Policy News Roundup: March 31, 2022

    Key reads

    Biden releases FY 2023 budget proposal

    President Biden released his FY 2023 budget proposal. It showcases the administration’s priorities, but Congress ultimately controls appropriations. It includes provisions to fund/improve mental health and addiction prevention and treatment services, workforce development, insurance coverage and parity enforcement, early childhood care and education, tobacco regulation and drug trafficking. For a more detailed summary, see President Biden’s FY 2023 Budget Proposal.

    Landmark Wit parity ruling overturned

    The Ninth Circuit Court of Appeals reversed the landmark Wit v. United Behavioral Health (UBH) decision that required UBH to adopt more stringent standards for mental health and substance use disorder (MH/SUD) treatment and reprocess thousands of claims. The Wit trial court described in detail how UBH made medical necessity determinations for MH/SUD care based on its own financial interests rather than patients’ interests. It described eight generally accepted standards of care for MH/SUD that UBH was obligated to follow when making medical necessity determinations. The Ninth Circuit three-judge panel undid this progress, saying it is “not unreasonable” for health insurers’ coverage determinations to be inconsistent with generally accepted standards of care. The panel did not cite a single holding of the trial court, despite the trial court’s exhaustive findings, and ignored important issues, including the fact that UBH violated multiple states’ laws in using their own criteria.

    Source: A landmark legal ruling in the fight for mental health equity has been overturned (Kennedy Forum)

    Federal news

    Congress working towards legislation to address mental health and addiction

    The Senate Finance Committee released a report based on findings from responses to its Request for Information and testimony presented at recent hearings on behavioral health. The report is the next step in the bipartisan effort to understand the behavioral care crisis and to craft a legislative package, which the Committee intends to consider this summer. The report summarizes the prevalence rates of behavioral health conditions, the impact of COVID-19 and spending on behavioral health. It outlines key challenges across five cross-cutting areas – status of the workforce; children, adolescents and young adults; access to care, integration and coordination; parity; and telehealth. The Committee also held a hearing yesterday on parity and behavioral health integration. The House Energy and Commerce Committee also scheduled a hearing for April 5 to consider nearly 20 bills related to behavioral health.

    Source: Mental Health Care in the United States: The Case for Federal Action (United States Senate Committee on Finance)

    HHS and Education Department launch effort to expand school-based health services

    The Department of Health and Human Services and the Department of Education are launching a joint-department effort to expand school-based health services. The departments will provide additional technical assistance, resources and support to schools that will provide guidance on the federal funding available for school-based physical and behavioral health services, including how Medicaid can support the delivery of these services; help reduce federal administrative burden for states and localities and barriers to the provision of school-based physical and behavioral health services; and improve and strengthen access to physical and behavioral health services.

    Source: HHS Secretary Xavier Becerra, Education Secretary Miguel A. Cardona Announce a Joint Effort to Develop and Share Resources to Ensure Children Have Access to School-based Health Services (Department of Health and Human Services)

    DEA working to expand MAT access

    The Drug Enforcement Administration (DEA) announced its continued commitment to expanding access to medications for addiction treatment (MAT). Beginning this month, practitioners working in hospitals, clinics and emergency rooms will be able to request an exception allowing them to dispense a three-day supply of MAT, including buprenorphine and methadone, to treat patients experiencing acute opioid withdrawal symptoms. DEA, with the Department of Health and Human Services, is engaging in regular outreach with pharmacists and practitioners to express support for the use of MAT. In July, DEA implemented a new regulation increasing the number of mobile methadone treatment facilities. In response to COVID-19, DEA implemented temporary regulations allowing MAT to be prescribed via telemedicine, and it is working to make those regulations permanent.

    Source: DEA’s Commitment to Expanding Access to Medication-Assisted Treatment (Drug Enforcement Administration)

    Congress moving on marijuana legislation

    Last week, the Senate passed the Cannabidiol and Marihuana Research Expansion Act, which would increase the number of researchers allowed to study marijuana and the quantity of marijuana that is produced for research. However, there is no House companion for the legislation yet. The House is expected to vote this week on the MORE Act, which would decriminalize marijuana. The China competitiveness bill now includes the SAFE Banking Act to allow marijuana businesses to access financial systems, but it is unclear if the Senate will retain the amendment in conference.

    Source: Marijuana is in the middle of a big week on Capitol Hill. The Senate passed a research bill, while the House moves next on decriminalization (Politico); Senate passes marijuana research bill unanimously (Politico)

    State and local news

    NGA releases report on state efforts to improve the continuum of care

    The National Governors Association released a report on state efforts to improve the continuum of addiction care. Key themes identified as essential to linking treatment and recovery in cross-agency programs included improving the person-centeredness of treatment and recovery systems, improving addiction outcomes and reducing health disparities, identifying/coordinating resources for services across agencies and reducing stigma. Challenges identified included COVID-19, data, governance, value-based purchasing and stigma. Common strategies emerged, including maximizing resources, addressing disparities, using data to understand need, addressing stigma and promoting linkages through criminal justice involvement. Lessons learned focused on ensuring consistent leadership, addressing racial/ethnic disparities, developing a data use plan, implementing creative purchasing approaches, leveraging federal initiatives, developing processes to support cross-agency collaboration and reviewing state policies/regulations for potential barriers.

    Source: State Efforts To Improve The Continuum Of Care For Substance Use Disorder And Opioid Use Disorder (National Governors Association)

    Drug checking equipment remains illegal or limited in many states

    A systematic legal review of U.S. state laws on the legality of drug checking equipment found that it is clearly legal to possess some or all drug checking equipment in 22 states and clearly legal to distribute it to adults in 19 states. Drug checking equipment is used to determine the presence of fentanyl and other contaminants. In 14 states where distribution is not clearly legal generally, it is legal when the equipment is obtained from syringe services programs. Potential penalties for violations range from small civil fines to multi-year jail sentences. Clarifying, modifying or repealing drug paraphernalia laws would likely improve access to the promising technologies and potentially reduce overdose deaths.

    Source: Legality of drug checking equipment in the United States: A systematic legal analysis (Drug and Alcohol Dependence)

    Ohio launches substance use education and mentorship program in schools

    Ohio Governor DeWine announced that the Drug Resilience Education Awareness Mentorship (DREAM) program, a new drug education and mentorship pilot program, has launched in several elementary schools. It provides educators, law enforcement, parents, guardians and others with a new opportunity to have important age-appropriate discussions with kids about substance use. The program is currently in multiple K-3 classrooms and will later expand to older age groups. It offers a variety of videos for students, including a special role model series featuring standout Ohioans delivering positive messages on the importance of hard work, the dangers of using substances and the importance of never giving up on dreams. The series focuses on Ohio’s Whole Child Framework, the state education department’s health, social and emotional learning requirements and role-playing opportunities. It also includes instructional videos for educators and guardians.

    Source: Governor DeWine Launches New Ohio Drug Education Pilot Program (Mike DeWine)

    Other news in addiction policy

    Only a quarter of people who needed OUD treatment received MOUD

    A study on medication for opioid use disorder (MOUD) use rates among people who needed opioid use disorder (OUD) treatment, using 2019 National Survey on Drug Use and Health data, found that only 27.8% of people needing OUD treatment received MOUD in the past year. No adolescents and only 13.2% of adults aged 50 and older reported past-year MOUD use. Among adults, the likelihood of past-year MOUD receipt (vs. no treatment) was lower for people aged 50 and older than for those 18-25 or with middle or higher income. Compared with receiving non-MOUD services, receipt of MOUD was more likely among adults with at least some college and less likely in small metropolitan areas. While contacts with the health care system and criminal legal system were common, most people encountering these systems did not report receiving MOUD. Findings show critical gaps in care delivery and linkage and that cross-system integrated interventions are needed.

    Source: Use of Medication for Opioid Use Disorder Among US Adolescents and Adults With Need for Opioid Treatment, 2019 (JAMA)

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    March 2022