Drug & Alcohol

The Substance Abuse and Mental Health Services Administration (SAMHSA) has published TIP 35: Enhancing Motivation for Change in Substance Use Disorder Treatment. This updated TIP includes the latest evidence on motivation-enhancing approaches and strategies. It describes how SUD treatment providers can use these approaches and strategies to increase participation and retention in SUD treatment. View/download this document here.

CMS BLOG
https://www.cms.gov/blog/future-medicare-program-integrity

October 21, 2019
By Seema Verma, Administrator, Centers for Medicare & Medicaid Services

The Future of Medicare Program Integrity

Earlier this month, President Trump announced an Executive Order charging CMS to propose annual changes to combat waste, fraud, and abuse in the Medicare program. That’s why I’m proud to announce our vision to modernize our program integrity methods to better protect taxpayers from fraud, waste and abuse in Medicare. Every dollar spent on Medicare comes from American taxpayers and must not be misused.

CMS defines program integrity very simply: “pay it right.”  Program integrity must focus on paying the right amount, to legitimate providers, for covered, reasonable and necessary services provided to eligible beneficiaries while taking aggressive actions to eliminate fraud, waste and abuse. Our health care programs are quickly evolving; therefore our program integrity strategy must keep pace to address emerging challenges.

Government watchdogs routinely identify concerns about waste and abuse within our programs. The Government Accountability Office (GAO) has designated Medicare as a High Risk program since 1990 because of its size, complexity and susceptibility to improper payments. In 2018, improper payments accounted for 5% of the total $616.8 billion of Medicare’s net costs. While CMS regularly implements GAO recommendations, sometimes we lack the tools or capabilities to integrate worthy suggestions. The Medicare Fee-For-Service (FFS) program is limited by statute as to what methods can be used to prevent fraud, waste, and abuse.  For example, last year’s President’s budget contained a legislative proposal to expand review of high risk areas in FFS. Under current statute, review is limited to durable medical equipment like wheelchairs. In contrast, other programs like Medicaid, Medicare Advantage, Medicare Prescription Drug Plans (PDPs), Tricare, Marketplace plans, and private insurers all have broad authority to review procedures for medical necessity and appropriateness. GAO has also recommended that Congress expand prior authorization in FFS.

As our programs become more complex, program integrity risks become increasingly difficult to recognize. New provider types have entered the program, including hospices, home health agencies, and federally qualified health centers. CMS has implemented a number of value-based payment programs that have improved quality and managed cost, but also bring new challenges in identifying improper payments, beneficiary safety and quality issues, and other program integrity concerns.  More challenging cross-ownership issues have emerged, such as one corporate parent owning various providers and provider types. Increasingly complex webs of affiliations can allow unscrupulous providers to simply appear, disappear if they come under scrutiny, and then re-appear as “new” entities.

Medicare’s transformation has raised the stakes of program integrity to historically high levels — taxpayers have more to lose than ever before from those who would, whether by negligence or by intent, improperly seek payment from our programs.  They necessitate a paradigm shift in how we approach program integrity.

When Medicare was signed into law 54 years ago, there were only 19 million beneficiaries. Today, there are almost 61 million and we are adding 10,000 new enrollees every day. When the programs began, Medicare and Medicaid accounted for only 2.3% of Federal spending. These government programs now account for 23.5% of Federal spending. We have witnessed exponential growth in the number and types of providers included, the types of benefits available, the number of claims processed and paid, and, perhaps most importantly, the number of dollars involved.

Medicare’s improper payment rates have declined but remain too high. That’s why CMS is developing a five-pillar program integrity strategy to modernize our approach and protect Medicare for future generations.

  • Stop Bad Actors. We work with law enforcement agencies to identify and take action on those who defraud the Medicare program. CMS, Office of the Inspector general (OIG), Department of Justice (DOJ), and the Unified Program Integrity Contractors (UPICs) jointly deliberate on potential healthcare fraud cases, quickly direct them to law enforcement, and take appropriate administrative action such as payment suspensions and revocations. This collaboration allows CMS is to maximize efforts to identify, investigate, and pursue providers who might otherwise endanger program beneficiaries or commit fraud on Federal programs. It has led to some of the biggest healthcare fraud takedowns ever — including two in just the past few months involving orthotic braces and genetic testing that saved taxpayers $3.3 billion dollars. In one recent takedown, it took only six months from identification of the fraud scheme to law enforcement action. We are taking steps to make such prompt enforcement the norm.
  • Prevent Fraud. We continue to focus on moving away from an expensive and inefficient “pay and chase” model. Instead we are improving infrastructure that prevents fraud, waste and abuse on the front end. After we identify bad actors and their schemes, we make system changes to avoid similar fraudulent activities in the future. CMS’s oversight, audit and investigative activities allow us to analyze data to identify potential problem areas. We then work with our law enforcement partners to develop policies, regulations, and processes to prevent vulnerabilities from being exploited before claims are paid. This close collaboration between enforcement entities stops payments to known or suspected bad actors without adversely impacting sensitive and critical law enforcement operations.

CMS integrates various processes to identify and mitigate vulnerabilities before exposure to protect proactively people with Medicare. For example, to mitigate risks during the recent efforts to send new Medicare cards to beneficiaries, CMS implemented an enhanced address validation process to verify beneficiaries’ identities and addresses against multiple information sources. This ensured that we mailed new Medicare cards to the right person at the right address. We reviewed over 61 million cards for address accuracy, which we estimate saved billions of dollars in fraudulent claim payments.

An important aspect of fraud prevention is having various sources of information. CMS relies on important partnerships to share data and information that help narrow down on potential areas of concern. One of our most critical relationships is the Healthcare Fraud Prevention Partnership (HFPP). This is a voluntary, public-private partnership between Federal government, state and local agencies, law enforcement, private health insurance plans, employer organizations, and healthcare anti-fraud associations that come together to collaboratively identify and reduce fraud, waste, and abuse across the healthcare sector. We use this partnership for stakeholder engagement and to share information and leads across partners. The leads are used to conduct various studies and the results help CMS identify potential issues that may not have otherwise been caught. Currently there are 144 partners and counting. The more members we have, the more data is gathered, and the better insights we have into fraud across the entire healthcare system.

We are also addressing potential healthcare fraud by targeting high-risk areas and implementing policy changes. In September, CMS issued a first-of-its-kind final rule, Program Integrity Enhancements to the Provider Enrollment Process (CMS-6058-FC), which will reduce criminal behavior across our programs. This rule applies proactive methods to keep unscrupulous providers and suppliers out of Medicare and Medicaid from the outset and enhances our ability to promptly identify and act on instances of improper behavior – helping us to stop fraud before it happens. It creates several new revocation and denial authorities to bolster CMS’ efforts to stop fraud, waste and abuse. Importantly, a new “affiliations” authority in the rule allows CMS to identify individuals and organizations that pose an undue risk of fraud, waste or abuse based on their relationships with other previously sanctioned entities. This rule marks a critical step forward in CMS’ longstanding fight to end “pay and chase” in Federal healthcare fraud efforts and replace it with smart, effective and proactive measures.

Looking forward, we are looking to add private sector technology tools to complement our fraud prevention analytics so our future capabilities will be faster, smarter and more robust.

  • Mitigate Emerging Programmatic Risks.Too often, tackling fraud, waste and abuse is akin to playing the world’s largest game of whack-a-mole. We must be vigilant in monitoring new and emerging areas of risk. To that end, tried and true methods like prior authorization have been effective. Just this year, we proposed a list of high-risk durable medical equipment, prosthetics, orthotics and supply (DMEPOS) items that could be subject to prior authorization. This allows us to capture vulnerable items that were previously excluded from prior authorization, such as orthotics and prosthetics, which have been the target of recent telemarketing fraud schemes. The proposed changes also give us the flexibility to respond to future data and trends and tailor our strategies accordingly. Implementing prior authorization for these items as well as additional items in the future will help ensure that services billed are medically necessary.

We also are using demonstrations to test new approaches for high vulnerability services such as home health. The Review Choice Demonstration for Home Health Services illustrates how CMS is working proactively to identify and prevent fraud in an area with high improper payment rates while minimizing unnecessary provider burden. The demonstration helps ensure that the right payments are made at the right time for home health services but allows providers the flexibility to choose what works best for them. This protects Medicare funding from improper payments, reduces the number of Medicare appeals, and improves provider compliance with Medicare program requirements. In response to stakeholder feedback, this demonstration incorporates more flexibility and choice for providers on how their claims are reviewed, as well as risk-based changes to reduce burden on providers demonstrating compliance with Medicare home health policies.

More recently, Medicare Advantage enrollment continues to grow and we have added many value-based payment programs as part of our strategy to improve how healthcare is delivered and paid for in the Medicare program. New payment models have been very beneficial but also have the potential to cause new challenges in identifying improper payments, beneficiary safety issues, and other program integrity concerns. CMS is continuing to explore ways to identify and reduce program integrity risks related to value-based payment programs by looking to experts in the healthcare community for lessons learned and best practices.

  • Reduce provider burden. While we strengthen program integrity we must ensure our efforts don’t create unnecessary time and cost burden on providers. To that end, we have increased efforts to educate providers in CMS program rules and regulations and remedy onerous processes to assist rather than punish providers who make good faith claim errors. That’s the purpose of our Targeted Probe and Educate (TPE) program and our efforts to streamline our recovery audit processes. It’s vital to separate providers who make clerical errors from truly nefarious actors. Our current program transparency and oversight efforts have reduced provider burden and appeals to an all-time low, but there is more to be done. That includes providing sufficient educational opportunities, including one-on-one education for providers who simply made mistakes. Between October 2017 and February 2019, we contacted 20,000 providers and suppliers through the TPE program to provide one-on-one education. As a result, approximately 80% of those providers and suppliers were released from further review. In FY 2018, the recovery audit program identified approximately $89 million in overpayments and recovered $73 million. Since its inception in 2009, the program has played a major role in reducing improper payments, recouping more than $10 billion for the Medicare program. These programs are one of several factors that led to more than a 10% decrease in the number of claims appeals. Fewer appeals mean providers are being paid what they expected, lowering Medicare’s administrative costs from resolving appeals. CMS will continue to streamline processes and grow the Targeted Probe and Educate program to allow more providers to have the benefit of one-on-one mentoring about proper medical record documentation.

The TPE program has also highlighted provider burden and confusing policies. The Medicare documentation requirements appear in various locations and on separate websites, causing burden to providers who must navigate the various websites to find coverage rules, including documentation and prior authorization requirements. That’s why CMS is collaborating with ongoing industry efforts to streamline workflow access to coverage requirements, starting with developing a prototype Medicare FFS Documentation Requirement Lookup Service. This initiative will allow providers to discover Medicare FFS prior authorization and documentation requirements at the time of service and within their EHR.

The initiatives above are a few of many projects we have to reduce provider burden. For example, we’re proposing to eliminate “certification statements” for some hospital transfers. These statements add time and burden and are often duplicative with other required documents. In addition, we’re changing our practices to focus more on problematic billing, not all billing. For example, we’re proposing to reduce DMEPOS prior authorization for some providers who demonstrate good billing practices. If they do a good job, we don’t need to make them jump through more hoops because others may not.

CMS also has vigorous provider screening and enrollment tools at our disposal to prevent fraud schemes. However, we believe that there is a tremendous opportunity for the Federal government and private plans to improve the provider enrollment experience. CMS is currently exploring ways to centralize screening and continuous monitoring for all payers.  Cumulatively, these efforts are defining a new approach to program integrity that reduces burden and increases education to achieve a better shared understanding of how the programs operate.

  • Leverage New Technology. We plan to leverage healthcare sector innovation to modernize and automate our program integrity tools. Today, the Medicare FFS program relies on clinician reviewers — human beings — to review the medical records associated with items and services billed to Medicare. Providers also have to send us copies of medical records which is time-intensive and burdensome. That is why we only review less than one percent of medical records. Looking forward, CMS is seeking new, innovative strategies and technologies, perhaps involving artificial intelligence and/or machine learning, which are more cost effective and less burdensome to both providers, suppliers and the Medicare program. This new technology could allow the Medicare program to review compliance on more claims with less burden on providers and less cost to taxpayers. Advanced analytics and artificial intelligence (AI) can perform rapid analysis and comparison of large scale claims data and medical records that could allow for more expeditious, seamless and accurate medical review, and ultimately, improved payment accuracy.

We currently use sophisticated systems such as the Fraud Prevention System, and case management systems that use predictive analytics to identify abnormal trends and billing patterns, investigate abnormalities to find the root cause, act quickly to address any potential fraud, and capture fraudulent behavior. While these systems have helped us to obtain a positive return on investment, we believe that by adopting cutting edge technology – such as AI and machine learning tools — we can achieve greater savings for taxpayers and allow us to review more claims. These innovations could be used in both our current payment models, as well as in new payment models.

RFI: Using Advanced Technology in Program Integrity: https://www.cms.gov/About-CMS/Components/CPI/Downloads/Center-for-Program-Integrity-Advanced-Technology-RFI.pdf

The Future of Medicare Program Integrity
As part of CMS’s program integrity strategy to leverage new technology, CMS seeks to hear from providers, innovators, and private insurers on ways CMS can advance and modernize efforts to combat Medicare fraud, waste, and abuse (FWA) through innovation. Today CMS is issuing two Requests for Information (RFIs) asking for input from the healthcare community on the program integrity challenges involved in the transition from a fee-for-service system to value based care. We are also requesting input on new techniques and approaches involving advanced data analytics and artificial intelligence. During the RFI comment period, CMS will be holding a series of listening sessions across the country soliciting ideas and feedback on how to tackle the enduring issues plaguing our efforts to “pay it right.”

Simply stated, CMS must elevate program integrity, unleash the power of modern private sector innovation, prevent rather than chase fraud waste and abuse through smart, proactive measures, and unburden our provider partners so they can do what they do best – put patients first.  For these very important reasons, we seek and welcome input and expertise from all stakeholders on how to best improve our program integrity strategy and tools as we strive to protect both taxpayer dollars and the health and well-being of beneficiaries.

RFI: The Future of Program Integrity: https://www.cms.gov/About-CMS/Components/CPI/Downloads/Center-for-Program-Integrity-Future-of-PI-RFI.pdf

###

Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS, @CMSgov, and @CMSgovPress

Gov Wolf Header

FOR IMMEDIATE RELEASE
October 15, 2019

View Online

Pennsylvania Awarded Grant to Support Access to the National Suicide Prevention Lifeline

Harrisburg, PA – Governor Tom Wolf announced today that Pennsylvania has been awarded a $1.3 million grant to increase access to the National Suicide Prevention Lifeline by expanding state-based call centers.

The grant was issued by Vibrant Emotional Health, the nonprofit administrator of the National Suicide Prevention Lifeline. The Lifeline is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), and provides confidential, free, 24/7 support to people in crisis, considering suicide, or helping another person.

“We have an obligation to provide resources and promote safe, supportive environments so people we serve know that there are places to turn if they are in crisis,” said Gov. Wolf. “Silence can perpetuate crisis and make people feel like they are struggling alone with no outlet or options for support, but things can and will get better, and help is always available. Expanding access to the National Suicide Prevention Lifeline is one more way to let more people know help is available in Pennsylvania.”

The Department of Human Services will partner with three Lifeline network centers to form three regional call centers to ensure at least 70 percent of calls are answered in Pennsylvania, with the goal of increasing that percent to 90 within two years. Partners include Center for Community Resources, Family Services Association of Bucks County, and New Perspectives Crisis Services. In 2018, partners supported nearly 3,000 calls. As of June 2019, they have received nearly 2,500 calls.

“No one should ever feel like they are alone – especially in times of crisis,” said Secretary Miller. “The Wolf Administration is committed to dispelling stigma around suicide and mental health and ensuring supports are available to promote a safe, supportive environment so people know there are resources, like the Lifeline, to turn to in emergencies. Expanding our in-state call centers is another opportunity to better serve our fellow Pennsylvanians and prevent suicide across our commonwealth.”

Pennsylvania is committed to reversing the rising national trend of suicide and supporting Pennsylvanians affected by suicide. In May 2019, Governor Wolf established a statewide Suicide Prevention Task Force. The task force brings together leaders from the departments of Human Services, Health, Corrections, Aging, Education, Military and Veterans Affairs, and Transportation as well as the Pennsylvania Commission on Crime and Delinquency, the Pennsylvania State Police, elected officials, and mental health and suicide prevention organizations to create a comprehensive suicide prevention plan for Pennsylvania.

The task force is holding public listening sessions through November to learn about how suicide impacts the lives of Pennsylvanians and to develop prevention efforts that reflect the diverse needs of individuals and families across Pennsylvania.

For more information on Pennsylvania’s Suicide Prevention Task Force and upcoming listening sessions, visit www.dhs.pa.gov/citizens/suicideprevention.

If you or someone you know is experiencing a mental health crisis or is considering suicide, help is available. Reach out to the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact Crisis Text Line by texting PA to 741-741.

MEDIA CONTACT:  J.J. Abbott, 717-783-1116

# # #

CERTIFICATION CONCEPT

Please find the details below regarding the application process for the upcoming Mental Health First Aid (MHFA) Certification courses. These trainings are funded through a Federal SERG Grant; funds may also be used for trainings throughout the Commonwealth.

                                                                                                                                                           

Pennsylvania has been awarded a Federal Substance Abuse and Mental Health Services Administration (SAMHSA) Emergency Response Grant (SERG) as a response to the tragic shooting at the Tree of Life Synagogue last fall. One component of the funding includes expansion of Mental Health First Aid across the Commonwealth. The Office of Mental Health and Substance Abuse Services (OMHSAS) will be hosting instructor certification courses to candidates interested in training in their region. Youth and Adult Certification Courses are three full days with a limit of 16 people per class.  Additional details are included below:

Dates:
Adult Mental Health First Aid Instructor Course
November 18, 19, and 20, 2019
8:30 am – 5:00 pm

Youth Mental Health First Aid Instructor Course
December 10, 11, and 12, 2019
8:30 am – 5:00 pm

Location:
BHARP – Behavioral Health Alliance of Rural Pennsylvania
301 Science Park Road | Suite 308 | State College, PA  16803

Registration:    Interested participants should contact Brandon Bennet by October 14, 2019.

Expectations:

  1. MHFA instructors must submit an application that will be reviewed by the National Council for acceptance.
  2. Once admitted, participants must attend three full days of training and pass a proficiency exam.
  3. Instructors are required to train a minimum of three times per year and log their courses and evaluations on the national website to maintain their certifications.
  4. In addition, participation in this free course includes the expectation to train at least one course to a target population in their area impacted by the Tree of Life tragedy. Course materials will be offered at no cost for these trainings.

The training application is available here.

Pennsylvania is requiring that prescriptions for controlled substances (Schedule 2–5) be completed electronically by October 24, 2019. If you are unable to meet this deadline, you may apply for a temporary exemption; the exemption is granted for one year from the date of the approval notice. Find more information, the actual law, and the temporary exemption form here.

On October 1, 2019, the PROMISe Service Location Enrollment process was effectuated. RCPA understands that many providers have submitted their requests and are awaiting the PROMISe numbers for their programs.

In conversations with the Office of Medical Assistance Programs (OMAP) and the Office of Mental Health and Substance Abuse Services (OMHSAS), we have been advised that as providers await confirmation on program PROMISe numbers for service locations, providers can continue to utilize their main physical site address for billing pending site enrollment.

This link will provide access to the bulletin. If you have any questions, please contact RCPA Children’s Division Director Jim Sharp.

0 43
business conference. people sitting rear and woman speaking at the screen

The Pennsylvania Department of Drug and Alcohol Programs (DDAP) is providing training information for primary care providers regarding application for ‘Integrating Medications for Opioid Use Disorder into Primary Care’ Preceptor Training Program.

Part A: Friday, November 8, 2019: 8:00 am – 4:00 pm — 123 S. Broad St, Philadelphia, PA 19109

Part B: Observation at Esperanza Health Center, Prevention Point Philadelphia, Jonathan Lax Treatment Center, or Stephen Klein Wellness Center (scheduled individually, for 1½ day or full day session)

Prior registration is required. Registrants must have already completed their waiver training and submit their license, resume, and waiver certificate prior to receiving their observation dates. This program, CME, breakfast, and lunch are provided at no cost. Funding is provided by the Philadelphia Department of Public Health.

Other training resources available to rural practitioners:

For any questions, please contact the list administrator.

The US Department of Labor has announced ‘The Right Talent, Right Now’ as the theme for 2019 National Disability Employment Awareness Month (NDEAM). Observed each October, NDEAM celebrates the contributions of workers with disabilities and educates about the value of a workforce inclusive of their skills and talents. The 2019 theme emphasizes the essential role that people with disabilities play in America’s economic success, especially in an era when historically low unemployment and global competition are creating a high demand for skilled talent. The Department’s Office of Disability Employment Policy (ODEP) administers NDEAM.

“Every day, individuals with disabilities add significant value and talent to our workforce and economy,” said US Secretary of Labor Alexander Acosta. “Individuals with disabilities offer employers diverse perspectives on how to tackle challenges and achieve success. Individuals with disabilities have the right talent, right now.”

Observed annually in October, NDEAM celebrates America’s workers with disabilities both past and present, and emphasizes the importance of inclusive policies and practices, to ensure that all Americans who want to work can work and have access to services and supports to enable them to do so. With continued advances in such supports, including accessible technology, it is easier than ever before for America’s employers to hire people with disabilities in high-demand jobs.

The official 2019 NDEAM poster is available for downloading or to order. For additional information, contact Carol Ferenz.

Today, the Senate cleared a short-term spending bill that includes an extension of the Certified Community Behavioral Health Clinics (CCBHC) Medicaid demonstration through November 21. The extension is retroactive to September 13. The bill now heads to President Trump for his signature; we will continue to keep you updated.

The latest extension does not impact grantee CCBHCs that are not participating in the demonstration — however, it is an important indication of congressional support for the program and we hope this support will ultimately be translated into an expansion of the program to additional states.

Contact Sarah Eyster, RCPA Mental Health Division Director, with questions.

Thursday, October 10, 2019
2:00 pm – 3:00 pm EST

According to the Centers for Disease Control and Prevention (CDC), suicide was the 10th leading cause of death overall in 2017. Addressing this public health issue has proven to be a challenge within the United States, where the suicide rate has increased steadily over the last two decades.

Join Dr. Christine Moutier, Chief Medical Officer at the American Foundation for Suicide Prevention, as she provides an overview of the current state of suicide in the United States. She will also discuss risk and protective factors for suicide, barriers to effective suicide prevention in various settings, and opportunities to improve suicide prevention and treatment.

In this webinar, participants will learn about:

  • Current trends and advocacy efforts in the United States;
  • Evidence-based best practices in suicide prevention and treatment; and
  • Gaps in suicide prevention and treatment as well as potential solutions.

Register online to participate.