Your voice in Washington

Innovation in Behavioral Health Model

This new voluntary state model aims to improve health outcomes and overall quality of care for Medicare/Medicaid populations. IBH will support care management teams, enabling providers to address behavioral health, physical health, and health-related social needs (HRSNs) in order to provide integrated, whole-person care. Intended outcomes also include improved health equity outcomes and strengthened health IT systems capacity.

Participation: CMS will select up to eight states, the District of Columbia, or U.S. territories to participate. Interested states must apply to a Notice of Funding Opportunity (NOFO), which will be announced in the spring (no date provided). Community-based behavioral health providers within selected states will be eligible to participate in both the Medicaid and Medicare payment models. The IBH Model is also intended to guide community-based behavioral health practices from fee-for-service (FFS) to value-based payments.

The Four Key Program Pillars of the model encompass key areas of whole-person care facilitated by Netsmart solutions, services and expertise:

• Care Integration, including the screening and assessment for behavioral, physical and social needs within a behavioral healthcare setting; person-centered planning and treatment of behavioral and physical conditions or closed-loop referral; monitoring of behavioral and physical health conditions, care plan adjustments based on health outcomes.
• Care Management, including a care management team with behavioral and physical health expertise that meets population health needs; the ongoing management of care plans, treatments and outcomes.
• Health Equity, the ability to screen, refer, and follow-up for health-related social needs; complete population health assessments and develop a health equity plan.
• Healthcare IT, including health IT infrastructure such as electronic health records (EHRs), interoperability standards, etc., telehealth tools that support integrated care delivery, practice transformation activities such as workflow improvements, staff development and retention plans, quality improvement, and more.

Netsmart Advocacy: As a founding member of the BHIT Coalition, Netsmart and other coalition members have engaged in long-standing advocacy and communication with the CMS Innovation Center to develop a behavioral health IT financing demonstration program per Sec. 6001 of the SUPPORT Act of 2018. We also provided behavioral health IT-related knowledge sharing and guidance for the model.

More Information
IBH Model Blog Announcement
Netsmart Human Services Regulatory and Funding Review and Forecast Webinar – 3-18-24
Source: CMS Innovation in Behavioral Health Model

Behavioral Health Information Technology Coordination Act

S. 2688 Lead Sponsors: Sen Markwayne Mullin (R-OK) and Sen. Catherine Cortez Masto (D-NV)

H.R. 5116 Lead Sponsors: Rep. Doris Matsui (D-CA-07), Rep. Ron Estes (R-KS-04), Rep. Sharice Davids (D-KS-03) and Rep. Bill Johnson (R-OH-06)

This proposed legislation would authorize grants totaling $100 million ($20 million per year over 5 years) to behavioral health providers to purchase software and support services needed to provide behavioral health care services. The Office of the National Coordinator for Health Information Technology (ONC) will administer the grant program. The agency would have up to 18 months after passage of the bill to issue a Notice of Funding Opportunity (NOFO).

With a significant focus on integrated care, program requirements specify that grantees use the funds to:

• Demonstrate the capacity to exchange patient clinical data with primary care physicians, medical specialty providers and acute care hospitals, psychiatric hospitals, and hospital emergency departments
• Promote, where feasible, the implementation and improvement of bidirectional integrated services, including evidence-informed screening, assessment, diagnosis, prevention, treatment, recovery, and coordinated discharge planning services for mental health and substance use disorders, and co-occurring physical health conditions and chronic diseases

Netsmart Advocacy: Netsmart and the BHIT Coalition provided recommendations on bill provisions, helped secure bill co-sponsors and are engaged in ongoing advocacy passage of the legislation in the current session of Congress.

More Information
Summary of the legislation

Ensuring Excellence in Mental Health Act

S. 2993 Lead Sponsor: Sen. Debbie Stabenow (D-MI)

House Bill (bill # to come) Lead Sponsors: Reps. Doris Matsui (D-CA-07), Larry Bucshon, M.D. (R-IN-08), Marc Molinaro (R-NY-19) and Angie Craig (D-MN-02)

This proposed bill includes a number of provisions to support the continued expansion and funding of Certified Community Behavioral Health Clinics (CCBHC), the emerging model of care for increasing access to a full range of mental health and substance use treatment services nationwide.

Highlights

• $51M+ in authorizations
• Selected Highlights
  • Creates a Medicaid State Plan option for States to cover CCBHC services
  • Defines State Plan CCBHC services the same as the services are defined under the PAMA Section 223 Medicaid demonstration
  • Establishes a Medicaid CCBHC Prospective Payment System (PPS) and allows States to elect, via the State plan, an alternative payment methodology (APM) in lieu of the CCBHC PPS
  • Establishes CCBHC services as a Medicare Part B benefit, with the services defined the same as in the Medicaid program
  • Establishes a Medicare CCBHC PPS payment methodology
  • Makes amendments to the Public Health Service Act (PHSA) to authorize a permanent CCBHC operating grant and other CCBHC grant programs
  • Adds a new section to the PHSA authorizing the Secretary to issue CCBHC technical assistance grants
  • Authorizes creation of a new HHS data collection infrastructure to support the various CCBHC programs
  • Adds CCBHCs that are participating in Medicare or Medicaid as covered entities for purposes of the PHSA Section 340B drug pricing program
  • Authorizes HHS to select private nonprofit organizations to function as accrediting bodies for CCBHCs

Netsmart Advocacy: Netsmart and the BHIT Coalition are engaged in advocacy for passage of this legislation in the current session of Congress. This will help ensure continued expansion and long-term sustainability of the CCBHC program, including sufficient funding for the data infrastructure program.

More Information
National Council for Mental Wellbeing Summary

Preserving Access to Home Health Act of 2023

S. 2137 Lead Sponsors: Sen. Debbie Stabenow (D-MI) and Sen. Susan Collins (R-ME)

H.R. 5159 Lead Sponsors: Rep. Terri Sewell (D-AL-07) and Adrian Smith (R-NE-03)

On November 1, 2023, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2024 Home Health Prospective Payment System Rate Update and Home Infusion Therapy Services Payment Update Final Rule. The Final Rule took effect January 1, 2024.

The -2.890% permanent adjustment to payment rates for home health agencies in CY24 equals half of the full permanent adjustment of -5.779%, but there are concerns about the methodology used to determine the amount of the cuts and that rate reductions would total more than 6.5% over 2023 and 2024.

These reductions are having significant, long-term repercussions for home health patients and home health providers. It is estimated that more than half of Medicare-certified home health agencies will be operating with negative margins because of the reductions.

Netsmart joins the National Association for Home Care & Hospice (NAHC), the Partnership for Quality Home Healthcare (PQHH), LeadingAge, and other organizations in asking Congress to curb further rate reductions.

The Preserving Access to Home Health Act of 2023 would block further rate reductions and help ensure stability in payments:

• Address cuts made to home health by CMS during the implementation of Medicare’s Patient Driven Groupings Model (PDGM)
• Repeal the requirement that CMS make determinations related to the impact of behavior changes on estimated aggregate expenditures
• Eliminate the authority of CMS to adjust home health payments based on such determinations under PDGM
• Instruct the Medicare Payment Advisory Commission (MedPAC) to review and report on aggregate trends under Medicare Advantage, Medicaid, and other payers and consider the impact of all payers on access to care for Medicare home health beneficiaries
• Add requirements for Medicare home health cost reports to include data on visit utilization and total payments by program

Netsmart Advocacy: Ongoing advocacy in collaboration with association partners the National Association for Home Health & Hospice (NAHC), the Partnership for Quality Home Healthcare (PQHH) and ADVION, including meetings with House and Senate offices and other efforts to gain co-sponsors and support for passage of the legislation.

More Information
CALL TO ACTION: Add your voice to advocacy opposing rate reductions
Bill Text
Partnership for Quality Home Healthcare news release  

42 CFR Part 2 Final Rule

• On January 18, U.S. Department of Health and Human Services (HHS), through its Substance Abuse and Mental Health Services Administration (SAMHSA) and Office for Civil Rights (OCR), announced a Final Rule modifying the Confidentiality of Substance Use Disorder (SUD) Patient Records regulations at 42 CFR Part 2 (“Part 2”).
• The Final Rule aligns the Part 2 statute more closely with HIPAA, enabling appropriate access to a patient’s substance use disorder (SUD) treatment records by a person’s medical providers (with patient consent), to help ensure accurate diagnosis, and effective treatment. It also enables coordinated, “whole-person” care in today’s integrated healthcare ecosystem
• Among many other provisions, the Final Rule allows for a single consent for future uses and disclosures to downstream providers (with associated privacy protections) enables a true continuum of care, removing significant barriers to electronic health information exchanges which will better support care to persons with a SUD or history of SUD treatment.

Netsmart Advocacy: On behalf of its clients, Netsmart played an instrumental role in development and passage of the Protecting Jessica Grubb’s Legacy Act (the Legacy Act) as part of the CARES Act in 2020. The Legacy Act served as the statutory basis for development of the 42 CFR Part 2 Final Rule.

Netsmart also filed comments to the SAMHSA Notice of Proposed Rulemaking (NPRM) and continues to work as a member of the Partnership to Amend 42 CFR Part 2 to help assure that the Final Rule closely aligns with the CARES Act statutory language.

More Information
2024 Final Rule SAMHSA Fact Sheet
Netsmart news release – 2024 Final Rule