DC Update

July 17, 2014

News from the States

• Pennsylvania releases physician guidelines for prescription opioids

Around the Agencies

• CMS awards health care innovation grants
• SAMHSA developing app to help parents and caregivers talk to their kids about underage drinking
• HHS announces Medicaid Innovation Accelerator Program

Capitol Hill News

• NASADAD attends briefing hosted by Coalition for Health Funding on the effects of sequestration on health
• Sens. Booker and Paul introduce legislation to improve employment opportunities for adult non-violent offenders

Events

• NASADAD attends town hall meeting hosted by Non-Defense Discretionary coalition on potential threats to discretionary spending
• Alliance for Health Reform hosts briefing on health insurance marketplaces
• National Academy for State Health Policy hosting webinar on Medicaid treatment services for children and adolescents

In the News

• Avalere Health releases observations on essential health benefits package
• New York Times publishes article on the IMD exclusion

Resources

• Medicaid Directors and Mental Health Program Directors send comments to SAMHSA regarding 42 CFR Part 2
• Commonwealth Fund study finds uninsured rate falls to 15%
• Association of Drug Court Professionals releases brief report on the ACA
• PDMP Center for Excellence releases report on State experiences with mandating provider participation in PDMPs
• State Budge Officers release report on using performance data to inform State budgets

News from the States

Pennsylvania releases physician guidelines for prescription opioids

The newly released guidelines were a collective effort between the Pennsylvania Department of Drug and Alcohol Programs (led by Gary Tennis, NASADAD Board Member), the Department of Health, and Governor Tom Corbett’s Administration and were adopted by the State Medical Society. The guidelines are voluntary and encourage providers to consider a number of identified evidence-based practices for treating patients receiving opioids for chronic, non-cancer pain. Those identified practices include discussing the benefits and risks associated with opioid therapy, individualizing opioid selection and dosing, monitoring and reassessing patients periodically, and others. The Pennsylvania Chapter of the American College of Emergency Physicians (PaACEP) also adopted voluntary guidelines for treating pain in the emergency department.

Around the Agencies

CMS awards health care innovation grants

The Centers for Medicare and Medicaid Services (CMS) announced the recipients of the Health Care Innovation Awards. The $360 million in 3-year grant funds will be awarded to 39 recipients in 27 States and the District of Columbia to test innovative care models. According to U.S. Department of Health and Human Services (HHS) Secretary Sylvia Burwell, “The Health Care Innovation Awards support our ongoing work to drive down health care costs while providing high quality care to CMS beneficiaries. These awards advance innovative solutions in delivering and improving care from all across our nation” (HHS press release). Award recipients will be testing models in a number of areas of health care including improving emergency care, promoting better rural care coordination and telehealth, and promoting better care for people living with HIV/AIDS.

SAMHSA developing app to help parents and caregivers talk to their kids about underage drinking

The Substance Abuse and Mental Health Services Administration (SAMHSA) is developing the app as part of their “Talk. They Hear You.” campaign. SAMHSA previously released a successful online simulation tool that helps parents and caregivers talk to their kids about the risks of underage drinking. The newest version will include a mobile app for Android, Apple, and Windows devices to reach parents on-the-go. The tool uses virtual humans or “avatars” to educate parents and caregivers about how to effectively communicate with their child about alcohol use. Parents will be able to use the avatars to have practice conversations and get help from coaches based on the Motivational Interviewing Model.

HHS announces Medicaid Innovation Accelerator Program

The U.S. Department of Health and Human Services (HHS) announced the program which will provide more than $100 million in funding for technical support to help States improve health, improve care, and reduce costs for Medicaid beneficiaries. The letter sent to Medicaid Directors regarding the program specifically highlighted the need for additional investment in addiction and substance use disorder services. “While complementing other federal-state delivery system reform efforts such as the State Innovation Models initiative, this new initiative will help jumpstart innovation by providing federal tools and resources to support states in advancing Medicaid-specific delivery system reform. The Medicaid Innovation Accelerator Program will develop Medicaid specific resources to support state-based innovative health care reform efforts by identifying and advancing new Medicaid service delivery and financing models to improve patient care by providing data analytics, improving quality measurement and rapid cycle evaluation capabilities, and advancing effective and timely dissemination of best practices and learning among states” (HHS release).

Also check out an informational bulletin from the Center for Medicaid and CHIP Services (CMCS) on medication-assisted treatment.

Capitol Hill News

NASADAD attends briefing hosted by Coalition for Health Funding on the effects of sequestration on health

Rob Morrison, Executive Director and Colleen Haller, Public Policy Associate attended the Senate briefing, Faces of Austerity: How Budget Cuts Hurt America’s Health, hosted by the Coalition for Health Funding on July 15^th. The Coalition for Health Funding is made up of a wide range of national organizations, including NASADAD, National Association of County and City Health Officials, American Public Health Association, National Association of Community Health Centers, and many more whose collective missions and members depend on federal funding to meet the health care and wellness needs of vulnerable populations. The panel of speakers came from varying health sectors and discussed how sequestration and other budget cuts have affected their ability to meet the health care needs of their communities. The reductions in funding have had wide ranging effects on the delivery of services, research and innovation, public health infrastructure, and individual health.

Panelists:

• Eve Anthony, Athens Community Council on Aging, Athens, GA
• Dr. Shobna Ghosh, Virginia Commonwealth Medical Center, Richmond, VA
• Dr. Glen Mays, University of Kentucky, Lexington, KY
• Tim Starkey, Great Salt Plains Health Center, Cherokee, OK
• Paulette Valentine, Southwest Utah Public Health Department, Saint George, UT

Sens. Booker and Paul introduce legislation to improve employment opportunities for ex- offenders

Senator Cory Booker (D-NJ) and Senator Rand Paul (R-KY) introduced the bill, The Record Expungement Designed to Enhance Employment Act of 2014 (REDEEM Act), in July 2014. The Act would create a pathway for nonviolent offenders, both adult and juveniles, to have their records sealed or expunged under certain circumstances. The REDEEM Act would also offer States incentives to raise the age of adult criminal activity to 18 years old, restrict room confinement of juveniles, lift the lifetime bans on some ex-offenders to receive benefits under the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF), and improve the accuracy of the FBI background check system.

Events

NASADAD attends town hall meeting hosted by Non-Defense Discretionary Coalition on threats to discretionary spending

Colleen Haller, Public Policy Associate attended the town hall, Continued Threats to Discretionary Spending (and What to Do About It) on July 8^th. The Non-Defense Discretionary (NDD) Coalition is made up of groups representing a wide range of non-defense related public interests that rely on discretionary or non-mandatory funding during the federal budget process. These groups represent issues including public health, education, housing, public safety, scientific research, and others. The meeting featured presentations by the Center on Budget and Policy Priorities (CBPP) on the repercussions of a national balanced budget amendment, as well as potential opportunities and threats to discretionary funding as the appropriations process moves forward.

Alliance for Health Reform hosts briefing on health insurance marketplaces

Colleen Haller, Public Policy Associate attended the briefing, Health Insurance Marketplaces in 2014: Behind the Numbers on July 11^th. The expert panel (complete list below) provided an in-depth look at enrollment numbers for the new private health insurance plans, including demographics, initial consumer experiences, and lessons learned as officials plan for the next open enrollment period. The panelists also compared enrollment across States, examined trends in access to affordable health care, and whether safeguards to prevent enrollment inaccuracies have been effective.

Panelists:

• Arnold Epstein, Deputy Assistance Secretary, Office of Health Policy, Assistant Secretary for Planning and Evaluation (ASPE)
• Linda Sheppard, special counsel and Director of Health Policy and Analysis at the Kansas Insurance Department
• Richard Onizuka, Chief Executive Officer, Washington Health Benefit Exchange
• Timothy Jost, professor, Washington and Lee University School of Law

Moderators:

• Ed Howard, Executive Vice President, Alliance for Health Reform
• Sara Collins, Vice President, Health Care Coverage and Access, Commonwealth Fund

National Academy for State Health Policy hosting webinar on Medicaid treatment services for children and adolescents

The webinar, Beyond the Screening: Treatment Services under the Medicaid Benefit for Children and Adolescents, will be held on Thursday, July 24^th from 2-3 pm EST. The webinar will feature a presentation from the Centers for Medicare and Medicaid Services (CMS) on how States can use the Medicaid benefit for children and adolescents to meet the children’s treatment needs. Presenters from Colorado and Washington will also discuss their processes for determining Medicaid coverage for this population.

In the News

Avalere Health releases observations on essential health benefits package

The Affordable Care Act (ACA) requires health plans that participate in the new insurance marketplaces to provide a set of essential health benefits (EHB). The U.S. Department of Health and Human Services (HHS) allowed for a transitional approach to the benefits package that would be largely State-driven for plan years 2014 and 2015. HHS plans to release rules for EHBs to be applied to 2016 plans. In anticipation of HHS releasing rules, Avalere offered a series of observations and thoughts regarding the potential rulemaking process, including:

• “Any EHB rulemaking will struggle to balance patient protections with affordability.”
• “Rulemaking proposing significant changes to EHB for the 2016 plan year would likely need to emerge before the end of 2014.”
• “Limited market experience makes wholesale reforms to current EHB policy unlikely.”
• “Annual guidance for health plans offered on the federal exchange provides a vehicle to dictate policy in the majority of States.”

New York Times publishes article on the IMD Exclusion

The article, “Obscure Rule Restricts Health Law’s Expansion of Care for Addicts,” was published on July 10^th and provides an overview of the IMD Exclusion and its effect on Medicaid reimbursement for residential treatment services for substance use disorders. While the Affordable Care Act (ACA) included treatment for substance use disorders in the Essential Health Benefits, a Medicaid rule from 1965 called the “Institutions for Mental Disease (IMD) Exclusion” makes it very difficult for residential treatment centers to qualify for Medicaid reimbursement. The IMD Exclusion 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. The article offers a number of State examples where the IMD Exclusion has had an impact on access to substance use disorder treatment, both from the provider and patient perspectives.

Resources

Medicaid Directors and Mental Health Program Directors send joint comments to SAMHSA regarding 42 CFR Part 2

The National Association of Medicaid Directors (NAMD) and the National Association of State Mental Health Program Directors (NASMHPD) sent the comments to Substance Abuse and Mental Health Services Administration (SAMHSA) Administrator Hyde regarding SAMHSA’s public listening session on 42 CFR Part 2 and confidentiality. The comments call for the repeal of provisions of 42 CFR Part 2 that are not aligned with the Health Insurance Portability and Accountability Act’s (HIPAA) privacy provisions, with the exception of the provision that prohibits the use of substance use disorder treatment records to initiate or substantiate criminal charges or conduct an investigation of a patient. The comments also include responses to the set of questions that SAMHSA posed regarding potential changes to 42 CFR Part 2.

Commonwealth Fund study finds uninsured rate falls to 15%

The study, Gaining Ground: Americans’ Health Insurance Coverage and Access to Care After the Affordable Care Act’s First Open Enrollment Period, looks at changes in the national uninsurance rate following the first open enrollment period under the Affordable Care Act (ACA). Significantly fewer working-age adults are uninsured than before the enrollment period began. The uninsurance rate for adults aged 19-64 fell from 20% in July-September 2013 to 15% in April-June 2014. Roughly 9.5 million fewer adults were uninsured. Younger adults aged 19-34 drove a large part of the decrease in rates. Of those with new coverage, 60% reported that they visited a doctor or hospital or filled a prescription (American Hospital Association Update).

Also check out the Commonwealth Fund’s infographic.

Association of Drug Court Professionals releases brief report on the ACA

The brief report, Engaging with the Affordable Care Act: Implications and Recommendations for Adult Drug Court Professionals, was released by the National Association of Drug Court Professionals (NADCP). The brief report provides an overview of the ACA, its provisions, and State actions to implement the law. The report also outlines potential challenges for drug courts, particularly in relation to medical necessity, residential treatment, Medicaid billing, changes in provider choice, changes in the Substance Abuse Prevention and Treatment (SAPT) block grant, parity for substance use disorder treatment, and more. NADCP offers a list of 10 actions that drug courts can undertake to best leverage the ACA’s provisions to best serve drug court participants.

PDMP Center for Excellence releases report on State experiences with mandating provider participation in PDMPs

The Brandeis University Prescription Drug Monitoring Program (PDMP) Center for Excellence released the report, Mandating PDMP Participation by Medical Providers: Current Status and Experience in Selected States, which describes the current status of States’ mandates and outcomes in Kentucky, Tennessee, and New York. “Experience in these States indicates that mandates can quickly increase registration and utilization of PDMPs, with subsequent decreases in the prescribing of some commonly abused controlled substances and in measures of doctor shopping. It also highlights policy and implementation issues for States considering mandates” (PDMP report).

State Budge Officers release report on using performance data to inform State budgets

The National Association of State Budget Officers (NASBO) released the report, Investing in Results: Using Performance Data to Inform State Budgeting, in July (NASUAD Update). The report provides information on State experiences and lessons learned from using performance data, particularly related to agency engagement and buy-in, the role of the legislature, budget purpose and design, and sustaining the initiative. The report also contains case studies on Connecticut, Iowa, Minnesota, Nevada, Oregon, Utah, Virginia, and Washington. NASBO provides a list of key terms and definitions and also provides background information on the evolution of using performance data to design State budgets.

DC Update

July 8, 2014

News from the States

• NASADAD attends forum on opioids held in Vermont Statehouse
• Hayden Mathieson to serve as Florida’s Assistant Secretary for Substance Abuse and Mental Health

From the Administration

• White House releases report on the Medicaid expansion
• Surgeon General releases resources to promote 2014 report on smoking and health

Around the Agencies

• SAMHSA releases two resources for clinicians on managing chronic pain in adults in recovery
• CDC releases resources on opioid prescribing by State
• DEA publishes final rule to reschedule tramadol to Schedule IV

Capitol Hill News

• NH Senators introduce bills to fight prescription drug abuse

Events

• Addiction Technology Transfer Center (ATTC) hosts webinar on telehealth

In the News

• AATOD releases paper on increasing access to medication-assisted treatment
• Urban Institute releases report on the Medicaid expansion

News from the States

NASADAD attends forum on opioids held in Vermont Statehouse

On June 16, 2014, Robert Morrison, NASADAD Executive Director, traveled to Montpelier, Vermont to attend a day-long forum designed to spur additional action related to the State’s opioid problem. Governor Shumlin provided remarks to the standing-room-only crowd. The Governor has identified addiction as a top priority for his Administration and dedicated his entire State-of-the-State address to the topic. Barbara Cimaglio, State substance abuse director of Vermont and member of the NASADAD Board of Directors, served as the emcee of the day’s activities. Other plenary speakers included:

• Dr. Harry Chen, Commissioner, Vermont Department of Health, spoke about opioid trends in Vermont and actions taken by the Department on prevention, treatment, and recovery.
• Dr. Mark McGovern, Dartmouth, spoke about the science of addiction and implications for the service system.
• Mayor Christopher Louras, Mayor of Rutland, Vermont, discussed the cross-sector collaboration moving forward in his city.
• Raina Lowell, person in recovery spoke about her challenges and current opportunities.

After the plenary speakers, representatives from different sectors discussed actions they are taking in quick five minute segments. Perspectives were shared by representatives of community coalitions, students, mentorship groups, hospitals, groups of parents that lost a child, adolescent treatment service providers, law enforcement, housing, faith community, recovery groups, businesses that noted the benefit of hiring people in recovery, and many more.

Break-out groups then offered meeting participants an opportunity to discuss specific issue areas.  NASADAD attended a session that explored the work of law enforcement. The session included a discussion from Chief Baker of the Rutland Police Department where he reviewed project VISION (Viable Initiatives and Solutions through Involvement of Neighborhoods) that promotes a collaborative approach across many sectors. “All hands on deck” is the motto of the Police Chief and Mayor.

Next, the meeting prompted participants to organize by regions. NASADAD attended a meeting of attendees from the Burlington area. A number of sectors were represented, including housing, LGBT groups, Boys and Girls Clubs, a State Senator overseeing the Committee of Jurisdiction over health issues, a State Representative overseeing law enforcement issues, a student, employer, a nurse working in a Federally Qualified Health Center (FQHC), and more.

The meeting reconvened all participants and held a short debrief session.  The regional groups planned to convene again with the goal of tangible action steps that will help reduce the impact of the opioid problem in the State.

Special thanks to Barbara Cimaglio and the rest of the staff from Vermont’s State substance abuse agency.

The article below from a Vermont newspaper described the event.

Hayden Mathieson to serve as Florida’s Assistant Secretary for Substance Abuse and Mental Health

Hayden Mathieson, Director of Substance Abuse and Mental Health and NASADAD member, will now serve as the Assistance Secretary for Substance Abuse and Mental Health. In addition to the promotion, Mr. Mathieson will continue to serve as the Florida State Director and NASADAD member. “Mathieson is an attorney with legislative experience, who prior to law school at Florida State, worked in behavioral healthcare with adolescents and families in inpatient and outpatient treatment settings” (Department of Children and Families press release).

From the Administration

White House releases report on the Medicaid expansion

The report, released by the White House Council of Economic Advisors, Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid, reviews the impact of the Medicaid expansion related to access to care, financial security, residents’ health and well-being, and State economies. The report also attempts to quantify these effects using economic analysis. According to the White House, an estimated 5.7 million people will be unable to access health insurance if the current number of States maintain current policies on expanding Medicaid.

Surgeon General releases resources to promote 2014 report on smoking and health

The new resources include a video interview with Rear Admiral Boris Lushniak, Acting Surgeon General on why Surgeon General reports matter. The Acting Surgeon General also gives an overview of the key findings of the previous 31 reports, providing valuable information on tobacco control, disparities, and the health effects of smoking. The Office of the Surgeon General will also be co-hosting a Twitter chat on July 16^th at 2 pm EST with the Centers for Disease Control and Prevention (CDC) on reproductive health and smoking. Finally, the Office is inviting people to sign up for their Tips from Former Smokers Thunderclap. A “Thuderclap” is an application that sends out identical messages via social media (Twitter, Facebook, Tumblr) form multiple accounts.

Use #SGR50chat to join the Twitter discussion on July 16^th at 2 pm EST

Around the Agencies

SAMHSA releases two resources for clinicians on managing chronic pain in adults in recovery

The Substance Abuse and Mental Health Services Administration (SAMHSA) released two KAP Keys based on Treatment Improvement Protocol (TIP) 54: Managing Chronic Pain in Adults with or in Recovery from Substance Use Disorders and a quick guide for clinicians. The resources provide concise information on “chronic non-cancer pain, pain management, treatment, and recovery for adults with substance use disorders” (SAMHSA press release). This includes information on comprehensive patient assessments, a summary of non-opioid pain relievers, and recommendations for clinicians when opioid therapy is indicated.

CDC releases report on opioid prescribing by State

The resources from the Centers for Disease Control and Prevention (CDC) provide State-specific information on opioid prescribing patterns, as well as information on prescription opioid overdoses. Variation across States varies widely with providers in the highest-prescribing State writing almost 3 times as many prescriptions for opioid pain relievers per person than the lowest-prescribing State. The resources, including two studies, a Vital Signs issue, and a fact sheet, also make recommendations for States to encourage more responsible prescribing practices. Firstly, CDC recommends that States increase use of prescription drug monitoring programs (PDMPs) and consider policies to better regulate pain clinics to ensure patient safety. One of the resources is a review of overdose death rates in Florida following State policy changes related to opioid prescribing patterns.

DEA publishes final rule to reschedule tramadol to Schedule IV

The U.S. Drug Enforcement Administration (DEA) published the final rule in the Federal Register rescheduling tramadol to Schedule IV, effective on August 18^th. Tramadol, an opioid pain reliever, was originally approved by the Food and Drug Administration (FDA) in 1995. In 2010, the U.S. Department of Health and Human Services (HHS) conducted a review and analysis of tramadol for the DEA. Given the drug’s abuse potential, the analysis recommended that the DEA schedule tramadol as a Schedule IV substance. Some States, including Arkansas, Mississippi, and New York have already listed tramadol as a controlled substance (National Association of State Controlled Substances Authorities (NASCSA) press release).

Capitol Hill News

NH Senators introduce bills to fight prescription drug abuse

New Hampshire Senators Kelly Ayotte and Jeanne Shaheen introduced their legislation in June and July of 2014, respectively. Sen. Ayotte’s bill, the “Heroin and Prescription Opioid Abuse Prevention, Education, and Enforcement Act of 2014,” creates an inter-agency task force with representatives from the U.S. Department of Health and Human Services (HHS), National Institutes of Health (NIH), Institute of Medicine (IOM), Department of Veterans Affairs (VA), Department of Defense (DOD), the Drug Enforcement Administration (DEA), and other professional addiction and physician experts to develop a set of best prescribing practices for pain management. The bill also authorizes appropriations for the Harold Rogers Prescription Drug Monitoring Program, reauthorizes the Byrne Justice Assistance Grant Program, directs the Office of National Drug Control Policy (ONDCP) to update the Prescription Drug Abuse Prevention Plan to account for the increase in heroin use, and directs the creation of a drug-free media campaign on prescription drug and heroin abuse.

Sen. Shaheen’s bill, the “National All Schedules Prescription Electronic Reporting Reauthorization Act of 2014,” reauthorizes the National All Schedules Prescription Electronic Reporting (NASPER) grant program for prescription drug monitoring programs (PDMPs) that is housed within HHS. The bill amends the 2005 NASPER reauthorization to emphasize data-sharing between States and integration between the PDMP and electronic health records, health information exchanges, and e-prescribing systems. The bill also provides that de-identified information from the PDMP may be released to other State agencies for the purposes of research. No later than 3 years from the date that funds are appropriated, the Secretary of HHS will complete a report that includes an analysis of the extent to which PDMPs have strengthened initiatives to link patients to substance use disorder services.

Events

Addiction Technology Transfer Center (ATTC) hosts webinar on telehealth

The webinar, Telehealth: Improving Access to Services, was hosted by the South Southwest Addiction Technology Transfer Center (ATTC) on July 9^th. As efforts to expand access to treatment continue to grow, some communities have a difficult time with access to care. This can result from a shortage in the health care workforce, as well as long-distances between treatment centers and those seeking help. Telehealth technology is one innovative way to increase access to treatment for those struggling, often rural, communities. The webinar featured presenations by Doug Denton, Executive Director of Homeward Bound, Inc. and Mary S. Cook, Research Associate at UT Austin Center for Social Work Research.

In the News

AATOD releases paper on increasing access to medication-assisted treatment

The American Association for the Treatment of Opioid Dependence (AATOD) released a paper, “Increasing Access to Medication to Treat Opioid Addiction versus Increasing Access for the Treatment of Opioid Addiction with Medications” on July 2^nd. The paper outlines the history surrounding access to and regulation of medication-assisted treatment (MAT). The paper touches on the full spectrum of FDA-approved medications to treat opioid addiction: methadone, buprenorphine, and naltrexone. AATOD calls on policymakers to fully investigate these issues and offers a series of questions to help facilitate the discussion. In particular, AATOD discusses the original intent of the patient limit for buprenorphine prescribers and offers some items to consider in efforts to raise or eliminate the limit. The paper provides a comprehensive overview of MAT for opioid addiction, as well as some important takeaways for policymakers.

Urban Institute releases report on Medicaid expansion

The Urban Institute report from the Health Reform Monitoring Survey, Increase in Medicaid under the ACA Reduces Uninsurance, According to Early Estimates, shows that States that expanded Medicaid had a 4% drop in the rate of uninsurance, compared to 1.4% in States that did not expand. This analysis shows that individuals gaining insurance through Medicaid under the Affordable Care Act (ACA) were previously uninsured, rather than switching from private insurance to Medicaid. According to the report, “Strong gains in any Medicaid/State coverage accompanied falling uninsurance rates among low-income adults, younger and older adults, white non-Hispanic adults, and women” (Urban Institute report).

DC Update

June 27, 2014

News from NASADAD

• NASADAD All States Policy Call scheduled for July 18^th from 4-5 pm EST
• Update on 42 CFR Part 2
• NASADAD sends letters to President and Vice President in support of ONDCP Acting Director Botticelli to serve as permanent Director

Around the Agencies

• SAMHSA releases two publications to help clinicians address viral hepatitis
• CDC releases resources on fetal alcohol spectrum disorders (FASD)
• CDC continues Tips from Former Smokers campaign with additional educational resources
• CMS announces $60 million in funding available to support Navigators in insurance marketplaces
• HHS announces auto-enrollment plans for current Marketplace consumers for 2015
• Government Accountability Office (GAO) releases report on tobacco product regulation

Capitol Hill News

• Mental Health Liaison Group and PhRMA sponsor Hill briefing on access to mental health treatment

Events

• White House hosts Men’s Health and My Brother’s Keeper briefing
• Faces and Voices of Recovery host America Honors Recovery reception

In the News

• The Washington Post publishes op-ed The Myths of Smoking Pot

News from NASADAD

NASADAD All States Policy Call scheduled for July 18^th from 4-5 pm EST

The next NASADAD All States Policy Call will be held on Friday, July 18^th from 4-5 pm EST (dial-in information below) and will feature a presentation by Mark Parrino, President of the American Association for the Treatment of Opioid Dependence (AATOD). Mr. Parrino will be discussing 42 CFR Part 2 among other issues. The All States Policy Calls will take place on the third Friday of each month from 4-5 pm EST, with the exception of the month of August. We wish everyone safe summer travels and will resume our regular call schedule in September.

NASADAD All States Policy Call Dial-In Information:

Toll Free: 1-855-747-8824

Passcode: 1287903424

Update on 42 CFR Part 2 – NASADAD did not send letter to SAMHSA

NASADAD will continue its discussions on 42 CFR Part 2. At this point, the Association has not sent any letters, but will continue to share updates and information with Members. The Substance Abuse and Mental Health Services Administration (SAMHSA) held a public listening session on June 11^th to solicit information on 42 CFR Part 2. SAMHSA also accepted written comments through June 25^th. NASADAD discussed confidentiality issues during their Board Meeting at the NASADAD Annual Meeting in June and held an informational call on June 9^th with the Legal Action Center. NASADAD Members noted the need for additional dialogue in the coming months. We will share any new information or documents from other organizations to help keep Members informed on any 42 CFR Part 2 developments.

NASADAD sends letters to President and Vice President in support of ONDCP Acting Director Botticelli to serve as permanent Director

On June 20^th, NASADAD sent a letter to President Obama and Vice President Biden in support of nominating Michael Botticelli, Acting Director of the Office of National Drug Control Policy (ONDCP), to serve as the permanent Director. Acting Director Botticelli has been an exceptional ally on addiction issues, and NASADAD looks forward to his continued leadership.

Around the Agencies

SAMHSA releases two publications to help clinicians address viral hepatitis

The Substance Abuse and Mental Health Services Administration (SAMHSA) released two publications on viral hepatitis Addressing Viral Hepatitis in People with Substance Use Disorders, one for clinicians and one for clinicians and administrators. The documents provide an overview of the disease, as well as “information on screening, evaluation, treatment, side effects management, and potential interactions among medications used to treat chronic hepatitis” (SAMHSA press release). The resources also provide information about interactions with medications used to treat mental health and substance use disorders.

CDC releases resources on fetal alcohol spectrum disorders (FASD)

The Centers for Disease Control and Prevention (CDC) released a series of free materials that promote “alcohol-free pregnancies to women in your communities” (CDC web page). These materials cover a broad array of topics related to alcohol use during pregnancy, including information on risk factors, health consequences, and frequently asked questions. The research-based materials include a brochure, posters, print ads, health e-cards, and social media tools. These items are downloaded free-of-charge, with the option to order print copies from the CDC.

CDC continues Tips from Former Smokers campaign with additional educational resources

The Centers for Disease Control and Prevention (CDC) launched the Tips from Former Smokers campaign in 2012. The campaign shares the stories of real individuals who are living with serious health problems due to smoking. The newest advertisements (radio, print, TV, posters, social media, etc.) will feature stories about cancer, stroke, pregnancy complications, and others. The ads remind viewers that there is a hotline available for people who want help to quit smoking. There are also a variety of other educational resources made available on the CDC website, including faith-based resources (Legacy Foundation update).

CMS announces $60 million in funding available to support Navigators in insurance marketplaces

The Centers for Medicare and Medicaid Services (CMS) announced that it is accepting letters of intent through June 30^th to apply for funding to support Navigators in insurance marketplaces (both State- and federally-facilitated). “The funding opportunity announcement is open to eligible individuals, as well as private and public entities, Indian tribes, tribal organizations, and urban Indian organizations applying to serve as Navigators in States with a federally-facilitated or State partnership marketplace. It is open to new and returning Navigator applicants” (CMS press release). The Navigator application closes on July 10^th. CMS is also hosting a pre-application webinar on July 1^st from 1:30-3:00 pm EST.

HHS announces auto-enrollment plans for current Marketplace consumers for 2015

The U.S. Department of Health and Human Services (HHS) plans to provide assistance to insurance marketplace consumers and offer them a simple way to auto-enroll in their existing plan each year, rather going through the enrollment process in 2015. This option would be available to those that would like to keep their existing plan, while those who want to make changes will be free to do so. Under the plan, consumers will receive a notice on how to update their income information for tax credit purposes and will receive information from their insurer about premiums and any other relevant payment information.

Government Accountability Office (GAO) releases report on tobacco product regulation

The report, Tobacco Product Regulation: Most FDA Spending Funded Public Education, Regulatory Science, and Compliance and Enforcement Activities, was released on June 20^th. Required by the Tobacco Control Act, the report “examines (1) how FDA spent tobacco user fees for key activities using its authorities granted in the act, and (2) any challenges FDA encountered in using its authorities” (GAO highlights). Of the $1.88 billion in tobacco user fees the FDA has collected since 2009, $1.48 have been spent on various activities. Activities include public education ($508 million), regulatory science ($478 million), and compliance and enforcement ($181 million).

Capitol Hill News

Mental Health Liaison Group and PhRMA sponsor Hill briefing on access to mental health and substance use disorder treatment

Colleen Haller, NASADAD Public Policy Associate attended the briefing, titled Mental Health: Partnering for Access and Treatments for Patients and co-hosted by Representatives Leonard Lance (NJ) and Doris Matsui (CA). The information session included information on the needs of patients living with mental illness and substance use disorders and developments made in research and emerging treatments, particularly pharmacological advances. The panelists offered a broad range of perspectives from pharmaceutical research to community substance abuse and mental health providers to a patient’s perspective (please see the complete list below). The panelists cited a need to expand public and private research partnerships, as well as remove barriers to accessing comprehensive treatment.

Panelists:

• Moderator – Dr. Bill Chin, Executive Vice President, Scientific and Regulatory Affairs, PhRMA
• Chuck Ingoglia, Senior Vice President, Public Policy and Practice Improvement, National Council for Behavioral Health and Co-Chair of the Mental Health Liaison Group
• Stevin Zorn, PhD, Executive Vice President and U.S. Site Head, Neuroscience Research and Development, Lundbeck Research USA
• Dr. Dario Mirski, Vice President, Medical Affairs, Otsuka America Pharmaceutical, Inc.

Events

White House hosts Men’s Health and My Brother’s Keeper briefing

Rob Morrison, NASADAD Executive Director attended the briefing which was co-hosted by the White House and the U.S. Department of Health and Human Services (HHS) and included information on a range of topics related to men’s health. The briefing included four sessions: Mental Health and Substance Abuse; Disease Prevention: Heart and Stroke, Diabetes, and Cancer; Engaging Young Men of Color in their Health; and My Brother’s Keeper: The Road Ahead. Dr. H. Westley Clark, Director of the Center for Substance Abuse Treatment, served as a speaker and moderated the breakout session on substance abuse and mental illness. A complete list of speakers is included below.

Speakers:

• Marlon Marshall, Special Assistant to the President, Principal Deputy Director of Public Engagement
• Dr. Samuel Acre, Chairman of the National Hispanic Medical Association
• Gautam Raghavan, Public Engagement Advisor, Office of Public Engagement
• Marco Davis, Deputy Director of the White House Initiative on Education Excellence for Hispanics
• Dr. H. Westley Clark, Director of the Center for Substance Abuse Treatment, U.S. Department of Health and Human Services
• Dr. George Askew, Chief Medical Officer for the Administration for Children and Families (ACF), U.S. Department of Health and Human Services
• Dr. Ananad Parekh, Deputy Assistant Secretary for Health, U.S. Department of Health and Human Services
• Jesse Moore, Speechwriter, Office of Public Engagement
• Heather Foster, Public Engagement Advisor, Office of Public Engagement

Faces and Voices of Recovery host America Honors Recovery reception

Rob Morrison, NASADAD Executive Director attended the reception which honors the recovery community and exceptional organizations that advocate for recovery. The reception, hosted by Faces and Voices of Recovery (FAVOR), was held in Washington, D.C. on June 25^th, and awards were presented to 5 individuals and one recovery organization for “their significant contributions toward putting a face on recovery, fighting discrimination facing people with addiction, and advocating for recovery” (FAVOR press release).

In the News

The Washington Post publishes op-ed The Myths of Smoking Pot

Washington Post columnist Ruth Marcus wrote the op-ed, featuring an interview with Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA). Dr. Volkow provided an overview of the research on marijuana use and important considerations and cautions related to efforts to legalize the drug for personal use. Dr. Volkow also discusses her particular concerns with adolescents and the effects of marijuana use during adolescent development. In addition to the health effects, Dr. Volkow also expressed concern about the impact of legalization on social norms and perceptions of risk, both of which have significant effects on youth and adolescent behavior.

D.C. Update

June 20, 2014

Around the Agencies

• ONDCP hosts summit on heroin and prescription drug abuse
• CMS launches “From Coverage to Care” to assist consumers with new health coverage
• The National Institutes of Health release resource to help older adults stop smoking

Capitol Hill News

• Sen. Hatch (UT) and Sen. Levin (MI) host Senate forum on buprenorphine
• Friends of NIDA host Congressional briefing, “Marijuana: Health Effects, Changing Patterns of Use and Societal Impact”

Events

• Upcoming webinar “Building a State Health Workforce Center: Lessons Learned in the Carolinas”
• The National Health Policy Forum host meeting on “Controlling Opioid Drug Excess: Health Plan Interventions”

Resources

• Applications to BHbusiness Plus open through August 15^th

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Around the Agencies

ONDCP hosts summit on heroin and prescription drug abuse

Robert Morrison, Executive Director presented at the Office of National Drug Control Policy’s (ONDCP) summit on heroin and prescription drug abuse on June 19^th. Mr. Morrison reviewed NASADAD’s report that was released just weeks ago detailing the actions that State substance abuse agencies have taken to address heroin and prescription drug abuse. The report found that 42 States categorize prescription drug abuse as “most” or “very” important, and that 37 States have seen increases in admissions to treatment for heroin abuse during the past two years. Mr. Morrison’s presentation was followed by two panels: “Prevention, Intervention, and Treatment” and “Overdose and Infectious Disease Prevention.” Other presenters included ONDCP Acting Director Michael Botticelli, U.S. Attorney General Eric Holder, Governor Peter Shumlin (VT), and representatives from the National Institute on Drug Abuse (NIDA), the Center for Substance Abuse Treatment (CSAT). Presenters discussed national opioid abuse trends and sought to “identify innovative practices and models, and discuss how practitioners at every level can help reduce overdose deaths and public health consequences” (Federal Register notice).

View the webcast at: https://www.youtube.com/ONDCP. There are multiple video clips uploaded to the site, NASADAD’s presentation is labeled: “Rx Drug and Heroin Epidemic in the States.”

Also check out NASADAD’s inquiry report on State responses to prescription drug and heroin abuse.

CMS launches “From Coverage to Care” to assist consumers with new health coverage

The Centers for Medicare and Medicaid Services (CMS) released their web-based resource, From Coverage to Care (C2C), “which is designed to help answer questions that people may have about their new health coverage, to help them make the most of their new benefits, including taking full advantage of primary care and preventive services. It also seeks to give health care providers the tools they need to promote patient engagement” (CMS press release). The website contains a variety of educational videos and other resources such as the Roadmap to Better Care and a Healthier You, which helps consumers and providers understand the terms and benefits of their new coverage, including how to use those benefits to seek primary care and preventive services. These and other resources are available on the C2C website.

The National Institutes of Health release resource to help older adults stop smoking

The web-based resource, “Quitting Smoking for Older Adults” features videos, worksheets, health information, quitting strategies, and other resources for older adults who want to quit smoking. The latest Surgeon General’s report, The Health Consequences of Smoking – 50 Years of Progress “provides new data that links smoking to bone disease, cataract, diabetes, macular degeneration, and erectile dysfunction. Research shows that people who quit smoking, regardless of their age, are less likely than those who continue to smoke to die from smoking-related illness. Although the rates of smoking have declined in recent years for all age groups, nearly 10 percent of adults over 65 – almost 4 million older Americans – continue to smoke” (NIH Press Release).

Capitol Hill News

Sen. Hatch (UT) and Sen. Levin (MI) host Senate forum on buprenorphine

Robert Morrison, Executive Director and Colleen Haller, Public Policy Associate attended the forum convened by Senators Hatch and Levin on June 18^th and titled “Buprenorphine in the Treatment of Opioid Addiction: Successes and the Impediments of Expanded Access.” Panelists (complete list of panelists below) were asked to discuss the benefits of medication-assisted treatment, particularly buprenorphine, and the challenges associated with expanding access to buprenorphine. Senator Levin expressed an interest in identifying clear action steps that could be taken at the federal level to expand access to buprenorphine. Of particular concern were identifying ways to reduce physician barriers to becoming buprenorphine prescribers, discussing the 100 patient limit and potential modifications, and strategies to improve coverage for buprenorphine treatment for patients with private insurance, Medicaid, and Medicare. A variety of strategies were discussed and participants agreed that the ultimate goal should be to expand quality access to buprenorphine for the treatment of opioid use disorders.

Panelists:

• Michael Botticelli, Acting Director, White House Office of National Drug Control Policy (ONDCP)
• June Sivilli, Chief, Treatment Branch, Office of Demand Reduction, ONDCP
• Jayme Delano, Policy Analyst, ONDCP
• Dr. Nora Volkow, Director, National Institute on Drug Abuse (NIDA)
• Dr. Jack Stein, Director, Office of Science Policy and Communications, NIDA
• Dr. Westley Clark, Director, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration (SAMHSA)
• Dr. Elinore McCance-Katz, Chief Medical Officer, SAMHSA
• Dr. Andrew Kolodny, Medical Director, Phoenix House Foundation; President, Physicians for Responsible Opioid Prescribing
• Dr. John Kitzmiller, Certified Buprenorphine Prescriber, Lake Orion, Michigan
• Dr. Corey Waller, American Society for Addiction Medicine (ASAM)
• Colleen LaBelle, Program Director, State Technical Assistance Treatment Expansion Office Based Opioid Treatment with Buprenorphine
• Two buprenorphine patients in recovery

Also check out NASADAD’s consensus statement on medication-assisted treatment.

Friends of NIDA host Congressional briefing, “Marijuana: Health Effects, Changing Patterns of Use and Societal Impact”

Colleen Haller, Public Policy Associate attended the briefing hosted by Friends of the National Institute on Drug Abuse (NIDA) in conjunction with the Addiction, Treatment, and Recovery Caucus on Thursday 19^th. Members of the Congressional Caucus were also in attendance including Rep. John Fleming (LA), Rep. Paul Tonko (NY), and Rep. Andy Harris (MD). Topics covered include youth perceptions of marijuana use risk, marijuana’s changing legal status, and the long-term effects of increased marijuana use on individuals’ health and society. Presentations were made by:

• Wilson Compton, MD, Deputy Director of the National Institute on Drug Abuse, will provide an overview of NIDA’s current and planned portfolio on marijuana research as well as scientific information on what we know about the health effects of marijuana use.
• Robert Booth, PhD, Professor of Psychiatry, University of Colorado School of Medicine, will discuss results from his NIDA-funded research on changing patterns of marijuana use and its consequences.
• Former Congressman Patrick J. Kennedy, Co-Founder Project SAM (Smart Approaches to Marijuana).

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Events

Upcoming webinar “Building a State Health Workforce Center: Lessons Learned in the Carolinas”

The webinar will be held on June 25^th at 2 pm EST and will feature a presentation by Linda M. Lacey, Director of the Office for Healthcare Workforce Analysis and Planning in South Carolina. Ms. Lacey has been part of the development process of two health workforce centers, one for the North Carolina nursing workforce and one working with all health worker groups in South Carolina. She will share her experience in working on these two projects and any important lessons learned. This webinar will be hosted by the Health Workforce Technical Assistance Center (HWTAC) and does not require prior registration.

The National Health Policy Forum held a meeting on “Controlling Opioid Drug Excess: Health Plan Interventions”

Colleen Haller, Public Policy Associate attended the National Health Policy Forum’s discussion called “Controlling Opioid Drug Excess: Health Plan Interventions” on June 20^th. The event was moderated by Judith Miller Jones, Director of the National Health Policy Forum and features presentations from four health plans: Blue Cross Blue Shield of Massachusetts, Florida Blue, Humana Pharmacy Solutions, and the Association for Community Affiliated Plans (complete list of the presenters below). The presentations focused primarily on supply-side solutions to the opioid pain reliever epidemic that health plans have undertaken, including prescriber and patient education, prescription drug utilization monitoring, and collaborating with pharmacies. Each of the panelists discussed these efforts in relation to commercial insurance plans, Medicare Part D, Medicaid, and dual-eligible populations.

Panelists:

• Thomas Kowalski, RPh; Clinical Pharmacy Director, Health and Medical Management; Blue Cross Blue Shield of Massachusetts
• Cynthia Griffin, PharmD; Senior Director, Pharmacy Government Programs; Florida Blue
• Kim Caldwell, RPh; Director of Pharmacy Professional Affairs; Humana Pharmacy Solutions
• Deborah Kilstein, JD, MBA; Vice President, Quality Management and Operational Support; Association for Community Affiliated Plans

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Resources

Applications to BHbusiness Plus open through August 15^th

BHbusiness is accepting applications now through August 15^th for round one learning networks to be held in October 2014 (rounds two and three will be held in winter and spring 2015, respectively). Applicants can join a learning network in two ways: as an individual provider who will be placed into a network or as a convener or group of providers to form a network. Single State Agencies (SSAs), State Mental Health Agencies, and ATTCs are all potential conveners. These learning networks offer more customized technical assistance with shorter time periods. Covered topics include “billing, third-party contract negotiations, new business planning, mergers and acquisitions, enrollment and eligibility, and much more” (BHbusiness press release).