Treatment Communities of America

Treatment Communities of America Treatment Communities of America (TCA) is a non-profit association comprised of community based substance abuse treatment providers throughout the United S

TCA is a national on-profit association representing
substance abuse and mental health treatment
programs. The member agencies provide services
to clients with a diversity of special needs, including
substance abuse, HIV/AIDS, mothers with children,
criminal justice clients, co-occurring adults including
individuals with chronic and persistent mental illness, the
homeless, veterans, and adolescents.

Operating as usual

Dear TCA Member,It is with deep sadness that we inform you of the passing of Richard Pruss, on Saturday, July 14, 2018. ...

Dear TCA Member,

It is with deep sadness that we inform you of the passing of Richard Pruss, on Saturday, July 14, 2018.

Richard was the TCA President from 1980-1984, Richard continued to be active after his presidency as an Officer and Executive Committee member and often attended the TCA Board meetings. Richard stepped down as President and CEO of Samaritan Village in 2008 and had served as a Board member and Chairman of the Board of Directors until this past December. Richard was one of the pioneers in our field, beginning his mission in the mid-60s, dedicating his life to Samaritan and saving the lives of thousands of individuals over his long and impressive career. We also know Richard as Kathy Riddle’s husband and know how Richard proudly supported her work at Outreach (NY).

Each of us not only grieves at the passing of such a tremendous individual, but also for this special loss for Kathy, and Richard’s family. Please hold them in your thoughts and prayers. Services will be private, but a memorial will be planned for a future date. Contributions may be made to the Samaritan Daytop Foundation or the Alzheimer’s Foundation of America.

Richard Pruss at the TCA Fall Reception

Richard Pruss at the TCA Fall Reception

Untitled Album

Untitled Album


1115 SUD Waiver Experience: The Good, the Bad and the Unexpected

On Wednesday, June 20th TCA in partnership with the Bipartisan Heroin Task Force and the Addiction, Treatment and Recovery Caucus, held a briefing titled: 1115 SUD Waiver Experience: The Good, the Bad and the Unexpected. The briefing featured a panel of speakers from several different states who shared their experience applying for, designing, and implementing a Medicaid 1115 waiver to provide Substance Use Disorder (SUD) treatment in an Institution for Mental Disease.

The Medicaid Institutions for Mental Disease (IMD) Exclusion is a significant barrier to many who seek appropriate and effective substance abuse treatment. In the face of an opioid epidemic, SUD patients often are turned away from appropriate treatment, in part because of the 50-year old provision under Medicaid that severely impedes availability and access to treatment in facilities of more than 16 beds. There is broad agreement – including by President Trump, the Opioid Commission, the Bipartisan Task Force on Heroin, National Governors Association, and the State Attorneys General – that significant reform of the IMD Exclusion would immediately expand access to treatment and is urgently needed. CMS began to permit states to experiment providing SUD in IMDs with 1115 waivers in 2015 and the Trump Administration has been expediting the approval of states’ waivers. So far, 11 states have had waivers approved. Experience with the waiver process has varied greatly, and panelists from states with waivers shared their successes, challenges, and unexpected issues that arose during the process. Importantly, the briefing answered the question “have waivers improved access to appropriate, effective treatment?”

The briefing was well attended and was moderated by TCA President, Dr. Kathy Icenhower, Speakers included: Robert Kent, General Counsel, New York State Office of Alcoholism and Substance Abuse Services (OASAS); Jen Katzman, Chief of Staff to the Medicaid Director, Louisiana Department of Health Bureau of Health Services Financing; Adam Cohen, Executive Director, Odyssey House-UT; and Dr. Sushma Taylor, CEO of Center Point, Inc. in California

Bloomberg Law) -- Eliminating Obamacare’s penalty for people who don’t have health insurance will make it easier to over...
APA Urges Congress to Reject Latest Proposal to Remove Mandate in Affordable Care Act

Bloomberg Law) -- Eliminating Obamacare’s penalty for people who don’t have health insurance will make it easier to overhaul the health law next year, Republican lawmakers told Bloomberg Law.
Since Senate leaders admitted defeat in their effort to repeal the Affordable Care Act in September, Republicans have sought to strike a major blow against the health law by ending the individual mandate as part of other legislation, Rep. Michael Burgess (R-Texas) told Bloomberg Law. Republicans see it as a down payment on repealing the ACA, clearing the way for a successful repeal effort, he said.
Republicans on the Senate Finance Committee moved to make that down payment by attaching a repeal of the individual mandate to their tax bill Tuesday. Ending the penalty for not having health insurance will disrupt the insurance markets, raising premiums by allowing healthy people to choose not to buy health insurance, insurers have warned. This disruption is likely to motivate Republicans to pass a repeal bill next year, lawmakers told reporters.
“It means you better do something,” Sen. Lindsey Graham (R-S.C.), one of the main sponsors of an ACA-overhaul bill, told Bloomberg Law Tuesday.
Repealing the individual mandate without making other changes to the ACA will prompt 4 million more Americans to go without health insurance in 2019 and raise insurance premiums by an average of 10 percent each year the mandate is absent, according to congressional researchers.

• Families USA statement on individual mandate repeal

• Patient/consumer groups letter opposing individual mandate repeal

• American Psychiatric Association-

Following today’s announcement that the Senate version of the tax bill contains an amendment revoking the individual mandate of the Affordable Care Act (ACA), the American Psychiatric Association (APA) released the following statement from APA CEO and Medical Director Saul Levin, M.D., M.P.A.


Trump nominating Azar as next HHS secretary
President Trump’s nominee to lead the Department of Health and Human Services has a deep knowledge of the regulatory process, those who worked with him said, but Democrats are likely to raise flags.

On Monday, Trump tapped Alex Azar to fill the HHS secretary role vacated by Tom Price in late September, amid revelations that Price took repeated trips on government and private jets that cost taxpayers over $1 million.
Read the full story here


Dear Partners,

Republicans in both the House and the Senate are working around the clock to pass a tax bill at the expense of health care for millions by repealing the Affordable Care Act’s individual mandate and cutting programs like Medicare and Medicaid. We anticipate that House Republicans will bring their bill to the floor for a vote within the next 48 hours, with the Senate soon to follow.

Make no mistake - this bill is yet another effort to attack health care, disguised as tax reform.

We know that the individual mandate is a core part of how the ACA works. As the Congressional Budget Office estimates, the repeal of the individual mandate will result in 13 million people losing their insurance coverage, particularly middle class families dealing with serious health conditions. Instead of supporting efforts to provide health care for their constituents, as the American people have asked for, Republicans continue to return to their failed attempts to undermine the ACA and gut critical programs like Medicare and Medicaid, this time as a way to pay for massive tax cuts to the wealthiest households and corporations.

We need you to call your Members of Congress today and tell them to vote no on this bill. Your voices made the difference before and we need to make sure members of congress hear from you again now.

Actions to take TODAY:
1. Call your Members using the congressional switchboard (202) 224-3121 and tell them to vote no on the bill because it cuts our healthcare.
2. Join Health Care for America Now in planning #NOTHANKS activities next week. Community Catalyst will share more shortly.

Thank you for continuing this drumbeat,

TCA Bestows Senator Dick Durbin (IL-D) with theCharlie Devlin “Award for Excellence” for his exemplary work in the Behav...

TCA Bestows Senator Dick Durbin (IL-D) with the
Charlie Devlin “Award for Excellence” for his exemplary work in the Behavioral Health Field

On September 27th Treatment Communities of America (TCA) gathered in the Nation’s capital to celebrate decades of federal advocacy in support of people recovering from substance use disorders. The leaders of TCA programs from across the country were joined by several Members of Congress to honor decades of federal outreach by the organization, which seeks to support and improve policies and funding that provide access to community-based treatment for Substance Use Disorders (SUD).

In addition, TCA bestowed to Senator Dick Durbin (D-IL) the “Charlie Devlin Award for Excellence,” for his years of work and dedication in the behavioral health field. This is the first time that the Charlie Devlin award has been given; named after a past TCA President and Executive Officer, Charlie had more than 50 years in recovery and worked tirelessly on behalf of the millions of individuals and familes whose lives had been impacted by addiction to alcohol and other substances of abuse. His passing marked a tremendous loss to all in the recovery community. TCA is honored to be able to have given an award named after our good friend, Charlie Devlin, to such a deserving public servant in Senator Dick Durbin. In addition to members of Congress and their staff, the event was well attended by national behavioral health advocates, federal agency representatives and people in recovery.

Among the Members of Congress who attended the reception, outside of Senator Durbin, were U.S. Representative Alcee Hastings (D-FL), U.S. Representative Wm. Lacy Clay (D-MO), U.S. Representative Dwight Evans (D-PA), and U.S. Representative Robin Kelly (D-IL).

How HIPAA1 Allows Doctors to Respondto the Opioid CrisisHIPAA regulations allow health professionals to share health inf...
Health Information Privacy

How HIPAA1 Allows Doctors to Respond
to the Opioid Crisis

HIPAA regulations allow health professionals to share health information with a patient’s loved ones in emergency or dangerous situations – but misunderstandings to the contrary persist and create obstacles to family support that is crucial to the proper care and treatment of people experiencing a crisis situation, such as an opioid overdose. This document explains how health care providers have broad ability to share health information with patients’ family members during certain crisis situations without violating HIPAA privacy regulations.2
HIPAA allows health care professionals to disclose some health information without a patient’s permission under certain circumstances, including:
 Sharing health information with family and close friends who are involved in care of the patient if the provider determines that doing so is in the best interests of an incapacitated or unconscious patient and the information shared is directly related to the family or friend’s involvement in the patient’s health care or payment of care.3 For example, a provider may use professional judgment to talk to the parents of someone incapacitated by an opioid overdose about the overdose and related medical information, but generally could not share medical information unrelated to the overdose without permission.
 Informing persons in a position to prevent or lessen a serious and imminent threat to a patient’s health or safety.4 For example, a doctor whose patient has overdosed on opioids is presumed to have complied with HIPAA if the doctor informs family, friends, or caregivers of the opioid abuse after determining, based on the facts and circumstances, that the patient poses a serious and imminent threat to his or her health through continued opioid abuse upon discharge. 5
1 “HIPAA” refers to the Health Insurance Portability and Accountability Act of 1996 and, for purposes of this guidance, the HIPAA privacy and security regulations.
2 This guidance does not discuss the requirements of other federal or state laws that apply to individuals’ health information, including the federal regulations that provide more stringent protections for the confidentiality of substance use disorder patient records maintained in connection with certain federally assisted substance use disorder treatment programs (42 CFR Part 2 implementing 42 U.S.C. §290dd–2). HIPAA does not interfere with other laws or medical ethics rules that are more protective of patient privacy. 3See 45 CFR §§ 164.510(b)(1)(i) and 164.510(b)(3). 4 See 45 CFR § 164.512(j)(1)(i).
5 HIPAA still requires that a disclosure to prevent or lessen a serious and imminent threat must be consistent with other applicable laws and ethical standards. 164.512(j)(1) . For example, if a state’s law is more restrictive regarding the communication of health information (such as the information can only be shared with treatment personnel in connection with treatment), then HIPAA compliance hinges on the requirements of the more restrictive state law.
HIPAA respects individual autonomy by placing certain limitations on sharing health information with
family members, friends, and others without the patient’s agreement.
 For patients with decision-making capacity: A health care provider must give a patient the
opportunity to agree or object to sharing health information with family, friends, and others
involved in the individual’s care or payment for care.6 The provider is not permitted to share
health information about patients who currently have the capacity to make their own health
care decisions, and object to sharing the information (generally or with respect to specific
people), unless there is a serious and imminent threat of harm to health as described above.7
HIPAA anticipates that a patient’s decision-making capacity may change during the course of
 Decision-making incapacity may be temporary and situational, and does not have to rise to the
level where another decision maker has been or will be appointed by law. If a patient regains
the capacity to make health care decisions, the provider must offer the patient the opportunity
to agree or object before any additional sharing of health information.8
For example, a patient who arrives at an emergency room severely intoxicated or unconscious
will be unable to meaningfully agree or object to information-sharing upon admission but may
have sufficient capacity several hours later. Nurses and doctors may decide whether sharing
information is in the patient’s best interest, and how much and what type of health information
is appropriate to share with the patient’s family or close personal friends, while the patient is
incapacitated so long as the information shared is related to the person’s involvement with the
patient's health care or payment for such care.9 If a patient’s capacity returns and the patient
objects to future information sharing, the provider may still share information to prevent or
lessen a serious and imminent threat to health or safety as described above.10
HIPAA recognizes patient’s personal representatives according to state law.
 Generally, HIPAA provides a patient’s personal representative the right to request and obtain
any information about the patient that the patient could obtain, including a complete medical
record.11 Personal representatives are persons who have health care decision making authority
for the patient under state law.12 This authority may be established through the parental
relationship between the parent or guardian of an un-emancipated minor, or through a written
directive, health care power of attorney, appointment of a guardian, a determination of
incompetency, or other recognition consistent with state laws to act on behalf of the individual
in making health care related decisions.
For more information visit:
6 See 45 CFR § 164.510(b)(2).
7 See 45 CFR § 164.512(j)(1).
8 See 45 CFR § 164.510(b)(2).
9 See 45 CFR § 164.510(b)(1)(i).
10 See 45 CFR § 164.512(b)(2).
11 See 45 CFR § 164.502(g).
12 See generally HHS Office for Civil Rights Guidance on Personal Representatives (providing a chart which explains
who must be recognized as a personal representative and the legal exceptions applicable to unemancipated
individuals and abuse, neglect and endangerment situations).

A recent article in the Wash Post that focuses on the IMD exclusion, references Gateway Foundation, etc.  It is a genera...
The Health 202: There's a no-brainer way to solve the opioid crisis

A recent article in the Wash Post that focuses on the IMD exclusion, references Gateway Foundation, etc. It is a general rundown on other matters as well, but leads on the IMD exclusion.

And it wasn't included in Trump's announcement yesterday.


President Trump Declares the Opioid Epidemic to be a National Public Health Emergency

At a White House event on October 26, President Trump declared the opioid epidemic to be a national public health emergency and spoke in personal terms about how his brother’s alcoholism has shaped his own views on addiction. The declaration allows key federal agencies, including HHS, to use emergency authority to address the opioid crisis. A refresher on the emergency authorities available under the Public Health Service Act is also included at the end of this memo.

During the event, President Trump announced his intent to reform the IMD exclusion rule which prevents states from providing care at treatment facilities with more than 16 beds to those suffering from drug addiction. This follows the President’s Commission interim report recommendations on providing expedited relief from the IMD Exclusion, and advocacy by TCA overall and TCA Members including Bob Budsock and others to Commissioners in an effort to ensure that the Administration takes meaningful action on the IMD Exclusion immediately. President Trump’s full remarks on the IMD exclusion are as follows:

“As part of the emergency response we will announce a new policy to overcome a restrictive 1970 rule that prevents states from providing care at certain treatment facilities with more than 16 beds for those suffering from drug addiction. A number of states have reached out to us asking for relief and you should expect to see approvals that will unlock treatment for people in need and those approvals will come very, very fast not like in the past.”

Additionally, the President noted that the FDA is requiring one high risk opioid to be completely taken off
the market while HHS is coming out with updated guidance on pain management.

A summary of the event is below for review.

First Lady Melania Trump
• Opioid epidemic has affected more than 2 million Americans nationwide;
• We have lost 175 Americans every day due to overdoses;
• Told the story of a young man suffering from depression and anxiety who overdosed on opioids;
• Visited Lily’s Place in West Virginia; Lily’s place puts an emphasis on the whole family;
• Drug addiction can happen to any of us, which is why my husband has put in resources for this disease.

President Trump
• Thank you to Members of Congress, state and local leaders, first responders and health care professionals;
• Lost 64,000 Americans to overdoses last year;
• Drug overdoses are leading cause of unintentional deaths- more people dying from drug overdoses than motor vehicle crashes and gun homicides combined;
• Last year more than 1 million Americans used heroin and 11 million Americans abused prescription opioids;
• In West Virginia 1 in 5 babies spends its first days in agony because they’re suffering from withdrawal;
• Opioid crisis is a national public health emergency under federal law and I am directing all agencies to use emergency authority to fight the crisis;
• Announcing a new policy as part of the emergency response to overcome a restrictive rule that prevents states from providing care at certain facilities with more than 16 beds for those suffering from drug addiction; States will get approvals very fast;
• Working with doctors and medical professionals to work on safe opioid prescribing; Requiring federally employed prescribers to receive special training;
• CDC has prescription guidelines that are being used by medical professionals;
• CVS Caremark will limit certain first time opioid prescriptions to 7 days supplies;
• FDA requiring drug companies that manufacture prescription opioids to provide more training on opioid prescribing; Requested one high risk opioid be taken off the market;
• Mail service is increasing surveillance to stop the inflow of fentanyl;
• DOJ has indicted Chinese drug traffickers for distributing fentanyl;
• Looking for federal government to bring lawsuits against people and companies hurting Americans;
• National Institute of Health has taken the first steps of an ambitious public private partnership to develop non addictive pain killers and new forms of treatment for overdose; will be pushing non-addictive options very hard;
• Will be asking NIH for assistance; will work on a massive advertising campaign to prevent kids from taking drugs;
• Distributing $1 billion in grants for addiction and prevention and over $50 million for law enforcement; launched $81 million partnership to research better pain management for veterans;
• HHS will create a task force to develop updated best practices for better pain management;

• Saturday is Take Back Day; Encourages people to take back their drugs;
• 90% of the heroin comes from South of the border but we will be building a wall;
• Must adopt most common sense solution—must confront culture of drug abuse; Everyone who buys drugs is risking their future and they should know that they’re helping finance murderous organization;
• Illegal drug use is not a victimless crime; there’s nothing desirable about drugs.

Separate from the event, WSW has previously advised TCA on the emergency authorities that are available under the Public Health Service Act. As a refresher, the authorities are as follows:
Public Health Service (PHS) Act
Determination of a public health emergency
Secretary of HHS may declare a public health emergency under Section 319 of the Public Health Service Act based on a determination that:
• A disease or disorder presents a public health emergency
• That a public health emergency, including significant outbreaks of infectious disease or bioterrorist attacks, otherwise exists

Duration and Notification
• Duration of the emergency or 90 days, but may be extended by the Secretary
• Congress must be notified within 48 hours, and relevant agencies, including DHS, DOJ, and FBI must be kept informed

Pursuant to Section 319 the Secretary of HHS can:
1. Take appropriate actions in response to the emergency, including: a. Making grants
b. Entering into contracts; and
c. Conducting and supporting investigations into the cause, treatment, or prevention of the disease or disorder.

2. Access “no-year” funds appropriated to the Public Health Emergency Fund. (Please note our current understanding is that existing balances for the PHEF are minimal).
3. Grant extensions or waive sanctions relating to submission of data or reports required under laws administered by the Secretary, when the Secretary determines that, wholly or partially, as a result of a public health emergency, individuals or public or private entities are unable to comply with deadlines for such data or reports.
4. Waive or modify certain Medicare, Medicaid, Children’s Health Insurance Program (CHIP) and Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule requirements.

a. Under section 1135 of the Social Security Act (SSA), the Secretary may waive or modify certain requirements as necessary to ensure to the maximum extent feasible that, in an emergency area during an emergency period, sufficient health care items and services are available to meet the needs of individuals enrolled in SSA programs (including Medicare, Medicaid, and CHIP) and that providers of such services in good faith who are unable to comply with certain statutory requirements are reimbursed and exempted from sanctions for noncompliance, absent fraud or abuse.
b. There must also be a Presidential declaration of an emergency or disaster in order to exercise this authority.

5. Adjust Medicare reimbursement for certain Part B drugs.
6. Make temporary (up to one year or the duration of the emergency) appointments of personnel to positions that directly respond to the public health emergency when the urgency of filling positions prohibits examining applicants through the competitive process.
7. Waive certain Ryan White HIV/AIDS program requirements (section 2683 of the PHS Act), allowing up to five percent of the funds available under each of the Parts A and B base supplemental pools to be shifted to ensure access to care. In addition, the Secretary may waive such requirements of title XXVI of the PHS Act to improve the health and safety of those receiving care under this title and the general public.
8. Modify practice of telemedicine. a. The Ryan Haight Online Pharmacy Consumer Protection Act and implementing regulations allow the Secretary, with concurrence of the DEA Administrator, to designate patients and use of controlled substances during a public health emergency declared by the Secretary.

9. Allow State and local governments to access the General Services Administration (GSA) Federal supply schedule when using federal grant funds. a. GSA policy allows state, local, and tribal government grantees to use federal supply schedules to respond to public health emergencies declared by the Secretary.

10. Temporary reassignment of state and local personnel.
11. Determine a waiver of Paperwork Reduction Act (PRA) requirements is necessary.
12. Allow the Department of Labor to issue dislocated worker program grants for disaster relief employment.


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