This year has seen a lot of attention paid to mental health by legislators and others alarmed by rising rates of suicide and opioid addiction. Here’s a rundown of how the most salient legislative and regulatory measures could affect clinical practice:
• The Comprehensive Addiction and Recovery Act. Signed into law in July, CARA is primarily intended, as its name indicates, to comprehensively address the opioid addiction crisis. The law includes components aimed at prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose treatment. It also has provisions aimed at expanded prescription drug monitoring programs and other drug abuse prevention mechanisms.
Another important part of this law is the expansion of buprenorphine prescribing rights to nurse practitioners and physician assistants who obtain the necessary training. Public comment is being taken through Nov. 1, on what the requirements should be. This provision will be revisited in 2021.
In all, the law allocates $25 million annually from 2017 through 2021 to expand medication-assisted treatment (MAT). An abundance of evidence shows that MAT – the use of opioid agonists and partial opioid agonists such as methadone, naltrexone, and buprenorphine, in combination with psychosocial therapies – is more effective than either modality alone.
• The Helping Families in Mental Health Crisis Act. Originating in 2013 in response to the Newtown, Conn., massacre, this bill (H.R. 2646) is focused on serious mental illness. It passed the House in July with near unanimous support, but awaits the Senate to sort out its own version of the bill. If this bill is passed, HIPAA laws would loosen, allowing practices to share all but psychotherapy notes with caregivers and guardians of people with serious mental illness. Practices also could bill Medicaid and Medicare for medical and mental health services delivered on the same day, and there would be support for the better integration of medical and mental health electronic medical records. The current 30-day limit on inpatient psychiatric facility services paid for by Medicaid would be lifted, and $20 million in grants would be made available for assisted outpatient treatment of this population. Grants for expanded use of telepsychiatry also would be available.
• The Mental Health Reform Act of 2016. Essentially the companion bill to the one passed in the House, this bill ( S. 2680 ) also calls for the expansion of telepsychiatry, especially for pediatric and adolescent mental and behavioral health needs. If it becomes law, grant money would be made available for better integration of primary and behavioral health care services. This bill calls for strengthening current mental health parity laws by requiring additional federal guidance to help insurance plans comply. The bill currently is stalled on the Senate floor and is not expected to be revisited until after the presidential election.
• The Medication Assisted Treatment for Opioid Use Disorders final rule. As of August, the rule allows addiction medicine specialists to treat up to 275 patients using buprenorphine for substance use disorder annually. Previously, they were held to treating no more than 100 such patients per year. For practices not already licensed to provide MAT, this rule doesn’t have much direct impact. However, for practices with patients on their panels who are struggling with substance use disorders, this could expand available referral resources.
• The Quality Payment Program final rule. While this rule – borne of the MACRA (Medicare Access and CHIP Reauthorization Act) law that is now referred to as the Quality Payment Program – does not directly address mental and behavioral health, it directly affects delivery of these services when it goes into effect in 2017. Because mental and behavioral health outcomes of patient panels that include Medicare populations will be assessed as part of overall patient outcomes, providing effective, integrated services will be imperative. How severely a practice will be penalized for poor outcomes will depend upon how that practice chooses to set up its reimbursement structures and quality metrics over the next few years.
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