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Behavioral Health Integration, 340B Litigation, and Medicare Advantage Plans

October 13, 2022

For more information about this blog post, please contact Khaled J. KleleRyan M. MageeRyan L. O’Neill, Connor Breza, William R. Meiselas or Labinot Alexander Berlajolli.

HHS Releases Roadmap for Behavioral Health Integration

In September 2022, the United States Department of Health and Human Services (“HHS”) released its “Roadmap for Behavioral Health Integration,” detailing policy solutions to help integrate mental health and substance use care into large healthcare systems. The Roadmap builds on the Biden Administration’s Strategy to Address Our National Mental Health Crisis and furthers HHS’s strategic goal of enhancing integrated care within healthcare systems, a goal which HHS has described as “critical” to transforming care for individuals with mental and substance use disorders ("M/SUD").

Five key takeaways from the September 2022 Roadmap are that:

  1. HHS is committed to providing integrated, equitable, evidence-based, culturally appropriate, and person-centered behavioral healthcare to the populations it serves;
  2. HHS has evaluated barriers to transforming behavioral healthcare and has identified policy solutions to overcome these barriers;
  3. HHS will develop a diverse workforce prepared to practice in integrated settings and invest in infrastructure for integrated care;
  4. HHS will leverage health financing arrangements, including efforts to fully realize the potential of parity; and
  5. HHS will invest in behavioral health promotions, upstream prevention and recovery.

The Roadmap reflects an overall agency strategy, detailing current and forthcoming HHS-funded programs that are aimed at achieving the agency’s goals for enhancement of M/SUD services. Such programs and proposals include Substance Abuse and Mental Health Services Administration ("SAMHSA") Minority Fellowship Program ("MFP") grants, CMS proposals to establish billing codes to account for monthly M/SUD care integration, and the Centers for Disease Control’s ("CDC") What Works in Schools Program, among others.

Federal Judge Accelerates Restoration 340B Drug Payments by HHS

The District Court for the District of Columbia recently ruled that the U.S. Department of Health and Human Services ("HHS") must immediately resume coverage of 340B hospitals' drug costs. The 340B program generally allows eligible hospitals to buy outpatient drugs at discounted rates. In 2018, HHS instituted rulemaking to lower the program's reimbursement rate to 22.5 percent. However, in June 2022, the Supreme Court of the United States ruled in favor of 340B hospitals, finding that HHS could not vary the program's reimbursement. In July 2022, HHS stated that it would restore its coverage of 340B drugs and biologics in CY 2023. The District Court for the District of Columbia’s ruling accelerates HHS’s restoration of the 340B program reimbursement rates, requiring that HHS immediately reverse its prior rate cuts.

CMS Tightens Scrutiny of Celebrity Endorsements of Medicare Advantage Plans

The U.S. Centers for Medicare & Medicaid Service ("CMS") has begun implementing tighter scrutiny of celebrity endorsements of Medicare Advantage ("MA") plans. Between 2019 and 2020, CMS noted a 165% uptick in consumer marketing complaints regarding Medicare Advantage advertisements featuring celebrities, many of which focused on confusion as to the difference between MA plans and original Medicare coverage. In response to such complaints, CMS has put into place stiffer rules for marketers that sell MA policies on behalf of insurers. Under CMS’s tightened scrutiny, marketers will be required to disclose more to their customers and the insurers will be responsible for what their marketers say. This policy stance shift builds off of established regulations regarding marketing of Medicare and MA plans and products, which may be found at 42 CFR § 422.2264, 423.2264, 422.2268, and 423.2268.

Our Team

Khaled John Klele

Khaled John Klele
Partner

​Ryan M. Magee

​Ryan M. Magee
Partner

Ryan Lee O'Neill

Ryan Lee O'Neill
Partner

Labinot Alexander Berlajolli

Labinot Alexander Berlajolli
Associate

Connor Bradford Breza

Connor Bradford Breza
Associate

William R. Meiselas

William R. Meiselas
Associate

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