budget amendment, as well as potential opportunities and threats to discretionary funding as the appropriations process moves forward.

Alliance for Health Reform hosts briefing on health insurance marketplaces

Colleen Haller, Public Policy Associate attended the briefing, Health Insurance Marketplaces in 2014: Behind the Numbers on July 11^th. The expert panel (complete list below) provided an in-depth look at enrollment numbers for the new private health insurance plans, including demographics, initial consumer experiences, and lessons learned as officials plan for the next open enrollment period. The panelists also compared enrollment across States, examined trends in access to affordable health care, and whether safeguards to prevent enrollment inaccuracies have been effective.

Panelists:

Arnold Epstein, Deputy Assistance Secretary, Office of Health Policy, Assistant Secretary for Planning and Evaluation (ASPE)
Linda Sheppard, special counsel and Director of Health Policy and Analysis at the Kansas Insurance Department
Richard Onizuka, Chief Executive Officer, Washington Health Benefit Exchange
Timothy Jost, professor, Washington and Lee University School of Law

Moderators:

Ed Howard, Executive Vice President, Alliance for Health Reform
Sara Collins, Vice President, Health Care Coverage and Access, Commonwealth Fund

National Academy for State Health Policy hosting webinar on Medicaid treatment services for children and adolescents

The webinar, Beyond the Screening: Treatment Services under the Medicaid Benefit for Children and Adolescents, will be held on Thursday, July 24^th from 2-3 pm EST. The webinar will feature a presentation from the Centers for Medicare and Medicaid Services (CMS) on how States can use the Medicaid benefit for children and adolescents to meet the children’s treatment needs. Presenters from Colorado and Washington will also discuss their processes for determining Medicaid coverage for this population.

In the News

Avalere Health releases observations on essential health benefits package

The Affordable Care Act (ACA) requires health plans that participate in the new insurance marketplaces to provide a set of essential health benefits (EHB). The U.S. Department of Health and Human Services (HHS) allowed for a transitional approach to the benefits package that would be largely State-driven for plan years 2014 and 2015. HHS plans to release rules for EHBs to be applied to 2016 plans. In anticipation of HHS releasing rules, Avalere offered a series of observations and thoughts regarding the potential rulemaking process, including:

“Any EHB rulemaking will struggle to balance patient protections with affordability.”
“Rulemaking proposing significant changes to EHB for the 2016 plan year would likely need to emerge before the end of 2014.”
“Limited market experience makes wholesale reforms to current EHB policy unlikely.”
“Annual guidance for health plans offered on the federal exchange provides a vehicle to dictate policy in the majority of States.”

New York Times publishes article on the IMD Exclusion

The article, “Obscure Rule Restricts Health Law’s Expansion of Care for Addicts,” was published on July 10^th and provides an overview of the IMD Exclusion and its effect on Medicaid reimbursement for residential treatment services for substance use disorders. While the Affordable Care Act (ACA) included treatment for substance use disorders in the Essential Health Benefits, a Medicaid rule from 1965 called the “Institutions for Mental Disease (IMD) Exclusion” makes it very difficult for residential treatment centers to qualify for Medicaid reimbursement. The IMD Exclusion was originally created so that patients receiving long-term, residential mental health services at a State psychiatric hospital would not be eligible to receive Medicaid coverage for that treatment. Substance use disorder treatment was included into the rule, banning Medicaid reimbursement for residential treatment centers with more than 16 beds, encompassing many residential treatment providers for substance use disorders. The article offers a number of State examples where the IMD Exclusion has had an impact on access to substance use disorder treatment, both from the provider and patient perspectives.

Resources

Medicaid Directors and Mental Health Program Directors send joint comments to SAMHSA regarding 42 CFR Part 2

The National Association of Medicaid Directors (NAMD) and the National Association of State Mental Health Program Directors (NASMHPD) sent the comments to Substance Abuse and Mental Health Services Administration (SAMHSA) Administrator Hyde regarding SAMHSA’s public listening session on 42 CFR Part 2 and confidentiality. The comments call for the repeal of provisions of 42 CFR Part 2 that are not aligned with the Health Insurance Portability and Accountability Act’s (HIPAA) privacy provisions, with the exception of the provision that prohibits the use of substance use disorder treatment records to initiate or substantiate criminal charges or conduct an investigation of a patient. The comments also include responses to the set of questions that SAMHSA posed regarding potential changes to 42 CFR Part 2.

Commonwealth Fund study finds uninsured rate falls to 15%

The study, Gaining Ground: Americans’ Health Insurance Coverage and Access to Care After the Affordable Care Act’s First Open Enrollment Period, looks at changes in the national uninsurance rate following the first open enrollment period under the Affordable Care Act (ACA). Significantly fewer working-age adults are uninsured than before the enrollment period began. The uninsurance rate for adults aged 19-64 fell from 20% in July-September 2013 to 15% in April-June 2014. Roughly 9.5 million fewer adults were uninsured. Younger adults aged 19-34 drove a large part of the decrease in rates. Of those with new coverage, 60% reported that they visited a doctor or hospital or filled a prescription (American Hospital Association Update).

Also check out the Commonwealth Fund’s infographic.

Association of Drug Court Professionals releases brief report on the ACA

The brief report, Engaging with the Affordable Care Act: Implications and Recommendations for Adult Drug Court Professionals, was released by the National Association of Drug Court Professionals (NADCP). The brief report provides an overview of the ACA, its provisions, and State actions to implement the law. The report also outlines potential challenges for drug courts, particularly in relation to medical necessity, residential treatment, Medicaid billing, changes in provider choice, changes in the Substance Abuse Prevention and Treatment (SAPT) block grant, parity for substance use disorder treatment, and more. NADCP offers a list of 10 actions that drug courts can undertake to best leverage the ACA’s provisions to best serve drug court participants.

PDMP Center for Excellence releases report on State experiences with mandating provider participation in PDMPs

The Brandeis University Prescription Drug Monitoring Program (PDMP) Center for Excellence released the report, Mandating PDMP Participation by Medical Providers: Current Status and Experience in Selected States, which describes the current status of States’ mandates and outcomes in Kentucky, Tennessee, and New York. “Experience in these States indicates that mandates can quickly increase registration and utilization of PDMPs, with subsequent decreases in the prescribing of some commonly abused controlled substances and in measures of doctor shopping. It also highlights policy and implementation issues for States considering mandates” (PDMP report).

State Budge Officers release report on using performance data to inform State budgets

The National Association of State Budget Officers (NASBO) released the report, Investing in Results: Using Performance Data to Inform State Budgeting, in July (NASUAD Update). The report provides information on State experiences and lessons learned from using performance data, particularly related to agency engagement and buy-in, the role of the legislature, budget purpose and design, and sustaining the initiative. The report also contains case studies on Connecticut, Iowa, Minnesota, Nevada, Oregon, Utah, Virginia, and Washington. NASBO provides a list of key terms and definitions and also provides background information on the evolution of using performance data to design State budgets.