Policy News Roundup: June 9, 2022

Key reads

Parity remains lacking for coverage of mental health and addiction services

Despite parity laws, enforcement remains lacking and insurance coverage of behavioral health care continues to be inadequate. People seeking care continue to contend with administrative roadblocks, network shortfalls and more-restrictive benefits than they receive for physical health coverage. Mental health providers receive lower reimbursement than physical health providers and consequently continue to flee insurance networks for cash-only arrangements. The insurance industry says it should not be held responsible for the inadequacy of the mental health system, which has long lacked sufficient numbers of providers. The industry has called for more use of telehealth and allowing providers with lesser credentials to shoulder more of the load. The government’s parity enforcement involves multiple departments, agencies and states overseeing different types of insurance. The Department of Labor has worked to explain parity requirements and provide assistance to insurers for years, but insurers still claim that they do not know what they are supposed to provide in comparative analyses.

Source: Equal mental health insurance coverage elusive despite legal guarantee (Washington Post)

Opioid and benzodiazepine co-prescription declines

A study found that co-prescription of opioids and benzodiazepines, which increases the risk of overdose, fell by nearly 60% between 2016 and 2019, with the drop-off most pronounced among adults. The period examined was after federal efforts to address co-prescribing, including warnings on prescriptions and prescribing guidelines. Linda Richter, Partnership to End Addiction’s Vice President of Prevention Research and Analysis, said that few people are aware of the role that co-use of benzodiazepines and opioids can have in overdose deaths. She noted that rates of concurrent prescriptions are still very high, and that data from the COVID-19 era, which saw an increase in overdose deaths and youth mental health problems, are not included. She said that improved awareness and education among providers and patients is key, as is ensuring that alternative medications are covered by insurance and made more accessible to providers and patients.

Source: Dangerous Prescriptions of Opioids-Plus-Sedatives Plummet in U.S. (HealthDay)

Gun legislation may include mental health provisions

A bipartisan group of senators is searching for a compromise on gun legislation, which may include new spending for mental health. While House Democrats are gearing up to vote on gun legislation that is not expected to pass the Senate, the Senate is hashing out a more narrow bipartisan compromise with the goal of forging a deal by the end of this week. The group is also working to find an agreement on new spending for mental health. This comes in addition to the mental health efforts recently in the House Energy and Commerce, House Education and Labor and Senate Finance Committees.

Source: The Health 202: Democrats are searching for a health-care win this month (Washington Post)

Legislation introduced to reauthorize and expand substance use block grant

Sens. Maggie Hassan (D-NH), Lisa Murkowski (R-AK) and Ben Ray Luján (D-NM) introduced the Substance Use Prevention, Treatment, and Recovery Act to increase investments in substance use prevention, treatment and recovery programs. The bill would reauthorize the Substance Abuse Block Grant Program, which is set to expire in 2022. It would increase the potential funding from $1.9 billion to $3.2 billion, create a 10% set-aside for recovery services and bar funds from going to programs that are not evidence-based (e.g., organizations that refuse to serve individuals receiving medication for addiction treatment would not be able to receive funding).

Source: Senators Hassan, Murkowski, Luján Introduce Bipartisan Bill to Increase Investments in Substance Misuse Prevention, Treatment, and Recovery (Maggie Hassan)

Most states provided flexibilities for addiction treatment during the pandemic

A survey of opioid treatment program authorities nationwide on how states adjusted opioid use disorder (OUD) treatment during the pandemic and how they plan to provide care in the future found that most states allowed patients take-home methadone during the pandemic. Many of those states plan to continue allowing take-home methadone through the public health emergency and beyond. At least 23 state Medicaid programs changed payment policies to cover OUD treatment services delivered by telehealth, and many states will continue to cover telehealth-delivered treatment services and to allow providers to bill the same rate for telehealth as in-person care.

Source: Most States Eased Access to Opioid Use Disorder Treatment During the Pandemic (Pew)

States pursuing legislation to expand treatment access

Since 2019, the National Conference of State Legislatures’ (NCSL) Substance Use Disorder Treatment Database has tracked state responses to the opioid crisis and the measures taken to increase access to care. The group says 36 states and D.C. enacted 175 bills in the last 3 years. Most of the laws have sought to improve access to medications for opioid use disorder (MOUD). NCSL tracked 72 bills in 27 states seeking to improve access to MOUD. At least 20 states have enacted legislation addressing access to substance use disorder treatment services through telehealth. Other states have enacted laws to improve parity. Many states have also enacted legislation to support people in long-term recovery. States are also allocating funding from lawsuits against opioid companies to support treatment and prevention programs.

Source: As Opioid Overdoses Surge, States Expand Treatment (National Conference of State Legislatures)

States are unprepared for 988 launch

A survey on preparedness for the launch of the 988 mental health emergency hotline indicates that many agencies at state and local levels are not prepared to meet an increased need. More than half of the 180 officials surveyed reported that they were not involved with the development of a strategic plan related to the launch of 988, and only around 16% had a budget to support 988 operations. Approximately 85% reported that there was a mental health emergency response hotline or call center in their jurisdiction, but fewer than half of those hotlines were part of the Lifeline network. The survey found 48% of jurisdictions had a short-term crisis stabilization program, and only 28% had urgent care units for mental health. Only 22% have crisis call centers or hotlines that can schedule intake and outpatient appointments on behalf of patients. Of jurisdictions with hotlines, 55% had staff specifically trained to interact with children/adolescents, 46% with individuals experiencing homelessness and 45% with LGBTQIA+ individuals.

Source: Preparedness for 988 Throughout the United States (RAND)

Some schools face pushback to mental health services

Legislation to expand Connecticut’s network of school-based mental health clinics sailed through the legislature, but when presented to Killingly’s Board of Education, it ran into resistance, mostly on the grounds that it infringed on the rights of parents. The board rejected the plan in March, but supporters filed a complaint. Since then, Killingly’s school board meetings have become a battleground for competing views on mental health. While legislators in more than 30 states have considered an expansion of school-based services over the last year, before services reach students, they must be embraced by communities. Lawmakers and conservative activists have targeted the mental health curriculum in several states, often taking aim at social and emotional learning programs.

Source: A Mental Health Clinic in School? No, Thanks, Says the School Board (New York Times)

Even as overdoses rise, concern about addiction is declining

A Pew Research Center survey found that the share of Americans who see addiction as a “major problem” in their community has declined in recent years (from 42% in 2018 to 35% in 2021), even as overdose deaths have risen sharply. Concern is down even in parts of the country where overdose death rates are the highest or have increased the most. Another Center survey in early 2022 found that dealing with addiction ranked lowest out of 18 priorities for President Biden and Congress to address this year. Fatal overdose rates increased in urban, suburban and rural areas between 2017 and 2020, but the share of Americans who say addiction is a major problem decreased in all three types of areas.

Source: Concern about drug addiction has declined in U.S., even in areas where fatal overdoses have risen the most (Pew Research Center)

Community health centers added new mental health and addiction services during the pandemic