Policy News Roundup: April 4, 2024

Key reads

Report finds that CMS did not ensure states complied with Medicaid parity requirements

The Department of Health and Human Services Office of the Inspector General conducted an audit to determine whether the Center for Medicare and Medicaid Services (CMS) ensured that selected states complied with Medicaid managed care parity requirements. CMS did not ensure that selected states complied with parity requirements. For all eight states reviewed, state contracts with managed care organizations (MCOs) did not contain required parity provisions by the compliance date. States and their MCOs did not conduct required parity analyses, and states did not make documentation of compliance available to the public. States may not have ensured that all services were delivered to MCO enrollees in compliance with parity requirements. MCOs in a few states applied financial requirements and quantitative treatment limitations for mental health/substance use disorder (MH/SUD) services that were more restrictive than for medical/surgical services, and in all states imposed non-quantitative treatment limitations on MH/SUD benefits that were not comparable to, or were more stringent than, those for medical/surgical benefits.

Source: CMS Did Not Ensure That Selected States Complied With Medicaid Managed Care Mental Health and Substance Use Disorder Parity Requirements (Department of Health and Human Services Office of the Inspector General)

Access to behavioral health providers severely lacking in Medicare and Medicaid

The Department of Health and Human Services Office of the Inspector General issued a report on access to behavioral health services in Medicare and Medicaid. There were few behavioral health providers in the selected counties who actively served Medicare and Medicaid enrollees. On average, there were fewer than five active behavioral health providers per 1,000 enrollees, and some counties had none. There were even fewer providers who could prescribe medication (2 per 1,000). Providers who served Medicare/Medicaid enrollees represented only about one-third of total behavioral health workers in the counties. Reasons for providers not participating in Medicare/Medicaid include burdensome administrative requirements and low payment rates. Despite unprecedented demand, treatment rates in Medicare and Medicaid remained relatively low (3-8% of enrollees). Enrollees typically traveled about 45 minutes to see providers, but about 1 in 4 traveled more than 1 hour, and about 1 in 10 traveled more than 1.5 hours.

Source: A Lack of Behavioral Health Providers in Medicare and Medicaid Impedes Enrollees’ Access to Care (Department of Health and Human Services Office of the Inspector General)

White House misses self-imposed March deadline for menthol ban rule

The White House’s timeline for banning menthol cigarettes and flavored cigars appears to have slipped again after the administration missed its self-imposed deadline to finalize the rules by March. The administration already delayed the timeline once before, from August to March. The Office of Management and Budget had one more meeting regarding the rule on its calendar for April 2 with lobbying firm Forbes Tate Partners, which represents Altria. Another delay could push the date beyond the election. Public health advocates, including the American Cancer Society, Campaign for Tobacco-Free Kids and American Heart Association, are pressuring Biden to act. Anti-smoking groups Action on Smoking and Health, the African American Tobacco Control Leadership Council and the National Medical Association sued the U.S. government over the stalled ban. The government will have about two months to respond to the lawsuit.

Source: Timeline for menthol ban slips again (Roll Call); Lawsuit seeks to force ban on menthol cigarettes after months of delays by Biden administration (Associated Press)

State attorneys general call on Congress to close Farm Bill loophole allowing psychoactive hemp products

A coalition of 22 state attorneys general is calling on Congress to address the loophole in the 2018 Farm Bill legalizing hemp, which inadvertently led to a multibillion-dollar market in intoxicating products that are arguably federally legal. In the new farm bill, the attorneys general want Congress to enshrine in statute the idea that intoxicating cannabis is not federally legal. The bipartisan coalition brings together representatives from states across the political spectrum and with varying legal statuses of marijuana. The letter notes that intoxicating hemp products are undermining regulations and consumer protections in states where adult-use legal cannabis programs are in place. It also highlights that the products pose a significant risk, particularly to children. A lack of regulation has allowed vendors to sell counterfeit versions of popular candies.

Source: In 2018, Republicans accidentally legalized cannabis. Now 22 AGs want them to undo it (The Hill)

Removing the buprenorphine waiver requirement has not increased prescriptions so far

Thomas Prevoznik, deputy assistant administrator for the Drug Enforcement Administration (DEA), said at the Rx and Illicit Drug Summit this week that the elimination of the buprenorphine waiver requirement has not been the game-changer many officials hoped. The total volume of buprenorphine prescriptions dispensed since has remained around 1.4 million. Prevoznik suggested that stigma among practitioners, low reimbursement rates and fear of attracting DEA scrutiny are among the reasons why prescriptions haven’t changed much. The DEA and the Department of Health and Human Services sent a letter last month to health care practitioners and distributors clarifying issues regarding providers’ fears of running afoul of DEA thresholds on how much buprenorphine can be bought, which Prevoznik said he has made clear the DEA does not have.

Source: Docs don’t want to treat ‘them’ (Politico)

NIDA director says increased prevention efforts are needed to reduce overdoses

At the Rx and Illicit Drug Summit this week, National Institute on Drug Abuse (NIDA) Director Nora Volkow said decreasing risk for substance use, such as by addressing early aggressive behavior and poor social skills, as well as supporting positive relationships and anti-drug use policies, could help reduce overdoses. She said NIDA has asked the National Academies of Sciences, Engineering and Medicine to put together recommendations and policies for substance use prevention. She warned that some racial/ethnic groups are not yet experiencing a drop in overdose deaths, highlighting high rates in American Indian/Alaska Native and Black communities.

Source: ‘Better Than the Drug Dealers’ (Politico)

Oregon governor signs bill recriminalizing drug possession

Oregon Governor Kotek signed into law the bill recriminalizing the possession of small amounts of substances, ending the first-in-the-nation experiment with decriminalization that was plagued by implementation issues. The new law rolls back the 2020 measure by making personal use possession a misdemeanor punishable by up to six months in jail. It also establishes ways for treatment to be offered as an alternative to criminal penalties by encouraging law enforcement agencies to create deflection programs to divert people to mental health and addiction services instead of the criminal justice system. As of this week, the legislature’s website shows that 23 counties have so far signed onto the approach. In a signing letter, Kotek said the law’s success will depend on deep coordination between courts, police, prosecutors, defense attorneys and local mental health providers. Kotek also signed a bill setting aside $211 million for programs to expand access to addiction treatment, including in jails, and mental health services, as well as funding for prevention education.

Source: Oregon governor signs a bill recriminalizing drug possession into law (Associated Press); Gov. Tina Kotek signs new law making drug possession a crime again, says ‘business as usual’ cannot continue (Oregon Live)

Amendment to legalize recreational marijuana will be on the November ballot in Florida

The Florida Supreme Court approved ballot language for a proposed constitutional amendment to legalize recreational marijuana, meaning the issue will be on the ballot in November. The amendment would permit nonmedical marijuana use and would remove criminal or civil penalties for adults 21+ who possess and use up to three ounces for personal use. At least 60% of voters must approve the measure for it to become law. The state attorney general had challenged the proposed amendment, arguing the ballot summary would mislead voters because it states that marijuana would be legal when it is illegally federally, but the conservative state Supreme Court ruled that the language was not misleading. If passed, the amendment will go into effect six months after the election, at which point those 21+ would be able to purchase marijuana products at existing and licensed medical marijuana distributors. The amendment would open the door for the state legislature to license other entities to cultivate, process, sell and distribute marijuana products.

Source: Recreational weed will be on Florida’s 2024 ballot, Supreme Court rules (Tampa Bay Times)

New database shows opioid settlement amounts by state and locality

Determining how much of the opioid settlement funds have arrived in a specific county or city can be challenging, as most localities are not required to make the information public. BrownGreer, the court-appointed firm administering the settlements, tracks much of the data and has started posting updated versions on a public website. The data is updated regularly when new payments are issued, which can be as frequent as twice a month. KFF Health News transformed the data from state-by-state spreadsheets with separate entries for each settling company to a searchable database. Users can determine the total dollar amount their city, county or state has received or expects to receive each year. The information currently reflects only the $26 billion settlement with AmerisourceBergen, Cardinal Health, McKesson and Johnson & Johnson.

Source: Track Opioid Settlement Payouts — To the Cent — In Your Community (KFF Health News)

Addiction treatment is needed in jails and prisons

There are 4,000 correctional facilities in the U.S., of which only a few dozen operate on-site opioid treatment programs. Many people are forced to undergo withdrawal without medical management while incarcerated, which increases risk of overdose upon release. Correctional facilities are increasingly partnering with treatment providers to start treatment programs that offer incarcerated people medications for opioid use disorder (MOUD). Federal policy is opening new pathways to treatment by setting legal expectations, providing regulatory flexibility and offering reimbursement for care. There is clear guidance that jails and prisons have legal obligations to make reasonable efforts to ensure MOUD is available. The Biden administration recently released updated regulations clarifying that methadone can be provided by any correctional facility that is registered as a hospital or clinic, provided that the patient is also being treated for another condition. The administration is allowing state Medicaid programs to apply for waivers to reimburse for health care services provided to those incarcerated in the weeks prior to release, with the requirement that programs include MOUD.

Source: Addiction treatment in prison is a crucial part of solving the opioid crisis (The Hill)

SUD treatment in Medicaid varies by service type, state and demographics

A KFF analysis of 2020 Medicaid claims data found that 7.2% of enrollees ages 12-64 have a diagnosed substance use disorder (SUD), though this may underestimate prevalence because screening/referral practices vary and SUD diagnoses often go unrecorded without treatment. As a result, estimates of treatment rates using claims data might appear higher than they really are since they do not account for the total number of enrollees with SUD. Nearly three-quarters of those with diagnosed SUD in claims data used SUD treatment or supportive services in 2020, but there are wide variations in service type. Counseling/therapy and medication treatment rates were higher than other services. Medication treatment rates were higher for those with opioid use disorder compared with those with alcohol use disorder. Black, Hispanic and Asian enrollees, as well as youth and young adults, have lower treatment rates. There is substantial state-level variation in treatment overall and by service. Spending for enrollees with SUD is twice as much as those without.

Source: SUD Treatment in Medicaid: Variation by Service Type, Demographics, States and Spending (KFF)