Briefly Noted

At last week's annual conference of the National Association for Behavioral Healthcare (NABH), the increase in managed care figured prominently as causing a significant barrier to access to treatment. “The issue that is front and center is access to care, the problems that people are having getting necessary care, and not being able to access the right care at the right time,” NABH President and CEO Mark Covall told ADAW. In addition, the continuum of care has been severely impacted by managed care, he said. “Managed care companies are restricting care to crisis care only,” he said. This means that the longer‐term care needed for recovery when patients emerge from a crisis is not being covered. There are no clear legislative or regulatory fixes yet, said Covall, speaking by phone from the busy meeting. As an organization, NABH “will continue to be proactive and reach out to managed care companies,” he said. “We hope the collaboration that is desperately needed will be a two‐way street.” NABH members have reported that “it has been exceedingly difficult to get patients the care they need, and our members are saying that it's hurting patients, and this is not acceptable.” Last week, NABH launched Access to Care, an initiative “that will send our message to policymakers, regulators, payers and patient advocates that only true access to care can lead to recovery.”     

Using telehealth for buprenorphine induction and engagement

CODAC Behavioral Healthcare, a Rhode Island–based opioid treatment program (OTP), has just won a $372,597 contract to implement a telehealth project that will create a rapid crisis response system linking high‐risk populations with buprenorphine. We spoke with Linda E. Hurley, president and CEO of CODAC, on how the program will work.     

Danielle Kirby receives Ramstad/Kennedy Award

The 12th annual Ramstad/Kennedy Award for outstanding leadership went to Danielle Kirby , director at the Division of Substance Use Prevention and Recovery at the Illinois Department of Human Services and the state's Single State Authority, for her leadership in recovery support programs across Illinois and nationally. The award was announced last week and was established in honor of Congressmen Jim Ramstad and Patrick J. Kennedy. The two congressmen have been vocal advocates of recovery support services in all forms and championed localized efforts to support prevention, treatment and recovery. Now more than ever, recovery leaders are essential to our ability to address historic rates of overdoses and suicides, said Kennedy, founder of the Kennedy Forum. “People like Danielle Kirby are not only serving the communities in which they work; they are also serving their country. We are extremely grateful for her hard work and dedication,” Kennedy said. Kirby addressed stigma through innovative public awareness campaigns, as well as including persons with lived experience at decision‐making tables, showing others in strategic roles the importance of making recovery visible, according to the award announcement, which came from the National Association for Children of Addiction (NACoA), a Recovery Month planning partner. “Danielle Kirby has been in this position for less than two years, and yet has shown an energetic and inclusive spirit in supporting and promoting recovery community organizations and recovery resources for the present and future benefit of Illinois families and communities,” said Sis Wenger, NACoA president and CEO. “Together, in partnership with the dedicated organizations who comprise the Recovery Month Planning Partners, recovery success stories are becoming commonplace in Illinois, in part because of Danielle's ongoing and exceptional leadership and commitment.”     

Briefly Noted

A federal audit of opioid treatment programs (OTPs) — methadone clinics — in New York City found that of 115 random sample claims, 35 did not comply with Medicaid requirements, and that of 598 claims in a non‐random sample, 299 were billed in error. Extrapolating these errors, the federal Department of Health and Human Services (HHS) says the state improperly claimed at least $39.3 million in the federal share of Medicaid reimbursement, and owes that money back. Improper claims were mainly due to failure to record patients in the central registry, which exists to make sure patients aren't enrolled in multiple OTPs (18 of the 35 noncompliant claims). This was not an audit alleging fraud. Extrapolation as an accounting method for OTPs, where patients often come in every day, so that each patient has more than 300 claims a year, is questionable, but OTPs are used to this even in state audits. In other words, one OTP patient comes in six days a week, with six claims, and the database balloons. “You're extrapolating over our universe, and our universe becomes large because people come in for medication,” said Allegra Schorr, president of the Coalition of Medication‐Assisted Treatment Providers and Advocates, a New York–based membership organization, and board member of the American Association for the Treatment of Opioid Dependence. “When you're just trying to get money, this counts,” said Schorr. “They hit the lottery when it comes to an audit because of that extrapolation.” However, Schorr, who is also an owner and vice president of West Midtown Medical Group, a Manhattan‐based group that was the first OTP to dispense buprenorphine in New York state, stresses that compliance is always important. “It's critical that there is oversight,” she told ADAW. Meanwhile, the state is reviewing the audit and will respond. “The Office of Addiction Services and Supports (OASAS), in partnership with the NYS Office of Medicaid Inspector General, intends to review the specific findings of this audit cited by OIG [Office of Inspector General] to verify its accuracy and to determine an appropriate course of action,” said Evan Frost, spokesman for OASAS. “As a proactive measure, we will remind our OTP providers of their obligations to comply with state and federal laws and rules for providing and claiming Medicaid reimbursement and ensuring the quality of care for those receiving OTP services.” OA SAS regulates OTPs in the state. For the audit, go to https://oig.hhs.gov/oas/reports/region2/21701021.pdf     

NAATP keeps focus on parity

We need to move beyond the principle of parity into the practice of parity.” These words from Mark Dunn, director of public policy for the National Association of Addiction Treatment Providers (NAATP), in an interview with ADAW last week are a sign of the frustration with how parity — the Mental Health Parity and Addiction Equity Act (MHPAEA), which guarantees that substance use disorders (SUDs) will be treated no differently from medical and surgical claims in the world of reimbursement — has been a real‐world disappointment to patients and providers alike.     

Aetna fined for parity violations in Pennsylvania

This month, Aetna was fined $190,000 for not complying with the federal Mental Health Parity and Addiction Equity Act. Specifically, the health insurer did not cover substance use disorder (SUD) and autism spectrum disorder as it was required to, according to a review by the Pennsylvania Department of Insurance. Aetna used “confusing policy language which could have led consumers to inaccurately believe they did not have coverage for certain substance use disorder services,” according to the insurance department. “While the department reviewed many priority areas through this examination, a significant focus was on the company's compliance with laws requiring parity of coverage for substance use disorders and mental health, which must be offered at the same level of benefits as medical or surgical treatment,” Pennsylvania Insurance Commissioner Jessica Altman said in a statement. She added, “Violations included incorrect application of copays, coinsurance and visit limits, as well as violations involving prior authorization for treatment and step therapy.”     

Caron in‐network with Aetna

Caron Treatment Centers is an in‐network provider for Aetna, effective Oct. 1, the Pennsylvania‐based program announced last week. “The COVID‐19 pandemic is taking a toll on the mental health of Americans,” said Doug Tieman, CEO and President of Caron Treatment Centers. “Unfortunately, isolation and anxiety make addiction worse, and we are already seeing a spike in substance use and substance use disorders. It's imperative that families have access to affordable, high‐quality, life‐saving treatment programs and support services.” The expansion of in‐network insurance relationships is among several recent moves by Caron to make treatment more accessible. Caron is also an in‐network provider with Highmark and the Blue Card program, which covers persons entitled to benefits as a member of any other Blue Cross and/or Blue Shield plan licensed by the Blue Cross Blue Shield Association, Independence Blue Cross, AmeriHealth Administrators, Independence Administrators, UPMC, Blue Cross Blue Shield, Employer Groups of Penn Medicine and Tower Health. “Accessing quality substance use disorder treatment has always been difficult for many families,” continued Tieman. “With more than 20 percent of the treatment sector reducing or closing services and programs as a result of the pandemic, it's even more difficult. This in‐network agreement with Aetna allows their members to access Caron at a time when they are needed the most.”     

Table of Contents

The Recovery Movement Grows Up: Paid Peers and Health Reform CEO Sees Merger With MH Organization as Positive Step in Health Reform Era Health Reform Will Bring More Patients: CATG Initiative National Council Wins HRSA/SAMHSA Integration Training Grant Reauthorization of STOP Act Bill Introduced Briefly Noted In the States Coming up     

Toolkit for MAT in jails and prisons from the National Council

The National Council for Behavioral Health has prepared a comprehensive and timely toolkit, Medication Assisted Treatment for Opioid Use Disorder in Jails and Prisons. The 132‐page manual, a copy of which was obtained by ADAW, was written in conjunction with Vital Strategies. It was funded by the Centers for Disease Control and Prevention and headed up by Shannon Mace, senior practice improvement advisor for the National Council.     

Briefly Noted

Carmen Beatrice Pearman Arlt died last December after a long illness. News of her death started circulating throughout the field only last month, however. Arlt, a longtime Indiana resident, was born in 1955. She organized one of the oldest chapters of the National Alliance for Medication Assisted Recovery (NAMA Recovery), the Methadone Advocacy Group (MAG) of Indiana. NAMA Recovery Director Joycelyn Woods recalled last week that Arlt, in the early 1990s, sent an index card to NAMA Recovery with dimes taped to it and a short message saying she could not afford the $10 membership fee. “Like all letters we receive from patients, she received a letter back saying that we would rather have her advocacy than money,” said Woods. One of the things MAG of Indiana did was clean the street around the methadone clinic. “While they were out picking up garbage and sweeping the street, the reverend from the church across the street came out to warn them about those addicts over there. Carmen explained that they were those addicts,” said Woods. “From this encounter, patients were given space in the church to set up 12‐Step groups and to have meetings. The following year, there was a big drug conference in Indiana, and the chapter acted as the color guard for the governor when he entered the arena. I remember Carmen sending a picture of them all dressed in white shirts, navy bowties for women and regular ties for men and navy pants.” Arlt received the Nyswander/Dole Award from the American Association for the Treatment of Opioid Dependence in 2001 for organizing the state provider organization — at the time, Indiana had no opioid treatment program representation and clinics saw one another more as competitors than associates working for a common cause, said Woods. More recently, in addition to being president of NAMA Recovery, Arlt developed the program for women and children at Porter‐Starke Services in Valparaiso. She was continuing her education to get a Ph.D. in social work when she became ill. “NAMA Recovery will miss Ms. Pearman‐Arlt's dedication and compassion to patients and the field,” said Woods..     

Scarce as hen's teeth: Women CEOs in large nonprofit organizations

This study examines an underlying mechanism behind the gender gap in nonprofit executive leadership, focusing on the link between the representation of women on governing boards and the hiring of female CEOs. The analysis of 340 human services organizations with gross receipts greater than $10 million in GuideStar's database reveals that organizations where women make up between one third and half of the board are more likely to have a female CEO compared to organizations where women account for less than one third or a majority of the board. The findings suggest that nonprofit organizations are more likely to hire a female CEO when women constitute a “substantial minority” of the governing board.     

In the states

The Coalition of Medication‐Assisted Treatment Providers and Advocates of New York State (COMPA) issued support and further encouragement to New York legislators last week for the passage of a package of bills to combat the opioid addiction epidemic by increasing access to medication‐assisted treatment (MAT). “We applaud the Senate and Assembly passing A2904 Quart/S4808 Harckham, which eliminates prior authorizations for all MAT medications for commercial insurance policies,” said Allegra Schorr, president of COMPA. “This will increase access to treatment and reduce barriers for delivering care.” She added, “We urge the passage of A7246 Rosenthal/S5935 Harckham, which provides critical access to all medications to vulnerable Medicaid populations during this opioid crisis. Moreover, in order to ensure that all New Yorkers can access care, we urge the state to implement the policy outlined in A833 Rosenthal/S2161 Bailey that would establish a patient‐centered MAT program for incarcerated individuals in jails and prisons, and COMPA supports A972A Rosenthal/S4643A Harckham, which would prohibit copays during the course of treatment at an opioid treatment program.” COMPA is a nonprofit membership organization dedicated to treating addiction through the use of pharmacotherapy as a part of a comprehensive biopsychosocial approach to treatment. COMPA's program members include both opioid treatment programs and office‐based opioid treatment providers. COMPA is the New York state member program of the American Association for the Treatment of Opioid Dependence.     

On the use of transcendence as an apologia strategy: The case of Johnson controls and its fetal protection policy

When charged with wrongdoing, most organizations rely on differientation strategies to extracate themselves from the crises that follow. Conversely, this essay focuses on the organizational use of transcendent appeals to redefine “sin” into a “virtue.”This study analyzes Johnson Controls' apologia after critics charged that its “fetal protection policy” was discriminatory, examining the redefinitions and ultimate terms invoked by the company to justify its choice of policy.This article completes a trilogy of monographs published in Public Relations Review that has attempted to distinguish the generic parameters that inhere in corporate apologetic discourse. The first essay, “Apologies and Public Relations Crises at Chrysler, Toshiba, and Volvo,” describes the communicative choices made by most corporations in apologetic crises and was published in the Summer 1994 issue. The second essay, “The Use of Counter-Attack in Apologetic Public Relations Crises: The Case of General Motors vs. Dateline NBC,” which was published in the Fall 1996 issue, analyzes those instances in which companies deny charges and directly challenge their accusers. This article was recently named the recipient of the 1996 PRIDE Award, which recognizes the top published essay in the previous year, by the Public Relations Division of the National Communication Association.The author is an assistant professor of public relations in the Department of Communication at Western Michigan University.     

Briefly Noted

A project that began a year ago (see ADAW, Jan. 15, 2018), Shatterproof's rating system of addiction treatment programs took another step last month when the nonprofit announced it would start out with a pilot, now that it has $5 million. Saying the current addiction treatment system is broken, Shatterproof founder and CEO Gary Mendell said the project was made possible by funding from two foundations (the Laura and John Arnold Foundation and the Robert Wood Johnson Foundation) and a coalition of five insurance companies. “People who need help for addiction don't know what to look for or where to turn,” said Sam Arsenault, director of national treatment quality initiatives at Shatterproof, in the Dec. 18 announcement of the project. “We are taking rating system best practices from health care and other business sectors and applying them to addiction treatment. This will not only provide critical information to individuals looking for care but also drive a long overdue transformation of the addiction treatment industry.” The Shatterproof Rating System will utilize data from three sources: insurance claims, provider surveys and consumer experience, with collaboration from the National Quality Forum (NQF), a membership organization composed of payers. Initially, the program will begin with a pilot, with analysis done by RTI International. “Consumers can find information and accurate data on the quality of nursing homes, hospitals, physicians and most other types of providers,” said Tami Mark, director of behavioral health financing and quality measurement at RTI International. “It's time that patients have reliable information on addiction treatment.”     

Hill Day: The three big ‘asks’ from NAATP

At the “Hill Day” event that marked the end of the annual leadership conference of the National Association of Addiction Treatment Providers (NAATP), 120 association members went to the Senate and House of Representatives to make their case. “I felt it would be successful if we had 50 members who stayed the extra day and did the Hill visits,” Mark Dunn, NAATP policy representative, told ADAW of the May 8 visits. So he was thrilled that so many went.     

Treatment center sues Tennessee town over zoning ordinance

Last week, ReVIDA Recovery Centers, which provides medication‐assisted treatment for opioid use disorder, announced that it would sue to keep its treatment program in Morristown, Tennessee, where the city has denied the company based on zoning. “Our patients are our first priority,” said CEO Lee Dilworth on September 25.     

Table of Contents

Volunteers Becoming an Increasingly Important Segment of Treatment Workforce. SAMHSA Guide Emphasizesstructure, Planning When Using Volunteers Handbook Can Help Recruit Volunteers Characteristics of Volunteers Bills Address National Shortage of children's Mental Health Professionals. Advocates Hail Bipartisan Workforce Legislation SAMHSA Focuses on Behavioral Workforce Development. Plans Include Development of National Action Plan Coalition Seeks Field Input for National Action Plan on Workforce Development Proposal to Unify Counselor Certification Under Review at ICRC and NAADAC/NCC. Membership Organizations also Explore Merger High Rate of Gambling Problems Found in Substance Abuse Counselors Pathological vs. Problem Gambling     

Mens Sana: The Growth of Mental Health in the American College Health Association

Abstract

In 1910, the first college mental health service sought to help college students with personality development and building a healthy mind. In 1920, the meeting that founded the American College Health Association (ACHA) identified “mental hygiene” as important, although a separate Mental Health Section was not established in ACHA until 1957. Between 1920 and 1960, a series of national meetings helped define the role and functioning of college mental health and counseling services. Most colleges employed a multidisciplinary staff of psychologists, psychiatric social workers, and psychiatrists to provide clinical services for students and consultation and education for faculty and staff. Mental health services on college campuses grew rapidly in the 1960s and 1970s, leading to discussions in the late 20th century of the use of brief psychotherapies, prevention and treatment of drug and alcohol abuse, prevention of suicide and homicide, the use of psychotropic medications, and effective campus interventions.     

Texas pharmacist works with harm reduction on STR naloxone distribution

Legislatively, Texas may have its problems in addressing opioid overdoses and evidence‐based treatment, but the Texas Targeted Opioid Response (TTOR) grant, from the Opioid State Targeted Response (STR) from the Substance Abuse and Mental Health Services Administration (SAMHSA), is changing all of that. “We have amazing folks in the TTOR department at the Texas Health and Human Services department who are aggressively minded and are focused on trying to do the right things with the money,” said Lucas Hill, Pharm.D., clinical assistant professor in the University of Texas at Austin College of Pharmacy and director of Operation Naloxone, which is funded by TTOR.     

Promotion of Sexual Health in the United States

Abstract

The United States has been experiencing a severe sexual health crisis in the last decade. This paper reviews these sexual health challenges and discusses a major initiative and a “Call to Action” that was launched by the U.S. Surgeon General in 2001 to promote sexual health. This led to several initiatives to overcome obstacles that were preventing the development of a sound, scientifically based public health policy to promote sexual health. This paper specifically outlines the components of the Sexual Health Program housed at the Morehouse School of Medicine's National Center for Primary Care, including the National Advisory Council and the National Consensus Process.