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    Policy News Roundup: July 27, 2023

    Key reads

    Federal agencies announce proposed rules to strengthen parity

    The Biden administration announced a proposal to force health insurers to cover mental health and addiction care as comprehensively as physical health care. While parity laws in place for decades already legally require this, many insurers have never truly complied. The proposed rules would force insurers to evaluate their networks to measure not just whether they are offering adequate mental health and addiction coverage, but also whether patients are accessing it. The new rule would attempt to crack down on tactics like offering lower rates to out-of-network mental health providers or imposing prior authorization requirements for mental health care but not comparable physical health care. It would also close a loophole that allowed nonfederal governmental health plans to opt out of parity requirements. The administration also issued a technical release requesting public feedback on proposed data requirements for limitations related to the composition of a plan’s network, as well as the second Mental Health Parity and Addiction Equity Act Comparative Analysis Report to Congress, which found plans continue to produce insufficient comparative analyses to demonstrate compliance, and a fact sheet on parity enforcement results.

    Source: White House unveils plan to make insurers cover mental health care (STAT); Departments Of Labor, Health And Human Services, Treasury Announce Proposed Rules To Strengthen Mental Health Parity And Addiction Equity Act (U.S. Department of Labor)

    Removing training requirements for buprenorphine waiver not sufficient to increase buprenorphine prescribing

    A study by top officials at the Department of Health and Human Services found that while recent moves to deregulate buprenorphine have led to a bump in new prescribers, they did not lead to a significant bump in overall prescribing volume. In April 2021, the administration allowed prescribers to receive a waiver to prescribe buprenorphine to up to 30 patients without an additional training requirement as previously required. The relaxed restrictions led more providers to get a waiver, but few providers actually prescribe buprenorphine. Clinicians reported other obstacles that kept them from prescribing, including concerns about Drug Enforcement Administration overreach, insurance approval processes, lack of institutional support, concerns about diversion and concerns about treating patients with opioid use disorder. Many physician assistant and nurse practitioner prescribers were unable to find a supervising physician to oversee their practice, which several states still require. The waiver requirement has now been eliminated altogether, but findings suggest these other obstacles will need to be addressed in order to increase buprenorphine prescribing.

    Source: Providers still hesitate to prescribe buprenorphine for addiction, despite ‘X-waiver’ removal (STAT)

    Federal news

    SAMHSA announces $47.8 million for grant programs addressing the substance use crisis

    The Substance Abuse and Mental Health Services Administration announced $47.8 million in five grant programs to combat the substance use and overdose crisis. SAMHSA said $18.4 million will go to the Medication-Assisted Treatment-Prescription Drug and Opioid Addiction program to help expand or enhance access to medications for opioid use disorder; $7.4 million will go to the Emergency Department Alternatives to Opioids Demonstration Program to develop and implement alternatives to opioids for pain management in hospitals and emergency department settings; $3 million will go to the Sober Truth on Preventing Underage Drinking (STOP) Act program to prevent and reduce alcohol use among youth; $13.6 million will go to the Adult Reentry Program to expand addiction treatment and recovery and reentry services to adults in the justice system who have substance use disorder (SUD); and $5.4 million will go to the State Pilot Grant Program for Treatment for Pregnant and Postpartum Women to support family-based services for pregnant and postpartum women with SUD.

    Source: HHS Distributes $47.8 Million in Grant Funding for Programs Expanding Access to Medications for Opioid Use Disorder, Addressing Other Facets of Overdose and Substance Use (Substance Abuse and Mental Health Services Administration)

    CMS approves California and Kentucky proposals to provide mobile crisis response services in Medicaid

    The Centers for Medicare and Medicaid Services approved proposals from California and Kentucky for community-based mobile crisis intervention teams to provide Medicaid crisis services. This marks six states that have expanded access to community-based mental health and substance use crisis care through the American Rescue Plan. The new option gives states an opportunity to support community-based mobile crisis intervention teams to provide services for individuals with Medicaid. This helps states better integrate behavioral health services into their Medicaid programs. California and Kentucky’s state plan amendments add mobile crisis response crisis planning, facilitation of a warm handoff, referrals to ongoing supports and follow-up check-ins for individuals experiencing a mental health or substance use crisis. Kentucky is also adding other services to the crisis continuum, including stabilization services beyond those provided by mobile crisis teams, which are delivered in the community following a crisis event.

    Source: CMS Approves California & Kentucky Requests to Provide Essential Behavioral Health Services Through Mobile Crisis Intervention Teams (Centers for Medicare and Medicaid Services)

    Sen. Cassidy introduces SUPPORT reauthorization in Senate

    Senator Bill Cassidy (R-LA) introduced the SUPPORT Reauthorization Act in the Senate. The bill would reauthorize expiring programs that support prevention, treatment and recovery. Among other provisions, the bill would also ensure access to treatment for patients with treatment-resistant depression, direct the Department of Health and Human Services and Drug Enforcement Administration to issue a special registration process for practitioners to prescribe controlled substances via telemedicine, direct the Food and Drug Administration to conduct a review of at-home disposal standards and systems, require a report from the Department of Labor on the implementation of parity laws and require reports from the National Institutes of Health on methadone access and regulatory restrictions and the removal of the buprenorphine waiver requirement. A different version of the bill was passed by the House Energy and Commerce Committee last week.

    Source: Ranking Member Cassidy Introduces SUPPORT Reauthorization Act to Continue Effort to Address the Nation’s Opioid and Mental Health Crisis (U.S. Senate Committee on Health, Education, Labor & Pensions)

    CDC releases data on adult use of e-cigarettes in 2021

    The Centers for Disease Control and Prevention found that in 2021, among adults 18 or older, 4.5% were current e-cigarette users. Use was higher among men than women. Current e-cigarette use was highest among those aged 18-24 and lowest among adults 45 and older. White adults were more likely to be current e-cigarette users than Asian, Black or Hispanic adults. The percentage of adults who used e-cigarettes decreased as family income increased, though the difference among those 18-24 and 45+ was not significant. The CDC found 1.3% of adults smoked cigarettes and used e-cigarettes, 10.2% smoked cigarettes only and 3.2% used e-cigarettes only. Among those 18-24, use of e-cigarettes only was higher than cigarette smoking only or use of both. Among those 25-44 and 45+, use of cigarettes only was higher than use of e-cigarettes only or both. Adults 18-24 were less likely than adults 25+ to smoke cigarettes only but more likely to use e-cigarettes only. Use of both was similar for adults 18-24 and 25-44 and higher for both compared with adults 45+.

    Source: Current Electronic Cigarette Use Among Adults Aged 18 and Over: United States, 2021 (Centers for Disease Control and Prevention)

    State and local news

    Appeals court says Purdue's settlement can go forward

    The 2nd U.S. Circuit Court of Appeals ruled yesterday that Purdue can start executing its opioid settlement. The ruling allows the company’s transformation to start, though it is still subject to approval from another court. Under the deal reached last year with thousands of state and local government entities, the company is to become a new entity, with profits being used to fight the opioid crisis. Sackler family members will pay up to $6 billion. Members of the Sackler family, who are not themselves seeking bankruptcy protections, will be shielded from future lawsuits. A 2nd Circuit panel approved the deal in May. The main remaining objector was the U.S. Bankruptcy Trustee, which says the Sacklers should not have legal protections. It has said in court filings that it intends to ask the U.S. Supreme Court to take the case. The 2nd Circuit said yesterday it would not hold back the settlement from being enacted. The Trustee could now ask the Supreme Court to put the settlement plan on hold.

    Source: Court says OxyContin maker’s bankruptcy and protections for Sackler family members can move ahead (Associated Press)

    First state trial for opioid case brought by hospitals starts

    A lawsuit brought by Alabama hospitals against opioid manufacturers and distributors kicked off this week, the first major test of whether hospitals can use state courts to hold opioid companies accountable for the opioid crisis. In their lawsuit, eight Alabama hospitals argue they have been on the front lines of treating victims of the opioid crisis and have borne a significant portion of the associated costs. The hospitals are seeking $300 million to $500 million from the nine defendants, which include Johnson & Johnson and AmerisourceBergen. The case marks the first opioid state trial involving hospitals in the country. Similar lawsuits brought by hospitals are pending in state courts across the country, and the outcome of this case could signal how well their argument will fare in court.

    Source: First opioid state trial involving hospitals begins (The Washington Post)

    Minneapolis moves toward decriminalization of psychedelic plants

    Minneapolis Mayor Frey on Friday ordered police to stop using taxpayer dollars to enforce most laws against hallucinogenic plants, backing away from enforcing laws that criminalize buying psychedelic plants or using them in private. Minneapolis still prioritizes enforcing laws against selling psychedelic plants, bringing them to schools or using them while driving.

    Source: Minneapolis backs off arrests for psychedelic plant use (Associated Press)

    Other news in addiction policy

    Patient survey demonstrates barriers to behavioral health care

    The Bowman Family Foundation released a report based on a NORC survey finding access challenges to mental health and substance use disorder (MH/SUD) care and disparities between mental and physical health services. It found that 57% of patients who sought MH/SUD care were unable to access care on at least one occasion between January 2019 and April 2022. Of patients with employer-sponsored insurance, 39% reported using at least one out-of-network provider for MH/SUD outpatient care, compared to just 15% for physical health care. Of such patients using out-of-network providers, 80% reported using out-of-network MH/SUD providers “all of the time,” compared to only 6% for physical health care. Even among patients who successfully made an appointment with a new in-network MH/SUD provider, 40% had to contact at least four providers. Nearly 70% of adolescents who sought MH/SUD care did not receive care on at least one occasion, compared to less than 20% for physical health care. Primary care doctors provide office-based care for more than half of patients with MH/SUD conditions, but 98% of adolescents who received MH/SUD care from primary care providers reported a need for more help from specialists.

    Source: New Patient Survey Shows Pervasive Disparities in Access Between Mental Health and Substance Use Versus Physical Health Care (Bowman Family Foundation)