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D.C. Update – August 14, 2014

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 7th 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 12th. 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 5th. 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:

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 11th-13th. 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 12th 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.

 

D.C. Update – August 8, 2014

DC Update

August 8, 2014

 

News from NASADAD

  • Hilary Jacobs named Interim Senior Policy Advisor to the Massachusetts Commissioner of Health – Lydie Ultimo named Interim State Director
  • NASADAD welcomes a new Research Associate, Elizabeth Selmi

Events

  • NASADAD attends briefing on health care provided in prisons and jails
  • NASADAD attends briefing on the experience of navigators and insurance brokers during the first open enrollment period of the exchanges

Around the Agencies

  • NASADAD attends DOJ meeting on naloxone and law enforcement – Attorney General Holder provides opening remarks – NASADAD sends follow-up letter
  • CMS officially sets Oct. 1, 2015 as ICD-10 transition date
  • NIH developing system to track emerging drug trends

In the News

  • Study finds that college students receive light penalties for alcohol-related infractions

 

News from NASADAD

Hilary Jacobs named Interim Senior Policy Advisor to the Massachusetts Commissioner of Health – Lydie Ultimo named Interim State Director

Hilary Jacobs was serving as the Director of the MA Bureau of Substance Abuse Services (BSAS) and NASADAD member. Ms. Jacobs will now be a Senior Policy Advisor to the MA Department of Public Health’s Commissioner, specializing in opioid policy. Ms. Jacobs will be coordinating in-State and interagency work, as well as inter-State deliverables based on those agreed to by a June meeting of New England Governors to address opiate use. Ms. Jacobs will also serve as the State Opioid Treatment Authority (SOTA) and will remain an important part of NASADAD’s Opioid Treatment Network (OTN). While we will miss Ms. Jacobs and her terrific work as a State Director, we congratulate her on her new position and look forward to her continued work to reduce opiate abuse in Massachusetts and beyond. Lydie Ultimo, currently a member of the National Treatment Network (NTN), will be serving as the interim SSA for Massachusetts, as well as continuing her work as an NTN. Ms. Ultimo has been with BSAS since 2008 and served as the Deputy Director since 2012.

NASADAD welcomes new Research Associate, Elizabeth Selmi

Elizabeth (Liz) graduated in May 2014 from Boston University with a Bachelor of Arts in Psychology. Prior to working at NASADAD, she interned at Standing Together Against Domestic Violence in London, which works to promote a coordinated, multi-agency community response to domestic violence. She also has clinical experience working as a research assistant at a psychiatry lab in Mount Sinai Hospital in New York, NY. The research focused on comparing cognition in bipolar individuals with their siblings unaffected by the disorder. Liz hopes to pursue her Master’s in Public Health in the future. We are thrilled to welcome Liz to the team! Liz will be working as a Research Associate, primarily supporting the National Treatment Network (NTN), Opioid Treatment Network (OTN), and HIV Coordinators.

Events

NASADAD attends briefing on health care provided in prisons and jails

Rob Morrison, Executive Director and Colleen Haller, Public Policy Associate attended the briefing, Health Care Behind Bars: A Key to Population Health?, hosted by the Alliance for Health Reform on August 1st. The panelists ranged from inmate activists with personal experiences with receiving health care while incarcerated to State officials responsible for managing health care programs for inmates (complete list below). Presenters from Georgia and Tennessee provided information on the innovative approaches those States have taken to improve health outcomes, while also operating on a limited budget.

Moderator:

Ed Howard, Alliance for Health Reform

Panelists:

Steve Rosenberg, Community Oriented Correctional Health Services (COCHS)

Debra Rowe, Returning Citizens United

Jacqueline Craig-Bey, Patient Advocate, former inmate

Sharon Lewis, Georgia Department of Corrections

Dr. Asher Turney, Centurion

NASADAD attends briefing on the experience of navigators and insurance brokers during the first open enrollment period of the exchanges

Colleen Haller, Public Policy Associate attended the briefing hosted by the Alliance for Health Reform. The briefing, Navigating the Health Insurance Landscape: What’s Next for Navigators, In-Person Assisters, and Brokers?, was held on August 5th and featured presentations by two State-based Assister groups, the insurance brokers’ association, and the Kaiser Family Foundation (complete list below). The panelists discussed the experiences of those helping consumers enroll in health insurance, including reviewing the results of a survey of Assister programs, as well as discussing the challenges that lay ahead for the next open enrollment period.

Moderators:

Ed Howard, Alliance for Health Reform

Jennifer Tolbert, Kaiser Family Foundation

Panelists:

Karen Pollitz, Kaiser Family Foundation

Jodi Ray, Florida Covering Kids and Families, University of South Florida

Lisa Stein, Seedco

Jessica Waltman, National Association of Health Underwriters

Around the Agencies

NASADAD attends DOJ meeting on naloxone and law enforcement – Attorney General Holder provides opening remarks – NASADAD sends follow-up letter   

On July 31st, Robert Morrison, Executive Director attended a meeting on law enforcement and naloxone sponsored by the Department of Justice (DOJ). Attorney General Eric Holder provided remarks at the beginning of the meeting. Michael Botticelli, Acting Director of the Office of National Drug Control Policy (ONDCP) also spoke. The meeting was convened by DOJ’s Bureau of Justice Assistance (BJA) which houses a number of NASADAD priority programs and is led by Denise O’Donnell. Mary Lou Leary, Principal Deputy Assistant Attorney General, also led the meeting. The meeting included a round-table of experts in law enforcement and addiction that have already taken a leadership role in the use of naloxone. National organizations (Major Cities Chiefs Association, National Sherriff’s Association, National Criminal Justice Association, National Alliance for Model State Drug Laws) including NASADAD, were invited to attend as well as other federal agencies (such as the Substance Abuse and Mental Health Services Administration (SAMHSA) and others). Tara Kunkel, Visiting Fellow, DOJ/BJA and Chris Traver, DOJ/BJA served as facilitators and guided participants in discussing some of the following areas: (1) championing the implementation of a law enforcement naloxone program, (2) acquisition and replenishment of naloxone, (3) law enforcement training issues, (4) medical oversight and models, (5) legal and liability issues, and (5) distribution of toolkit materials that DOJ is putting together that would serve as a resource for the law enforcement community to consider as a resource. Throughout the day-long meeting, the conversation recognized the need for and benefits of addiction treatment, prevention, and recovery resources. NASADAD sent a follow-up letter to Attorney General Holder, thanking DOJ for convening this meeting and offering recommendations as DOJ develops its toolkit.

Also check out NASADAD’s recently released Fact Sheet on DOJ priority programs.

CMS officially sets Oct. 1, 2015 as ICD-10 transition date

The Centers for Medicare and Medicaid Services (CMS) issued a final rule establishing Oct. 1, 2015 as the date that health care providers must include ICD-10 diagnosis and procedure codes on Medicare and other health care claims. The new date complies with a provision in the Protecting Access to Medicare Act of 2014 delaying the transition for at least one year. The final rule also requires the continued use of ICD-9 through Sept. 30, 2015. “While many providers, including physicians, hospitals and health plans, have completed the necessary system changes to transition to ICD-10, the time offered by Congress and this rule ensure all providers are ready,” CMS said (American Hospital Association Newsletter).

NIH developing system to track emerging drug trends

The National Institutes of Health (NIH) is developing the National Drug Early Warning System (NDEWS) to track emerging drug use trends and assist health officials respond quickly to potential outbreaks of illicit drug use. The system will scan social media and other websites to identify new trends as well as conventional national and local data collected. Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA) says that “by monitoring trends at the local level, we hope to prevent emerging drug problems from escalating or spreading to surrounding regions” (press release). The University of Maryland Center for Substance Abuse Research (CESAR) will receive a five-year grant from NIDA to develop the system.

In the News

Study finds that college students receive light penalties for alcohol-related infractions

The study, published in Alcoholism: Clinical and Experimental Research, was conducted at 343 colleges and found that law enforcement was not likely to issue citations to students for violating alcohol laws (press release). Students were often referred to the school for discipline rather than the criminal justice system. Students were also not generally sent to a campus health center for alcohol abuse screening, intervention, or treatment. The authors of the study suggest that reduced penalties for alcohol-related offenses may contribute to binge drinking along with the easy availability of alcohol at parties and other events and a “social life that emphasizes drinking create an environment where binge drinking is a normative and expected part of college life” (Toben Nelson, Lead Researcher).

D.C. Update – August 1, 2014

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 16th. 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 23rd. 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 23rd (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 13th. 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 19th 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 Appropriations – July 24, 2014

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.