The week of January 19-26:
The Government Shutdown Ends
- On Monday Congress agreed to a short-term budget deal to end the 3-day government shutdown.
The three-week extension keeps the government open until Congress can hopefully pass a spending bill good through September. The three week funding bill agreement includes six years of funding for the Children's Health Insurance Program (CHIP) which has been unfunded since October.
The funding bill does not include Community Health Centers, known to provide primary care and behavioral health services to areas of greatest need.
IN THE EXECUTIVE BRANCH
White House Looking to Further Weaken ACA Mandate Penalty
- CMS is looking to expand the number of exemptions available to individuals who don't want to enroll in Obamacare plans
- Repeal of the mandate, which was in the GOP tax overhaul, doesn't take effect until 2019, so CMS is looking at options to ease the coverage requirement before it ultimately goes away for good.
- There are hardship exemptions for individuals who have had their utilities shut off or who have dealt with the death of a family member, for example. Then there's the exemption for "another hardship," which allows individuals to detail whatever misfortune made it too challenging to adhere to the mandate.
- 12.7 million individuals received an exemption in 2015, nearly double the 6.5 million who paid a penalty for failing to get coverage, according to the IRS.
SAMHSA Announces New Grant Opportunities
- New Efforts to Advance Evidence-based Practices for Opioid Use and Serious Mental Illness
- On January 17, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced major efforts to advance evidence-based practices in the behavioral health field. In conjunction with the Presidential Public Health Emergency Declaration on October 27, SAMHSA announced a new Technical Assistance (TA) effort to focus on the specific needs of states and local jurisdictions to address the opioid crisis in their areas. This week, SAMHSA released $12 million in funding to the American Academy of Addiction Psychiatry to begin the effort to utilize local expertise to provide TA and training on scientifically based evidence-based practices to combat the nation’s opioid crisis. The Opioid State Targeted Response TA program aims to provide TA on evidence-based practices across the spectrum of prevention, treatment and recovery. The program is funded to support the Opioid STR program authorized by the 21st Century Cures Act. The TA program will ensure that Americans suffering with opioid use disorders will gain access to the life-saving evidence-based medication-assisted treatment and psychosocial services they need. In keeping with that priority, SAMHSA has also released a new funding opportunity to develop a national Center of Excellence dedicated to the implementation of evidence-based practices to treat individuals living with serious mental illness (SMI).
- SAMHSA’s $14.5 million Clinical Support Services for SMI TA Center will provide training and education to providers across the country to treat the nation’s most vulnerable populations. The Clinical Support System for Serious Mental Illness Funding Opportunity Announcement (FOA) is available at https://www.samhsa.gov/grants/grant-announcements/sm-18-020.
- The Assistant Secretary for Mental Health and Substance Use indicates that this is only the start of SAMHSA’s new efforts to ensure that communities are well equipped with the knowledge and training needed to implement evidence-based practices for those living with behavioral health conditions
- $52 Million in Grants For People Affected by Homelessness and Mental Illness
- The Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting applications for up to $52 million in grants under its Treatment for Individuals Experiencing Homelessness program. The money will be used to help local service providers offer behavioral health and recovery support services to people experiencing homelessness.
- The purpose of this program is to support the expansion of behavioral health care for people experiencing homelessness along with a serious mental illness or serious emotional disturbance. Grantees will also offer treatment for substance use disorders as needed.
- SAMHSA expects to make as many as 16 grants of up to $500,000 or $1 million annually, depending on the grantee. The grants will be awarded for up to five years and are subject to availability of funds.
- WHO CAN APPLY:
- Eligible applicants are domestic public and private non-profit entities, for example
- States, the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the Virgin Islands, American Samoa, the Federated States of Micronesia, the Republic of the Marshall Islands and the Republic of Palau
- Governmental units within political subdivisions of a state, such as a county, city or town
- Federally recognized American Indian/Alaska Native tribes, tribal organizations, Urban Indian Organizations and consortia of tribes or tribal organizations
- Public or private universities and colleges
- Community and faith-based organizations
- HOW TO APPLY: All applicants must register with the National Institutes of Health’s electronic Research Administration (eRA) Commons in order to submit an application. This process takes up to six weeks. If you believe you are interested in applying for this opportunity, you must start the registration process immediately. Do not wait to start this process. If your organization is not registered or you do not have an active eRA Commons account by the deadline, the application will not be accepted. Applicants must also register with the System for Award Management, SAM.gov, and Grants.gov.
- APPLICATION DUE DATE: March 5, 2018 at 11:59 p.m. Eastern. Applications must be received by the due date to be considered for review.
- ADDITIONAL INFORMATION: Applicants with questions about program issues should contact Maia Banks-Scheetz at (240) 276-1969 or Maia.Banksemail@example.com (link sends e-mail). For questions on grants management and budget issues please contact Gwendolyn Simpson at (240) 276-1408 or FOACMHS@samhsa.hhs.gov
Early Diversion Grants
- The Substance Abuse and Mental Health Services Administration (SAMHSA) is accepting applications for the Law Enforcement and Behavioral Health Partnerships for Early Diversion (Early Diversion Grants) grant program totaling up to $13.4 million over the next five years.
- The purpose of this program is to establish or expand programs that divert adults with a serious mental illness (SMI) or a co-occurring (mental and substance use) disorder (COD) from the criminal justice system to community-based services prior to arrest and booking. Special consideration will be given to applicants proposing to use grant funding to support early diversion services for veterans.
- SAMHSA expects to fund up to eight grantees with up to $330,000 per year for up to five years. The actual award amount may vary, depending on the availability of funds.
- WHO CAN APPLY: Eligibility is statutorily limited by Section 520G of the Public Health Service Act to states; political subdivisions of states; and Indian tribes and tribal organizations as defined in Section 4 of the Indian Self-Determination and Education Assistance Act or through agreements with other public and private non-profit entities. For example,
- States and territories, including the District of Columbia, Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the Virgin Islands, American Samoa, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.
- Governmental units within political subdivisions of a state (e.g., counties, cities, towns, villages).
- Federally recognized American Indian/Alaska Native (AI/AN) tribes, tribal organizations, and consortia of tribes or tribal organizations.
- Acting HHS Secretary Eric Hargan on Friday signed an extension of the emergency declaration for the opioid crisis which officially goes into effect today. Public health emergency declarations, under the Public Health Service Act, last 90 days and can be extended at the discretion of the HHS secretary.
- Little of consequence has been done during the first 90 days of the declaration.
Senate Confirmed Alex Azar to be the new Secretary for the Department of Health and Human Services
The 24th secretary of Health and Human Services was confirmed in a 55-43 vote yesterday, securing enough support thanks to Democrats.
- The six Democrats who backed him. Sens. Tom Carper, Chris Coons, Joe Donnelly, Heidi Heitkamp, Doug Jones and Joe Manchin.
President Trump Extends Opioid Emergency Declaration
Homeland Security Committee Hosts Hearing on
- The Senate Homeland Security and Governmental Affairs Permanent Subcommittee on Investigations discussed the results of a report released a day earlier that showed how easy it is to purchase the powerful opioid fentanyl online.
- Fentanyl and similar substances have been a major contributor to the rising number of drug overdose deaths in recent years. Since small amounts can be diluted into larger quantities or mixed with other drugs, there is a large profit margin. Sending small packages through the mail is an attractive, low-risk proposition for international drug traffickers. The U.S. Postal Service, Customs and Border Protection, Drug Enforcement Administration and other agencies try to screen packages for illegal contents. But with nearly 500 million international packages coming to the U.S. each year, it’s nearly impossible for them to catch all illegal shipments.
- The investigation examined six online fentanyl sellers, which subcommittee Chairman Rob Portman (R-OH) said were “shockingly easy” to find. “All you had to do was search ‘fentanyl for sale’,” he said. Portman wants the Postal Service to require all packages to have “advanced electronic data” that includes names and addresses, cargo descriptions and weight.
- The data can help law enforcement identify packages that might be higher-risk or more suspicious and screen them more closely.
- He’s introduced a bipartisan bill (S 372) to require that data on shipments.
Senator Chuck Grassley (R-IA) Targets Telemedicine for Aging Rural Areas
- Telemedicine could help aging populations in rural states stave off illness, but only if more money is directed at broadband service
- Video consultations and other virtual health care services allow clinicians to not only ensure that rural seniors are "active and alive" but also can monitor whether patients are taking their medication on time, he said. But that requires having a reliable internet connection.
Senate Democrats Oppose Cuts to Drug Policy Office
- A group of Senate Democrats sent a letter to Trump urging him to reconsider those plans to slash the ONDCP's budget.
- The senators call the plan "misguided" and instead support "increased funding and a comprehensive plan to provide much needed relief to families, treatment providers, first responders, and law enforcement officials across the country." The Trump administration considered similarly dramatic cuts to the office last year, but they never were carried out.
House Oversight Seeks Answers on Opioid Commission's Recommendations
- House Committee on Oversight and Government Reform Chairman Trey Gowdy wants to know the status of the Trump administration's efforts to implement recommendations from the president's opioids commission.
- In a letter to Office of National Drug Control Policy Acting Director Richard Baum, Gowdy asks for an update on implementation of a number of recommendations, including that the drug policy office develop infrastructure to track spending on all relevant federal funding initiatives, as well as reviewing all existing research programs on pain management. Gowdy requests updates by Feb 1.
- The ONDCP accepted the recommendations of Trump's opioid commission, led by then-New Jersey Gov. Chris Christie. But the Trump administration has so far not provided details on when it will implement the proposals and last week
- The president is planning to cut the ONDCP by 95 percent and shift its key grants into other agencies.
STATE BY STATE REPORTS
ALABAMA: The state's Opioid Overdose and Addiction Council publicly released a report containing policy recommendations Wednesday.
ARIZONA: The Legislature on Thursday unanimously passed Gov. Doug Ducey's opioid epidemic response despite considerable grumbling from fellow Republicans during the special session. The measure limits initial pain medicine prescriptions to five days, restricts the maximum dosage and requires all pharmacists to check a prescription drug monitoring database prior to dispensing. It also creates a $10 million fund to help uninsured or underinsured people get addiction treatment. The first-time governor is expected to sign the bill today
IDAHO: The state Department of Insurance is letting insurers sell products that don't comply with Obamacare requirements, testing the boundaries of what the Trump administration will allow for conservative states highly critical of the health law. Idaho's bulletin would allow insurers to impose annual spending limits, and exclude some benefits mandated by the health law — as well as protections for people with pre-existing conditions. It's unclear whether the state's move would survive if challenged, and whether any insurers would seek to offer the non-compliant products. Separately, Idaho has already drafted an ACA Section 1332 waiver proposal that seeks to expand eligibility for the law's premium tax credits to individuals below the federal poverty line. Obamacare originally envisioned they would be covered by Medicaid expansion.
KENTUCKY: The class-action lawsuit filed today by multiple advocacy groups aims to block Kentucky from imposing work requirements in Medicaid, which the Trump administration allowed the state to do earlier this month. A federal waiver let Kentucky "require some Medicaid enrollees to work 80 hours per month or lose their health benefits, marking a significant philosophical shift in the 52-year-old entitlement program. "The lawsuit — filed in U.S. District Court for the District of Columbia on behalf of 15 Medicaid enrollees — alleges that the Trump administration abused its executive power by granting a sweeping Medicaid waiver to Kentucky that does not promote the objectives of the program."
MASSACHUSETTS: Gov. Charlie Baker's fiscal 2019 budget request proposes to move roughly 140,000 non-disabled adults off of Medicaid and onto subsidized Obamacare plans, according to the proposal he presented to state legislators this week. But Baker's plan to save the state money likely faces steep resistance in the heavily Democratic Legislature, with the Boston Globe noting opposition from at least one top lawmaker. The GOP governor, who is up for reelection this year, has already submitted a Medicaid waiver request to the Trump administration to allow the shift.
MINNESOTA & NEW YORK: The Trump administration is wrongfully withholding more than $1 billion from New York and Minnesota, jeopardizing two state budgets and the health insurance of nearly 1 million people, according to a federal lawsuit filed Friday. The complaint, filed in U.S. District Court for the Southern District of New York, is an expected challenge to the Trump administration’s decision to withhold money from the Basic Health Program, a creature of the Affordable Care Act, which relied on disputed congressional funding. At stake is the fate of two popular programs that benefit low-income residents and the Trump administration’s ability to cripple aspects of Obamacare despite Congress’ failure to repeal the law. New York and Minnesota are the only two states to have a Basic Health Program, called the Essential Plan in New York and MinnesotaCare in Minnesota. The ACA allows these types of plans if states can provide subsidized health insurance to low-income residents who do not qualify for Medicaid. New York and Minnesota have 700,000 and 100,000 people, respectively, enrolled in these plans.
OREGON: Ballot initiatives continue to be an effective tool for progressive activists to force changes to their state health systems. Oregon provides the latest evidence as voters Tuesday decisively directed state officials to add a tax and keep funding Medicaid, three months after Maine approved a first-ever referendum to expand its program.
TEXAS: THe likelihood of the state actually applying for a 1332 waiver to let it try reinsurance remains low, said Jan Graeber at the state Department of Insurance. Last year, the Legislature gave the department authority to apply for a waiver through August 2019. Even with federal funding, the state would be on the hook for hundreds of millions of dollars to run the program, Graeber said Wednesday during a presentation at a Texas Association of Health Underwriters conference in Austin. Plus, it would likely take the state about 18 months to draw up a proposal and get CMS approval, she said. Still, the insurance department is exploring the option — something the underwriters, contending with rising premiums in the individual market, were grateful to hear.