News from NASADAD

• NASADAD attends briefing on the collateral consequences of addiction led by Senators Portman (R-OH), Whitehouse (D-RI), Ayotte (R-NH), and Klobuchar (D-MN)
• NASADAD submits comments to SAMHSA and CMS on State certified behavioral health clinic pilot

News from the States

• Statewide system reform program to expand the reach of Family drug courts

Around the Agencies

• CDC releases fact sheet on life-saving HIV care
• HHS reports 17% reduction in hospital-acquired conditions over three years
• SAMHSA releases report on Medicaid coverage for medications to treat substance use disorders

Upcoming Events

• December 10^th: Webinar on worker’s compensation and prescription painkiller misuse

News from NASADAD

NASADAD attends briefing on the collateral consequences of addiction led by Senators Portman (R-OH), Whitehouse (D-RI), Ayotte (R-NH), and Klobuchar (D-MN)

Rob Morrison, Executive Director and Colleen Haller, Public Policy Associate attended the December 2^nd forum hosted by Senators Sheldon Whitehouse (D-RI) and Rob Portman (R-OH) and attended by Senators Kelly Ayotte (R-NH) and Amy Klobuchar (D-MN). The forum included presentations by researchers, practitioners, individuals in recovery, and Members of Congress. The three highlighted topics were the science of addiction, addiction and the criminal justice system, and the collateral consequences of addiction through the lens of individuals in recovery. This is the third in a series of forums hosted by the two Senators to identify policy priorities for the next Congress related to prevention, treatment, and recovery for substance use disorders. The Senators introduced their bill, the Comprehensive Addiction and Recovery Act of 2014, during the fall and plan to re-introduce it in the next Congress. There are also efforts to introduce a companion bill in the House of Representatives.

NASADAD submits comments to SAMHSA and CMS on certified community behavioral health clinic pilot

NASADAD submitted comments to the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Medicare and Medicaid Services (CMS) regarding individual aspects of the certified community behavioral health clinic pilot project. In March of this year, Congress passed the Protecting Access to Medicare Act that, among other provisions, created a demonstration program to establish certified community behavioral health clinics that expand access to mental health and substance use disorder services and enhance Medicaid reimbursement for such services. Certification criteria must be published by September 2015, with the Substance Abuse and Mental Health Services Administration (SAMHSA) taking the lead. SAMHSA held a listening session on November 12th to seek public and stakeholder input on the criteria.

CMS also held a listening session to discuss the guidance that CMS is developing on how States can establish a prospective payment system for the clinics. Rick Harwood, Deputy Executive Director/Director of Research and Program Applications participated in both listening sessions and provided verbal comments, as well as written comments to both CMS and SAMHSA.

News from the States

Statewide system reform program to expand the reach of family drug courts

Five states have been selected to receive additional funding from the Department of Justice’s (DOJ) Office of Juvenile Justice and Delinquency Prevention (OJJDP) in order to expand the reach of their Family Drug Courts. The five states: Alabama, Colorado, Iowa, New York, and Ohio, will receive funding under the new Statewide System Reform Program (SSRP). This program aims to improve parental participation in substance abuse treatment, as well as build an effective framework for statewide Family Drug Court policies. The shift in focus from individual Family Drug Court innovation to a Statewide system will be critical in moving towards Family Drug Court expansion on a national level.

Around the Agencies

CDC releases fact sheet on life-saving HIV care

The Centers for Disease Control and Prevention (CDC) published a report on critical measures concerning HIV care. The CDC reported that viral suppression, or keeping a patient’s HIV levels low, is the most important factor in saving lives. However, viral suppression is achieved through HIV care, which only 4 in 10 Americans receive. 76% of patients who receive HIV care achieve viral suppression. The fact sheet provides steps towards achieving both HIV care and viral suppression, as well as expanded statistics on HIV care.

HHS reports 17% reduction in hospital-acquired conditions over three years

The Department of Health and Human Services (HHS) reports that the rate of hospital-acquired conditions declined 17% between 2010 and 2013, saving an estimated 50,000 lives and $12 billion. The report focuses on nine conditions of interest, including adverse drug effects and bloodstream infections. These nine conditions have both the highest costs and inpatient mortality rates per patient. Additionally, The American Hospital Association’s (AHA) Health Research & Educational Trust (HRET) has provided tools and resources for tracking improvements in hospital care. HRET has also trained over 2,500 hospital staff on improved care practices for the nine conditions of interest.

SAMHSA releases report on Medicaid coverage for medications to treat substance use disorders

The report, “Medicaid Coverage and Financing of Medications to Treat Alcohol and Opioid Use Disorders,” was released by the Substance Abuse and Mental Health Services Administration (SAMHSA) in November. The report provides information about Medicaid coverage for medication-assisted treatment (MAT) for alcohol and opioid dependence, as well as information on cost effectiveness and treatment outcomes. Innovative approaches from Vermont, Massachusetts, and Maryland are also included. Check out NASADAD’s statement on MAT.

Upcoming Events

December 10^th: Webinar on workers’ compensation and prescription painkiller misuse

The National Safety Council (NSC) will host a webinar on Wednesday, December 10^th at 3:00pm EDT. The webinar, titled “Workers’ Compensation: Managing Prescription Painkiller Misuse,” will cover the impact of painkiller misuse on claiming workers’ compensation claims as well as how managers can improve their prescription drug monitoring program. While prescription painkillers are often used to treat injured workers, misuse often increases cost and recovery time. The NSC will discuss these effects and what providers are doing to address this issue.

News from NASADAD

• NASADAD releases section-by-section analysis of overdose legislation by Senator Markey (D-MA)
• NASADAD releases section-by-section analysis of IMD legislation by Representative Fudge (D-OH)
• NASADAD attends Capitol Hill briefing on opioid use during pregnancy
• NASADAD signs on to a letter recognizing the importance of federal research funding

News from the States

• OhioMHAS releases November e-update

Around the Agencies

• Medicaid.gov expands and improves

Upcoming Events

• November 24^th:  Webinar on HIV and enrollment in the health insurance marketplace
• December 9^th: Webinar on screening and assessment for family engagement and retention

News from NASADAD

NASADAD releases section-by-section analysis of overdose legislation by Senator Markey (D-MA)

The legislation, the Opioid Overdose Reduction Act of 2014, S. 2092, was introduced by Sen. Edward Markey (D-MA) and co-sponsored by Sens. Kelly Ayotte (R-NH), Jay Rockefeller (D-WV), and Tim Kaine (D-VA). The legislation would extend civil liability protections to health care professionals who provide or prescribe naloxone, to individuals who distribute naloxone from an overdose prevention program, and to individuals who administer naloxone. State laws that are inconsistent with the above mentioned civil liability protections would be preempted, though State laws that provide additional protections would not. The legislation also provides a mechanism for States to opt out of its provisions.

NASADAD releases section-by-section analysis of IMD legislation by Representative Fudge (D-OH)

The legislation, the Breaking Addiction Act of 2014, H.R. 5136, was introduced by Rep. Marcia Fudge (D-OH) and originally co-sponsored by Reps. Tim Ryan (D-OH), Elijah Cummings (D-MD), Barbara Lee (D-CA), Eleanor Holmes Norton (D-DC), Cedric Richmond (D-LA), Alcee Hastings (D-FL), and Yvette Clarke (D-NY). The legislation would expand community treatment options by creating a 5-year demonstration project waiving the Institutions for Mental Diseases (IMD) Exclusion for those suffering from substance abuse. The IMD Exclusion originated in the 1965 Medicaid statute and 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 has been included in subsequent enacting legislation, thereby banning Medicaid reimbursement for residential treatment centers with more than 16 beds, which constitute a significant proportion of all residential treatment providers for substance use disorders. This makes it difficult for Medicaid beneficiaries to receive the residential substance use treatment services they need. When the pilot is completed, the bill directs the Secretary of the U.S. Department of Health and Human Services (HHS) to prepare a report to evaluate the impact of the program on a range of health care issues including costs, access to care, re-admissions, and emergency care.

NASADAD attends Capitol Hill briefing on opioid use during pregnancy

Shalini Wickramatilake-Templeman, Research Analyst attended the briefing, “Drug Exposure in Mothers and Newborns: Addressing Neonatal Abstinence Syndrome,” hosted by the March of Dimes Birth Defects Foundation (MDBDF) on November 19^th. The briefing featured remarks by Rep. Steve Stivers (R-OH) and Rep. Katherine Clark (D-MA) who co-sponsored the Coordinated Recovery Initiative for Babies (CRIB) Act which was introduced in June and seeks to increase research at the federal level on neonatal abstinence syndrome (NAS), including identification, treatment, and surveillance. Jennifer Conklin from Sen. Mitch McConnell’s (R-KY) office also provided remarks about a similar piece of legislation the Senator introduced called the Protecting Our Infants Act. Jessica Young of the American Congress of Obstetricians and Gynecologists (ACOG) gave an overview of NAS and the negative effects of punitive measures against pregnant women who use opioids, both medically and non-medically. Dr. Cecilia Spitznas of the Office of National Drug Control Policy (ONDCP) presented on ONDCP efforts related to NAS and Dr. Mark Hudak of the American Academy of Pediatrics provided an overview of the current body of research on NAS, including variability in symptoms and treatment options.

NASADAD signs on to a letter recognizing the importance of federal research funding

NASADAD was one of over 300 groups that signed on to a letter urging Congress to prioritize fiscal year 2015 budget appropriation legislation. The letter, published on November 12^th, 2014, was put together by the Ad Hoc Group for Medical Research and expressed the importance of bipartisan action to pass final, omnibus spending legislation by the end of the year. The omnibus, the group writes, should include appropriations that restore funding for the National Institutes of Health (NIH) to pre-sequestration levels. The group mentioned the importance of the research conducted and funded by NIH, and wrote that only through restored funding could NIH continue their record of excellence. NASADAD priority programs with NIH include the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

News from the States

OhioMHAS releases November e-update

The Ohio Department of Mental Health and Addiction Services (OhioMHAS) has released their November 2014 e-Update. The update includes a series of stories detailing Ohio’s progress in addiction and mental health services, beginning with a $10 million increase in funding for addiction recovery housing. Additionally, the update discusses the recent grant awarded to the University of Cincinnati to continue combating Hepatitis C among needle users. Finally, the update provides links to research publications, recent studies, and national news.

Around the Agencies

Medicaid.gov expands and improves

In time for the 2015 open enrollment period, Medicaid.gov has announced several improvements to the Medicaid website. The improved website is more streamlined, modern, and accessible. This means that consumer resources are more easily available through a Consumer Action page. Additionally, the Medicaid Moving Forward section has been remodeled to provide information about both Medicaid and the Children’s Health Insurance Program (CHIP). This section is coupled with expanded Medicaid and CHIP profiles for each state.

Upcoming Events

November 24^th:  Webinar on HIV and enrollment in the health insurance marketplace

The US Department of Health and Human Services (HHS) will host a webinar on Monday, November 24^th, 2014 from 2:00-2:45pm EST. The webinar, titled “Toward an AIDS-free Generation: Healthcare Outreach and Enrollment for People Living with HIV,” will discuss the critical relationship between the 2015 open enrollment period and the needs of the HIV community. This webinar, designed for service providers and community-based organizations, will also focus on the role of the Affordable Care Act in implementing the National HIV/AIDS Strategy and Viral Hepatitis Action Plan.

December 9^th: Webinar on screening and assessment for family engagement and retention

The New England Addiction Technology Transfer Center (ATTC) Network will host a webinar on Tuesday, December 9^th, 2014 from 1:00-2:30pm EST. The webinar will focus on effective strategies and practices for working with families with substance use disorders. This is the second webinar that will focus on screening and assessment targeted towards family engagement and retention. It will also explore effective methods of substance abuse treatment for parents at both a practice and systems level. Panelists will discuss the importance of expanding collaboration between States and stakeholders.

Initial Review of Elections: Republicans Capture Senate, Expand Majority in House – 3 Senate Races Remain Undecided

As you know, voters took to the polls on Tuesday, November 4^th and paved the way for a change in party leadership in the Senate and an expanded Republican majority in the House. Three Senate races, in Alaska, Louisiana, and Virginia are still being decided. In terms of Governors’ races, voters in a majority of States (31 vs. 17) elected Republican chief executives, with two additional races undecided.

We have drafted some supplemental materials that detail results from all of the Governor and Senate races, in addition to information about key Congressional Committees that have an impact on NASADAD priorities.

Senate

• Appropriations, Subcommittee on Labor, Health and Human Services, Education, and Related Agencies
• Health, Education, Labor and Pension (HELP) Committee
• Judiciary Committee

House of Representatives

• Appropriations, Subcommittee on Labor, Health and Human Services, Education, and Related Agencies
• Appropriations, Subcommittee on Commerce, Justice, Science, and Related Agencies
• Energy and Commerce, Subcommittee on Health

The Committees listed above have a direct role in the appropriations process and have jurisdiction over key issue areas of concern to the Association.

Over the next few days, NASADAD Public Policy staff will continue to review other Committee changes, including changes in Chairmanships and other leadership positions. In addition, we plan to review this information and provide additional updates during the next All States Public Policy call on Friday, November 14^th at 4 pm EST.

Current Breakdown of House and Senate Membership

Currently the Senate has 52 Republicans, 43 Democrats, 2 Independents (both caucus with the Democrats), and 3 undecided races in Alaska, Louisiana, and Virginia. Alaska incumbent Mark Begich (D-AK) is currently trailing challenger Dan Sullivan (R) as the remaining ballots are counted. Neither Louisiana Democrat Mary Landrieu nor challenger Bill Cassidy (R) received the required 50% of the vote – a runoff election will be held in January. Finally, in Virginia, Incumbent Mark Warner (D-VA) has a narrow lead over challenger Ed Gillespie (R-VA). Given the close result, Mr. Gillespie has not ruled out a recount.

In the House, there are 243 Republicans and 179 Democrats, with 13 races still undecided.

Key Changes: Committee Leadership vs. “Rank and File” Members

Generally speaking, there were relatively few changes in the “rank and file” make-up of the key Committees of interest to NASADAD. However, there will be significant changes in the leadership of some of the Committees.

There is no precise method of predicting how Chairmanships will be assigned. On the Senate side, Chairmanships are often, though not exclusively, determined by seniority. In contrast, the process in the House is somewhat less clear. Seniority is certainly a factor, though there is also some degree of jockeying between Chairmanships. House Republican leaders also self-imposed a 6 year term limit on their Chairmanships. This means that in addition to election results, Chairmen/Chairwomen whose term has expired may switch Chairmanships, taking leadership positions in completely different Committees. House Republicans will take an anonymous vote to elect the new leadership for Committee vacancies.

The following updates include potential candidates for leadership positions; however, we cannot confirm any of the positions until they are made public. We will continue to update the members as more information becomes available.

One constant for the full House Appropriations Committee is the Chairmanship of Rep. Hal Rogers (R-KY). Rogers is expected to maintain his role as Chairman of the Committee and continue his work to support work on issues related to addiction in general and the opioid problem in particular.

The House Appropriations Subcommittee on Labor, HHS, Education, and Related Agencies will see a change in Chairmanship. Chairman Jack Kingston (R-GA) unsuccessfully ran for Georgia’s Senate seat, giving up his seat in the House of Representatives. House leadership has not announced who the new Chairperson will be, although Vice Chairman Steve Womack (R-A) may be a potential candidate. Rank and file membership will likely not change, with the possible exception of Rep. Mike Honda (D-CA), whose race is still too close to call.

This Appropriations Subcommittee has jurisdiction over the budgets for the Departments of Labor, Education, and Health and Human Services (HHS). This includes funding for the Substance Abuse and Mental Health Services Administration (SAMHSA), Centers for Disease Control and Prevention (CDC), and National Institutes of Health (NIH). In March, NASADAD presented testimony to this Subcommittee to provide recommendations on FY 2015 funding for SAMHSA, including the Substance Abuse Prevention and Treatment (SAPT) Block Grant; the National Institute on Drug Abuse (NIDA); and the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

The House Appropriations Subcommittee on Commerce, Justice, Science, and Related Agencies will also see a change in Chairmanship. Chairman Frank Wolf (R-VA) lost his reelection bid to Barbara Comstock (R). House leadership has not indicated who the new Chairperson will be, although Vice Chairman Robert Aderholt (R-AL) may be considered. Rank and file membership will likely not change, with the possible exception of Rep. Mike Honda (D-CA), whose race is still too close to call.

This Appropriations Subcommittee has jurisdiction over the budgets of the Department of Commerce and Department of Justice (DOJ), in addition to federal science policy. This includes funding for DOJ programs like the Hal Rogers Prescription Drug Monitoring Program (PDMP), drug courts, and others. Chairman Wolf demonstrated intense interest in addiction issues, calling a series of hearings to explore substance use disorder programming within the Department of Justice (DOJ).

The House Energy and Commerce Subcommittee on Health will see a number of changes in the rank and file membership. On the Republican side, Rep. Mike Rogers (R-MI) retired from Congress, Rep. Phil Gingrey (R-GA) did not seek reelection to unsuccessfully pursue Georgia’s Senate seat, and Rep. Bill Cassidy (R-LA) did not run for reelection and will be competing for Louisiana’s Senate seat in a runoff election to be held in January. Four Democrats from this Committee will not be returning to the chamber: Rep. John Dingell (D-MI) announced his retirement after serving for more than 58 years, Rep. Jim Matheson (D-UT) did not seek reelection, Rep. John Barrow (D-GA) lost his reelection bid to Rick Allen (R), and Rep. Henry Waxman (D-CA) did not seek reelection. Chairman Joe Pitts (R-PA) was reelected to Congress and there have been no announced changes to his leadership position.

This Subcommittee has jurisdiction over health related issues, including portions of Medicaid, Medicare, programs authorized under the Public Health Service Act, and more – this includes SAMHSA. Rep. Tim Murphy’s (R-PA) widely discussed bill, the Helping Families in Mental Health Crisis Act (H.R. 3717), was referred to this Subcommittee for consideration. The legislation touches a variety of issues including patient privacy, court-ordered community treatment, reauthorization of mental health courts, and a significant reorganization of the Substance Abuse and Mental Health Services Administration (SAMHSA). There has been some discussion about breaking Rep. Murphy’s bill into multiple bills so that less controversial provisions could be voted on individually, though Rep. Murphy remains committed to passing the comprehensive bill.

The Senate Appropriations Subcommittee on Labor, HHS, Education, and Related Agencies will see significant leadership changes. Chairman Tom Harkin (D-IA) retired from the Senate, leaving his position open in addition to the change in majority leadership. Ranking Member Jerry Moran (R-KS) is a likely choice to become Chairman, with Sen. Patty Murray (D-WA) likely to become Ranking Member. Sen. Mark Pryor (D-AR), a member of the Subcommittee, lost reelection to Tom Cotton (R). While the Republican membership will likely grow, Democratic membership on all of the Senate committees will likely be reduced, so Sen. Pryor will likely not be replaced on the Subcommittee.

This Subcommittee is the Senate companion to the House Subcommittee of the same name. It has jurisdiction over the budgets for the Departments of Labor, Education, and Health and Human Services (HHS), which includes SAMHSA.

The Senate Health, Education, Labor, and Pension (HELP) Committee will also see significant leadership changes. Sen. Tom Harking (D-IA) was also Chairman of the HELP Committee. Ranking Member Lamar Alexander (R-TN) is a likely candidate for the Chairmanship. Sen. Barbara Mikulski (D-MD) or Sen. Patty Murray (D-WA) will likely become Ranking Member. The only rank and file change will be Sen. Kay Hagan (D-NC), who lost her reelection bid to Thom Tillis (R). Similar to above, Sen. Hagan will likely not be replaced on the Committee.

The HELP Committee, like its name, has jurisdiction over issues related to health, education, and labor. Statues related to SAMHSA, including reauthorization, and other HHS programs fall under this Committee’s jurisdiction. Committee also looks at other issues including public health, biomedical research and development, individuals with disabilities, and much more. The Committee has held a number of listening sessions regarding potential action related to the opioid problem. This includes considerations of a number of bills, including legislation to reauthorize the National All Schedules Prescription Electronic Reporting (NASPER) Act, Senator Markey’s (D-MA) bill to change prescriber limits for buprenorphine, and many others.

The Senate Judiciary Committee did not have any changes in membership due to the election. However, Chairman Patrick Leahy (D-VT) will likely become Ranking Member and Ranking Member Chuck Grassley (R-IA) will likely assume the Chairmanship. There will likely be reductions in the nine Democratic members of this Committee.

This Committee has jurisdiction over statues related to criminal justice issues, oversees the Office of National Drug Control Policy (ONDCP), and conducts hearings on federal judges and other presidential nominees before they are considered by the entire Senate. The Committee also reviews legislation for the Department of Justice (DOJ) programs, including the Second Chance Act. The Committee still may consider (this year) the nomination of Michael Botticelli to serve as the Director of ONDCP. Further, there is a chance that the Judiciary Committee will take action on the Comprehensive Addiction and Recovery Act of 2014 (S. 2839), introduced by Sens. Whitehouse (D-RI) and Portman (R-OH). This action could take the form of a hearing or a formal mark-up of the bill.

Looking Forward: Wrapping Up the 113^th Congress and Clearing the Way for the 114^th

A good deal of work remains for the 113^th Congress, both in terms of budget appropriations and leadership selections.

First, the 113^th Congress must finish its business when they return from the elections. This includes FY 2015 appropriations work. The current continuing resolution that was passed this fall to postpone budget discussions until after the elections expires on December 11^th. Congress must either pass a budget resolution, outlining the scope of the federal FY 2015 budget or pass another continuing resolution to further postpone negotiations until after the new Congress has been sworn in.

Second, party leadership will also adjust as a result of the elections. Sen. Harry Reid (D-NV), current Majority Leader in the Senate, is expected to run for Minority Leader. He does not appear to have any significant opposition at this point. Sen. Mitch McConnell (R-KY) will likely be elected Majority Leader, although some members of his caucus have expressed doubts about his leadership. We do not expect major changes in House leadership. Committee Chairmanships will likely shift, as we have outlined above.

NASADAD will continue to monitor new developments and provide updates to the membership as they occur.