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:
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.
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.
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).
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.
Now outdated for today’s integrated care settings, Part 2 prevents our clients from providing fully-informed diagnosis and treatment for patients with a substance use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 was instrumental in driving a change via a previous rule to permit sharing of SUD information with a person’s treating providers within a Health Information Exchange (HIE) with 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.
SAMHSA is reviewing the more than 700 comments submitted and is expected publish a Final Rule in September 2020.
Identical bipartisan bills more closely 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 protections related to any substance use disorder (SUD) patient record that is mistakenly, wrongfully, or intentionally used or disclosed.
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 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.
Currently pushing for Senate committee hearings in early 2020. 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.
Potential for Senate bill to be introduced in early 2020.
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.
Potential for incentive funding for Netsmart clients for EHR purchase or upgrade and related care management technology.
Advocacy to CMMI for inclusion of health IT funding under Sec. 6042 of the SUPPORT Act, a demonstration program scheduled for rollout in December 2020. The program would increase access to comprehensive, evidence-based outpatient treatment for 20,000 Medicare beneficiaries with opioid use disorders.
CMMI is in the process of formulating details and funding amounts for the Sec. 6042 demonstration program. It would require participating providers to provide care management, treatment plans, medication and psychosocial supports for eligible beneficiaries.
This legislation would extend the Certified Community Behavioral Health Clinic (CCBHC) pilot program in its original 8 states (Minnesota, Missouri, Nevada, New Jersey, New York, Oklahoma, Oregon and Pennsylvania) for two years and expand the program to as many as 11 additional states that applied but were not accepted for the initial pilot.
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 participated in a special National Council for Behavioral Health CCBHC Hill Day to advocate for the extension, and is engaged in ongoing advocacy for expansion.
Congress has extended the existing 8-state Medicaid CCBHC pilot program four times, most recently through May 22, 2020.
This legislation addresses major concerns with the Patient Driven Groupings Model (PDGM), a completely new payment model for home health services that took effect 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.
CMS is implementing PDGM with a 4.36% first-year base rate reduction for home health providers based on assumptions of provider behavior under the new payment system. While this is a smaller decrease than the originally-planned 8.01% reduction, the amount will still impact the sustainability of home health providers (especially small providers) and their ability to provide Medicare home health services.
House bill referred to House Ways & Means and Energy & Commerce Committees. Senate bill referred to Senate Finance Committee.
This bill is designed to significantly improve the Medicare telemental health benefit by including services provided in the patient’s home.
Potential to significantly expand access to mental health evaluation and treatment with use of technology
To be determined in conjunction with deliberations on the anticipated May 2020 healthcare bill.
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.
Several Netsmart client communities appear to meet the proposed eligibility requirements – community mental health centers, home health, public health and skilled nursing facilities.
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.
FCC is reviewing comments filed and will publish a Final Rule.