Policy News Roundup: April 25, 2024

Key reads

RTI study shows continued lack of parity and access to behavioral health care

A study using claims and enrollment data from more than 22 million individuals between 2019 and 2021 across all 50 states found large disparities for out-of-network use and reimbursement rates for behavioral versus physical health, adding to research demonstrating the lack of parity and access to affordable behavioral health treatment. Patients went out-of-network 3.5 times more often to see a behavioral health clinician than a medical/surgical clinician. In-network office visit reimbursement was 22% higher on average for medical/surgical clinicians than office visits with behavioral clinicians. Disparities in out-of-network use were higher for patients who received care for substance use disorder (SUD) than for mental health conditions. SUD office visits were out-of-network 4.2 times more often than medical/surgical office visits, while mental health office visits were out-of-network 3.4 times more often. Acute inpatient SUD care was out-of-network 12.4 times more often than medical/surgical care, while inpatient mental health care was out-of-network 3 times more often. A comparison to a similar 2013 study reveals no improvement in disparities in out-of-network use.

Source: New study finds continuing pervasive disparities in access to in-network mental health and substance use disorder treatment (RTI International)

CMS releases final rules on network adequacy and provider payment rates

The Centers for Medicare and Medicaid Services issued final rules to improve access to care, accountability and transparency for Medicaid/CHIP beneficiaries enrolled in managed care plans. They will require a limit on how long enrollees have to wait for an appointment and allow people to compare plan performance based on quality and access to providers. For the first time ever, states will be required to have national appointment wait time standards. States will enforce these wait time standards by conducting secret shopper surveys, which can help verify compliance with appointment wait time rules and correct provider directory inaccuracies. States will also be required for the first time to disclose provider payment rates publicly. The rules define the scope of “in lieu of services and settings” services in managed care to better address enrollees’ health-related social needs and establish a quality rating system for managed care plans so beneficiaries can learn about eligibility for plans and compare them based on quality and other factors.

Source: Biden-Harris Administration Takes Historic Action to Increase Access to Quality Care, and Support to Families and Care Workers (Department of Health and Human Services)

Supreme Court hears case on local bans on homeless encampments

The Supreme Court heard arguments this week in a case on whether unhoused people can be fined or hit with criminal charges for camping and sleeping in public places when shelter beds are unavailable. City leaders argue that a lower court ruling declaring the practice unconstitutional has made it more difficult to address safety and public health risks linked to encampments, including chronic disease, addiction and mental illness. However, evidence suggests sweeps can worsen the health of people in encampments while causing turmoil in their lives. A majority of the justices appeared inclined to uphold local ordinances that allow Grants Pass, Oregon, to ban homeless people from sleeping or camping in public places. The justices seemed split along ideological lines. The conservatives appeared sympathetic to arguments that homelessness is an issue best handled by local lawmakers, not judges. The liberal justices pushed back on the argument that homelessness was not a status protected under the Eighth Amendment’s prohibition on cruel and unusual punishment.

Source: SCOTUS confronts a public health challenge: Homeless encampments (Washington Post); Supreme Court Seems Poised to Uphold Local Bans on Homeless Encampments (The New York Times)

New York budget includes new enforcement measures to shut down illegal marijuana shops

The New York FY 2025 Enacted Budget includes new initiatives to shut down illicit cannabis operations. It provides the Office of Cannabis Management (OCM) and local municipalities with new authority to take action against illicit storefronts. OCM will be authorized to padlock businesses immediately following an inspection if they are selling illicit cannabis and pose an imminent threat to health and safety. If a business is found not to meet the standards of imminent harm required for padlocking, OCM will issue a notice of violation and an order to cease unlicensed activity. The stores will be padlocked upon reinspection if unlicensed activity is ongoing. If the store has approval to sell alcohol, lottery tickets or tobacco and vaping products, OCM will notify the licensing agencies and the business will be warned they are at risk of losing their licenses. It establishes penalties for landlords who fail to bring eviction proceedings against tenants in violation of the cannabis law and lowers the standard of proof required for eviction. A statewide task force will carry out civil enforcement to close stores.

Source: Governor Hochul Unveils New Initiatives to Shut Down Illicit Cannabis Operations and Protect Legal Marketplace in FY25 Budget Agreement (Governor Kathy Hochul)

Los Angeles's R95 initiative aims to make addiction services more accessible

A Los Angeles County initiative, Reaching the 95% (R95), aims to engage with more people than the fraction already getting addiction treatment. The L.A. County Department of Public Health’s Substance Abuse Prevention and Control division is trying to nudge addiction treatment facilities to change their approach by offering financial incentives for those that meet R95 requirements, including changing their rules to not automatically eject people from treatment for substance use. To get funding, they cannot require total abstinence before admission. Treatment programs are encouraged to partner with harm reduction programs and to look more closely at the “customer experience.” As of last month, roughly half of the treatment providers that contract with L.A. County were on track to become “R95 Champions,” which could yield additional funding if the programs turn in admissions, discharge and engagement policies that adhere to the R95 guidelines.

Source: How L.A. County is trying to remake addiction treatment — no more ‘business as usual’ (Los Angeles Times)

Community health worker in Utah county sheriff's office helps incarcerated people with reentry

The sheriff in Sanpete County, Utah, has a new community health worker who meets with every person booked into the county jail after they arrive and helps them create a release plan. She makes sure everyone has a state ID card, a birth certificate and a Social Security card so they can qualify for government benefits, apply to jobs and get to treatment and probation appointments. She helps nearly everyone enroll in Medicaid and apply for housing benefits and food stamps. She connects people to addiction medications or a place to stay, if needed, coordinating with the jail to have people released directly to the treatment facility. Nobody leaves jail without a ride and a backpack filled with items like toothpaste, a blanket and a personalized list of job openings. She also assesses the addiction history of everyone held by the county. Since the sheriff’s office hired the community health worker last year, recidivism has dropped.

Source: Rural Jails Turn to Community Health Workers To Help the Newly Released Succeed (KFF Health News)

Data from New York's overdose prevention centers shows hundreds of lives saved

In the first year of operation of the two overdose prevention centers (OPCs) in New York City (November 30, 2021 to November 30, 2022), 2,841 individuals visited the two OPCs 48,533 times, and staff intervened during 636 visits (1.3%) to prevent overdose-related injury and death. Emergency medical services were called only 23 times, and no overdose deaths occurred in the OPCs. Results suggest that the OPCs diverted up to 39,000 instances of public drug use and played a critical role in connecting participants to care, with 75% of participants accessing other harm reduction, social and medical services through the centers. Despite these early successes, these and other OPCs face challenges sustaining operations in uncertain legal and law enforcement, legislative and funding environments.

Source: NYC’s Overdose Prevention Centers: Data from the First Year of Supervised Consumption Services (NEJM Catalyst)

Medicaid reimbursement can help street medicine, but more is needed

In October, the federal government announced that it would allow providers to bill for services delivered in a “non-permanent location on the street or found environment.” States such as Pennsylvania, California and Hawaii had already made this move. The main beneficiaries are practices that seek out people living in hard-to-reach places like encampments, but the shift is important even for brick-and-mortar clinics that already receive Medicaid reimbursement for services performed from mobile vans. Street medicine units offer a low-threshold approach that has been shown to increase access to treatment. Mobile units offer same-day medications for opioid use disorder, do not require counseling sessions and will continue treatment even if individuals are not completely abstinent. Street medicine practices are under-resourced, however. They cannot get reimbursed at the full cost of care, and some services are not billable to Medicaid. Strategies increase the effectiveness and availability of street and mobile medicine include reimbursing registered nurses for treating wounds; speeding up Medicaid payments; increasing mail service; and encouraging staff recruitment and retention with loan forgiveness.

Source: Medicaid’s New Policy Boosts Street Medicine in the U.S. (Penn Leonard Davis Institute of Health Economics)

988 and 911 need better coordination

An important aspect of 988 implementation that has received relatively little attention is the relationship between 988 and 911. 911 operates on a local basis out of more than 5,700 public safety answering points (PSAPs). Federal and state officials have directed 988’s implementation, and the lack of federal and state control over 911 makes coordination challenging. Few 911 call center staff have behavioral health crisis training, and most do not use standardized tools to identify behavioral health crisis calls. For widespread diversion from 911 to occur, in many municipalities, a single 988 call center will need to work with multiple nearby PSAPs, develop memoranda of understanding with each and train 911 call takers and dispatchers to recognize 988-appropriate calls. There is a clear need for national standards for effective diversion. Communities must continue to invest in mobile crisis teams that can be dispatched by 988 or 911 in lieu of the police. The public and 911 centers must trust that 988 and the behavioral health system have the capacity to respond. States and communities should develop awareness campaigns that explain the differences between 988 and 911, as well as other lines such as 211 and 311.

Source: Promoting 988 And 911 Coordination To Ensure Timely And Appropriate Mental Health Crisis Response (Health Affairs)