ASTHO Annual Policy Summit and Leader to Leader Roundtable Highlights

October 04, 2018|12:54 p.m.| ASTHO Staff

ASTHO hosted its annual policy summit last week, offering state and territorial health officials and other invited guests an opportunity to focus on priority and emerging policy issues facing public health agencies. After a morning plenary presentation from the National Partnership for Action on ways state and territorial health agencies can help end health disparities, participants attended a set of leader to leader executive roundtables. These roundtables featured leaders from numerous federal agencies and organizations, including CDC, HRSA, SAMHSA, EPA, the Centers for Medicare and Medicaid Services (CMS), the Office of the National Coordinator in Health IT, ASPR, and others. Roundtable speakers discussed federal initiatives and resources to address a number of public health concerns, including the primary prevention of chronic disease, maternal mortality, adverse childhood experiences, value-based healthcare, health equity, health information privacy and cybersecurity, partnerships to combat the opioid epidemic, emerging health security threats, responding to public health emergencies, the use of screening and treatment to eliminate chronic viral disease, and key priorities for the U.S. territories and freely associated states. After learning about federal efforts, participants were able to provide insight into state and territorial activities to address issues and identify areas of connection and future policy needs. Below is a brief summary of a few roundtables and a look at recent state and federal policy activities ASTHO is following.

Maternal Mental Health, Neonatal Abstinence Syndrome (NAS), and Resiliency

Representatives from CDC and HRSA discussed current policy and programmatic activities, including the development of case definitions for NAS, strengthening systems of care for pregnant and postpartum women with substance use and related mental health disorders, and identifying upstream prevention strategies, namely comprehensive family planning. Several states have recently considered legislation to address NAS, as well as contraceptive access for women prescribed to opioids and those with substance use disorders. For example, Louisiana recently passed a law directing the state health agency to establish a pilot program to treat infants with NAS. In addition, Tennessee now requires healthcare providers prescribing more than three days of opioids to a woman of childbearing age to counsel the patient about the risk of opioid use during pregnancy and offer information about the availability of contraception options.

Addressing Rural Health and Serving Populations

HRSA, CDC, and CMS representatives discussed how ASTHO members can partner with state offices of rural health to address rurality and improve outcomes for vulnerable populations. They also discussed addressing emerging challenges such as rural hospital closures, the opioid crisis, and other rural workforce needs. This week, the U.S. Senate will consider the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act). The proposed law would address some of the issues impacting rural health and opioids, including access to treatment via telehealth and Medicaid reimbursement. Current federal law prohibits the delivery, distribution, or dispensing of controlled substances via telemedicine without a healthcare provider first conducting an in-person medical evaluation of the patient. The U.S. Attorney General is authorized to issue a special registration to healthcare providers to prescribe controlled substances via telemedicine without the initial in-person evaluation. However, rules for the special registrations have not yet been developed. The SUPPORT Act requires the attorney general to issue final rules for determining the circumstances in which a special registration may be issued and the procedure for obtaining a special registration. Even with a special registration, a healthcare provider must also maintain compliance with state laws when delivering, distributing, dispensing, and prescribing a controlled substance. Therefore, it is important to be aware of any state laws or regulations that may—independent of federal law—require an initial in-person evaluation or restrict the kinds of drugs that can be prescribed via telemedicine.

The SUPPORT Act also requires CMS to issue guidance to states on options for providing substance use disorder treatment via telehealth for which they can receive federal reimbursement. The services that could be provided via telehealth include assessment, medication-assisted treatment, counseling, medication management, and medication adherence.

Threats to Our Nation’s Drinking Water: PFAS

Speakers from EPA, CDC, and the Agency for Toxic Substances and Disease Registry discussed how federal agencies are addressing the issue of per- and polyfluoroalkyl substances (PFAS) in drinking water. State health agencies will play a critical role in addressing this issue and ASTHO can help support S/THOs in this endeavor. Over the past couple of years, states have taken a variety of approaches to address PFAS contamination, including assessing or monitoring the presence and health effects of PFAS, setting quality standards, restricting the use, sale, or distribution of PFAS, as well as PFAS remediation, response activities, and calls for federal support. View ASTHO’s recent examination of these legislative efforts to learn more.

Combating Antimicrobial Resistance: The Threat, Challenges, and Opportunities

Representatives from CDC discussed a new HHS and CDC effort with the Antimicrobial Resistance (AMR) Challenge, a year-long initiative to accelerate the fight against antimicrobial resistance with action across governments and private partners, as well as other efforts to detect and contain resistant bacteria using genetic testing and laboratory networks for enhanced testing. Concerns about AMR have caused states to advance antibiotic stewardship policies for their healthcare and agricultural systems. For example, in 2015, California’s legislature enacted a law restricting the use of antibiotics in livestock feed. The law prohibits the use of important antibiotics to promote animal growth and requires veterinary approval for antibiotic use to treat animals that are sick. The agency rules implementing these new requirements went into effect at the beginning of this year.

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