News from NASADAD

• NASADAD attends briefing on enhancing access to healthcare among minority and low-income communities
• NASADAD attends briefing on prescriber preparation for opioid crisis
• NASADAD attends Alliance for Health Reform briefing on  home and community-based care services

Around the Agencies

• CMS releases EHR reporting period final rule

In the News

• Parental substance use disorders drive growth in number of children in foster care
• AMA Task Force releases report for increasing access to naloxone
• Kelly Ayotte requests study of implementation and enforcement of the Mental Health Parity and Addiction Equity Act
• Governing magazine releases story on challenges facing State Medicaid programs

Upcoming Events

• ASAM announces webinars discussing evidence-based clinical treatment of opioid use disorders

News from NASADAD

NASADAD attends briefing on enhancing access to healthcare among minority and low-income communities
Brian Denten, Public Policy Intern, attended the event hosted by the National Journal on Thursday, October 9^th. Two panels of individuals working in the healthcare industry spoke about healthcare access among minority and low-income communities. Despite the Affordable Care Act’s (ACA) expansion of healthcare coverage, many newly insured remain unclear on how to access and utilize health insurance. Panelists discussed the importance of telehealth in disseminating information to minority and low-income communities about where and how to receive healthcare, stating that many people still rely on emergency departments as their primary source of healthcare. Several panelists emphasized cultural competency among medical professionals as essential in improving healthcare outcomes. Speakers further asserted the need for greater continuity of care within the healthcare system for treating the newly insured.

Panelists:

• Nadine Gracia, M.D.; Deputy Assistant Secretary and Director, Office of Minority Health, U.S. Department of Health and Human Services
• Georges Benjamin, M.D.; Executive Director, American Public Health Association
• Patrice Harris, M.D.; Chair-Elect, American Medical Association
• Justine Handelman; Vice President of Legislative and Regulatory Policy, Blue Cross Blue Shield Association
• Seiji Hayashi, M.D.; Executive Vice President for Transportation and Innovation, Practicing Physician, Unity Health Care
• McCrae Parker; Managing Director, Zero Divide
• Ruth Perot; Executive Director and CEO, Summit Health Institute for Research and Education (SHIRE)
• Ramanathan Raju, M.D.; President and CEO, New York City Health and Hospitals Corporation
• Diane Rowland; Executive Vice President, Kaiser Family Foundation
• Michael Scott; Chief Equity Officer, President, and Co-Founder, Equity Matters

NASADAD attends briefing on prescriber preparation for opioid crisis
Robert Morrison, Executive Director, and Shalini Wickramatilake-Templeman, Public Policy Associate, attended the briefing sponsored by the Hazelden Betty Ford Institute for Recovery Advocacy and National Council for Behavioral Health on Tuesday, October 6^th.  Speakers, including members of Congress, discussed the increasing prescription opioid and heroin problem in the United States. In particular, speakers emphasized the importance of prescriber education in the prevention of opioid use disorders.

Speakers:

• Kelly Ayotte (R-NH)
• Shelley Moore Capito (D-WV)
• Mary Bono, Principal, FaegreBD Consulting
• Michael Botticelli, Director, Office of National Drug Control Policy
• Joe Manchin (D-WV)
• Edward Markey (D-MA)
• Mehmet Oz; Host of The Dr. Oz Show
• Mackenzie Phillips; Actress and Person in Long-Term Recovery from an Opioid Use Disorder
• Dr. Marvin Seppala; Chief Medical Officer, Hazelden Betty Ford Foundation
• Dr. Jeannie Sperry; Adult Pain Rehabilitation Clinical Director, Mayo Clinic
• John Tilley; Kentucky House of Representatives

NASADAD attends Alliance for Health Reform briefing on home and community-based care services
Brian Denten, Public Policy Intern, attended the briefing sponsored by the Alliance for Health Reform. Several panelists working to identify ways to improve the provision of home and community-based healthcare services spoke at the event. As the United States’ population continues to age, home and community-based caretaker services for the elderly will become an increasingly large percentage of healthcare costs. Institutional solutions for the elderly, such as nursing homes, have trended downwards since the late 1990s, with home and community-based services making up the largest percentage of Medicaid long-term care expenditures in 2013. Several panelists discussed methods for improving the quality of long term-services and support (LTSS), including increasing affordability and access, increasing the amount of providers to choose from, increasing quality of life and care, and providing additional support for family caregivers.

Panelists:

• Anne Montgomery; Altarum Institute
• Bea-Alise Rector; Department of Social and Health Services, Washington State
• Abby Marquand; Paraprofessional Healthcare Institute (PHI)
• Jean Accius; AARP

Around the Agencies

CMS releases EHR reporting period final rule
The Centers for Medicare & Medicaid Services (CMS) released a final rule for the Medicare and Medicaid Electronic Health Records Incentive Programs in 2015 (EHR) this past week. The rule adjusts the EHR reporting period to 90 days in order to align with the remainder of the calendar year.  The rule further includes additional measures including “reducing the share of patients that must use the patient portal from 5% to at least one patient, and modifying the summary care requirements.”

In the News

Parental substance use disorders drive growth in number of children in foster care
Parents with substance use disorders are a major cause for the increase of children in foster care services, according to a new article by Pew Charitable Trusts. The number of children living in foster care began to increase in 2013, after years of decline. 415,000 children were living in foster care in 2014 according to an Administration for Children and Families (ACF) report, many as a result of their parents’ substance use disorders. Ohio saw a 19 percent increase from 2010 to 2013 in the percentage of child welfare cases involving heroin or cocaine, with seventy percent of children less than a year old in foster care as a result of parents using drugs. Similar trends were observed in Indiana and Vermont. Child welfare cases involving drug addiction present unique challenges, as many parents have difficulty recovering from their substance use disorder in the time allotted by federal law to reunite with their children.

AMA Task Force releases report for increasing access to naloxone
The American Medical Association (AMA) Task Force to Reduce Opioid Abuse issued a new report compiling resources for States and physicians to consider when increasing access to naloxone this past week. The report includes several webinars and overdose prevention resources from a variety of organizations, including the Harm Reduction Coalition and the American Academy of Addiction Psychiatry. One of the AMA Task Force’s primary goals is the encouragement of physicians to “co-prescribe naloxone to a patient or prescribe naloxone to a family member or close friend when it is clinically appropriate.” The report also provides an overview of naloxone laws in States across the country.

Sen. Kelly Ayotte requests study of implementation and enforcement of the Mental Health Parity and Addiction Equity Act
Senator Kelly Ayotte (R-NH) requested a study of the implementation and enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 in a letter to the head of the U.S. Government Accountability Office (GAO) last week. 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.

Governing magazine releases story on challenges facing State Medicaid programs
Governing magazine released a story on the challenges facing State Medicaid programs last week, featuring commentary from several State Medicaid Directors on the current status of Medicaid. Medicaid programs have grown substantially in recent years, yet State Medicaid Directors assert that they have not been given extra resources—such as more administrative positions, salary increases, and more technical assistance—to handle the increased capacity.  Matt Salo, Director of the National Association of Medicaid Directors, states that Medicaid’s role has evolved from being “bill payer” to having a number of new responsibilities. Many States do not consider Medicaid a separate agency, and include Medicaid programs within larger agencies such as health and human services.

Upcoming Events

ASAM announces webinars discussing evidence-based clinical treatment of opioid use disorders
The American Society of Addiction Medicine (ASAM) has announced a series of webinars discussing evidence-based clinical treatment of opioid use disorders to be held throughout the remainder of 2015. These webinars will discuss recommendations from the new ASAM National Practice Guideline for physicians treating patients with opioid use disorders, including the primary components of patient assessment and diagnosis, the use of pharmacotherapy (including buprenorphine, methadone, naltrexone, and naloxone), and the needs of special populations (including pregnant women, adolescents, and individuals within the criminal justice system). The webinars will be held on Wednesday, October 28 at 3PM EST; Tuesday, November 17 at 12PM EST; and Thursday, December 10 at 12PM EST.

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.

Around the Agencies

• CDC study examines alcohol use and binge drinking among women of childbearing age
• CAPT web area moves to the Programs and Campaigns section of the SAMHSA website
• NIDA reorganizes divisional structure to emphasize research on neuroscience and brain development

News from the States

• Maryland opioid task force releases series of recommendations to Governor Larry Hogan
• Indiana governor announces new task force on substance use disorders
• Oregon communities prevent recreational sale of marijuana

In the News

• New article examines provider application of SBIRT to young people
• Study finds substance use disorders associated with increased risk of death after release from prison
• Center for Health Care Strategies releases new tool on mental health and substance use disorder integration into Medicaid accountable care organizations
• States warn insurance agencies against using consumer reports to determine premiums
• Governors Highway Safety Association reports increase in drug use as cause of fatal car crashes
• Affordable Care Act amendment passes Senate, expects to be signed by President Obama

Upcoming Events

• IRETA announces webinar discussing substance use disorders in the military

Around the Agencies

CDC study examines alcohol use and binge drinking among women of childbearing age
The Centers for Disease Control and Prevention (CDC) released a new study this past week examining alcohol use among women of childbearing age. The study used Behavioral Risk Factor Surveillance System (BRFSS) data from 2011-2013 to form its conclusions. Fifty-three percent of non-pregnant women reported alcohol use and 18percent of non-pregnant women reported binge drinking.  Ten percent of pregnant women reported alcohol use and 3 percent of pregnant women reported binge drinking. Within the category of pregnant women, “women aged 35-44 years reported a significantly higher prevalence of any alcohol use (18.6%) than all other age groups.” Alcohol use among pregnant women with college degrees was twice as high compared to pregnant women with a high school diploma or less. The study notes an overall increase in alcohol use and binge drinking among pregnant and non-pregnant women compared to a similar study examining 2006-2010, but cautions that this increase may be a result of methodological changes in the BRFSS rather than an increase in alcohol use. The CDC recommends a “comprehensive approach to reduce alcohol use and binge drinking among pregnant women, and binge drinking among women of childbearing age” as a result of the study.

CAPT web area moves to the Programs and Campaigns section of the SAMHSA website
The Center for the Application of Prevention Technologies (CAPT) web area has moved to the “Programs and Campaigns” section of the Substance Abuse and Mental Health Services Administration (SAMHSA) website. The move is intended to streamline access to related resources on SAMHSA’s overall website. The new CAPT web area features the same content as its previous location, and will continue to be updated over the next several months. CAPT online courses will remain on a separate, password-protected online portal.

NIDA reorganizes divisional structure to emphasize research on neuroscience and brain development
The National Institute on Drug Abuse (NIDA) has reorganized its internal structure to emphasize research on neuroscience and brain development. The reorganization follows an evaluation by a NIDA Advisory Council Workgroup in response to reduced staffing and new scientific advances. The Advisory Council Workgroup found that “advances in addiction neuroscience outpaced or rivaled those achieved for any other brain disease.” The new structure will “strengthen functional integration throughout NIDA and continue to emphasize translational neuroscience, brain development, and neurobehavioral interventions research as core elements of NIDA’s mission.”

NIDA’s Division of Clinical Neuroscience and Behavioral Research (DCNBR) will merge with the Division of Basic Neuroscience and Behavioral Research to form the Division of Neuroscience and Behavior as a result of the restructuring. Additionally, DCNBR’s behavioral treatment portfolio will merge with the Division of Pharmacotherapies and Medical Consequences of Drug Abuse to form the Division of Therapeutics and Medical Consequences (DTMC). The focus of the new Division will be treatment development and interventions targeting the “brain circuits” associated with substance use disorders. The new structure is effective October 1^st.

News from the States

Maryland opioid task force releases series of recommendations to Governor Larry Hogan
The Maryland Heroin and Opioid Emergency Task Force submitted its initial report and series of recommendations to Governor Larry Hogan last month, as the National Governors Association (NGA) reports. The task force was created by Governor Hogan in February 2015 to advise the governor on ways to improve access to treatment, healthcare quality, and alternatives to incarceration for individuals with substance use disorders. The initial series of recommendations include “earlier and broader incorporation of heroin and opioid prevention into the health curriculum, the infusion of heroin and opioid prevention into additional disciplines, student-based heroin and opioid prevention campaigns, and Maryland State Police training on the Good Samaritan Law,” among several other suggestions. The task force also released ten funding announcements to treatment facilities in an effort to expand access to treatment and overall quality of care. The task force’s final report is expected to be released in December 2015.

Indiana Governor Mike Pence announces new task force on substance use disorders
Indiana Governor Mike Pence announced a new task force focusing on combating substance use disorders last month, as the National Governors Association (NGA) reports. The Task Force will employ Indiana experts from a variety of backgrounds to examine substance use disorders within the State. Key goals of the Task Force include assessing the existing resources used to treat substance use disorders, identifying ways for federal, State, and local law enforcement to collaborate, identifying best practices for substance use disorder treatment, and identifying successful prevention programs. The Task Force will meet on a monthly basis for the remainder of the year before issuing a series of final recommendations to the Governor.

Oregon communities prevent recreational sale of marijuana
Several Oregon cities have moved to prevent the recreational sale of marijuana in their communities, despite recreational marijuana being legal in the State. Oregon Live reports that many rural communities are fearful that the recreational sale of marijuana will lead to increases in adolescent use and crime. The recreational sale of marijuana was legalized last year in Oregon through the ballot initiative Measure 91, which stipulated that “any local attempt to ban sales would have to go to the ballot after 10 percent of local voters signed a petition.” To date 13 counties in eastern Oregon have voted to ban medical and recreational marijuana sales of any type, with eight other cities planning similar votes next year.

In the News

New article examines provider application of SBIRT to young people
A new article written by Alexa Eggleston, Senior Program Officer at the Conrad N. Hilton Foundation, examines the growing application of screening, brief intervention and referral to treatment (SBIRT) to young people. Many health care providers do not currently examine adolescent patients for substance use disorders, despite the negative health implications alcohol and drugs can have on patients’ lives. Young people in recovery for substance use disorders often lament “missed opportunities” for intervention by health professionals, according to many recovery advocates. SBIRT provides a robust methodology for healthcare providers to approach the topic of substance use with adolescent patients, and screen them for substance use disorders if necessary. Positive feedback is provided to youth not using alcohol and drugs, while those who have begun using substances are advised on stopping use and remaining safe. Several organizations have partnered to increase the use of SBIRT, including the American Academy of Pediatrics, the School-Based Health Alliance, YouthBuild USA, Reclaiming Futures, and Young People in Recovery.

Study finds substance use disorders associated with increased risk of death after release from prison
A new study tracking formerly-incarcerated individuals in Sweden has found that inmates with substance use disorders experienced higher rates of death post-incarceration than inmates without substance use disorders. The study examined individuals released from prison in Sweden from January 1, 2000 to December 31, 2009, finding an “estimated probability of death within 5 years of release from prison of 10.2% among men with substance use disorders compared to 3.2% among those without.” Women with substance use disorders exhibited a probability of death within 5 years of 6.5% compared to 2.6% among those without. The study’s authors conclude that more expansive treatment options are required “beyond the immediate period after incarceration,” and suggest investigating alternatives to incarceration for individuals with substance use disorders.

Center for Health Care Strategies releases new tool on mental health and substance use disorder integration into Medicaid accountable care organizations
The Center for Health Care Strategies released a new tool examining State integration of mental health and substance use disorders into Medicaid accountable care organizations (ACOs) last week. Many States have begun developing ACOs for Medicaid populations in order to reduce health care costs and improve health care quality by increasing communication across the continuum of care. The Center for Health Strategies asserts that many Medicaid patients with co-occurring mental health and substance use disorders are not receiving optimal care due to the fragmented nature of the healthcare delivery system. ACOs address this problem through greater mental health and substance use disorder integration. The new tool explores strategies States can use when creating ACO systems.

States warn insurance agencies against using consumer reports to determine premiums
Several States have warned insurance agencies against using consumer reports to determine premiums, as Pew Charitable Trusts reports. Ten States (including California, Florida, Indiana, Maine, Maryland, Ohio, Pennsylvania, Rhode Island, Vermont, Washington, and the District of Columbia) have issued warnings to insurance agencies using spending habits or shopping history as factors in determining insurance premium increases. State agencies and the Consumer Federation of America (CFA) have expressed concern that if left unchecked, insurance companies’ technology will outpace the ability of insurance regulators to regulate the industry – leading to larger annual premium increases. Insurance companies have countered these assertions by stating that new “price optimization” practices only analyze groups of people, and that the practice is necessary to stay competitive.

Governors Highway Safety Association reports increase in drug use as cause of fatal car crashes
A new Governors Highway Safety Association (GHSA) report has found increased rates of driving while under the influence of drugs as the cause of increased fatal car accidents over the past decade, as the Washington Post reports this week. The report finds that 40 percent of fatally injured drivers tested positive for drugs in 2013, compared to 29 percent in 2005. The report analyzed federal data from the National Highway Traffic Safety Administration (NHTSA), finding that driving under the influence of drugs has increased as a result of the proliferation of prescription medications and the legalization of marijuana. The GHSA recommends the NHTSA issue best practices on preventing marijuana-impaired driving in response to the report, concluding that “marijuana is by far the most common drug that is used… and found in fatally-injured drivers.”

Affordable Care Act amendment passes Senate, expects to be signed by President Obama
An amendment to the Affordable Care Act (ACA) was passed by the Senate lastweek and is expected to be signed by President Obama. The amendment (HR 1624) modestly adjusts the categorization of midsized employers under the ACA, allowing business with 51 to 100 workers to be placed into the large employer category, while providing States discretion to categorize them as small employers if they choose. The bill aims to prevent midsized employers from being forced to change coverage and absorb large premium increases associated with the small group marketplace. The bill additionally provides $205 million to “a Medicare improvement fund that was cut under the health law.”

Upcoming Events

IRETA announces webinar discussing substance use disorders in the military
The Institute for Research, Education & Training in Addictions (IRETA) announced a new webinar discussing substance use disorders in the military last week. The webinar will be held on October 14^th from 1-2PM EST. Ariel David, Project Coordinator of the Armed Services Network of Louisiana, will present on the aspects of substance use disorders unique to the military and the best practices used to address them. The webinar will also examine ways health care providers can be more productive when dealing with members of the military.

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.