D.C. Update – October 19, 2015

News from the States

  • Ayotte writes letter to major health insurance companies in support of mental health and substance use disorder parity
  • Colorado’s Rocky Mountain High Intensity Drug Trafficking Area releases report on impact of marijuana legalization
  • Ohio State Board of Pharmacy redesigns prescription drug monitoring program website
  • Harlem Parole Reentry Court study highlights importance of reentry programs for reducing substance use by parolees

In the News

  • Luján introduces Improving Treatment for Pregnant and Postpartum Women Act of 2015
  • Johns Hopkins study finds that 80 percent of individuals with opioid use disorders do not receive treatment
  • Several States move to increase smoking age to 21
  • Kaiser Family Foundation report examines Medicaid enrollment and payment trends

Around the Agencies

  • HHS announces planning grant awards for Certified Community Behavioral Health Clinics
  • CDC website updated with new resources on FASDs
  • CMS releases guide aiding ICD-10 transition
  • CDC report finds opioid pain relievers prescribed twice as frequently in some States
  • CMS releases bulletin guiding early treatment intervention for young adults experiencing psychosis

News from NASADAD

  • NASADAD attends NHTSA briefing on new tools for fighting DUIs

News from the States

Sen. Ayotte writes letter to major health insurance companies in support of mental health and substance use disorder parity
Senator Kelly Ayotte (R-NH) urged major health insurance companies to comply with mental health and substance use disorder parity in a letter sent last week. In the letter, Sen. Ayotte states her concern that individuals with mental health and substance use disorder are being denied health insurance coverage. Sen. Ayotte drafted an additional letter with Sen. Chris Murphy (D-CA) and a bipartisan group of twenty-two Senators calling on the Department of Health and Human Services (HHS) and Department of labor (DOL) to take immediate action to fully implement mental health parity. The messages follow a recent communication from Sen. Ayotte to the Government Accountability Office (GAO) regarding implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. Despite going into effect in January 2014, implementation of mental health parity has proven difficult, as many individuals continue to report denial of coverage for substance use disorder treatment by health insurance companies. In the letter, Sen. Ayotte expresses her concern that large barriers to accessing treatment for substance use disorders remain despite the passage of the law, and suggests the GAO review insurance company compliance with mental health parity.

Colorado’s Rocky Mountain High Intensity Drug Trafficking Area releases report on impact of marijuana legalization
Colorado’s Rocky Mountain High Intensity Drug Trafficking Area (RMHIDTA) released a new report on the impact of marijuana legalization in Colorado last week. The report finds that marijuana-related traffic deaths increased 92 percent from 2010 to 2014, and that positive marijuana toxicology DUI reports increased 45 percent since retail marijuana businesses began operating in early 2014. Colorado youth and adults have begun using marijuana at higher rates in recent years, with “11.6 percent of Colorado youth ages 12 to 17 years old considered current marijuana users compared to 7.15 percent nationally,” and “10.13 percent of adults aged 26 years old and over considered marijuana users compared to 5.45 percent nationally.” Marijuana-related emergency room visits and hospitalizations have also substantially increased, with a 29 percent increase in marijuana-related emergency room visits and a 38 percent increase in marijuana-related hospitalizations in the first year of legalization.

Ohio State Board of Pharmacy redesigns prescription drug monitoring program website
The State of Ohio Board of Pharmacy redesigned the State’s prescription drug monitoring program (PDMP) website last week. The redesigned website seeks to offer a better user experience by streamlining access to information contained within the PDMP system. In addition to offering several new training videos and documents, the redesign adds a new statistics feature that allows anyone to create custom reports and maps with PDMP data. Ohio’s PDMP, also known as the Ohio Automated Rx Reporting System (OARRS), was established in 2006 and remains the only Statewide database collecting information on all controlled substance prescriptions issued within the State.

Harlem Parole Reentry Court study highlights importance of reentry programs for reducing substance use by parolees
A recently released randomized control trial study of the Harlem Parole Reentry Court has emphasized the importance of reentry programs for reducing substance use by parolees. The “Coming Home to Harlem” study compared recidivism, employment, and substance use between regular parolees and parolees processed through the Harlem Parole Reentry Court. The Harlem Parole Reentry Court serves approximately 200 parolees each year in a program partnered with the New York State Department of Corrections and New York City Mayor’s Office of Criminal Justice. The program seeks to increase the availability of support services such as cognitive behavioral therapy to new parolees. The study found that parolees in the Harlem Parole Reentry Court made easier transitions into society, with study participants “60 percent less likely to be reconvicted for felonies within 18 months of release than traditional parolees.” Additionally, 65 percent of Harlem Parole Reentry Court parolees were not using drugs one year after release – compared to only 39 percent of regular parolees.

In the News

Rep. Luján introduces Improving Treatment for Pregnant and Postpartum Women Act of 2015
On October 6th, Rep. Luján (NM) introduced the Improving Treatment for Pregnant and Postpartum Women Act of 2015. This proposed bill would reauthorize the Substance Abuse and Mental Health Services Administration’s Grant Program for Residential Treatment for Pregnant and Postpartum Women. Additionally, the legislation would create a pilot program to give States the flexibility to implement family-based substance use disorder services for pregnant and postpartum women at various levels of care, not only residential settings. The pilot program would help State substance abuse agencies address gaps in services for pregnant and parenting women along the continuum of care, and encourage new approaches and models of service delivery.

Johns Hopkins study finds that 80 percent of individuals with opioid use disorders do not receive treatment
A new study conducted by the Johns Hopkins School of Public Health has found that 80 percent of individuals with opioid use disorders do not receive treatment. The study investigated substance use disorder treatment rates and trends from 2004 to 2013. Outpatient treatment and self-help groups remained the most common treatment options across the observed time period, finding that “the percentage of patients receiving care in a doctor’s office rose from 25 percent in 2004 to 35 percent in 2013.” The study concludes that statutory restrictions and overcrowded or unavailable treatment programs are key factors in limiting access to substance use disorder treatment.

Several States move to increase smoking age to 21
Several States across the country have begun drafting legislation to increase the legal age for purchasing tobacco from 18 to 21, as Pew Charitable Trusts reported last week. Hawaii successfully passed legislation increasing the smoking age this past summer. California, Massachusetts, New York, Oregon, Rhode Island, Utah, Vermont, and Washington have also introduced measures to increase the smoking age, although none have passed thus far. Efforts to increase the smoking age are driven by new reports suggesting that increasing the smoking age to 21 would cut smoking by 12 percent, in addition to preventing 223,000 premature deaths. Researchers believe that the increase will prevent more people from starting to smoke, as “90 percent of adults who become daily smokers say they started before the age of 19.” Several smokers’ rights groups and retailers have warned against increasing the smoking age, suggesting that cigarette taxes comprise an important segment of State tax revenue.

Kaiser Family Foundation report examines Medicaid enrollment and payment trends
A new Kaiser Family Foundation report released last week examines Medicaid enrollment and payment trends, finding that Medicaid enrollment increased an average of 13.8 percent, and Medicaid spending increased an average of 13.9 percent in FY 2015 as a result of Affordable Care Act (ACA) expansions. The report used information gathered from the annual survey of Medicaid Directors conducted by the Kaiser Commission on Medicaid and the Uninsured. Medicaid enrollment and payment is expected to slow in FY 2016, as only two additional States plan to expand Medicaid coverage.

Around the Agencies

HHS announces planning grant awards for Certified Community Behavioral Health Clinics
Today the Substance Abuse and Mental Health Services Administration (SAMHSA), Centers for Medicare & Medicaid Services (CMS), and Assistant Secretary of Planning and Evaluation (ASPE), announced planning grants to 24 States to provide community-based mental and substance use disorder treatment. The planning grants are part of an effort to integrate mental health, substance use disorder, and physical health care services, and improve access to high quality care.  States will use the planning grants to certify community behavioral health clinics, establish prospective payment systems for demonstration reimbursable services, and prepare an application to participate in the demonstration program.  Populations to be served with grant funds will include adults with substance use disorders, serious mental illness, and children with serious emotional disturbance.

CDC website updated with new resources on FASDs
The Centers for Disease Control and Prevention (CDC) updated their website with several new web resources last week. The new resources include maps documenting State information on alcohol use by pregnant women, a new fact sheet on alcohol use and pregnancy, and a new fact sheet on fetal alcohol spectrum disorders (FASDs). Recent CDC studies “have identified 0.2 to 1.5 infants with fetal alcohol syndrome (FAS) for every 1000 live births in certain areas of the United States.”

CMS releases guide aiding ICD-10 transition
The Centers for Medicare & Medicaid Services (CMS) released a new guide aiding the October 1st transition to the International Classification of Diseases, 10th Revision (ICD-10) last week. The new guide provides Medicare- and Medicaid-specific contacts for healthcare providers with questions about the transition. CMS advises any claims-related questions be directed to the provider’s Medicare Administrative Contractor or State Medicaid Agency. The ICD-10 includes new codes for medical diagnoses and hospital procedures that aim to better identify complex medical conditions, in addition to increasing the coordination of care among health providers.

CDC report finds opioid pain relievers prescribed twice as frequently in some States
The Centers for Disease Control and Prevention (CDC) released a new report last week finding that opioid pain relievers are prescribed twice as frequently in some States compared to others. The report was released in the CDC’s October Morbidity and Mortality Report (MMWR). The MMWR is the first multi-state report from the Prescription Behavior Surveillance System, which captures State prescription drug monitoring program (PDMP) data from California, Delaware, Florida, Idaho, Louisiana, Maine, Ohio, and West Virginia. The study additionally found that “opioid pain relievers are prescribed twice as often as antianxiety and insomnia medication,” and that the top 10% of prescribers provide over half of opioid prescriptions. The CDC suggests that this report’s findings indicate the need for improved prescribing practices.

CMS releases bulletin guiding early treatment intervention for young adults experiencing psychosis
The Centers for Medicare and Medicaid Services (CMS) released a new bulletin on creating early treatment intervention benefit packages for young adults experiencing first episode psychosis. The bulletin was a collaborative effort with the National Institute of Mental Health (NIMH), Centers for Medicare and Medicaid Services’ Center for Medicaid and CHIP Services (CMCS), and the Substance Abuse and Mental Health Services Administration (SAMHSA). Untreated psychosis increases a person’s risk for suicide, involuntary emergency care, and poor clinical outcomes. However, early intervention can alter this illness trajectory and enable individuals experiencing first episode psychosis to live in community settings and participate fully in family and community life.

News from NASADAD

NASADAD attends NHTSA briefing on new tools for fighting DUIs
Shalini Wickramatilake-Templeman, Public Policy Associate, attended the briefing hosted by the National Highway Traffic Safety Administration (NHTSA) on Wednesday, October 14th. The briefing focused on two newly developed assessment tools to be used in DUI offender populations: the Computerized Assessment and Referral System (CARS) and the Impaired Driving Assessment (IDA) Tool. CARS is a structured diagnostic assessment that can be used in DUI treatment settings, developed by the Cambridge Health Alliance through funding from the Foundation for Advancing Alcohol Responsibility (FAAR).  CARS is based on research findings indicating a strong association between repeat DUI offences with co-morbid mental health and substance use disorders. After the assessment has been completed, the tool generates a diagnostic report based on the DSM-IV, and provides an individualized and geographically tailored referral.  Several DUI offender treatment facilities are implementing CARS to assess the usability of the assessment among treatment professionals and clients.

The IDA, developed by the American Probation and Parole Association (APPA), with support from NHTSA, is designed to assist probation and parole officers in identifying DWI offenders’ risk of repeating their offense, and in determining the most effective supervision that will reduce such risk.  APPA is currently developing a computerized version of this tool to make it more widely accessible.

Should you have any questions, or require additional information, please do not hesitate to contact Robert Morrison, Executive Director, (202) 293-0090 or Shalini Wickramatilake-Templeman, Public Policy Associate, at (202) 293-0090.