DC Update

August 14, 2014

 

News from the States

• Pennsylvania SSA Gary Tennis unveils Building Bridges to Recovery project
• Ohio offers funding opportunity for recovery housing support

Capitol Hill News

• House September legislative agenda does not mention appropriations work
• Hospitals urge Congress to expand, protect access to health care-related data

Around the Agencies

• CMCS releases resources on renewal process for Medicaid and CHIP beneficiaries and June enrollment report
• SAMHSA creating Office of Tribal Affairs and Policy
• SAMHSA releases quick guides for clinicians and administrators to meet the needs of women with substance use disorders
• HHS sends notices to federal insurance marketplace consumers with immigration status inconsistencies
• HHS awards more than $106 million for State home visiting programs
• GAO releases report on cost-effective preventive services in peer-reviewed literature

News from NASADAD

• NASADAD meets with the American College of Obstetricians and Gynecologists
• NASADAD presents at SAMHSA Policy Academy on prescription drug abuse

Resources

• Report released on the impact of legalization of marijuana in Colorado

 

News from the States

Pennsylvania SSA Gary Tennis unveils Building Bridges to Recovery project

The project, sponsored by the Pennsylvania Department of Drug and Alcohol Programs (DDAP) in partnership with the Pennsylvania Drug and Alcohol Advisory Council and the Pennsylvania Parent Panel Advisory Council, aims to build informational and resource bridges between the medical, treatment, and recovery communities and the person in need of treatment. Secretary Tennis sent a letter to stakeholders on August 7^th to inform them about the initiative and to invite them to participate in advance of Recovery Month in September. Secretary Tennis writes “I am asking you to identify how you might, as an individual or an organization, initiate dialogue with health care professionals to provide information about substance use disorders and recovery.” The letter offers recommendations for individuals, providers, and organizations on how they can get involved. DDAP will be posting resources on their website to assist participants, and ultimately build momentum for Recovery Month.

Ohio offers funding opportunity for recovery housing support

The Ohio legislature made an investment of $5 million into recovery housing under House Bill 483. The purpose of the initiative is to increase community capacity to provide recovery housing to individuals recovering from substance use disorders. The Ohio Department of Mental Health and Addiction Services (OhioMHAS) released a request for proposal (RFP) to identify an organization to form an Ohio affiliate of the National Alliance of Recovery Residences (NARR). The affiliate will develop quality standards for recovery houses that comply with national quality standards, as well as State and local requirements. The affiliate will also develop and implement a plan for outreach and implementation support for the operators of recovery houses. Finally, the organization will collaborate with a range of stakeholders and provide education about recovery housing in Ohio communities. Questions related to the RFP can be submitted online by August 22. The due date for proposals is August 29 (OhioMHAS News).

Capitol Hill News

House September legislative agenda does not mention appropriations work

House of Representatives Majority Leader Kevin McCarthy (R-CA) sent a memo to the Republican caucus outlining the September legislative agenda. The memo cites “jobs and economic growth,” “lowering costs on gas and groceries,” and “health care” as the major efforts that the House will consider after the August recess. The memo does not mention any work related to appropriations. If Congress fails to pass their appropriations bills, it is likely that they will vote on a continuing resolution to provide short-term funding until appropriations work resumes.

Hospitals urge Congress to expand, protect access to health care-related data

The American Hospital Association (AHA) received a request from Sens. Ron Wyden (D-OR) and Charles Grassley (R-IA) to weigh in on health care data discussions, AHA urged Congress to increase access to meaningful and useful data across the care continuum while protecting the privacy and security of individual patient data as they consider ways to accelerate improvement in health care quality and value. Among other actions, AHA recommends that Congress direct the Centers for Medicare and Medicaid Services (CMS) to release certain Medicare data on Part B carriers, Part D prescription drugs, Medicare Advantage enrollees, and inpatient hospital discharges. As data resources are expanded, AHA urged Congress to ensure that the privacy and security of individual patient information is maintained. As covered entities under the Health Insurance Portability and Accountability Act (HIPAA), health care providers, payers, and clearinghouses bear special responsibilities to keep individual patient information private and secure, and face significant financial and criminal penalties in the event of unauthorized use or disclosures, protections that do not extend to entities that have not signed a specific agreement with a HIPAA-covered entity (AHA News Now).

Around the Agencies

CMCS releases resources on renewal process for Medicaid and CHIP beneficiaries and June enrollment report

The resources, released by the Center for Medicaid and CHIP Services (CMCS), provide information on new enrollees in both Medicaid and the Children’s Health Insurance Program (CHIP) and information about the beneficiary renewal process. The first resource is a PowerPoint presentation from a webinar with ideas and strategies for a streamlined renewal process, which has been posted in Medicaid.gov’s State toolbox for expanding coverage. CMCS also released the June 2014 Medicaid and CHIP Enrollment Report which reports on State Medicaid and CHIP eligibility and enrollment. Since the new insurance marketplaces opened, more than 7.2 million additional people have enrolled in health coverage through Medicaid and CHIP.

SAMHSA creating Office of Tribal Affairs and Policy

The new office will be the Substance Abuse and Mental Health Services Administration’s (SAMHSA) primary point of contact for tribal governments, tribal organizations, federal departments and agencies, and other governments and agencies on mental health and substance use disorder issues facing American Indians and Alaska Natives in the U.S. (SAMHSA press release). Mirtha Beadle, MPA will lead the new office. Ms. Beadle is currently the Deputy Director of the Center for Substance Abuse Prevention. The Senior Advisor for Tribal Affairs, Sheila Cooper, as well as the staff from the Office of Indian Alcohol and Substance Abuse (OIASA) will also join the new office.

SAMHSA releases quick guides for clinicians and administrators to meet the needs of women with substance use disorders

The Substance Abuse and Mental Health Services Administration (SAMHSA) released the guides on August 12^th. Both guides are based on SAMHSA’s TIP 51, Substance Abuse Treatment: Addressing the Specific Needs of Women. The first guide will help clinicians and counselors serve women with substance use disorders using the most up-to-date, gender-specific best practices and approaches. The second guide is designed for administrators and focuses on program development, procedures, and policies that help women with substance use disorders. Both guides seek to help professionals take note of and effectively address the unique needs of women in treatment.

HHS sends notices to federal insurance marketplace consumers with immigration status inconsistencies

Consumers with coverage through the federal health insurance marketplace with inconsistencies in their citizenship or immigration data have been sent notices to submit additional supporting documents by September 5^th. The U.S. Department of Health and Human Services (HHS) has also sent additional notices via mail, email, and phone. Consumers who do not respond by the deadline will lose their marketplace coverage at the end of September. Inconsistencies do not necessarily mean that someone is not eligible for coverage, but may instead arise when the application is incomplete or different from the information that the government has on file. State-run marketplaces are also in the process of verifying citizenship and immigration information and will resolve those issues independently of HHS. Many consumers’ application inconsistencies have been resolved – the number of outstanding cases has fallen from 970,000 in May to 310,000 today. Consumers are encouraged to respond as quickly as possible so that they do not experience an interruption of health insurance coverage.

Also check out a visual breakdown of the notices and blog from HHS with tips or consumers with inconsistencies.

HHS awards more than $106 million for State home visiting programs

U.S. Department of Health and Human Services Secretary Sylvia Burwell announced the grants for 46 States, the District of Columbia, and five jurisdictions as part of the Maternal, Infant, and Early Childhood Home Visiting Program (Home Visiting Program). The Home Visiting Program was established as part of the Affordable Care Act (ACA). The funds can be used to expand evidence-based home visiting services for women during pregnancy and for parents with young children (ages 0-5). Home visits are conducted by nurses, social workers, or educators and have been shown to prevent child abuse and neglect and promote the child’s health and development (HHS press release). The program also specifies that women with substance use disorders receive treatment.

GAO releases report on cost-effective preventive services in peer-reviewed literature

The U.S. Government Accountability Office (GAO) reviewed the peer-reviewed literature on preventive services that were deemed to be cost-effective. GAO reviewed studies from January 2007 to April 2014. The services were categorized into a type such as clinical intervention or screening. GAO also recorded the target population, whether the service was cost-saving, and whether it has been recommended by the Preventive Services Task Force or the Advisory Committee on Immunization Practices. GAO looked at a range of services including tobacco prevention and treatment and substance use disorder treatment for high-risk populations to prevent HIV infection.

News from NASADAD

NASADAD meets with the American College of Obstetricians and Gynecologists

Rob Morrison, Executive Director; Rick Harwood, Director of Research and Program Applications; Shalini Wickramatilake, Research Analyst; and Colleen Haller, Public Policy Associate met with Kate Vlach and Betsy Wieand of the American College of Obstetricians and Gynecologists (ACOG) to discuss areas of potential collaboration between NASADAD and ACOG on women’s health issues. Ms. Vlach and Ms. Wieand were also interested in learning more about the work of State substance abuse agencies, particularly in regards to the management and financing of treatment for women with substance use disorders. ACOG has developed a number of “Committee Opinions” related to substance abuse that may be of interest to NASADAD members (listed below).

ACOG Committee Opinions can be found on:

• Treating opioid dependence during pregnancy,
• Nonmedical use of prescription drugs,
• Reporting on substance abuse during pregnancy, and
• Methamphetamine use in women of child-bearing age.

NASADAD presents at SAMHSA Policy Academy on prescription drug abuse

Rob Morrison, Executive Director; Colleen Haller, Public Policy Associate; Nima Shahidinia, Research Analyst; and Candice Russell, Research Associate attended the Policy Academy hosted by the Substance Abuse and Mental Health Services Administration (SAMHSA) in partnership with the Association of State and Territorial Health Officials (ASTHO) from August 11^th-13^th. The Prescription Drug Abuse Policy Academy featured teams from ten States: CT, KS, KY, MN, NJ, NM, NC, OH, RI, and WI. The prevention-focused Academy featured presentations from several distinguished speakers including Frances Harding (Director, Center for Substance Abuse Prevention), Dr. H. Westley Clark (Director, Center for Substance Abuse Treatment), Michael Botticelli (Acting Director, Office of National Drug Control Policy), Dr. Wilson Compton (Deputy Director, National Institutes on Drug Abuse), and Dr. Paul Jarris (Executive Director, ASTHO) and offered ample time for State teams to work on their own prescription drug abuse plans. On Tuesday morning, Rob Morrison presented findings from NASADAD’s membership inquiry on prescription drugs and heroin on a panel with General Arthur Dean (Chairman and CEO, Community Anti-Drug Coalitions of America) and Nancy Young, PhD (Project Director, National Center on Substance Abuse and Child Welfare). Other presentations included information on prescription drug overdose, opioid use in pregnancy and neonatal abstinence syndrome (NAS), federal initiatives on prescription drug abuse, monitoring and surveillance, improving access to treatment and recovery supports, and much more.

Resources

Report released on the impact of legalization of marijuana in Colorado

The report, The Legalization of Marijuana in Colorado: The Impact, Volume 3, was released on August 12^th by the Rocky Mountain High Intensity Drug Trafficking Area (HIDTA). The report includes information on impaired driving, youth use, adult use, emergency room admissions, marijuana-related exposure, treatment, diversion, THC extraction labs, and related data. Data show that the majority of arrests for driving under the influence involve marijuana and 25-40% of arrests involve marijuana alone. From 2011-2013, marijuana-related emergency room visits increased by 57%, and hospitalizations for marijuana increased by 82% from 2008-2013. With legalization still in the early stages, this report offers preliminary data on the impact on the State and individual Coloradans. Rocky Mountain HIDTA will continue to track this information and release the latest data so that other States and localities that may be considering legalization have a better understanding of the potential short- and long-term impacts.

 

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.