News from the States

• Maryland Court of Appeals rules that adults providing alcohol to underage drinkers responsible for associated deaths and injuries

Around the Agencies

• ASPE issues report examining the effects of the Affordable Care Act’s Medicaid Expansion in 2014 and 2015
• Obama Administration issues final rule on MAT for opioid use disorders
• CDC issues report examining the relationship between methadone sales, diversion, and overdose deaths

In the News

• Obama Administration issues final rule on MAT for opioid use disorders
• House of Representatives passes Comprehensive Addiction & Recovery Act (CARA)
• Helping Families in Mental Health Crisis (H.R. 2646) passes House of Representatives
• National Governors Association releases opioid road map detailing State efforts to combat opioid epidemic
• Legal Action Center releases guide detailing federal mental health and substance use disorder parity law
• Ellen Weber rejoins Legal Action Center to serve as Vice President for Health Initiatives

 

News from the States

Maryland Court of Appeals rules that adults providing alcohol to underage drinkers responsible for associated deaths and injuries
Maryland’s Court of Appeals has issued a ruling holding adults who provide alcohol to underage drinkers responsible for any deaths and injuries that occur as a result. The ruling follows several years of deliberation by the Maryland General Assembly on how to penalize adults who hold parties and supply alcohol to underage drinkers. The court stated that, “Children under 21 are often less able to make responsible decisions regarding the consumption of alcohol and, as a result, are more susceptible to harming themselves or others when presented with the opportunity to drink . . . The adult increases the risk of harm to themselves and others by facilitating the improper conduct of another.” This is the first time the Maryland Court of Appeals has addressed “social host liability”—referring to individuals who negligently serve alcohol. Maryland’s legislature passed a bill increasing fines and jail time for adults providing alcohol to underage drinkers last May.

Read more about this story here.

Around the Agencies

ASPE issues report examining the effects of the Affordable Care Act’s Medicaid expansion in 2014 and 2015
Last month the Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a report examining the effects of the Affordable Care Act’s (ACA) Medicaid expansion. The report is broken down into four sections: 1) examining the evidence to date on the impact of Medicaid expansion on health insurance coverage; 2) exploring the impact on beneficiaries by examining access to care and utilization; 3) examining research to date on affordability; and 4) examining quality including enrollee financial well-being, satisfaction and experience. Key findings include that Medicaid expansion States experienced a 9.2 percent reduction in the number of uninsured adults, compared to a 7.9 percent reduction in non-expansion States. ASPE’s report also finds that Medicaid expansion has increased access to primary care and prescription medicine, and that low-income adults reporting problems paying medical bills declined by 10.5 percent, from 34.7 percent pre-expansion to 24.2 percent post-expansion.

Read the full report here.

CDC issues report examining the relationship between methadone sales, diversion, and overdose deaths
The Centers for Disease Control and Prevention (CDC) issued a report last week examining the relationship between methadone sales, diversion, and overdose deaths. The report, published in the CDC’s Morbidity and Mortality Weekly Report (MMWR), highlights the study performed by Dr. Chris Jones, Director of the Division of Science Policy in the Office of the Assistant Secretary for Planning and Evaluation (ASPE) within HHS. The report’s main findings include that methadone overdose rates for most demographics peaked between 2005 and 2007 before declining in subsequent years. The observed decline in methadone overdose rates is suggested to be a result of national and State actions reducing the use of methadone in pain treatment. The report concludes that methadone-related harms may be further reduced by implementing additional clinical guidelines restricting the use of methadone for pain, increasing the use of care coordination plans, and strengthening public health policies for pain management.

Read the full report here.

In the News

Obama Administration issues final rule on MAT for opioid use disorders

Last week the Administration released its final rule on Medication-Assisted Treatment for Opioid Use Disorders, which allows eligible practitioners to request approval to treat up to 275 patients. Before being able to treat 275 patients, qualified practitioners must undergo a one year trial period where they are only allowed to treat a maximum of 30 patients at a time.

The final rule can be found here.

House of Representatives passes Comprehensive Addiction & Recovery Act (CARA)
The House of Representatives passed the conference report for the Comprehensive Addiction & Recovery (CARA; S. 524) with a vote of 407-5 on Friday afternoon. During floor statements preceding the vote, House Democrats reiterated the need for funding to address the opioid crisis, but ultimately showed support for the bill and indicated the need for resources to be allocated through the regular appropriations process. The bill now requires a vote by the Senate. Senate Majority Leader Mitch McConnell (R-KY) has indicated that he hopes to hold a vote on the conference report before adjourning for recess this week.

As a reminder, the bill includes the following provisions that NASADAD has been tracking throughout the legislative process, among many others:

• Evidence-Based Prescription Opioid and Heroin Treatment and Interventions Demonstration: The bill authorizes a grant within CSAT for State substance abuse agencies, local governments, nonprofit organizations, and tribes to support treatment for opioid use disorders where medication-assisted treatment is an allowable use of funds.  This mirrors the current CSAT “MAT-PDOA” grant. For the current fiscal year, the MAT-PDOA grant is receiving $25 million.  The President proposed $50 million for FY 2017, and the Senate Appropriations has proposed $60 million in FY 2017.  However, in the conference report, there is only an authorization of appropriations of $25 million (level with FY 2016). NASADAD expressed the importance of authorizing this program for at least $60 million in CARA (to align with Senate Appropriations Committee’s recommendation), but NASADAD will continue to track the appropriations process as it relates to MAT-PDOA and other priority programs.

• Improving Treatment for Pregnant and Postpartum Women: This provision reauthorizes the residential services for pregnant and postpartum women program (PPW) grant program within SAMHSA’s Center for Substance Abuse Treatment (CSAT).  This program supports family-centered substance use disorder services for women and young children in residential settings. This provision would also create a pilot program for State substance abuse agencies to use up to 25 percent of funds for services to pregnant and parenting women in non-residential settings. The purpose of the pilot program is to spur innovation and fill gaps in family-centered services across the continuum of care.  The legislation would require SAMHSA to lead a process in which State substance abuse agencies, experts in addiction services, and others would meet to develop the new application for the pilot program. A section-by-section summary of the bill as originally introduced can be found here.

The conference report language includes the House “trigger” language, in which the pilot program would not move forward unless funding for the PPW program is above the FY 2016 level ($15.9 million). The conference report would authorize $16.9 million for FY 2017 through FY 2021. Language has also been added that would give award prioritization for the residential services grant program to programs serving rural areas, areas with a health professional shortage, and areas with a shortage of family-based treatment options. Additionally, language has been added that would require the report to Congress on outcomes of the pilot program to also include a recommendation by the Director of CSAT as to whether the pilot program should be extended beyond 5 years.

• Opioid Use Disorder Treatment Modernization (Buprenorphine Prescribing): Prior to finalizing the conference report, the House and Senate had markedly different proposals regarding the buprenorphine patient limit cap. The House version would have allowed physician assistants (PAs) and nurse practitioners (NPs) to prescribe for three years, and  included a non-binding “Sense of the Congress” that the cap should be raised to 250. The Senate version would permit PAs and NPs to prescribe with no time limit, and it proposed raising the cap to 500 patients, but would require physicians to (1) participate in the State’s PDMP; (2) completed 24 hours of training; (3) maintain records on whether on-site counseling services are provided and the extent such services are provided; the extent to which practitioners refer patients to counseling services off-site and the percentage of patients using such services; the number of times patients terminate services against medical advice; and other data.

The language included in the conference report does not change the current bupe cap of 100 (30 in the first year), but it does include language stating that the Secretary of HHS may change the cap by regulation. The conference report also amends the Controlled Substances Act by adding to the category of “qualifying practitioner” a nurse practitioner who had some nursing courses or physician assistant who satisfies various criteria.

Helping Families in Mental Health Crisis (H.R. 2646) passes House of Representatives
The House of Representatives passed the Helping Families in Mental Health Crisis Act (H.R. 2646) by Rep. Tim Murphy (R-PA) last week with a vote of 422-2. Some of the provisions in the bill that impact the substance use disorder field include: 1) the creation of an Assistant Secretary for Mental Health and Substance Use Disorders, who would assume all the authorities of the SAMHSA Administrator; 2) establishment of a National Mental Health and Substance Use Policy Laboratory that would assume the authorities of the Office of Policy, Planning, and Innovation (OPPI); and 3) amending the section of the Public Health Service Act that authorizes the Center for Substance Abuse Treatment (CSAT) to use “substance use disorders” instead of “substance abuse,” and to incorporate person-first language where appropriate.

National Governors Association releases opioid road map detailing State efforts to combat opioid epidemic
The National Governors Association (NGA) released a resource detailing State efforts to combat the opioid epidemic last week. The resource, titled “Finding Solutions to the Prescription Opioid and Heroin Crisis: A Road Map for States,” aims to help officials determine new policies to address the opioid epidemic in their own States by providing background information on the epidemic, steps to address the crisis, and a summary of evidence-based health care and public safety strategies to reduce the prevalence of opioid misuse and overdose. The resource also includes an appendix containing State data sources and sample State plans for addressing the opioid epidemic.

The NGA plans to continue discussing next steps for addressing the growing prevalence of opioid overdoses at their upcoming Summer Meeting held in Des Moines, IA between July 14^th and July 17^th. Health and Human Services (HHS) Secretary Sylvia Burwell will attend the meeting to discuss State strategies.

Access the opioid road map here.

Access more information about the NGA’s Summer Meeting here.

Legal Action Center releases guide detailing federal mental health and substance use disorder parity law
The Legal Action Center released a new guide exploring the Mental Health Parity and Addiction Equity Act (MHPAEA) last month. The guide, titled “Health Insurance for Addiction & Mental Health Care: A Guide to the Federal Parity Law” aims to provide a summary of federal parity law and the protections it affords. The Legal Action Center’s guide provides a list of “red-flags” indicating than an insurer may be violating the law, and helps educate consumers about their health insurance coverage plan.

Read more, and download the guide here.

Ellen Weber rejoins Legal Action Center to serve as Vice President for Health Initiatives
The Legal Action Center announced that Ellen Weber, who previously worked at the Legal Action Center from 1985 to 2002, will be rejoining the organization as of July 5^th to serve as Vice President for Health Initiatives. Ms. Weber will focus on the Mental Health Parity and Addiction Equity Act’s (MHPAEA) enforcement – as well as State-based health insurance support and other national health care policies. Since her previous time at the Legal Action Center, Ms. Weber has served on the faculty of the University of Maryland Carey School of Law, where she directed the school’s Drug Policy and Public Health Strategies Clinic. Throughout the next year, Ms. Weber plans to continue to work on Maryland health care initiatives in collaboration with the Open Society Institute-Baltimore as a part-time Carey Law School faculty member.

Read the full story here.

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.

News from NASADAD

• NASADAD releases updated summary of FY 2017 appropriations for NASADAD’s priority programs
• NASADAD Annual Meeting slides now available on website

News from the States

• Ohio Governor John Kasich signs Good Samaritan law protecting those seeking medical help for overdoses

Around the Agencies

• SAMHSA reintroduces the Substance Abuse and Mental Health Data Archive
• FDA approves buprenorphine implant for treatment of opioid use disorders
• HHS releases fact sheet on the opioid epidemic
• HHS details objectives of its Mental Health and Substance Use Disorder Parity Task Force
• NIH study reveals the role of endocannabinoids in habit forming behavior
• CDC releases results from the 2015 National Youth Risk Behavior Surveillance System Survey
• NIH study finds rates of nonmedical prescription opioid use and opioid use disorders have doubled in the past decade

In the News

• Senate names Conferees for Comprehensive Addiction and Recovery Act (CARA)
• Vera Institute of Justice releases report summarizing State trends in sentencing and corrections from 2014-2015
• Pew Charitable Trusts report discusses growing prevalence of “sober dorms” in universities
• New report on strategies for utilizing MAT within drug courts

Upcoming Events

• Ramstad-Kennedy Award Nominations Due July 8^th

News from NASADAD

NASADAD releases updated summary of FY 2017 appropriations for NASADAD’s priority programs
NASADAD has updated its summary of FY 2017 appropriations for NASADAD’s priority programs within the Department of Health and Human Services (HHS) and the Department of Justice (DOJ). The updated summary now contains language from the Senate Appropriations Committee’s report, as well as both Senate and House report language for programs housed within DOJ. For FY 2017, the Senate Appropriations Committee recommends level funding of $1.8 billion for the Substance Abuse Prevention and Treatment (SAPT) Block Grant, a $14 million increase for the Center for Substance Abuse Prevention (CSAP), and an increase of $2.6 million for the Center for Substance Abuse Treatment (CSAT).

Read the full summary here.

NASADAD 2016 Annual Meeting slides now available on website
NASADAD has uploaded slides from the presentations at the 2016 Annual Meeting in Salt Lake City, Utah onto our website. Plenary session topics included: Federal Initiatives on the Opioid Epidemic, SAMHSA/State Efforts to Prevent Opioid Misuse and Overdose, Substance Use Disorder Services for Women and the Family, SSAs in Criminal Justice Reform, Pathways to Recovery Housing, SAMHSA Key Initiatives, Role of the SAPT Block Grant in non-Medicaid Expansion States, and Role of the SAPT Block Grant in Medicaid Expansion States.

Access the slides here.

News from the States

Ohio Governor John Kasich signs Good Samaritan law protecting those seeking medical help for overdoses
Ohio Governor John Kasich has signed a Good Samaritan law, which will provide immunity from arrest, prosecution, or conviction to individuals seeking medical help as a result of a drug overdose. The bill (HB 110) also requires emergency medical services to “report the administration of naloxone on request of a law enforcement agency in specified circumstances and for specified purposes.”

Read more about the legislation here.

Around the Agencies

SAMHSA reintroduces the Substance Abuse and Mental Health Data Archive
The Substance Abuse and Mental Health Services Administration (SAMHSA) reintroduced the Substance Abuse and Mental Health Data Archive (SAMHDA) late last month. The enhanced SAMHDA website provides centralized access to several public use databases related to substance use disorders, including the National Survey on Drug Use and Health (NSDUH) and the Treatment Episodic Data Set – Admissions (TEDS-A). SAMHSA plans to continue updating the archive throughout this year by adding an online analysis tool in late summer 2016 and providing approved researchers access to restricted-use data in early winter 2016.

Access the SAMHDA website here.

FDA approves buprenorphine implant for treatment of opioid use disorders
The U.S. Food and Drug Administration (FDA) has approved the first buprenorphine implant for the treatment of opioid use disorders. The implants, named Probuphine, “provide constant, low-level doses of buprenorphine to patients who are already stable on low-to-moderate doses of other forms of buprenorphine, as part of a complete treatment program.” Probuphine is administered through the surgical implantation of four, one-inch rods under the skin of the patient’s inside upper arm. The unique nature of the implants requires specific training through the Probuphine Risk Evaluation and Mitigation Strategy (REMS) program administered by the FDA.  Clinical trials examining the effects of Probuphine demonstrated the implants’ success, with 63 percent of Probuphine-treatment patients exhibiting no signs of illicit opioid use throughout the six month treatment period.

Read the full story here.

HHS releases fact sheet on the opioid epidemic
The Department of Health and Human Services (HHS) has released a fact sheet on the opioid crisis. The fact sheet features several maps displaying drug overdose and opioid misuse rates throughout the United States, stating that the opioid epidemic has a $55 billion impact on health and social costs each year. The fact sheet goes on to evaluate and discuss next steps for HHS’s opioid initiative. While HHS successfully designed several grant programs to aid States most acutely affected by the opioid epidemic, the fact sheet notes that more work remains.

Read the full fact sheet here.

HHS details objectives of its Mental Health and Substance Use Disorder Parity Task Force
The Department of Health and Human Services (HHS) detailed the objectives of its Mental Health and Substance Use Disorder Parity Task Force on its webpage earlier this month. The Task Force was created in March 2016 via a memorandum signed by President Obama. The Task Force’s objectives include increasing the awareness of protections provided by federal mental health and substance use disorder parity laws, improving the understanding of parity among health plans, insurers, and State regulators, and increasing the transparency around compliance with parity. The White House Domestic Policy Council, the Department of the Treasury, the Department of Defense, the Department of Justice, the Department of Labor, the Department of Health and Human Services, the Department of Veterans Affairs, the Office of Personnel Management, and the Office of National Drug Control Policy comprise the Task Force. The Task Force will submit its findings in a report to the White House by October 31, 2016.

Read more about the Mental Health and Substance Use Disorder Parity Task Force here.

NIH study reveals the role of endocannabinoids in habit forming behavior
A study published by the National Institutes of Health earlier this month reveals the relationship between endocannabinoids and habit forming behavior. The study was conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in an effort to understand previously unknown brain functions that regulate habitual behaviors. The NIAAA’s study used mice to demonstrate that endocannabinoid receptors in the brain influence the prevalence of habit forming behavior. Mice with endocannabinoid receptors used habitual responses to obtain food rewards, while those with the endocannabinoid receptors removed used “goal-directed” responses instead. The authors of the study assert that it demonstrates “the existence of parallel brain circuits that mediate goal-directed and habitual behaviors,” and could explain how marijuana affects memory and decision making.

Read the full study here.

CDC releases results from the 2015 National Youth Risk Behavior Surveillance System Survey
The Centers for Disease Control and Prevention (CDC) released results from the 2015 National Youth Risk Behavior Surveillance System (YRBSS) survey last week. The YRBSS monitors a range of health risk behaviors among high school students at the national, State, and local levels by conducting surveys among representative samples every two years, with students in 37 different State and 19 large urban school districts participating in the 2015 survey. The results indicate that while current cigarette use has decreased from 28 percent in 1991 to 11 percent in 2015, e-cigarette use among high school students is on the rise, with 24 percent reporting use in the past 30 days. The survey further finds that high school students reporting past-month alcohol consumption has decreased from 50.8 percent in 1991 to 32.8 percent in 2015.

Read the full results here.

NIH study finds rates of nonmedical prescription opioid use and opioid use disorders have doubled in the past decade
A National Institutes of Health (NIH) study examining the rates of nonmedical prescription opioid use and opioid use disorders in the United States has found that both have nearly doubled in the past decade. The study, conducted by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), found that “10 million Americans, or 4.1 percent of the adult population, used opioid medications in 2013-2013 without a prescription or not as prescribed in the past year.” The study notes that this is an increase from the 1.8 percent reporting nonmedical use in 2001-2002. Over 2 million adults, or 0.9 percent of the adult population, reported symptoms of nonmedical opioid use disorder in 2012-2013.

Read more about the study here.

In the News

Senate names Conferees for Comprehensive Addiction and Recovery Act (CARA)
On June 16^th the Senate voted 95-1 in favor of going to conference on the Comprehensive Addiction and Recovery Act (CARA; S. 524). The Senate conferees will work with the House conferees to send the final version of the opioids bill to the President. Senate conferees include chairmen and ranking members from the Judiciary Committee [Sen. Grassley (R-IA) and Sen. Leahy (D-VT)]; the Health, Education, Labor and Pensions Committee [Sen. Alexander (R-TN) and Sen. Murray (D-WA)]; and the Finance Committee [Sen. Hatch (R-UT) and Sen. Wyden (D-OR)]; as well as Majority Whip John Cornyn (R-TX), and Sen. Jeff Sessions (R-AL). The House conferees include: Reps. Goodlatte (R-VA), Sensenbrenner (R-WI), Smith (R-TX), Marino (R-PA), Collins (R-GA), Trott (R-MI), Bishop (R-MI), Upton (R-MI), Pitts (R-PA), Lance (R-NJ), Guthrie (R-KY), Kinzinger (R-IL), Bucshon (R-IN), Brooks (R-IN), Barletta (R-PA), Carter (R-GA), Bilirakis (R-FL), Walorski (R-IN), Pallone (D-NJ) , Conyers (D-MI), Scott (D-VA) , McDermott (D-WA), Green (D-TX), Jackson Lee (D-TX), Courtney (D-CT), Cohen (D-TN), Sarbanes (D-MD), Luján (D-NM), Chu (D-CA), Esty (D-CT) , Kuster (D-NH), and Ruiz (D-CA).

During the vote, the Senate also approved a measure by Sen. Shaheen (D-NH) that instructs the conferees to insist that the final conference report include funding for the opioid crisis. There is no guarantee that the final report will include language related to funding, but Sen. Shaheen’s motion—which passed with a vote of 66-29—conveyed a message that funding is crucial for State and local prevention, treatment, and recovery efforts.

Vera Institute of Justice releases report summarizing State trends in sentencing and corrections from 2014-2015
The Vera Institute of Justice has released a report summarizing State trends in sentencing and corrections policy during 2014 and 2015. The report finds that 46 States made at least 201 changes to sentencing and corrections laws during this time, an increase over the 85 bills passed in 35 States in 2013. The Vera Institute reports that most of these 201 changes can be placed into three main categories: “1)creating or expanding opportunities to divert people away from entering the system; 2) reducing prison populations by making certain offenses eligible for community-based sentences, reducing the length and severity of custodial sentences, adding early release options, and reducing the number of people re-admitted for violating probations or parole; and 3) supporting reentry into the community for those leaving prison.”

View a summary of Vera’s report here.

Read Vera’s full report here.

Pew Charitable Trusts report discusses growing prevalence of “sober dorms” in universities
The Pew Charitable Trusts issued a report earlier this month discussing the growing prevalence of “sober dorms” in universities throughout the country. The article discusses the difficulties many college students face in maintaining recovery while attending college. More than 35 percent of American college students report having more than five drinks in one sitting in the past two weeks, compared to 29 percent of their non-college peers. In addition, “daily marijuana use among full-time college students has more than tripled in the past 20 years.” In response to this growing problem, States have begun passing legislation and creating programs facilitating the ability of students to live in “sober dorms” during their time at school. In 2014, New Jersey Governor Chris Christie signed a law requiring that all State colleges in New Jersey offer sober housing if at least one quarter of students reside on campus. The University of Vermont launched a similar program in 2010 through its Catamount Recovery Program for students in recovery. Other universities, while not creating sober housing, have begun investing in recovery initiatives to aid students in need.

Read the full report here.

New report on strategies for utilizing MAT within drug courts
The Center for Court Information, the Legal Action Center, and the New York State Unified Court System’s Office of Policy and Planning have released a new report discussing recommended strategies for the utilization of medication-assisted treatment (MAT) within drug courts. The report contains profiles of three New York State drug courts (each in a different region of the State), as well as nine components of successful MAT programs. These components include the provision of counseling and other services, strong relationships and regular communication with treatment programs, monitoring for the illicit use and diversion of MAT medication, and ensuring judges and court staff fully understand and rely on the clinical judgment of treatment providers. The report additionally highlights problems unique to drug courts located in rural areas.

Read the full report here.

Upcoming Events

Ramstad-Kennedy Award Nominations due July 8^th
The Ramstad-Kennedy Award was established in 2008 to recognize a Single State Authority (SSA) Director who has demonstrated outstanding leadership in support of recovery and National Recovery Month, and to acknowledge Congressmen Ramstad and Kennedy for their commitment to recovery and recovery-oriented policies. This year’s Ramstad-Kennedy award will be presented on August 10^th, 2016 at the 2016 SAMHSA National Block Grant Conference. Selection is based on the following criteria: a State Director who as provided outstanding leadership and innovation in promoting the goals of National Recovery Month in their State; strengthened and expanded Recovery Month activities within their agency and throughout other State agencies; provided support to strengthen and expand Recovery Month activities throughout their State; expanded the number and impact of National Recovery Month activities in their local communities; and encouraged and expanded recovery organizations in their State.

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.

News from the States

• Ohio launches naloxone public awareness campaign for counties experiencing high rates of fentanyl overdose
• Rhode Island Senate approves legislation addressing opioid crisis

In the News

• House of Representatives passes package of bills addressing opioid epidemic
• Poison control centers report increase in exposure to e-cigarettes among children
• Mathematica Policy Research highlights success of evidence-based treatment and the cost of excessive drinking in recognition of National Prevention Week
• Senate Judiciary Committee holds hearing on supporting youth in the foster care and juvenile justice systems

News from NASADAD

• NASADAD attends National Viral Hepatitis Roundtable briefing on ending hepatitis C

Legislation Related to Opioids

• House of Representatives passes package of bills addressing opioid epidemic

News from the States

Ohio launches naloxone public awareness campaign for counties experiencing high rates of fentanyl overdose
Ohio has launched a new public awareness campaign advocating for increased usage of naloxone in counties experiencing high rates of fentanyl overdoses. The campaign will focus on 15 counties that experienced 80 percent of Ohio’s fentanyl-related overdose fatalities in 2014. Family members and friends of individuals with opioid use disorders will be encouraged to obtain naloxone kits to reverse overdoses before first-responders arrive. The campaign will be supported by both the Ohio Department of Health (ODH) and the Ohio Department of Mental Health and Addiction Services (OhioMHAS), of which NASADAD member Tracy Plouck serves as Director. Fentanyl-related deaths have substantially increased in Ohio over the past several years, rising from 84 in 2013 to 503 in 2014.

Read the full press release here.

Rhode Island Senate approves legislation addressing opioid crisis
Last week the Rhode Island State Senate approved a series of bills addressing the opioid crisis. The bills were crafted in partnership with Governor Gina Raimondo’s Overdose Prevention and Intervention Taskforce. Legislators aim for the bills to deliver a more comprehensive approach to prevention and enhance the availability of substance use disorder treatment. The bills contain provisions requiring insurance companies to cover medication-assisted treatment medications, including methadone, buprenorphine, and naltrexone, as well as providing prescription coverage for opioid antagonists to family members and friends of individuals with opioid use disorders. Other provisions include the expansion of residential substance use disorder treatment and additional prescribing limits for pain medications used for acute pain. The bills now move to the Rhode Island House of Representatives.

Read more about the legislation here.

In the News

Poison control centers report increase in exposure to e-cigarettes among children
A new study conducted by the Center for Injury Research and Policy of the Research Institute and the Central Ohio Poison Center reports that poison control centers throughout the United States have observed an increase of calls related to e-cigarette exposure among children. Total number of e-cigarette exposures in children younger than 7 years old increased approximately 1,500 percent between 2012 and 2015, with ingestion of liquid nicotine being the most common form of exposure. Between 2012 and 2015, poison control centers received more than 29,000 calls related to e-cigarette and other tobacco exposure, with e-cigarettes accounting for 14 percent of the calls versus 60 percent for traditional cigarettes, and 16 percent of for other forms of tobacco. The researchers found that “young children exposed to liquid nicotine were more than five times more likely to be admitted to the hospital, and two-and-a-half times more likely to have a severe medical outcome, compared with children exposed to traditional cigarettes.”

Read the full story, and access the article here.

Mathematica Policy Research highlights success of evidence-based treatment and the cost of excessive drinking in recognition of National Prevention Week
Earlier this month Mathematica Policy Research highlighted two of its projects advancing substance use disorder awareness in recognition of National Prevention Week. The first study observed data from Mathematica’s national cross-site evaluation of Regional Partnership Grants (RPGs), which aim to strengthen families and treat substance use disorders.  Mathematica found that at time of enrollment, 35 percent of adults enrolled in RPG services had high levels of drug and alcohol use, with marijuana, amphetamines, and alcohol as the most commonly used substances. Nine percent of RPG-enrolled adults used heroin and 40 percent used other opiates.

The second study highlighted by Mathematica explores the cost of excessive drinking in the United States. High rates of drinking cost the United States almost $250 billion in 2010, with “two out of every five dollars paid for by the government, and three-quarters of the costs related specifically to binge drinking.” Mathematica goes on to discuss a November 2015 article published in the American Journal of Preventive Medicine finding that evidence-based prevention strategies may help reduce excessive drinking and its associated costs.

Read the full article here.

Senate Judiciary Committee holds hearing on supporting youth in the foster care and juvenile justice systems
The Senate Judiciary Committee held a hearing on supporting youth in the foster care and juvenile justice systems on Tuesday, May 17^th. Brian Denten, Public Policy Intern, attended the hearing. The hearing featured testimony from several public officials engaged in both foster care and juvenile justice systems at the State level. Witnesses stated that a lack of communication between foster care and the juvenile justice system remains commonplace throughout many states, making it difficult for systems to identify “crossover” foster youth that have been placed within the juvenile justice system. While some States have developed working practice models to address this lack of communication, problems continue to pervade both systems. Several witnesses advocated for the reauthorization of the Juvenile Justice and Delinquency Prevention act to ensure prevention and early intervention initiatives continue to receive funding.

Witnesses:

• Sonya Brown; New Orleans, LA
• Lisa Nelson; Juvenile Court Officer, Third Judicial District, State of Iowa
• Jeff Lind; Social Services Division Director, Beltrami County Health and Human Services, Bemidji, MN
• Macon Stewart; Senior Program Manager, Center for Juvenile Justice Reform, McCourt School of Public Policy, Georgetown University

News from NASADAD

NASADAD attends National Viral Hepatitis Roundtable briefing on ending hepatitis C
On May 23^rd, Brian Denten, NASADAD Public Policy Graduate Intern attended the briefing hosted by the National Viral Hepatitis Roundtable. The briefing featured several presentations from researchers working on ending hepatitis C and expanding access to hepatitis C medications to wider populations. Between 2013 and 2015, several hepatitis C medications were developed that effectively “cure” the disease for many individuals who properly adhere to the treatment regimen. Despite the success of this medication, insurance costs negatively affect adherence to treatment as many people find the mediation prohibitively expensive. Speakers highlighted the need to reform payment and financing options to ensure that individuals diagnosed with hepatitis C are able to begin treatment immediately before the more debilitating symptoms of the disease develop, stating that large cost savings may be realized from treating hepatitis C in this way. Hepatitis C has experienced an alarming rise in prevalence among young people as a result of the ongoing opioid crisis. CMS sent guidelines to State Medicaid agencies in November 2015 suggesting that agencies address the large costs of hepatitis C medications.

Speakers:

• Jay Bhattacharya, MD, PhD; Professor of Medicine at the Center for Primary Care and Outcomes Research Stanford University
• Ryan Clary; Executive Director, National Viral Hepatitis Roundtable
• Anupam Jena, MD, PhD; Associate Professor of Health Care Policy, Harvard Medical School
• Darius Lakdawalla, PhD; Quintiles Chair in Pharmaceutical Development and Regulatory Innovation, School of Pharmacy at the University of Southern California

Read the CMS guidance to State Medicaid agencies on hepatitis C medication here.

Legislation Related to Opioids

House of Representatives passes package of bills addressing opioid epidemic

On May 13^th, the House of Representatives voted 400 to 5 in favor of a package of bills designed to address the opioid crisis. On March 10^th, the Senate voted 94 to 1 in favor of the Comprehensive Addiction and Recovery Act (CARA).  A “conference committee” composed of House and Senate “conferees” shall be formed to iron out the many differences between the House opioids package and CARA. The Senate has not appointed conferees.  The House of Representatives has appointed the following conferees:

Rep. Bob Goodlatte (R-VA)
Rep. Jim Sensenbrenner (R-WI)
Rep. Lamar Smith (R-TX)
Rep. Tom Marino (R-PA)
Rep. Doug Collins (R-GA)
Rep. Dave Trott (R-MI)
Rep. Mike Bishop (R-MI)
Rep. Fred Upton (R-MI)
Rep. Joseph Pitts (R-PA)
Rep. Leonard Lance (R-NJ)
Rep. Brett Guthrie (R-KY)
Rep. Adam Kinzinger (R-IL)
Rep. Larry Bucshon (R-IN)
Rep. Susan Brooks (R-IN)
Rep. Lou Barletta (R-PA)
Rep. Buddy Cater (R-GA)
Rep. Gus Bilirakis (R-FL)
Rep. Jackie Walorski (R-IN)

Rep. Frank Pallone of (D-NJ)
Rep.  John Conyers of (D-MI)
Rep.  Robert C. “Bobby” Scott (D-VA)
Rep.  Jim McDermott (D-WA)
Rep.  Gene Green (D-TX)
Rep. Sheila Jackson Lee (D-TX)
Rep.  Joe Courtney (D-CT)
Rep.  Steve Cohen (D-TN)
Rep.  John Sarbanes (D-MD)
Rep.  Ben Ray Luján (D-NM)
Rep. Judy Chu (D-CA)
Rep. Elizabeth Esty (D-CT)
Rep. Ann Kuster (D-NH)
Rep.  Raul Ruiz (D-CA)

Although some are calling for a final bill to be sent to the White House by the end of this month, it may take more time will be needed to develop a final product.

The Senate version of CARA includes a number of distinct, authorized programs within the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) designed to address the crisis.  The Senate Judiciary Committee coordinated with the Senate Health, Education, Labor and Pensions Committee (HELP) as the legislation moved forward.

To see a summary of the Senate Judiciary Committee-approved version of CARA, please click here.

The House package includes three core components with many parts:  (1) a large grant program housed within DOJ that contains a number of “allowable use of funds,” (2) a number of health related bills considered and approved by the House Energy and Commerce Committee and (3) other bills considered by other Committees of jurisdiction.

The bills considered and passed by the House of Representatives include the following:

Within the jurisdiction of the House Committee on the Judiciary:

• The Comprehensive Opioid Abuse Reduction Act (H.R. 5046) authorizes the Attorney General within Department of Justice (DOJ) to make grants to States, units of local government and non-profits “to provide services primarily relating to opioid abuse” where a number of “allowable uses” of funds are listed.  These allowable uses include:

• providing training and resources for first responders on carrying/administering an opioid overdose reversal drug approved by the FDA ad purchasing such drug or device for first responders who have received training;
• investigations to locate or investigate illicit activities related to the unlawful distribution of opioids;
• developing, implementing or expanding a medication-assisted treatment program used or operated by a criminal justice agency, which may include training;
• developing, implementing or expanding PDMPs;
• developing, implementing or expanding programs to prevent and address opioid abuse by juveniles;
• developing, implementing or expanding an integrated and comprehensive opioid abuse response program, including prevention and recovery programs;
• developing, implementing, or expanding a program (which may include demonstration projects) to utilize technology that provides a secure container for prescription drugs that would prevent individuals, particularly adolescents, from gaining access to opioid medications that are lawfully prescribed for other individuals;
• developing, implementing, or expanding a program to prevent and address opioid abuse by veterans; and
• developing, implementing, or expanding a prescription drug take-back program.

One section emphasizes coordination between State criminal justice agencies and substance abuse agencies:  The bill notes that in the case where a State is the applicant, a core focus of the grant activities would be “…facilitating or enhancing planning and collaborating between State criminal justice agencies and State substance abuse systems in order to more efficiently and effectively carry out programs described in paragraph (1) that address problems related to opioid abuse.”  The programs listed in paragraph 1 include:

• developing, implementing, or expanding treatment alternative to incarceration program, which may include pre-booking or post-booking components;
• training for criminal justice agency personnel on substance use disorders and co-occurring mental illness and substance use disorders;
• a mental health court;
• a drug court;
• a veterans court;
• a focus on parents whose incarceration could result in their children entering the child welfare system; and
• a community-based substance use diversion program sponsored by a law enforcement agency.

Prevention provisions added to H.R. 5046. Senate-passed CARA includes an enhancement grant program for current and former Drug-Free Communities grantees to tackle prescription drug abuse and methamphetamines in their communities. While this program is not included in H.R. 5046, the House bill was amended that makes prevention an allowable use of grant funding.

Language on veterans services:  The bill includes additional language authorizing services to “qualified” veterans.  The bill defines a qualified veteran as a “…preliminary qualified offender who served on active duty in any branch of the Armed Forces, including National Guard or Reserves, and was discharged or released from such service under conditions other than dishonorable.”  The additional language authorizes a Veterans Court program within DOJ, along with a Veterans Assistance Program.

Inclusion of services for pregnant women under family-based substance abuse treatment has been added. Since the bill was introduced in April, a provision was added to amend the Omnibus Crime Control and Safe Streets Act to add pregnant women to the list of eligible recipients of family-based substance abuse treatment as an alternative to incarceration.

A provision has been added that would require the GAO to study existing programs and research gaps on substance use among adolescents and young adults. This new provision would require the Comptroller General of Government Accountability Office (GAO) to conduct a study on how the Department of Justice (DOJ) is addressing prevention, treatment, and recovery services for adolescents and young adults.

Medication Assisted Treatment (MAT) defined:  The bill defines “medication-assisted treatment” as “the use of medications approved by the Food and Drug Administration for the treatment of opioid abuse.”

• H.R. 5048, Good Samaritan Assessment Act of 2016 requires the Government Accountability Office to submit a report about the Office of National Drug Control Policy’s (ONDCP’s) review of State and local Good Samaritan laws that exempt from criminal or civil liability any individual who administers an opioid overdose reversal drug or device or who contacts emergency services providers in response to an overdose (Rep. Guinta, R-NH).

Within the jurisdiction of the House Committee on Energy and Commerce:

• H.R. 3691, Improving Treatment for Pregnant and Postpartum Women Act would reauthorize the residential services for pregnant and postpartum women program (PPW) grant program within SAMHSA’s Center for Substance Abuse Treatment (CSAT). The bill would also create a pilot program for State substance abuse agencies to use up to 25 percent of these funds for services to pregnant and parenting women in non-residential settings. The purpose of the pilot program is to spur innovation and fill gaps in family-centered services across the continuum of care.

A section-by-section summary of the bill can be found here.

In FY 2016, the PPW grant program was funded at $15.9 million.  The bill as introduced authorized $40 million for the PPW and pilot program.  During the markup by the Committee on Energy and Commerce last month, an amendment was offered to change the authorization of funds in the bill from $40 million to $16.9 million.  Further, Rep. Ben Ray Luján (D-NM), the original sponsor of the bill, offered an amendment that would authorize the use of funds for the pilot program only if the amount for the overall PPW program exceeded FY 2016 funding levels. The bill passed the House as amended, with the “trigger language” and an authorization level of $16.9 million.

• H.R. 4978, Nurturing and Supporting Healthy Babies Act which would mandate the Government Accountability Office (GAO) to write a report neonatal abstinence syndrome (NAS) – including prevalence, coverage available under Medicaid, any federal barriers to treatment, particularly in non-hospital settings, and more.

• H.R. 4641, To provide for the establishment of an inter-agency task force to review, modify, and update best practices for pain management and prescribing pain medication, and for other purposes (Rep. Brooks, R-IN and Rep. Kennedy, D-MA).

• H.R. 3680, Co-Prescribing to Reduce Overdoses Act of 2015, for the Secretary of Health and Human Services to carry out a grant program for the co-prescribing of opioid overdose reversal drugs for patients at high risk of overdose (Rep. Sarbanes, D-MD). The Energy and Commerce Committee included an offset to pay for the bill when it considered the legislation earlier this month.

• H.R. 1818, Veteran Emergency Medical Technician Support Act of 2016 amends the Public Health Service Act to direct the Department of Health and Human Services to establish a demonstration program for States with a shortage of emergency medical technicians (EMTs) to streamline State requirements and procedures to assist veterans who completed military EMT training to meet state EMT certification, licensure, and other requirements (Rep. Kinzinger, R-IL and Rep. Capps, D-CA).

• H.R. 4969, John Thomas Decker Act of 2016 to authorize a grant program within CDC to educate teens and youth injured playing sports regarding the dangers of prescription drug misuse and abuse (Rep. Meehan, R-PA).

• H.R. 4586, Lali’s Law, to authorize grants to States for developing standing orders and educating health care professionals regarding the dispensing of opioid overdose reversal medication without person-specific prescriptions, and for other purposes (Rep. Dold, R-IL).

• H.R. 4599, Reducing Unused Medications Act of 2016 to amend the Controlled Substances Act in order to allow partial fills of schedule II controlled substances (Rep Clark, D-MA).

• H.R. 4976, Opioid Review Modernization Act to require the Food and Drug Administration (FDA) to seek recommendations from an advisory committee before approval of certain new opioid-based drugs without abuse-deterrent properties (Rep. Sean Maloney, D-NY).

• H.R. 4982, Examining Opioid Treatment Infrastructure Act of 2016 would require the GAO to develop a report on the availability of substance use disorder treatment in inpatient, outpatient and detox settings (Rep.  Foster, D-IL).

Within shared jurisdiction of the House Energy and Commerce Committee and House Committee on the Judiciary:

• S. 32, Transnational Drug Trafficking Act of 2015 amends the Controlled Substances Import and Export Act to prohibit the manufacture or distribution of a controlled substance in schedule I or II, or a listed chemical by individuals having reasonable cause to believe that such substance or chemical will be unlawfully imported into the United States (Rep. Marino, R-PA and Rep. Pierluisi, D-PR; Sen. Dianne Feinstein, D-CA and Sen. Udall D-NM).

• H.R. 5052, OPEN Act to direct the Attorney General and the Secretary of Health and Human Services to evaluate the effectiveness of grant programs that provide grants for the primary purpose of providing assistance in addressing problems pertaining to opioid abuse (Rep. McCarthy, R-CA and Rep. Hoyer, D-MD).

• R. 4981, Opioid Use Disorder Treatment Expansion and Modernization Act: As passed by the House Committee on Energy and Commerce, the Opioid Use Disorder Treatment Expansion and Modernization Act (H.R. 4981) would have changed the number of patients to whom a practitioner can prescribe buprenorphine from 100 to 250. However, the bill was modified from the version approved by the Energy and Commerce Committee due to cost concerns.  The bill approved by the House last week includes only a “Sense of Congress” (language which doesn’t have the force of law) that HHS should increase the caps on buprenorphine prescribing by physicians to 250 patients. Additionally, the bill only temporarily permits nurse practitioners and physician assistants to prescribe buprenorphine for 3 years, whereas the bill as approved by the Committee would have permanently allowed them to prescribe. On the floor, bill sponsor Rep. Tonko (D-NY) called on Congress to replace the Sense of Congress with a statutory increase and permanently permit mid-level prescribing during the House/Senate negotiation process (Rep. Bucshon, R-IN and Rep. Tonko D-NY).

Within the jurisdiction of the House Committee on Education and the Workforce:

• H.R. 4843, Infant Plan of Safe Care Improvement Act to amend the Child Abuse Prevention and Treatment Act (CAPTA) by requiring the Department of Health and Human Services (HHS) to provide information about best treatment practices for infants born affected by illicit drug exposure, withdrawal symptoms, or a Fetal Alcohol Spectrum Disorder. States will be required to submit data reports that “include the total number of such infants for whom a plan of safe care was developed, and for whom referrals are made for appropriate services, including services for the affected family or caregiver” (Rep. Barletta, R-PA and Rep. Walberg, R-MI).

Within the jurisdiction of the House Committee on Veterans’ Affairs:

• H.R. 4063, Promoting Responsible Opioid Management and Incorporating Scientific Expertise Act or the Jason Simcakoski PROMISE Act to improve the use of opioids by the Secretary of Veterans Affairs in treating veterans (Rep. Bilirakis, R-FL and Rep. Kind, D-WI).

Within the jurisdiction of the House Committee on House Foreign Affairs and Committee on the Judiciary:

• H.R. 4985, Kingpin Designation Improvement Act of 2016 amends the Foreign Narcotics Kingpin Designation Act to allow classified information to be submitted to a reviewing court ex parte or in camera in a judicial review of a determination by the President that a foreign person is subject to sanctions as a significant foreign narcotics trafficker. (Rep. Katko, R-NY and Rep. Rice, D-NY).

 

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.

In the News

• House of Representatives approves Improving Treatment for Pregnant/Postpartum Women Act (H.R. 3691)
• House of Representatives passes Improving Safe Care for the Prevention of Infant Abuse and Neglect Act (H.R. 4843)
• White House issues statement calling for additional funding for opioid legislation
• House Energy and Commerce Committee Chairman Fred Upton (R-MI) writes blog about committee’s determination to fight opioid epidemic
• Altarum Institute releases addiction recovery timeline, highlighting milestones in the history of recovery services

News from the States

• Vermont details plans for Next Generation Accountable Care Organization program
• Delaware proposes stricter prescribing guidelines for prescription pain medications

Around the Agencies

• HHS issues final rule on Section 1557 of the Affordable Care Act, clarifying nondiscrimination requirements

In the News

House of Representatives approves Improving Treatment for Pregnant/Postpartum Women Act (H.R. 3691)
The full House of Representatives considered and passed H.R. 3691, the Improving Treatment for Pregnant and Postpartum Women Act last week. The bill was authored by Rep. Luján (D-NM), with original co-sponsors including Reps. Tonko (D-NY), Matsui (D-CA), and Cardenas (D-CA). The bill contains the following provisions:

Reauthorization of the “PPW” Program: The Improving Treatment for Pregnant and Postpartum Women Act would reauthorize the residential services for pregnant and postpartum women program (PPW) grant program within the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Treatment (CSAT).  This important program supports family-centered substance use disorder for women and young children in residential settings.

Creation of Pilot Program for State Substance Abuse Agencies: The bill would also create a pilot program for State substance abuse agencies to use up to 25 percent of these funds for services to pregnant and parenting women in non-residential settings. The purpose of the pilot program is to spur innovation and fill gaps in family-centered services across the continuum of care.  The legislation would require SAMHSA to lead a process where State substance abuse agencies, experts in addiction services and others would meet to discuss the development of the new application for the pilot program.

Funding: In FY 2016, the PPW received $15.9 million. The bill as introduced authorized $40 million for the PPW and pilot program.  During the markup held in the full House Energy and Commerce Committee, an amendment was offered to change the authorization of funds in the bill from $40 million to $16.9 million.

“Trigger Language” Added During Mark-Up:  Further, Rep. Ben Ray Luján (D-NM), the original sponsor of the bill, offered an amendment that would authorize the use of funds for the pilot program only if the amount for the overall PPW program exceeded FY 2016 funding levels.

Next Steps: The bill was inserted into a larger House package on the opioid crisis that was approved on May 13^th.

Read NASADAD’s section-by-section summary of the bill here.

House of Representatives passes Improving Safe Care for the Prevention of Infant Abuse and Neglect Act (H.R. 4843)
The House of Representatives unanimously passed the Improving Safe Care for the Prevention of Infant Abuse and Neglect Act (H.R. 4843) with a vote of 421-0 last week. The legislation, originally introduced by Rep. Barletta, Lou (R-PA), amends the Child Abuse Prevention and Treatment Act (CAPTA) by requiring the Department of Health and Human Services (HHS) to provide information about best treatment practices for infants born affected by illicit drug exposure, withdrawal symptoms, or a Fetal Alcohol Spectrum Disorder. States will be required to submit data reports that “include the total number of such infants for whom a plan of safe care was developed, and for whom referrals are made for appropriate services, including services for the affected family or caregiver.” H.R. 4843 was inserted into a larger House package on the opioid crisis that was approved on May 13^th.

Read more about this bill here.

White House issues statement calling for additional funding for opioid legislation
Last week the White House issued a statement calling for additional funding for opioid legislation. The statement acknowledges that while pieces of legislation such as H.R. 4641 (To provide for the establishment of an inter-agency task force to review, modify, and update best practices for pain management and prescribing pain medication) and H.R. 5046 (the Comprehensive Opioid Abuse Reduction Act of 2016) move treatment and recovery services in the right direction, they will require appropriate financial resources to be effective. The Obama Administration previously submitted a budget proposal in February 2016 to provide for $1.1 billion in new funding to address the opioid epidemic and expand access to treatment.

Read the full statement here.

House Energy and Commerce Committee Chairman Fred Upton (R-MI) writes blog about committee’s determination to fight opioid epidemic
Last week the House of Representatives’ Energy and Commerce Committee Chairman Fred Upton (R-MI) released a blog detailing the committee’s determination to fight the opioid crisis. The blog describes the impact opioid use has had in Rep. Upton’s district in Kalamazoo, MI, as opioid overdoses increased from 9 in the first quarter of 2012 to 13 in the first quarter of 2013. Rep. Upton emphasizes the need for policies that contain both public health and criminal justice approaches, stating that “we cannot simply arrest our way out of this epidemic.” The blog concludes by highlighting the passage of the Protecting Our Infants Act of 2015 (S. 799) and the Improving Regulatory Transparency for New Medical Therapies Act (H.R. 639) at the end of 2015 as indications of the Energy and Commerce Committee continued commitment to combating the opioid epidemic.

Read the full blog here.

Altarum Institute releases addiction recovery timeline, highlighting milestones in the history of recovery services
The Altarum Institute released its addition recovery timeline last week, highlighting a variety of milestones in the history of recovery support services. The timeline traces the history of recovery support services from the formation of Native American recovery circles beginning in 1750 to the UNITE to Face Addiction Rally held in Washington, DC in October 2015. The timeline was compiled with the support of William L. White and other recovery movement historians, and will be updated as new events occur.

Access the timeline here.

News from the States

Vermont details plans for Next Generation Accountable Care Organization program
Vermont‘s forthcoming Next Generation Accountable Care Organization (Vermont Next Gen ACO) program was detailed in a Center for Health Care Strategies, Inc. article last week. Vermont released a request for proposals for its Next Gen ACO program in April, stating that the program will enable Vermont’s Medicaid Shared Savings Program (VMSSP) to save money and deliver high-quality health care services to Medicaid enrollees throughout the State. The Vermont Next Gen ACO is similar to CMS’s Medicare Next Gen Model, yet differs in several ways – most notably by “requiring participating ACOs to accept full risk for their Medicaid patients in exchange for a capitated payment.”

The Vermont Next Gen ACO also contains differences from Vermont’s existing Medicaid ACO program by shifting to prospective payment and by reducing the number of quality metrics from 28 to 6, with each metric in the Next Gen ACO model related to payment. The Vermont Next Gen ACO is expected to launch sometime in 2017.

Read the full article here.

Delaware proposes stricter prescribing guidelines for prescription pain medications
Delaware has announced plans to more strictly regulate prescription pain medications, as the Wilmington News Journal reports. The new regulations limit the amount of pain medication doctors are able to prescribe by restricting initial maximums to a seven-day supply. The regulations further require that patients’ histories be examined in Delaware’s Prescription Drug Monitoring Program (PDMP) and that doctors provide information about addiction risks when providing medication to patients. Chronic pain patients would be required to sign a treatment agreement and take urine-based drug tests twice each year. Medications falling under the new regulations include morphine, codeine, fentanyl, meperidine, and methadone. While Delaware officials do not believe the regulations will interfere with treatment, pain management specialists are concerned that limiting initial supplies to seven days will hinder the ability of doctors to help patients.

Read the Wilmington News Journal article here.

Read more about Delaware’s efforts to combat the opioid epidemic here.

Around the Agencies

HHS issues final rule on Section 1557 of the Affordable Care Act, clarifying nondiscrimination requirements
The Department of Health and Human Services (HHS) issued its final rule on Section 1557 of the Affordable Care Act (ACA) last week. The rule clarifies and codifies nondiscrimination requirements and describes plans to implement Section 1557. Section 1557 prohibits discrimination on the basis of sex in any health program or activity that receives HHS funding, insurers in the marketplace that receive HHS funding, and any other program that HHS administers. The final rule prohibits discrimination on the basis of gender identity and sex stereotyping, and requires that individuals be provided access to facilities consistent with their gender identity. The rule also contains provisions providing guidance on requirements for language assistance services, including oral interpreters and written translations. The rule will be made effective on July 18, 2016.

Read the full final rule here.

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.