Letters from the CEO: February 2006
Dear Member:
The start of 2006 has been difficult. The implementation of the Medicare drug benefit has been an extremely challenging unfunded mandate for our member organizations. And the fact that the House of Representatives last week passed approximately $42 billion in Medicaid and human service cuts was a great disappointment to our entire community.
Congress narrowly passes $42 billion in Medicaid and human service cuts
On February 1, the House adopted a budget reconciliation package that reduces Medicaid and human services spending by almost $42 billion. The National Council staff and our members worked very hard to defeat this package. In addition to our own strong advocacy with individual House members, we joined an array of advocacy coalitions in a united effort. In the end the reconciliation bill passed narrowly, 216 to 214, with 13 Republican members voting no, including four members who reversed their previous position supporting the cuts.
The Temporary Assistance for Needy Families (TANF) program was reauthorized through 2010. The bill did not include the proposal to count drug treatment and other rehabilitative services as work activities, and instead directed the Health and Human Services administration to use its regulatory process to define what counts as work. The budget did loosen federal student aid eligibility restrictions for individuals convicted of a drug offense. The ban on receiving federal aid will now apply only to students convicted of a drug offense while receiving aid.
The budget reconciliation measure allows but doesnt require states to restructure Medicaid through increased cost sharing and benefit reductions, and sets the stage for a coordinated campaign to remind state legislators of the strong and passionate opposition to such cuts. The National Council will be working to affect the federal governments regulatory interpretation of the budget, and to support coordinated state advocacy efforts to protect service funding.
President's 2007 budget proposals
Of note in a very preliminary review of the Presidents 2007 budget proposals are: a revival of the proposal to lower the match rate for Targeted Case Management to 50%; a proposed clarification of services that are allowable and can be claimed as rehabilitative services; and a proposal to use the mental health block grant to fund transformation activities in additional states. We will remind Congress that this years advocacy efforts resulted in passage of the reconciliation bill by one vote in the Senate and two votes in the House, and expect them to be more cautious in 2007.
The budget also proposes cuts to Medicare including higher premiums and offers increased tax incentives for Health Savings Accounts (HSAs). Highlighted by the President in his state of the union address, HSAs are viewed as a means for encouraging market forces to control health costs. The administration believes that healthcare costs will come down as providers compete for the more personally and carefully managed healthcare dollar. Consumer-driven is a nice slogan, but it remains to be seen if buying healthcare is the same as shopping for a dress. Operating like 401K retirement plans, an individual can invest the money put into the HSA. The accounts are more attractive to healthier, younger people and to the affluent, potentially leaving traditional insurance plans for those who are poorer and sicker. Health insurance appears to be headed the way of pension plans.
For a more in depth review of the proposed 2007 budget, go to www.nccbh.org/policy/FY07budget.htm.
Members testify to Congress on Medicare prescription plans bumpy start
The new Medicare prescription drug benefit became effective January 1 and, as expected, brought with it many challenges.
National Council staff led by Kristin Battista-Frazee worked very hard to assist your organization in preparing for the transition. Kristin continues to talk to your staff, working through the issues your staff present to us and connecting your staff with help from CMS and with other providers facing similar issues. We recognize and appreciate the tremendous additional burden that your staff, especially case managers, have taken on as they help consumers navigate this complex new benefit. You can visit our website at www.nccbh.org/MEDICARE/INDEX.HTM for the latest on providers and Part D.
And on February 2, Michael Donato, an individual with mental illness and Sharon Farr, a staff member from the Center for Individual and Family Services in Mansfield, Ohio bravely told their stories to the Senate Committee on Aging. This committee, chaired by Senator Smith (R-OR) held a hearing on the plans implementation problems and once again we were able to arrange for testimony by members on the frontlines. The result was that we broadened the discussion from the plight of over-burdened pharmacists to highlight over-burdened mental health organizations and practitioners. It was another opportunity to tell the story of the work you do and build recognition on the Hill for our members. The testimony is available at www.nccbh.org/WHO/NEWSROOM.HTM.
HHS Secretary Mike Leavitt said in a letter to The Washington Post, The addition of the drug coverage is the biggest change to the Medicare program in 40 years, and any time you make a big change in a small time, unanticipated problems will arise. What Secretary Leavitt did not address is that the drug benefit is the complicated result of blending a new entitlement with a market-oriented philosophy. This blending of government and private markets requires an extreme degree of coordination that is often very difficult to achieve. And for individuals eligible for both Medicare and Medicaid, the new drug benefit means losing a far simpler state administered Medicaid benefit. The Medicare prescription plan also adds the problem of co-pays that, no matter how small, are punishing to individuals barely able to afford food and shelter. Congress believes the moral hazard theory of healthcare, that without co-pays people will overuse healthcare, choosing doctor visits and medicines over bingo or the movies. We need to convince them that a country as rich as ours should be ashamed to punish those among us who are poor and ill.
The marketplace philosophy requires vigilance in our monitoring of plan formularies. Future plan restrictions may not be overt. Plans are already requiring pre-authorizations for medicines commonly prescribed for those with mental illnesses and could begin to impose onerous paperwork requirements for more expensive psychiatric medications. These commercial, for-profit companies are difficult to engage and we know one size doesnt fit all when it comes to psychiatric medications. We will need to be strong advocates to ensure that consumers have access to a full array of medications.
Raising member visibility in the media
The Medicare drug benefit is another unfunded mandate for our members, but it is also another opportunity to tell your story. The story of provider organizations heroic efforts to get consumers the psychiatric medications they must have. On January 19, Meena Dayak, our Director of Marketing and Communications, organized a media briefing on Part D. Along with consumers and staff from member organizations, I spoke to the media highlighting implementation problems and the work of our members to address those problems and offered potential solutions. The briefing elicited a strong response and representatives from The New York Times, The Washington Post, National Public Radio, Reuters, and Medill News Service participated. Also, note the trade press coverage, featuring the National Council and our members, in the January 23 issue of Mental Health Weekly, available at www.nccbh.org/MEDICARE/MentalHealthWeeklyVol16Issue4p1-8_1.pdf
With Meenas leadership, the National Council is using every opportunity available to connect with trade and national media on the wide range of issues that impact you and the consumers you serve. From the electronic health record to the CATIE study, from the IOM report to your work with survivors of Hurricane Katrina, we are calling attention to the vital role you play in the health of this nation. Thanks to all of you who have responded to our calls and participated in our media outreach efforts. And also thank you for sharing your stories with us and with your colleagues through the Member Listserve, and through our Meet Me calls. I read and listen to all you have to say and that helps us become a more effective voice for you.
New leader for our public policy team
The National Councils increased impact on the Hill and in the Administration is only possible with your support and personal involvement and with the efforts of talented staff at the National Council. In an earlier letter, I told you about Chuck Ingoglia joining us, and now Im very pleased to announce that he has agreed to lead our public policy efforts. Those of you who have worked with him during the past few months have shared your positive impressions of Chuck with me, and I know the rest of you will share those views as you begin to work with him. Chucks understanding of government and Medicaid and his experience in state policy will help to connect our federal efforts with state level activity and the efforts of our state association partners. Public policy is our priority, strengthening your voice in Congress is our focus. We will continue our progress with Chucks leadership, Al Guidas guidance and the vision and commitment of our public policy committee chair, Rusty Selix and co-chair, Jim Dill.
2nd Annual Hill Day is May 3please join us
We need you on the Hill! Please plan to join National Council staff, public policy experts and colleagues from across the country for our 2nd Annual Hill Day on May 3 in Washington, DC. Together, we will educate Congress on the issues critical to you and to the adults, children and families your organization serves. We must work very hard if we are going to protect further erosion of the mental health and addictive disorders treatment and rehabilitation funding that makes recovery possible, and if we are going to be successful with legislation that would enable you to more effectively deliver services. You are the grasstops advocacy community, you serve and you employ. Come and continue to build your relationships with national legislators and their staff. Once again we are holding hotel rooms, preparing briefing materials, can help arrange appointments and are planning an evening Hill reception. Please contact Allison Fort at (301) 984-6200, ext. 235 or email AllisonF@nccbh.org for details. I look forward to walking the halls of Congress with you.
Annual Conference is April 8-11--see you in Orlando
The National Council's Annual Conference, April 8-11 in Orlando, Florida is fast approaching. I hope you have made plans to attend and that youre bringing your leadership team. The conference is an opportunity to rekindle your mission, sharpen your skills and explore new directions. We are especially excited about this years new offerings, the Executive Leadership Institute, the Public Policy Academy, a day of workshops and a reception for medical directors, and the IMPACT depression treatment workshop led by Dr. Jurgen Unutzer. We are also planning an array of networking and informal learning opportunities. Visit www.nccbh.org/orlando to learn more about the conference. Mickey, Minnie and the National Council staff look forward to seeing you in Orlando.
New learning and leadership development opportunities
The conference is not the only venue through which the National Council brings you state-of-the-science information. We work very hard to translate legislation, policies, regulations and practices into educational and technical assistance opportunities that you, your board and your staff can access easily and put to immediate use.
Among our newest educational opportunities are E-learning courses, offered in partnership with Essential Learning. These courses are a cost-effective staff development resource, complete with CEUs. Individual courses and comprehensive organizational subscriptions are discounted for National Council members. E-learning courses can help ensure compliance with training mandates, reduce overall training costs, and increase skills. New courses are being added every month. Visit our website at www.nccbh.org/SERVICE/e-learning.htm for details or email your questions, feedback or suggestions to KristinBF@nccbh.org
A very special new opportunity is the Leadership Academy, brought to you by the National Council in partnership with Behavioral Health Strategies (a subsidiary of Valley Mental Health). The Leadership Academy builds on the success of our ongoing Middle Management Academy. While the Middle Management Academy focuses on preparing and supporting new managers, the Leadership Academy is a strategy for developing managers into leaders. The Leadership Academy is designed to groom individuals for organizational leadership positions, and will help you to protect your organizations critical knowledge base and address your organizations need for succession planning. The academy is an intensive 1-year training for the next generation of behavioral healthcare leaders and will be offered at selected sites around the country. Built upon research-based practices in leadership development, the Leadership Academy offers personalized training including pre- and post-assessments, coaching and mentoring, and individual and team projects. We will be sending you more information about the academy but in the interim to learn more, email KristinBF@nccbh.org.
Best regards,
Linda
The start of 2006 has been difficult. The implementation of the Medicare drug benefit has been an extremely challenging unfunded mandate for our member organizations. And the fact that the House of Representatives last week passed approximately $42 billion in Medicaid and human service cuts was a great disappointment to our entire community.
Congress narrowly passes $42 billion in Medicaid and human service cuts
On February 1, the House adopted a budget reconciliation package that reduces Medicaid and human services spending by almost $42 billion. The National Council staff and our members worked very hard to defeat this package. In addition to our own strong advocacy with individual House members, we joined an array of advocacy coalitions in a united effort. In the end the reconciliation bill passed narrowly, 216 to 214, with 13 Republican members voting no, including four members who reversed their previous position supporting the cuts.
The Temporary Assistance for Needy Families (TANF) program was reauthorized through 2010. The bill did not include the proposal to count drug treatment and other rehabilitative services as work activities, and instead directed the Health and Human Services administration to use its regulatory process to define what counts as work. The budget did loosen federal student aid eligibility restrictions for individuals convicted of a drug offense. The ban on receiving federal aid will now apply only to students convicted of a drug offense while receiving aid.
The budget reconciliation measure allows but doesnt require states to restructure Medicaid through increased cost sharing and benefit reductions, and sets the stage for a coordinated campaign to remind state legislators of the strong and passionate opposition to such cuts. The National Council will be working to affect the federal governments regulatory interpretation of the budget, and to support coordinated state advocacy efforts to protect service funding.
President's 2007 budget proposals
Of note in a very preliminary review of the Presidents 2007 budget proposals are: a revival of the proposal to lower the match rate for Targeted Case Management to 50%; a proposed clarification of services that are allowable and can be claimed as rehabilitative services; and a proposal to use the mental health block grant to fund transformation activities in additional states. We will remind Congress that this years advocacy efforts resulted in passage of the reconciliation bill by one vote in the Senate and two votes in the House, and expect them to be more cautious in 2007.
The budget also proposes cuts to Medicare including higher premiums and offers increased tax incentives for Health Savings Accounts (HSAs). Highlighted by the President in his state of the union address, HSAs are viewed as a means for encouraging market forces to control health costs. The administration believes that healthcare costs will come down as providers compete for the more personally and carefully managed healthcare dollar. Consumer-driven is a nice slogan, but it remains to be seen if buying healthcare is the same as shopping for a dress. Operating like 401K retirement plans, an individual can invest the money put into the HSA. The accounts are more attractive to healthier, younger people and to the affluent, potentially leaving traditional insurance plans for those who are poorer and sicker. Health insurance appears to be headed the way of pension plans.
For a more in depth review of the proposed 2007 budget, go to www.nccbh.org/policy/FY07budget.htm.
Members testify to Congress on Medicare prescription plans bumpy start
The new Medicare prescription drug benefit became effective January 1 and, as expected, brought with it many challenges.
National Council staff led by Kristin Battista-Frazee worked very hard to assist your organization in preparing for the transition. Kristin continues to talk to your staff, working through the issues your staff present to us and connecting your staff with help from CMS and with other providers facing similar issues. We recognize and appreciate the tremendous additional burden that your staff, especially case managers, have taken on as they help consumers navigate this complex new benefit. You can visit our website at www.nccbh.org/MEDICARE/INDEX.HTM for the latest on providers and Part D.
And on February 2, Michael Donato, an individual with mental illness and Sharon Farr, a staff member from the Center for Individual and Family Services in Mansfield, Ohio bravely told their stories to the Senate Committee on Aging. This committee, chaired by Senator Smith (R-OR) held a hearing on the plans implementation problems and once again we were able to arrange for testimony by members on the frontlines. The result was that we broadened the discussion from the plight of over-burdened pharmacists to highlight over-burdened mental health organizations and practitioners. It was another opportunity to tell the story of the work you do and build recognition on the Hill for our members. The testimony is available at www.nccbh.org/WHO/NEWSROOM.HTM.
HHS Secretary Mike Leavitt said in a letter to The Washington Post, The addition of the drug coverage is the biggest change to the Medicare program in 40 years, and any time you make a big change in a small time, unanticipated problems will arise. What Secretary Leavitt did not address is that the drug benefit is the complicated result of blending a new entitlement with a market-oriented philosophy. This blending of government and private markets requires an extreme degree of coordination that is often very difficult to achieve. And for individuals eligible for both Medicare and Medicaid, the new drug benefit means losing a far simpler state administered Medicaid benefit. The Medicare prescription plan also adds the problem of co-pays that, no matter how small, are punishing to individuals barely able to afford food and shelter. Congress believes the moral hazard theory of healthcare, that without co-pays people will overuse healthcare, choosing doctor visits and medicines over bingo or the movies. We need to convince them that a country as rich as ours should be ashamed to punish those among us who are poor and ill.
The marketplace philosophy requires vigilance in our monitoring of plan formularies. Future plan restrictions may not be overt. Plans are already requiring pre-authorizations for medicines commonly prescribed for those with mental illnesses and could begin to impose onerous paperwork requirements for more expensive psychiatric medications. These commercial, for-profit companies are difficult to engage and we know one size doesnt fit all when it comes to psychiatric medications. We will need to be strong advocates to ensure that consumers have access to a full array of medications.
Raising member visibility in the media
The Medicare drug benefit is another unfunded mandate for our members, but it is also another opportunity to tell your story. The story of provider organizations heroic efforts to get consumers the psychiatric medications they must have. On January 19, Meena Dayak, our Director of Marketing and Communications, organized a media briefing on Part D. Along with consumers and staff from member organizations, I spoke to the media highlighting implementation problems and the work of our members to address those problems and offered potential solutions. The briefing elicited a strong response and representatives from The New York Times, The Washington Post, National Public Radio, Reuters, and Medill News Service participated. Also, note the trade press coverage, featuring the National Council and our members, in the January 23 issue of Mental Health Weekly, available at www.nccbh.org/MEDICARE/MentalHealthWeeklyVol16Issue4p1-8_1.pdf
With Meenas leadership, the National Council is using every opportunity available to connect with trade and national media on the wide range of issues that impact you and the consumers you serve. From the electronic health record to the CATIE study, from the IOM report to your work with survivors of Hurricane Katrina, we are calling attention to the vital role you play in the health of this nation. Thanks to all of you who have responded to our calls and participated in our media outreach efforts. And also thank you for sharing your stories with us and with your colleagues through the Member Listserve, and through our Meet Me calls. I read and listen to all you have to say and that helps us become a more effective voice for you.
New leader for our public policy team
The National Councils increased impact on the Hill and in the Administration is only possible with your support and personal involvement and with the efforts of talented staff at the National Council. In an earlier letter, I told you about Chuck Ingoglia joining us, and now Im very pleased to announce that he has agreed to lead our public policy efforts. Those of you who have worked with him during the past few months have shared your positive impressions of Chuck with me, and I know the rest of you will share those views as you begin to work with him. Chucks understanding of government and Medicaid and his experience in state policy will help to connect our federal efforts with state level activity and the efforts of our state association partners. Public policy is our priority, strengthening your voice in Congress is our focus. We will continue our progress with Chucks leadership, Al Guidas guidance and the vision and commitment of our public policy committee chair, Rusty Selix and co-chair, Jim Dill.
2nd Annual Hill Day is May 3please join us
We need you on the Hill! Please plan to join National Council staff, public policy experts and colleagues from across the country for our 2nd Annual Hill Day on May 3 in Washington, DC. Together, we will educate Congress on the issues critical to you and to the adults, children and families your organization serves. We must work very hard if we are going to protect further erosion of the mental health and addictive disorders treatment and rehabilitation funding that makes recovery possible, and if we are going to be successful with legislation that would enable you to more effectively deliver services. You are the grasstops advocacy community, you serve and you employ. Come and continue to build your relationships with national legislators and their staff. Once again we are holding hotel rooms, preparing briefing materials, can help arrange appointments and are planning an evening Hill reception. Please contact Allison Fort at (301) 984-6200, ext. 235 or email AllisonF@nccbh.org for details. I look forward to walking the halls of Congress with you.
Annual Conference is April 8-11--see you in Orlando
The National Council's Annual Conference, April 8-11 in Orlando, Florida is fast approaching. I hope you have made plans to attend and that youre bringing your leadership team. The conference is an opportunity to rekindle your mission, sharpen your skills and explore new directions. We are especially excited about this years new offerings, the Executive Leadership Institute, the Public Policy Academy, a day of workshops and a reception for medical directors, and the IMPACT depression treatment workshop led by Dr. Jurgen Unutzer. We are also planning an array of networking and informal learning opportunities. Visit www.nccbh.org/orlando to learn more about the conference. Mickey, Minnie and the National Council staff look forward to seeing you in Orlando.
New learning and leadership development opportunities
The conference is not the only venue through which the National Council brings you state-of-the-science information. We work very hard to translate legislation, policies, regulations and practices into educational and technical assistance opportunities that you, your board and your staff can access easily and put to immediate use.
Among our newest educational opportunities are E-learning courses, offered in partnership with Essential Learning. These courses are a cost-effective staff development resource, complete with CEUs. Individual courses and comprehensive organizational subscriptions are discounted for National Council members. E-learning courses can help ensure compliance with training mandates, reduce overall training costs, and increase skills. New courses are being added every month. Visit our website at www.nccbh.org/SERVICE/e-learning.htm for details or email your questions, feedback or suggestions to KristinBF@nccbh.org
A very special new opportunity is the Leadership Academy, brought to you by the National Council in partnership with Behavioral Health Strategies (a subsidiary of Valley Mental Health). The Leadership Academy builds on the success of our ongoing Middle Management Academy. While the Middle Management Academy focuses on preparing and supporting new managers, the Leadership Academy is a strategy for developing managers into leaders. The Leadership Academy is designed to groom individuals for organizational leadership positions, and will help you to protect your organizations critical knowledge base and address your organizations need for succession planning. The academy is an intensive 1-year training for the next generation of behavioral healthcare leaders and will be offered at selected sites around the country. Built upon research-based practices in leadership development, the Leadership Academy offers personalized training including pre- and post-assessments, coaching and mentoring, and individual and team projects. We will be sending you more information about the academy but in the interim to learn more, email KristinBF@nccbh.org.
Best regards,
Linda
