Policy News Roundup: January 25, 2024

Key reads

CMS announces behavioral health integration model

The Centers for Medicare and Medicaid Services announced the Innovation in Behavioral Health (IBH) Model to test approaches for addressing behavioral and physical health, as well as health-related social needs, of people with Medicaid and Medicare. The goal is to improve the quality of care and outcomes for adults with mental health or substance use disorders by connecting them with physical, behavioral and social supports needed to manage their care. Community-based behavioral health practices will form inter-professional care teams consisting of behavioral and physical health providers, as well as community-based supports. Through inter-professional care teams, integrated services will bridge gaps between physical and behavioral health, enabling a “no wrong door” approach. The model will incentivize providers to work collaboratively to screen, assess and coordinate physical and behavioral health. Practice participants will be equipped with the necessary resources to facilitate integrated care, including infrastructure payments to support health information technology capacity, electronic health records and practice transformation; technical assistances; and value-based payment. The model will launch in Fall 2024 and is anticipated to operate for eight years in up to eight states.

Source: CMS Announces New Model to Advance Integration in Behavioral Health (Centers for Medicare and Medicaid Services)

Bill introduced to include approved opioid settlement fund uses in law

Rep. Marcy Kaptur (D-Ohio) and Rep. Ashley Hinson (R-Iowa) introduced legislation that would write into law approved uses for opioid settlement funds. It is the third time since 2019 Kaptur has proposed similar legislation, but she considers it more important now because settlement money has started to flow and examples of questionable uses have surfaced. The bill’s path is difficult in this Congress. Most settlements specify that states must spend at least 85% to address the epidemic. They include a list of suggested investments, many of which echo the uses in the bill. But a lack of transparency and enforcement has made it difficult to determine if states are meeting that 85% threshold, and several jurisdictions have made controversial purchases. Advocates and experts are hopeful that increasing congressional attention could push state and local governments to spend the money on the right things, but they are wary of the bill proposed, saying it lacks teeth and may be a hollow promise of oversight. The bill does not specify consequences for flouting the rules or name an entity in charge of monitoring compliance.

Source: Federal Lawmakers Take First Steps Toward Oversight of $50 Billion in Opioid Settlements (KFF Health News)

Department of Education reports prevalence of substance-related incidents and mental health supports in schools

The Department of Education reported findings from the School Survey on Crime and Safety, 2021-2022. About 71% of public high schools reported at least one incident of distribution, possession or use of illegal substances, 34% reported such incidents for alcohol and 18% for prescription drugs. The survey found 90% of public schools reported increasing social and emotional support for students in response to COVID. In addition, 94% reported having procedures for suicide threats or incidents. The factors reported most often as limiting efforts to reduce or prevent crime “in a major way” were lack of or inadequate alternative placements or programs for disruptive students (30%) and inadequate funding (27%). The most common factors limiting efforts to provide mental health services to students were inadequate access to licensed mental health professionals and inadequate funding (39% each). The survey found 49% of schools provided diagnostic mental health assessments to evaluate students for mental health disorders and 38% provided treatment for mental health disorders.

Source: Crime, Violence, Discipline, and Safety in U.S. Public Schools Findings From the School Survey on Crime and Safety: 2021–22 (U.S. Department of Education)

HHS outlines actions taken on behavioral health integration

The Department of Health and Human Services released a fact sheet outlining policy actions it has taken to expand access to and quality of behavioral health care since launching its Roadmap for Behavioral Health Integration last year. It outlines some of the steps taken over the last year to expand behavioral health access by integrating behavioral health with primary care and other physical health and community settings; recruit, train and support a diverse behavioral health workforce; strengthen implementation and enforcement of parity; engage high-risk populations in integrated behavioral health care through targeted outreach tailored to them; align structural supports and financing to integrate promotion and prevention programs in community-based settings from early childhood to young adulthood; and test models of care integration facilitated through value-based payment and technology.

Source: HHS Roadmap for Behavioral Health Integration Fact Sheet of Accomplishments (Department of Health and Human Services)

Members of Congress call for more training for medical students on medication for OUD treatment

Rep. Annie Kuster (D-NH) led 14 members of Congress in a letter calling for more experiential training for medical students to learn to use medications for opioid use disorder treatment. Reps. Fitzpatrick (R-PA), Trone (D-MD), Turner (R-OH), Trahan (D-MA), and Miller (R-WV) were co-leads. The letter applauds the Accreditation Council for Graduate Medical Education (ACGME) for convening stakeholders to develop recommendations and curricular resources to confront the opioid crisis. It recognizes steps the Association of American Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM) have taken to ensure medical students and resident physicians have training needed to tackle the opioid crisis, including by joining over 80 organizations to form the Action Collaborative on Combating Substance Use and Opioid Crises. However, it stresses that more can be done and urges ACGME, AAMC and AACOM to accelerate efforts to ensure medical students and residents have the necessary clinical experiences to treat opioid use disorder.

Source: Kuster Leads Letter To Ensure Medication-Assisted Treatment Training Is Available to Medical Students (Congresswoman Ann McLane Kuster)

Cities and states equipping public transit with naloxone

Over the last few years, U.S. cities and states have started installing Narcan containers near public transit and equipping transit officers with it. Trains, buses and transit stations have become the sites of many overdoses. In 2019, San Francisco began equipping transit officers with Narcan and requiring a training video on how to intervene. Massachusetts approved $95,000 in August to place Narcan boxes at some stations in the Boston region. The Chicago Department of Public Health has initiated a pilot program to install five public health vending machines across the city, including one at a transit station. Even where Narcan is already available, administering these programs can be challenging. Last year, D.C. partnered with a nonprofit to equip and train Metro Transit Police and crisis intervention specialists on Narcan. But supplying officers with naloxone is difficult because government entities must go through their own channels for naloxone, rather than the nonprofit. Advocates say the greatest barriers remain criminalization and stigma.

Source: Public Transit Agencies Join the Fight to Curb Overdose Deaths (Bloomberg)

Methadone particularly difficult to access in upstate New York

New York proposed funding up to 35 mobile medication units, but only 11 were planned, and only two are operational, both in New York City. Upstate New Yorkers are more likely to die from an opioid overdose and are more often prescribed opioids and admitted to emergency departments for overdoses than people in the city. The average New Yorker must travel at least 9.6 miles to the nearest methadone clinic, and 15.1 miles outside New York City. Since 2018, the average distance has increased 60%. Just 34 of the state’s 62 counties have an opioid treatment program (OTP). 68% of OTP capacity is in New York City, but 57% of state residents live outside the city. People outside the city must travel nearly three times further on average to an OTP. The federal government started allowing new mobile units in 2021, but they can only be run by preexisting brick-and-mortar OTPs, which are rare upstate. OTPs are difficult to start in rural areas. Providers have to recruit trained staff, develop a large enough client base to be financially viable and potentially defeat local opposition.

Source: In Upstate New York, Treatment for Opioid Addiction Gets Harder to Find (New York Focus)

New bill would undo part of Oregon's decriminalization law

Democratic lawmakers in Oregon unveiled a bill that would undo part of the state’s decriminalization law. It would recriminalize possession of small amounts of substances as a low-level misdemeanor. “Personal use” possession of illegal substances would become a misdemeanor punishable by up to 30 days in jail or a $1,250 fine. Those arrested for small amounts would be referred to a peer support specialist to schedule an assessment or intervention. If they show up to the meeting, they would not be charged. If they do not, the offense would be referred to the district attorney. If charges are filed, they could avoid jail by agreeing to certain probation conditions or drug court. The bill would make it easier to prosecute people for selling drugs and create harsher penalties for doing so in parks and near homeless shelters and treatment centers. The bill would allow doctors to prescribe medications for substance use disorder treatment without prior approval or review from insurers and would make it easier for pharmacists to refill prescriptions. It would expand fair housing standards to protect people prescribed medications for substance use disorder from being discriminated against in long-term living facilities such as permanent supportive housing.

Source: With Oregon facing rampant public drug use, lawmakers backpedal on pioneering decriminalization law (Associated Press)

Opioid crisis cost Virginia $5 billion in 2021

Data show that nearly 150,000 Virginians had opioid use disorder in 2021, with at least six Virginians dying of an opioid overdose every day on average. The overall cost of the epidemic in 2021 was more than $5 billion. The financial impact of the opioid epidemic amounted to $558 per Virginian, on average. The majority of costs were shouldered by families and businesses through lost labor (such as lost wages) due to missed work, incarceration or death from opioids ($3.3 billion). Federal, state and local governments were also financially impacted due to loss of income tax revenues, increased opioid-related health care costs ($1.1 billion) and higher expenditures required within the criminal justice system, child and family services and K-12 education ($657.3 million). Households bore most of the cost ($2.7 billion), followed by state/local government ($1.6 billion) and federal government ($695.3 million).

Source: The opioid epidemic cost Virginians $5 billion in 2021, new data shows (VCU News)

Report outlines state efforts and federal recommendations to support whole child health

Nemours Children’s Health and the Whole Child Health Alliance released a report on how Massachusetts, North Carolina and Washington have implemented key elements of whole child health. Each state implemented financing reforms that advance comprehensive, whole child care; integrated health care delivery and social supports by reforming Medicaid to cover services that address social determinants for children and families; and integrated behavioral health services into primary care settings and offered programs that promote prevention and align care. Congress could support and fully fund the Centers for Medicare and Medicaid Services (CMS) and implement initiatives that support whole child health, including a demonstration model. CMS could establish a learning collaborative or Medicaid Innovation Accelerator program among states in partnership with pediatric providers regarding implementation and financing of prevention- and/or population health-driven whole child health delivery models. The White House could specifically focus on addressing health equity in the pediatric population. CMS could emphasize whole child approaches to care that integrate team-based primary care, mental health and oral health.

Source: Spreading and Scaling Whole Child Health: Examples from Leading States and Federal Policy Recommendations (Nemours Children’s Health)

988 counselors report need for more training

An estimated 10,000-11,000 counselors work at more than 200 suicide and crisis 988 call centers nationwide. A new report, based on responses from 47 crisis counselors, explored variations in their training and work experiences. Counselors who responded noted variations in training, from four days or less to two weeks. Most counselors said they were trained in four weeks or less and considered it inadequate. Some counselors said they received training only in talking to people experiencing suicidal thoughts, not how to deal with other mental health issues. They said they were not prepared for the range of calls of varying levels of intensity. Some suggested that opportunities to listen to 988 calls or role-playing exercises would have been helpful. Some said they were expected to end conversations with first-time callers and texters who did not have immediate plans of suicide after 15 minutes, while others reported limits of up to an hour. Centers have different policies on informing callers with imminent plans of suicide or actively attempting suicide that first responders are being dispatched. Vibrant Emotional Health, which administers 988, recently created online, self-paced training courses for crisis counselors.

Source: 988-Hotline Counselors Air Concerns: More Training Needed to Juggle a Mix of Calls (KFF Health News)