DC Update

August 1, 2014

News from NASADAD

• NASADAD to develop position statement on 42 CFR Part 2
• NASADAD releases fact sheet on priority grants in the Department of Justice

Events

• NASADAD participates in Coalition for Health Funding Capitol Hill day

Around the Agencies

• NIDA study reaffirms device’s ability to detect marijuana in breath hours after smoking
• NIDA studies show that marijuana use may encourage nicotine use

Capitol Hill News

• Sen. Markey introduces legislation to raise buprenorphine prescriber limit
• Reps. Butterfield and Johnson form State Medicaid Expansion Caucus

In the News

• NGA announces new executive committee leadership

News from the States

• Ohio launches Start Talking! prevention campaign
• OhioMHAS releases recovery housing resources
• Oregon voters to vote on ballot initiative to legalize marijuana

 

News from NASADAD

NASADAD to develop position statement on 42 CFR Part 2 – all States to be invited to future Public Policy Committee call on the topic

As noted by NASADAD Board Chair Mark Stringer (MO) during the most recent All States Public Policy Call (held on July 18th), the Association shall be developing a revised policy statement regarding 42 CFR Part 2. This comes after a tremendous amount of membership feedback noting the benefit of Association leadership in this area. Confidentiality has been discussed in a variety of settings over the past few months. In June, the Substance Abuse and Mental Health Services Administration (SAMHSA) held a listening session and solicited feedback on a number of areas.  During the June Annual Meeting, the State Directors engaged in an initial dialogue regarding confidentiality matters in general, and 42 CFR Part 2 in particular. In addition, NASADAD hosted two conference calls where the issue was reviewed: the first with Paul Samuels of the Legal Action Center (LAC) held in June and the second with Mark Parrino of the American Association of the Treatment of Opioid Dependence (AATOD) held in July where a portion of his presentation covered these issues.  NASADAD’s Public Policy Committee will host a special conference call to consider a statement. All State Directors will be invited to participate. Further, NASADAD has dedicated a portion of the web page to resources on the confidentiality where letters, papers and other documents will be posted. To visit this section, please click here.

NASADAD’s 2010 statement on confidentiality

In 2010, NASADAD issued a one-page statement on 42 CFR Part 2 that has guided the Association’s views up until this point. The statement offers support for stakeholders and policy makers to have a thoughtful and inclusive discussion about how confidentiality protections can best be utilized with more advanced health information technologies. A core principle noted in the statement is the need to maintain the goal of 42 CFR Part 2, which is to protect personal privacy and confidentiality and prevent discrimination of people with alcohol and other drug histories.

NASADAD releases fact sheet on priority grants in the Department of Justice

NASADAD released the fact sheet, Overview of NASADAD Priority Programs within the Department of Justice, earlier today. The fact sheet describes the programs and funding allocations that NASADAD members have identified as priorities that are housed within the Department of Justice. The programs include:

• Harold Rogers Prescription Drug Monitoring Program (PDMP),
• Drug Court Discretionary Program,
• Second Chance Act,
• Enforcing Underage Drinking Laws (EUDL),
• Residential Substance Abuse Treatment for State Prisoners (RSAT) Program,
• Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA),
• Edward Byrne Memorial Justice Assistance Program (Byrne/JAG), and
• Justice Information Sharing Solutions (JIS) Implementation Program.

Events

NASADAD participates in Coalition for Health Funding Capitol Hill day

Rob Morrison, Executive Director attended the “Faces of Austerity Hill Day” as part of the Coalition for Health Funding on July 16^th. The Coalition for Health Funding is a broad coalition that promotes the importance of non-discretionary health spending and published the report, Faces of Austerity: How Budget Cuts Hurt America’s Health. The report also includes information on the Substance Abuse Prevention and Treatment (SAPT) Block Grant, citing the importance of the funding, as well as the effects that reductions in funding have had at the State and local level. The report provides an in-depth look at how SAPT Block Grant cuts have affected the State of Illinois at large, as well as a local Chicago treatment provider. The meetings with Congressional offices focused on the importance of federal health funding and the consequences of austerity and other cost-cutting measures. Mr. Morrison visited offices with representatives from other health care organizations including the American Society for Biochemistry and Molecular Biology, American College of Preventive Medicine, Endocrine Society, and National Multiple Sclerosis Society.

Around the Agencies

NIDA study reaffirms device’s ability to detect marijuana in breath hours after smoking

The study by the National Institute on Drug Abuse (NIDA)’s Intramural Research Program finds that the Breathalyzer-like device detected marijuana’s main psychoactive ingredient, tetrahydrocannabinol (THC) up to two hours after smoking. The small-scale study provides preliminary evidence that breath testing may be a viable option for law enforcement seeking to enforce drugged-driving laws. As efforts to legalize marijuana continue in States beyond Washington and Colorado, concerns about potential increases in drugged driving fuel the need for better testing approaches. The current method, testing blood, cannot be done road-side, therefore delaying the test which could show lower THC-levels than when the driver was pulled over.

NIDA studies show that marijuana use may encourage nicotine use

Studies by the National Institute on Drug Abuse (NIDA)’s Intramural Research Program find that marijuana use makes smoking cigarettes more pleasurable and may encourage nicotine use. The animal studies found that tetrahydrocannabinol (THC)-treated rats were more likely to self-administer nicotine, at higher amounts over time. In addition, the brain signaling systems activated by THC and nicotine overlap. In fact, blocking the cannabinoid receptors, or those for THC, has been shown to also weaken the reinforcing effect of nicotine. This effect seems to be unique to nicotine – similar effects were not found for cocaine or heroin.

Capitol Hill News

Sen. Markey introduces legislation to raise buprenorphine prescriber limit

The bill, The Recovery Enhancement for Addiction Treatment Act (TREAT Act) was introduced by Sen. Edward Markey (D-MA) and co-sponsored by Senators Diane Feinstein (D-CA), John Rockefeller (D-WV), Sherrod Brown (D-OH), and Mazie Hirono (D-HI) and announced on July 23^rd. The legislation would increase the number of patients that a waivered provider is allowed to treat to 100 in the first year and then request to remove the limit after the first year if they are substance abuse treatment specialists or if they completed additional training and practice in a qualified practice setting (named in the legislation). The legislation would also allow certain nurse practitioners and physician assistants to treat up to 100 patients per year if they are licensed in a State that allows that to prescribe controlled substances, complete the training, and are supervised by a waivered physician or are certified addiction treatment nurse practitioners who practice in a qualified practice setting. The Government Accountability Office (GAO) will also be required to produce a report on the legislation looking at chances in treatment availability and utilization, quality of treatment, primary care integration, diversion, and more. The legislation has been endorsed by a variety of organizations including the American Society for Addiction Medicine (ASAM), Trust for America’s Health (TFAH), Association of State and Territorial Health Officials (ASTHO), National Association of State and Territorial AIDS Directors (NASTAD), and others.

Also check out a summary of the legislation.

Reps. Butterfield and Johnson form State Medicaid Expansion Caucus

Representatives G. K. Butterfield (D-NC) and Hank Johnson (D-GA) announced the formation of the caucus on July 23^rd (Families USA announcement). The State Medicaid Expansion Caucus will promote all States to expand Medicaid under the Affordable Care Act (ACA) via floor speeches, op-eds, social media, briefings, and other events. According to Rep. Johnson, “Expanding Medicaid will ensure access to health care for millions of low-income Americans. It will bring the security of health insurance to working people who are struggling to make ends meet. But it will also bring billions of dollars into each State’s economy as people go to work providing care and beneficiaries see improved health outcomes. The people who will benefit from expanding Medicaid are no less deserving of health care than anyone else” (press release).

In the News

NGA announces new executive committee leadership

The National Governors Association (NGA) announced the leadership changes on July 13^th. The new leadership will serve throughout the 2014-2015 year. Colorado Governor John Hickenlooper will serve as the NGA Chair and Utah Gov. Gary Herbert as the NGA Vice Chair. The other Executive Committee members include Gov. Dan Malloy (CT), Gov. Terry Branstad (IA), Gov. Mark Dayton (MN), Gov. Steve Bullock (MT), Gov. Pat McCrory (NC), Gov. Mary Fallin (OK), and Gov. Scott Walker (WI). As a review, the NGA also has a Health and Human Services Committee. That Committee is chaired by Gov. Bill Haslam (TN) and Gov. Peter Shumlin serves as Vice Chair.

News from the States

Ohio launches Start Talking! prevention campaign

Ohio Governor John Kasich launched the campaign to prevent substance abuse among children and youth. The Start Talking! campaign gives “parents, guardians, educators, and community leaders the tools to start the conversation with Ohio’s youth about the importance of living healthy, drug-free lives” (program home page). The program website includes educational tools, videos, discussion guides, and much more. NASADAD member and Ohio State Director Tracy Plouck will be participating in a webinar on August 19^th to discuss how they’re using the campaign materials and to raise awareness about the program. The webinar will also feature stories from individuals and families whose lives have been affected by substance abuse.

OhioMHAS releases recovery housing resources

In the Mid-Biennium Review (House Bill 483), the legislature made a very large investment of $5 million into recovery housing. The purpose of the initiative is to increase community capacity to provide recovery housing to individuals recovery from drug addiction. A funding opportunity related to the release of the dollars will be going out to the field early next week. In preparation, the Ohio Department of Mental Health and Addiction Services (OhioMHAS) is making available several new housing resources, including a housing definitions document and a crosswalk of housing categories and definitions. Also, helpful information about recovery housing is available in a two-part series webinar from Faces and Voices of Recovery. If you have any questions related to recovery housing, please contact Alisia Clark at Alisia.Clark@mha.ohio.gov.

Oregon voters to vote on ballot initiative to legalize marijuana

Come November, Oregon voters will vote on a ballot initiative to legalize marijuana for personal use for adults age 21 and older. The initiative was spearheaded by New Approach Oregon and would allow possession of up to eight ounces of marijuana at home and to cultivate up to four plants. Oregonians would not be legally allowed to consume marijuana in public. Under the initiative, the Oregon Liquor Control Commission would oversee and regulate sales of the drug beginning in January 2016. Revenues from the drug sales would be used to fund schools, law enforcement, substance abuse treatment, and mental health treatment. A similar ballot initiative was rejected by Oregon voters in 2012. Currently Washington and Colorado are the only States that have legalized marijuana for personal use.

 

D.C. Special Update on FY 2015 Appropriations

July 24, 2014

 

The Senate Appropriations Committee today released its draft bill and report that would provide FY 2015 funding for the Department of Health and Human Services (HHS) – including NASADAD priority programs within the Substance Abuse and Mental Health Services Administration (SAMHSA).  At this point, we are not aware of a specific date of potential action by the Committee regarding the draft.  However, the documents released by the Committee are still extremely important in that they provide the road map of the full Senate Appropriations Committee led by Barbara Mikulski (D-MD), Chair.  The Ranking Member is Richard Shelby (R-AL).  The full report may be accessed at http://www.appropriations.senate.gov/news/fy15-lhhs-subcommittee-reported-bill-and-draft-report.

We offer a NASADAD summary below.

SAMHSA: Overall, the SAMHSA would receive $3,577,545,000 in FY 2015.

Substance Abuse Prevention and Treatment (SAPT) Block Grant – $1,815,443,000 or cut of $4.4 million compared to FY 2014.  The Administration proposed level funding for FY 2015.

No redirection of funds or “tap” in the documents: NASADAD members may recall that the Administration proposed in previous budgets to allocate a certain percentage of SAPT Block Grant funds to other programs within HHS.  This practice effectively cut the funding available to States through the SAPT Block Grant.  Last year, Congress included language in the final FY 2014 funding bill exempting the SAPT Block Grant from having its funds redirected to other programs.  For FY 2015, the SAMHSA budget observes this direction from the Appropriations Committee, noting, “The 2015 President’s Budget continues this exemption in 2015.”  NASADAD applauded the Administration for this decision. In the draft released today, the Appropriations Committee specifically continues this exemption to ensure no “tap” is added through other mechanisms.

The Committee should be applauded for this action.  The exact bill language is below:

The Committee recommendation continues bill language included last year that instructs the Administrator of SAMHSA and the Secretary to exempt the Mental Health Block Grant and the Substance Abuse Prevention and Treatment Block Grant from being used as a source for the PHS evaluation set-aside in fiscal year 2015, as was done prior to fiscal year 2012.

Center for Substance Abuse Prevention (CSAP) – $175,217,000 or level funding compared to FY 2014.  The Administration proposed $185.5 million for an increase of $10 million over the FY 2014 level of $175.5 million.  The Committee draft plan includes the following proposals for programs within CSAP:

Strategic Prevention Framework/Partnerships for Success Grants: $109.4 million or level funding compared to FY 2014.  The Administration proposed $119.7 million for an increase of $10 million over FY 2014.  This proposed $10 million would be allocated to the Strategic Framework Prescription Drug Abuse and Overdose Prevention (SPF Rx) Initiative. Of this proposed $10 million, the Administration would direct certain funds to support States to (1) use the State’s strategic plan to target prescription drug abuse and misuse within the State; (2) use data from Prescription Drug Monitoring Programs (PDMP) for prevention planning and (3) implement evidence-based practices and/or environmental strategies aimed at reducing prescription drug abuse and misuse.

The Appropriations Committee draft language is included below:

The Committee recommendation provides $109,484,000 for the Strategic Prevention Framework State Incentive Grant [SPFSIG] and Partnerships for Success programs. The Committee intends that these two programs continue to focus exclusively on: addressing State- and community-level indicators of alcohol, tobacco, and drug use; targeting and implementing appropriate universal pre-vention strategies; building infrastructure and capacity; and pre-venting substance use and abuse. Due to budgetary constraints, the Committee recommendation does not include funding for the new Strategic Prevention Framework Rx program requested by the administration.

The Committee does not approve of SAMHSA’s proposal to use $1,500,000 from the SPFSIG to expand the focus of community coalitions to include mental health promotion and mental illness prevention. SAMHSA is directed not to use any SPFSIG funds for this initiative.

The Committee directs that all of the money appropriated explicitly for substance abuse prevention purposes both in CSAP’s PRNS lines as well as the funding from the 20 percent prevention set-aside in the SAPT Block Grant be used only for bona fide substance abuse prevention programs and strategies and not for any other purposes.

Sober Truth on Preventing Underage Drinking (STOP Act) – $7 million or level funding compared to FY 2014 and the Administration’s FY 2015 proposal.

Fetal Alcohol Spectrum Disorder – $1 million or level funding compared to FY 2014.  The FASD portfolio absorbed a significant cut of $8.8 million last year when the program went from $9.8 million in FY 2013 to $1 million in FY 2014.  SAMHSA noted that the $1 million would be supporting the FASD Center of Excellence in FY 2015.

Center for the Application of Prevention Technologies (CAPTs) – $7.5 million or level funding compared to FY 2014 and the Administration’s FY 2015 proposal.

Building Behavioral Health Coalitions Program – The Senate Committee Report does not allow $1.5 million from CSAP “…to support active community coalitions and/or organizations to expand their focus and activities to include mental health promotion, mental illness prevention and substance abuse prevention.”  Under this proposal, CSAP funds would be provided “…to coalitions with a mental health focus to expand their activities to include substance abuse prevention.”

The committee language is below:

The Committee does not approve of SAMHSA’s proposal to use $1,500,000 from the SPFSIG to expand the focus of community coalitions to include mental health promotion and mental illness prevention. SAMHSA is directed not to use any SPFSIG funds for this initiative.

Center for Substance Abuse Treatment (CSAT) – $324,573,000 or a cut of approximately $37 million compared to FY 2014.  The Committee’s draft plan compares to the Administration’s proposed cut of $64 million or $297,400,000. The Committee’s draft report includes the following proposals for programs within CSAT:

Opioid Treatment Programs/Regulatory Activities – $8.7 million or level funding compared to FY 2014 and the Administration’s proposal.

Screening and Brief Intervention and Referral to Treatment (SBIRT) – $46,889,000 or level funding FY 2014.  The Administration proposed $30 million in FY 2015.

The Committee included specific language on SBIRT which is included below:

The Committee provides funding for SBIRT through budget authority rather than through transfers from section 241 of the PHS Act as requested by the administration. The Committee continues to direct SAMHSA to ensure that funds provided for SBIRT are used for existing evidence-based models of providing early intervention and treatment services to those at risk of developing substance abuse disorders.

Targeted Capacity Expansion (TCE) Program – $23.2 million or an increase of $10 million compared to FY 2014.  The Administration proposed $15.2 million or an increase of $2 million compared to FY 2014.

Specific funding for States for Opioid Treatment – including Medication Assisted Treatment (MAT):The Committee draft provides $12 million for discretionary grants (as part of the Targeted Capacity Expansion (TCE) portfolio) to States to expand treatment services for those with opioid dependence.  The grants would include, as an allowable use, the support of medication- assisted treatment (MAT) and other clinically appropriate services.  This recommendation aligns with testimony submitted by NASADAD to Congress regarding FY 2015 appropriations priorities.  NASADAD applauds the Senate Appropriations Committee for recognizing the pressing nature of the opioid problem.

The language appearing in the Committee draft is below:

The Committee recognizes that the United States has seen a 500 percent increase in admissions to treatment for prescription drug abuse since 2000. Further, according to a recent study, 37 States saw an increase in admissions to treatment for heroin dependence during the past 2 years. Of the amount provided for Targeted Capacity Expansion, the Committee recommendation includes $12,000,000 for discretionary grants to States for the purpose of expanding treatment services to those with heroin or opioid dependence. The Committee directs CSAT to ensure that these grants include as an allowable use the support of medication assisted treatment [MAT] and other clinically appropriate services. These grants should be made available to States with the highest rates of primary treatment admissions for heroin and opiates per capita, and should target those States that have demonstrated a dramatic increase in admissions for the treatment of opiates and heroin in recent years.

Pregnant and Postpartum Women (PPW) Program – $15.9 million or level funding compared to FY 2014 and the Administration’s request.

Strengthening Treatment Access and Retention – $1 million or a cut of $668,000 compared to the FY 2014 level of $1.6 million.  The Committee’s draft is the same as the Administration’s proposal for FY 2015.

Access to Recovery (ATR) – Eliminated for a cut of $50 million compared to FY 2014.  It is important to note that ATR sustained a cut of $43 million in FY 2014.  This draft is the same as the Administration’s proposal for FY 2015.

Primary Care and Addiction Services Integration (PCASI) – The Committee did not provide funding for this proposal.  The Administration proposed $20 million for this new program in FY 2015.

Children and Families Program – $29.6 million or level funding compared to FY 2014 and the Administration’s request for FY 2015.

Treatment Systems for Homeless – $41 million or level funding compared to FY 2014 and the Administration’s request for FY ’15.

Minority AIDS Initiative – $65.5 or level funding compared to FY 2014.  The Administration proposed $58.9 million or a cut of $6.8 million compared to the FY 2014 level.

Criminal Justice Activities – $74.8 million or level funding compared to FY 2014.  The Administration proposed $64.4 million or a cut of $10.4 million compared to the FY 2014 level of $74.8 million.

The draft Committee Report includes the following language regarding Drug Treatment Courts:

Drug Treatment Courts: The Committee continues to direct SAMHSA to ensure that all funding appropriated for Drug Treatment Courts is allocated to serve people diagnosed with a substance use disorder as their primary condition. The Committee expects CSAT to ensure that non-State substance abuse agency applicants for any drug treatment court grant in its portfolio continue to demonstrate extensive evidence of working directly and extensively with the corresponding State substance abuse agency in the planning, implementation, and evaluation of the grant.

Addiction Technology Transfer Centers (ATTCs) – $11 million or an increase of $2 million compared to FY 2014.  The Administration proposed $8 million in FY 2015 or a cut of $1 million compared to FY 2014.

The Committee included Report Language for the ATTC program that is included below:

Addiction Technology Transfer Centers [ATTCs]: The Committee rejects the administration’s proposed reduction to the ATTCs, which are a network of regional and national centers that develop and strengthen the addiction treatment workforce. The Committee notes that the demand for substance use disorder treatment services is anticipated to increase as a result of the Affordable Care Act and the Mental Health Parity and Addictions Equity Act. The Committee recommendation includes $11,024,000 for the ATTCs. The Committee expects that the increased funding should be used by the National and Regional ATTCs to enhance the skills of the current addiction workforce and to recruit and mentor new professionals into the addiction workforce. The Committee expects a report on the use of these additional funds in the SAMHSA fiscal year 2016 CJ. The Committee continues to direct SAMHSA to ensure that ATTCs maintain a primary focus on addiction treatment and recovery services.

Selected Mental Health Services Programs

Community Mental Health Services (CMHS) Block Grant – $482,571,000 or a decrease of approximately $1 million compared to FY 2014.  The Administration proposed $483.7 million or level funding compared to FY 2014.  The CMHS Block Grant, per a directive by Congress in the FY 2014 appropriations bill, includes a new set-aside for evidence-based programs that address the needs of individuals with early serious mental illness.  The set-aside amount equals $24.1 million.

The Committee Report Language is included below:

The Committee recommends $482,571,000 for the MHBG. The recommendation includes $21,039,000 in transfers available under section 241 of the PHS Act.  The MHBG distributes funds to 59 eligible States and territories through a formula based on specified economic and demographic factors. Grant applications must include an annual plan for providing comprehensive community mental health services to adults with a serious mental illness and children with a serious emotional disturbance. The Committee recommendation continues the bill language it added last year requiring that at least 5 percent of the funds for the Mental Health Block Grant program be set-aside for evidence-based programs that address the needs of individuals with early serious mental illness, including psychotic disorders. The Committee commends SAMHSA for its collaboration with NIMH on the implementation of this set-aside. The Committee notes that it usually takes 17 years to translate research findings into practice, and hopes that this joint effort between NIMH and SAMHSA may be a model for how to reduce this timeframe. The Committee recommends that SAMHSA continue its collaboration with NIMH to ensure that funds from this set-aside are used only for programs showing strong evidence of effectiveness.

Center for Mental Health Services (CMHS) – $378 million for CMHS or level funding compared to FY 2014.  The Administration proposed $354.7 million or a decrease of approximately $23 million compared to the FY 2014 level of $378 million.

Project AWARE (Advancing Wellness and Resilience in Education) State Grants – Approximately $40 million or level funding compared to FY 2014. This program, according to SAMHSA, builds on the Safe Schools/Healthy Students State Planning and Community Pilot Program.  The grants, if funded by Congress, would “…go to 20 State Educational Authorities (SEAs) and in collaboration with Education and Justice, will promote comprehensive, coordinated and integrated State efforts to make schools safer and increase access to mental health services.”  SAMHSA notes that SEAs would be required to partner with State mental health directors and State law enforcement authorities.

Mental Health First Aid – $15 million or level funding compared to FY 2014 and the Administration’s FY 2015 proposal.

Healthy Transitions – $20 million or level funding compared to FY 2014. This program would “assist 16 to 25 year olds with mental illnesses and their families in accessing and navigating behavioral health treatment systems.”  In particular, SAMHSA notes the program for States would focus on “new and creative approaches to provide support for transition-age youth with mental health and/or co-occurring substance abuse disorders and their families.”

Youth Violence Prevention – $23 million or level funding compared to FY 2014 and the Administration’s proposed FY 2015 budget.

National Traumatic Stress Network – $45.8 million or level funding compared to both FY 2014 and the Administration’s proposal for FY 2015.

Children and Family programs – $6.4 million or level funding compared to both FY 2014 and the Administration’s proposal for FY 2015.

Consumer and Family Networks – $4.9 million or level funding compared to both FY 2014 and the Administration’s proposal for FY 2015.

Mental Health Transformation and Health Reform – $3.7 million compared to $10.5 million in FY 2014 and the Administration’s proposed $10.5 million in FY 2015.

Project LAUNCH – $34.5 million or level funding compared to both FY 2014 and the Administration’s proposal for FY 2015.

Primary and Behavioral Health Care Integration – $49.8 million or level funding compared to FY 2014.  The Administration proposed $26 million for this program in FY 2015.

The Committee’s language on this initiative is below:

The Committee provides funding for this program through budget authority rather than through transfers from the PPH Fund as requested by the administration. The Committee continues to direct SAMHSA to ensure that new Integration grants awarded for fiscal year 2015 are funded under the authorities in section 520K of the PHS Act.

National Strategy for Suicide Prevention – $2 million or level funding compared to FY 2014.  The Administration proposed $4 million in FY 2015.

Suicide Lifeline – $7.1 million or level funding compared to FY 2014.  The Administration proposed $5.5 million in FY 2015.

There are a number of additional CMHS programs not listed here.  See the link provided at the end for the full report.

Additional Aspects of the Appropriations Committee Report – Specific Language

Viral Hepatitis Screening:

The Committee commends SAMHSA’s leadership to recommend screening injection drug users [IDUs] in opioid treatment programs for viral hepatitis. The Committee encourages SAMHSA to continue to expand opportunities for screening constituents who are at-risk for hepatitis. Injection drug use is a factor in many of the newly acquired viral hepatitis C cases and IDUs are more likely to experience adverse hepatitis related health outcomes compared to other infected populations.

The Committee continues to be deeply concerned about the increasing number of unintentional overdose deaths attributable to prescription and nonprescription opioids. The Committee commends SAMHSA for the letter sent in April to State agencies that administer the SAPT block to clarify that block grant funds may be used for the purchase of naloxone, as well as for assembling and disseminating overdose kits. The Committee encourages SAMHSA to continue to support initiatives that improve access to naloxone for public health and law enforcement professionals.

Data collection:

The Committee is aware that SAMHSA is taking steps to change the platforms used to collect data describing outcomes associated with substance abuse grants and mental health grants. The Committee maintains a distinct interest in not only the type of data col-lected but the mechanisms used to gather this important information. The Committee believes that any data collection effort must reflect the fact that mental illness and addiction are two separate and unique diseases requiring different data elements to accurately assess program performance. Therefore the Committee directs SAMHSA to submit a report to the Committee by October 31, 2014, describing any changes made to date and any plans for additional changes to data platforms; the reasons behind the structural changes; the process by which input is sought regarding any proposed changes to the type of data by multiple stakeholders and any other relevant information.

The Committee recommendation includes $1,000,000 requested by the administration for the Behavioral Health Minimum Data Set, which will develop consistent data collection methods to iden-tify and track the behavioral health workforce needs.

Language on transferring funds:

The Committee does not include bill language requested by the administration that would provide additional transfer authority to the Administrator beyond that which is already provided to the Secretary.

Next Steps: The release of the draft documents comes during a period of continued uncertainty about the fate of FY 15 appropriations measures.  Budget observers note the potential for a “Continuing Resolution” or stop-gap funding bill that would fund government operations through some period after the November elections.  No such “CR” has cleared Congress yet, however.  Speaker Boehner today he expects that a “CR” will be considered by the House of Representatives after Congress returns from its August break.  NASADAD will continue to monitor budget issues and report on developments as they occur.

DC Update

July 22, 2014

 

Around the Agencies

• NASADAD attends HHS 50-State meeting on prescription drug abuse
• NASADAD participates on conference call hosted by HHS about Medicaid Innovation Accelerator Program
• SAMHSA posts blog explaining health insurance coverage options
• SAMHSA names Tom Coderre as new Senior Advisor
• HHS announces $11 million to better integrate HIV services into community health centers
• Small Business Administration to kick off Spanish language webinar series

Capitol Hill News

• OH Representatives introduce legislation in response to heroin epidemic

Events

• NASADAD attends briefing on the treatment of alcohol use disorders sponsored by Friends of NIAAA
• NASADAD attends briefing on women and addiction sponsored by Senators Portman and Whitehouse
• APHA hosts webinar on health indicators for substance abuse
• National Behavioral Health Network for Tobacco and Cancer Control hosts webinar on nicotine addiction

Resources

• National Safety Council releases prescription drug employer kit

 

Around the Agencies

NASADAD attends HHS 50-State meeting on prescription drug abuse

Rob Morrison, Executive Director attended the meeting, Advancing Policy and Practice: A 50-State Working Meeting to Prevent Opioid-Related Overdose, hosted by the U.S. Department of Health and Human Services (HHS) and held in Washington, DC. Many NASADAD members also participated in the meeting on behalf of their individual States. HHS Secretary Sylvia Burwell offered remarks. The meeting brought together State and local substance abuse prevention and treatment experts with HHS leaders to discuss experiences with implementing prevention strategies and to discuss potential interventions targeted toward opioid prescribers. Governors were invited to select a three-person delegation to represent the State, though some States funded additional representatives to attend. The two-day meeting involved presentations from leading experts and ample time to work directly with State partners and regions to draft action plans for States to reduce the burden of prescription drug abuse in their State. Rob participated in the closing session with representatives from the National Governors Association (NGA), Association of State and Territorial Health Officials (ASTHO), and the Safe States Alliance.

NASADAD participates on conference call hosted by HHS about Medicaid Innovation Accelerator Program

Rob Morrison, Executive Director and Colleen Haller, Public Policy Associate participated on the conference call hosted by the U.S. Department of Health and Human Services (HHS) on July 16^th. The call provided information about the recently announced Medicaid Innovation Accelerator Program and gave participants an opportunity to ask questions about the program. Cindy Mann and Patrick Conway, Deputy Administrators of the Centers for Medicare and Medicaid Services (CMS) both presented on the call. The program is primarily a technical assistance program to help States improve the patient experience for Medicaid beneficiaries. CMS has identified substance use disorders as an important focus area for the Medicaid population. The presenters gave a number of examples to use the program to improve substance use disorder treatment including developing tools to leverage new Medicaid data sources to identify high-risk/high-need populations, assess provider capacity, or build health information exchanges. During the call, Rob thanked CMS for this initiative, recognized the leadership of John O’Brien, and promoted the inclusion of State substance abuse agencies, and NASADAD during the next phase.

SAMHSA posts blog explaining health insurance coverage options

The blog, Your Health Insurance Coverage Options: The Basics, was posted on July 16^th by the Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA has a released a series of blogs and webinars aimed to educate the public about coverage options under the Affordable Care Act (ACA). The blog describes the health insurance marketplace and newly required insurance protections including providing preventive services without a co-pay, banning pre-existing condition exclusions, and covering services for mental health and substance use disorders. The blog also describes the public insurance options available: Medicaid, Medicare, and the Children’s Health Insurance Program (CHIP). 2014 open enrollment for the marketplace is over, but enrollment for 2015 plans will begin this November.

SAMHSA names Tom Coderre as new Senior Advisor

The Substance Abuse and Mental Health Services Administration (SAMHSA) Administrator Pam Hyde sent the announcement on July 17^th. Mr. Coderre was the Chief of Staff to the President of the Rhode Island Senate and is well-known in the addiction and recovery community. He previously served as the Board Chair for Rhode Island Communities for Addiction Recovery Efforts and the Field Director of Faces and Voices of Recovery. Administrator Hyde describes Mr. Coderre as “a passionate advocate and committed public servant who will be a tremendous asset as we continue our important work of crafting effective public policy to reduce the impact of substance abuse and mental illness on America’s communities” (SAMHSA email).

HHS announces $11 million to better integrate HIV services into community health centers

U.S. Department of Health and Human Services Secretary Sylvia Burwell announced the availability of the funding though the Affordable Care Act (ACA) and the Secretary’s Minority AIDS Initiative Fund. The funds can be used to support the integration of HIV services into primary care through partnerships with health centers and State health departments in Florida, Massachusetts, Maryland, and New York. The funding is part of a 3-year project called Partnerships for Care: Health Departments and Health Centers Collaborating for Improve HIV Health Outcomes. 22 health centers in those four States have been deemed eligible to apply for the funding. The funding will support health center workforce development, infrastructure development, HIV service delivery across the HIV care continuum, and the development of sustainable partnerships with State health departments.

Small Business Administration to kick off Spanish language webinar series

Small Business Administration (SBA) Administrator Maria Contreras-Sweet kicked off the series by delivering the introductory remarks at the first webinar, held on July 22^nd. Representatives from the U.S. Department of Health and Human Services (HHS) and the Small Business Majority were also present for the inaugural webinar. The bimonthly webinars will run through late September 2014 and cover a wide range of topics related to the Affordable Care Act (ACA). Administrator Contreras-Sweet said “The Affordable Care Act is already helping millions of small business owners and their employees access quality, affordable health insurance. Through these webinars, small business owners will learn the important facts about the health care law so they can make the best decisions possible for their company. These interactive dialogues are a great way for small businesses to get the information they need to take advantage of and comply with key provisions of the health care law” (press release).

Capitol Hill News

OH Representatives introduce legislation in response to heroin epidemic

OH Representatives Tim Ryan and Marcia Fudge introduced the legislation, “The Breaking Addiction Act of 2014” on July 18^th. The legislation would expand community treatment options by creating a pilot program to eliminate the IMD Exclusion for substance abuse providers. The Institutions for Mental Disease (IMD) Exclusion is from a 1965 Medicaid rule that was originally created so that patients receiving long-term, residential mental health services at a State psychiatric hospital would not be eligible to receive Medicaid coverage for that treatment. Substance use disorder treatment was included into the rule, banning Medicaid reimbursement for residential treatment centers with more than 16 beds, encompassing many residential treatment providers for substance use disorders. This makes it difficult for Medicaid beneficiaries to receive residential substance use treatment services. 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. Representative Fudge describes the effort saying, “By removing an outmoded barrier to funding for substance abuse treatment, we can go a long way toward reversing the heroin epidemic and saving lives. I am also confident that data collected from this demonstration project will show community treatment will lower the bill to taxpayers for overall health care and decrease law enforcement costs associated with opiate addiction.

Events

NASADAD attends briefing on the treatment of alcohol use disorders sponsored by Friends of NIAAA

Rob Morrison, Executive Director and Colleen Haller, Public Policy Associate attended the briefing, New Horizons in the Treatment of Alcohol Use Disorders, hosted by the Friends of the National Institutes on Alcohol Abuse and Alcoholism (NIAAA) coalition on July 21^st. The briefing provided an overview on emerging research into alcohol use disorders and treatment best practices. The panelists included George Koob, PhD (Director, NIAAA), Betsy McCaul, PhD (Professor of Psychiatry, Johns Hopkins University School of Medicine), and a person in recovery. This event is one in a series of educational briefings hosted by the coalition to educate Congress about the value of alcohol use research. This particular briefing attracted a standing-room only crowd of more than 100 people.

NASADAD attends briefing on women and addiction hosted by Senators Portman and Whitehouse

Rob Morrison, Executive Director; Colleen Haller, Public Policy Associate; and Shalini Wickramatilake, Research Analyst attended the July 22^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, policymakers, and Members of Congress. The three highlighted topics were Women and Addiction: Treatment and What Works; Women, Addiction, and Motherhood; and The Role of Trauma as a Factor Contributing to Addiction, Relapse, and Recidivism in Women. This is the second 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.

APHA hosts webinar on health indicators for substance abuse

The webinar, Who’s Leading the Leading Health Indicators: Substance Abuse, will be hosted by the American Public Health Association (APHA) on July 24^th from 12-1 EST. The panelists (listed below) will address the following learning objectives: 1) describe the impact substance abuse has on the health of our nation, 2) review effective strategies to address substance abuse in multiple populations, 3) explain effective strategies to address substance abuse in youth through a collaborative effort, and 4) discuss existing resources for stakeholders to use as they address substance abuse in their communities. Work being done in a community in Wisconsin will be highlighted.

Panelists:

• Dr. Don Wright, Director, Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services (HHS)
• Dr. Howard Koh, Assistant Secretary for Health, HHS
• Rear Admiral Peter Delaney, PhD, Director, Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration (SAMHSA)
• Melissa Dotter, Marathon County Health Department, Wausau, WI

National Behavioral Health Network for Tobacco and Cancer Control hosts webinar on nicotine addiction

The Centers for Disease Control and Prevention (CDC) funded National Behavioral Health Network for Tobacco and Cancer Control will host the webinar, A Journey to Recovery: What Does the Cigarette Represent, on July 29^th. The panelists (listed below) will discuss how the substance abuse and mental health treatment environments can facilitate people in recovery going tobacco-free. They will also discuss some of the common myths that reinforce smoking among people working to recover from substance use disorders.

Panelists:

• Eric Arauz, President, Arauz Inspirational Enterprises LLC
• Chad Morris, PhD, Director, Behavioral Health and Wellness Program and Associate Professor, University of Colorado at Denver
• Steven Schroeder, MD, Director, Smoking Cessation Leadership Center, Distinguished Professor of Health and Health Care, University of California at San Francisco

Resources

National Safety Council releases prescription drug employer kit

The kit helps educate employers about the risks of prescription drug abuse and provides tools to help them communicate those risks to their employees. The kit is divided into two sections: executive action materials to help manage prescription opioid use and misuse in the work place and educational materials for employees on prescription drug abuse. The executive action materials contain a variety of resources on the issue itself, how to update drug-free workplace programs, structuring benefit programs to address opioid misuse, and others. The educational materials include fact sheets on opioid pain relievers and the risk of addiction and overdose, medication disposal, and alternative chronic pain treatments.