Your voice in Washington

Netsmart advocacy on key legislative and public policy issues

Lawmakers and regulators make decisions every day that impact healthcare and how providers deliver services. Netsmart is an advocate on key federal legislative and regulatory issues on behalf of our clients and those they serve. Scroll to learn more about our current areas of focus:

 

CMMI Financing Demonstrations

Netsmart is advocating for testing of incentive payments for behavioral health and substance use treatment providers for adoption and use of certified EHR technology to improve the quality and coordination of care.

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S. 433/H.R. 2573: Home Health Payment Innovation Act of 2019

This legislation addresses major concerns with the Patient Driven Groupings Model (PDGM), a completely new payment model for home health services effective January 1, 2020.

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H.R. 2062: Overdose Prevention and Patient Safety Act / S. 1012: Protecting Jessica Grubb’s Legacy Act  

Identical bipartisan bills aligning 42 CFR Part 2 substance use treatment privacy regulations with HIPAA solely for the purposes of treatment, payment, and health care operations (TPO).

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SAMHSA Proposed 42 CFR Part 2 Rule

Summary

Link to Netsmart Comment Filing
Link to Legal Memorandum re: SAMHSA authority on redisclosure (see p. 5)
Link to Netsmart Summary/Impact
Link to Netsmart Detailed Summary
Link to Current 42 CFR Part 2 Statute
Link to Text of Proposed Rule
Link to HHS Proposed Rule Fact Sheet

SAMHSA issued a Notice of Proposed Rulemaking (NPRM), “Coordinating Care and Information Sharing in the Treatment of Substance Use Disorders,” in August 2019. This is SAMHSA’s third rulemaking on this topic in the past two years…nearly unprecedented in the federal regulatory arena.

Why Important?

Now outdated for today’s integrated care settings, Part 2 prevents our clients from providing fully-informed diagnosis and treatment for patients with a substance use disorder (SUD) or history of SUD treatment. SAMHSA issued a Final Rule in January 2018 that made some modifications to 42 CFR Part 2 to accommodate billing, payment, claims management, collections and healthcare data processing. However, the rule excluded SUD patient diagnosis, treatment, and treatment referrals from the list of permissible activities for disclosure by lawful holders of patient identifying information to a person’s treating providers. In other words, it is easier for an insurer or billing company to obtain a person’s SUD history than their own doctors.

Netsmart Advocacy

Netsmart advocacy was instrumental in driving a change via a previous rule to permit sharing of SUD information with a person’s treating providers within an HIE based on a single consent (vs. the patient having to provide separate consents for each treating provider). We also provided a legal memorandum to SAMHSA outlining its ability to go farther in making modifications to Part 2 for treatment and operations. We have also met with HHS and SAMHSA leadership about this issue and submitted comments to this latest NPRM.

Status

SAMHSA is reviewing comments filed and will publish a Final Rule.

 

H.R. 2062: Overdose Prevention and Patient Safety Act / S. 1012: Protecting Jessica Grubb’s Legacy Act

Summary

Bill Text

Identical bipartisan bills aligning 42 CFR Part 2 substance use treatment privacy regulations with HIPAA solely for the purposes of treatment, payment, and health care operations (TPO).

Also increases penalties for information breaches and strengthens patient protections around criminal proceedings by only allowing disclosure to law enforcement with a court order; prohibiting disclosure to initiate or substantiate any criminal charges against a patient or to conduct an investigation against a patient; and excluding from evidence in any proposed criminal proceedings any substance use disorder (SUD) patient record that is mistakenly, wrongfully, or intentionally used or disclosed.

Why Important?

42 CFR Part 2 prevents Netsmart clients and other providers from providing fully-informed diagnosis and treatment for SUD patients. This is especially challenging in integrated care models like Health Information Exchanges (HIEs) and Health Homes, where every member of a patient’s treatment team needs to understand their full medical/SUD history. The regulation also poses a serious safety risk to persons with SUD via potential drug interactions, co-existing medical problems and unintended prescribing errors due to lack of complete information for prescribers.

Netsmart Advocacy

Netsmart has been engaged on this issue for several years as a member of the Partnership to Amend 42 CFR Part 2, which includes providers, health systems, health plans and patient advocacy organizations. Our healthcare privacy counsel testified in a House Energy and Commerce Health Subcommittee hearing, and we have met with senior HHS leadership, House and Senate members, their health staffs and majority and minority committee staff members with jurisdiction over this bill.

Status

Focus is on including S. 1012 as amendment to S. 1895, the Lower Health Care Costs Act, expected to be up for a vote before the end of 2019.

 

CMMI Financing Demonstrations

Summary

The Center for Medicare and Medicaid Innovation (CMMI) is in the process of structuring pilot programs tied to provisions of the SUPPORT for Patients and Communities Act (the large opioid treatment bill passed by Congress last fall). Section 6001 of the SUPPORT Act authorizes the testing of incentive payments for behavioral health and substance use treatment providers for adoption and use of certified EHR technology to improve the quality and coordination of care through the electronic documentation and exchange of health information. CMMI is an entity of the Center for Medicare and Medicaid Services (CMS) that allows the Medicare and Medicaid programs to test models that improve care, lower costs and better align payment systems to support patient-centered practices.

Why Important?

Potential for incentive funding for Netsmart clients for EHR purchase or upgrade and related care coordination technology.

Netsmart Advocacy

Advocating for inclusion and funding under a demonstration project to increase access to comprehensive, evidence-based outpatient treatment for 20,000 Medicare beneficiaries with opioid use disorders…and a bundled payment program to expand Medicare coverage to include Opioid Treatment Programs (OTPs), including the delivery of Medication-Assisted Treatment (MAT).

Status

CMMI is in the process of formulating details and funding amounts for the various financing demonstration programs.

 

S. 824/ H.R. 1767: Excellence in Mental Health and Addiction Treatment Expansion Act

Summary

Bill Text

This legislation would extend the Certified Community Behavioral Health Clinic (CCBHC) pilot program in its original eight states (Minnesota, Missouri, Nevada, New Jersey, New York, Oklahoma, Oregon and Pennsylvania) for two years and expand the program to several additional states TBD.

Why Important?

CCBHCs are a proven vehicle for expanded access to intensive community-based services for individuals with untreated severe mental illness or addiction, and are required to obtain behavioral health IT as condition of participating in the program.

Netsmart Advocacy

Netsmart participated in a special National Council for Behavioral Health CCBHC Hill Day to advocate for the extension and in ongoing advocacy with Congressional offices.

Status

The existing 8-state Medicaid CCBHC demonstration has been extended through Nov. 21. There may be one more short-term extension before an end-of-year package likely to produce a multi-year CCBHC extension and expansion to some additional states.

 

S. 433/H.R. 2573: Home Health Payment Innovation Act of 2019

Summary

Bill Text
Partnership for Quality Home Health Care letter to CMS.

This legislation addresses major concerns with the Patient Driven Groupings Model (PDGM), a completely new payment model for home health services effective January 1, 2020. The bills would require CMS to use actual changes in provider behavior based on claims and other data after PDGM is implemented (instead of assumed behavior) as the basis for payment changes to providers. The bills also reinforce the need for any new model to be budget neutral and limit an agency’s losses or gains to 2% per year.

Why Important?

Among other provisions, CMS plans to implement PDGM with an 8.01% first-year base rate reduction for home health providers based on assumptions of provider behavioral under the new payment system. It is estimated that this action could reduce payments in the Medicare Home Health Program by $1.298 billion in 2020, causing instability to all providers, threatening access to care and harming the Medicare home health program for seniors.

Netsmart Advocacy

Advocacy collaboration with the Partnership for Quality Home Health Care and the National Association for Home Care & Hospice, and meetings with CMS.

Status

House bill referred to House Ways & Means and Energy & Commerce Committees. Senate bill referred to Senate Finance Committee. Potential to attach to “extender” legislation this fall that renews or extends other programs.

 

H.R. 1301: Mental Health and Telemedicine Expansion Act

Summary

Bill Text

This bill is designed to significantly improve the Medicare telemental health benefit by including services provided in the patient’s home. Currently, Medicare reimburses solely for telehealth services offered by a healthcare provider at a distant site to a Medicare beneficiary (the patient) at an originating site. This bill includes the patient’s home in the definition of originating site. Several provisions causing concern by some industry associations/groups are a requirement that the mental health clinician first have a face-to-face encounter with the patient (and likely do an assessment)…and limiting reimbursement under the program to only two CPT codes – CPT 90834 and CPT 90837 – both relating to the reimbursement for psychotherapy services.

Why Important?

Potential to significantly expand access to mental health evaluation and treatment with use of technology

Status

The House Ways and Means Committee has added the telemental health bill into a larger piece of Medicare extenders legislation called the BETTER Act (Sec. 103 of HR 3417).

 

FCC Connected Care Telehealth Pilot Program Notice of Proposed Rulemaking (NPRM)

Summary

Link to Netsmart Comment Filing
Text of NPRM

The NPRM seeks comment on testing a new program that would use the FCC’s existing Rural Health Care Program authority to defray the costs of purchasing broadband Internet access service necessary for providing connected care services directly to low-income patients and veterans.

Anticipated $100 million in funding would provide an 85% discount on connectivity for broadband-enabled telehealth services that connect patients directly to their doctors and are used to treat a wide range of health conditions.

Why Important?

Several Netsmart client communities appear to meet the proposed eligibility requirements – community mental health centers, home health, public health and skilled nursing facilities.

Netsmart Advocacy

Netsmart provided comments to the NPRM about importance of including/funding these under-resourced entities that serve high-risk, high-cost persons with co-occurring mental and physical health conditions.

Status

FCC is reviewing comments filed and will publish a Final Rule.