Last Week Tonight episode highlights lack of parity and mental health care
Last Week Tonight with John Oliver aired an episode on the lack of adequate mental health care. It discussed the workforce shortage and lack of parity enforcement. It highlighted issues including ghost networks, medical necessity denials, inadequate reimbursement rates and high rates of out-of-network care for mental health. It suggested that we need to recruit more professionals and ensure they are reimbursed adequately, as well as strengthen and enforce parity laws at the state and federal level. It highlighted California’s parity law, which requires insurers to base medical necessity determinations on generally accepted standards of care, as a model for other states. The segment reinforced the critical importance of rehearing the Wit v. United Behavioral Health case in the full 9th Circuit Court of Appeals to revisit the panel’s previous, flawed ruling that allows insurers to deny coverage of medically necessary treatment by using their own standards that benefit their financial interests, rather than generally accepted standards of care based on patient needs.
Source: Mental Health Care: Last Week Tonight with John Oliver (HBO)
Biden administration announces new efforts on school mental health
The Biden-Harris administration announced two new actions to strengthen school-based mental health services. First, it is awarding the first of nearly $300 million secured through the Bipartisan Safer Communities Act and the FY 2022 Omnibus to help schools hire more school-based mental health professionals and build a strong pipeline into the profession. In the following months, the administration will deliver additional funding to foster trauma-informed services in schools, expand mental health services through full-service community schools and respond to childhood trauma associated with community violence. Second, the Departments of Education and Health and Human Services sent a letter to governors highlighting federal resources available to states and schools to invest in mental health services for students. It highlights actions the administration has taken and previews forthcoming Medicaid guidance on how states can leverage Medicaid funding to deliver mental health services to more students.
Source: FACT SHEET: Biden-Harris Administration Announces Two New Actions to Address Youth Mental Health Crisis (White House)
Behavioral Health Coverage Transparency Act introduced in Congress
Senator Elizabeth Warren (D-Mass.), and Representatives Katie Porter (D-Calif.) and Tony Cárdenas (D-Calif.) reintroduced the Behavioral Health Coverage Transparency Act, which would strengthen oversight and enforcement of federal parity laws. The bill would require insurance plans and third-party administrators to submit annual reports with information on non-quantitative treatment limitations and to disclose additional data on denial rates, reimbursement rates and network adequacy; and require the Departments of Health and Human Services, Labor and Treasury to conduct reviews of no fewer than 100 plans per year, including 40 randomized audits. The measure would also establish a toll-free phone number and online Consumer Parity Portal to offer patients and providers information on patients’ rights, findings from oversight efforts and resources to ensure that consumers receive protections guaranteed by law; and encourage collaboration across federal agencies and states, including by awarding grants to establish, expand or provide support for offices of health insurance consumer assistance and health insurance ombudsman programs. Partnership to End Addiction endorsed this legislation.
Sign an action alert to tell your members of Congress to support this bill and other legislation to strengthen parity.
Source: Senator Warren and Representatives Porter and Cárdenas Reintroduce the Behavioral Health Coverage Transparency Act (Elizabeth Warren)
Senate releases FY 2023 appropriations bills
The Senate Appropriations Committee released its 12 appropriation bills for FY 2023. The package includes $2.4 billion for the Substance Use Prevention and Treatment Block Grant and $2.025 billion for State Opioid Response grants. It includes $662.8 million for veteran opioid prevention and treatment programs, $631 million in dedicated grant funding in the Commerce, Justice and Science bill to respond to addiction and drug trafficking, $140 million for the HEAL Initiative, $25 million for HUD’s Recovery Housing Program, $40 million for the COPS anti-heroin task force and $15 million for the anti-methamphetamine task force. It would eliminate the Needle Exchange Amendment, which prohibited federal funding from being used to support syringe services programs. It would include $13.9 billion for mental health programs, $1.42 billion for the Mental Health Block Grant and $824 million for suicide prevention programs, including funding for 988, Certified Community Behavioral Health Clinics and Project AWARE.
Source: Fiscal Year 2023 Chairman’s Mark Appropriations Bill Highlights (United States Senate Committee on Appropriations)
Skepticism surrounds Califf's promised opioid review
In 2016, Robert Califf, as incoming head of the Food and Drug Administration (FDA), promised a “sweeping review” of prescription painkillers. He personally commissioned a report from the National Academies of Sciences that recommended reforms, including potentially removing some substances from the market. Six years later, however, the FDA has actually added six new painkillers. Califf is now back in charge at the FDA and faces skepticism. The FDA seems to have incorporated several of the report’s recommendations into recent decisions, including a broader consideration of a substance’s public health risks, but there is more to be done. Califf said a new internal review of opioids has been underway for months and that the public will soon be hearing more. The review will look at past FDA decisions, but the focus will be on future policy. Califf has said the FDA cannot require new opioids to be safer or more effective than ones already on the market without congressional action.
Source: FDA chief’s long-promised opioid review faces skepticism (Associated Press)
SAMHSA planning for psychedelic treatment
Assistant Secretary for Mental Health and Substance Use Miriam Delphin-Rittmon sent a letter to Rep. Madeleine Dean (D-Pa.) saying that the potential of psychedelic-assisted therapies “must be explored.” The administration “anticipates” that regulators will approve MDMA and psilocybin within two years for designated breakthrough therapies for post-traumatic stress disorder and depression. The administration is “exploring the prospect of establishing a federal task force to monitor” the emerging psychedelic treatment ecosystem.
Source: Biden Administration Plans For Legal Psychedelic Therapies Within Two Years (The Intercept)
State and local news
West Virginia reaches settlement with opioid distributors
West Virginia’s cities and counties reached a $400 million settlement with McKesson, AmerisourceBergen and Cardinal Health. The settlement resolves allegations by more than 100 cities and counties that the distributors fueled the opioid crisis by oversupplying West Virginia with pain medication.
Source: West Virginia cities reach $400 mln opioid distributor deal (Reuters)
California bill to authorize safe consumption site pilots heads to governor's desk
The California Senate cleared changes made to a bill to allow San Francisco, Oakland and the city and county of Los Angeles to pilot supervised consumption sites. The Assembly previously passed the measure, so the bill now heads to Governor Newsom. The amendments added the city of Los Angeles to the bill and require any participating jurisdiction to authorize and fund a peer-reviewed study to assess the programs’ efficacy. It is unclear whether Newsom will sign the bill. He has not weighed in publicly on the issue since taking office. During his 2018 campaign, following former Governor Brown’s veto, Newsom described himself as being “very, very open” to the concept.
Source: Safe injection sites in Newsom’s hands (Politico)
States continue push for cannabis legalization
Last year, four states legalized marijuana through their legislatures, but so far in 2022, only Rhode Island has managed to legalize, despite all-time highs in public support. Currently 19 states have embraced full legalization, while 19 others have enacted medical marijuana programs. Many of the remaining holdouts are staunchly conservative states where legalization skepticism runs deep among lawmakers. The biggest setback this year for advocates was Delaware, where a bill to remove penalties for possession passed both chambers of the legislature, only to be vetoed by the Democratic governor. Recreational legalization efforts also fell short in Ohio, Hawaii and New Hampshire. Medical marijuana bills failed in Kansas, South Carolina, Tennessee and Kentucky. Democratic-sponsored adult-use bills in GOP-dominated legislatures were doomed from the outset in Louisiana, Wisconsin and Indiana. At least half a dozen states could have legalization questions on their November ballots, however.
Source: Where cannabis legalization efforts stand across the country (Politico)
Other news in addiction policy
Report highlights underinvestment in public health
Trust for America’s Health released an annual report tracking federal, state and local investment in public health. The report describes how underinvestment in public health programs hobbled the COVID-19 response, exacerbates health inequities and continues to put lives and livelihoods at risk. It recommends investments and policy actions to build a stronger public health system, prioritize prevention and address the ways in which social and economic inequities create barriers to health in many communities. It includes recommendations that would substantially increase core funding to strengthen public health infrastructure and grow the public health workforce, invest in the nation’s health security, address health inequities and their impact on root causes of disease and safeguard and improve health across the lifespan (including making it a priority to reinvigorate programs that support children and families and prevent substance use and suicide).
Source: The Impact of Chronic Underfunding on America’s Public Health System: Trends, Risks, and Recommendations, 2022 (Trust for America’s Health)
Advocate for Change
Ask your members of Congress to cosponsor legislation to strengthen parity enforcement to ensure that those in need of mental health and substance use treatment are no longer denied coverage in violation of the law.