Hill Day 2009

Dear Member:

It was indeed a proud June moment when a group of the 380 National Council members that had gathered in Washington DC to advocate for mental health and addictions services stood on the steps of Capitol Hill to reaffirm our rallying cry, “Together We Will.”

Together we can, and we will, ensure…

• Mental health/SUD benefits are included in healthcare reform benefits package
• Federal status for community behavioral healthcare organizations
• People with serious mental illnesses have a healthcare home in community behavioral healthcare
• Inclusion of community behavioral healthcare organizations in federal HIT funding initiatives
  

Congregating at the seat of power in the nation’s capital was the culmination of two very full days of activity that marked the National Council’s fifth annual Hill Day, June 9 and 10. It was a moment that heralded both how far we’ve come and how much we have yet to accomplish.

Thank you to all those who came to Hill Day, your participation is already having an impact. Just one example —  as a result of member advocacy, the Mental Illness Chronic Care Improvement Act S. 1136 introduced by Senator Debbie Stabenow (D-MI) — authorizing a new $250 million, four-year, Medicaid demonstration program to improve the outcomes and satisfaction of individuals with serious mental illness has co-sponsors — Carl Levin (D-MI), Mark Begich (D-AK), Michael Bennet (D-CO), Bernard Sanders (I-VT) — and the companion HR 3065 has been introduced in the House by Janice Schakowsky (D-IL 9th) with co-sponsor Carolyn Cheeks Kilpatrick (D-MI 13th).

NATIONAL COUNCIL POLICY AGENDA

All signs point to Congress passing a healthcare reform bill in 2009, potentially expanding health insurance coverage to 46 million uninsured Americans. We expect this to be achieved through a combination of Medicaid eligibility expansions as well as the creation of a new health insurance exchange — basically a new health insurance market place — for persons earning above 100% of the Federal Poverty Level. Premiums for participants in the exchange will be heavily subsidized by the federal government. In return for this expansion of coverage, Congress will be seeking opportunities to introduce greater provider accountability and consumer responsibility into the healthcare system, while promoting initiatives which increase efficiency and reduce variations in care and medical errors.

Since many who receive care in community behavioral health organizations are low income uninsured (or underinsured) individuals, providers need to prepare for increased demand. The 2005 National Co-morbidity Survey reports that 7.6 million indigent, uninsured persons need mental health services during the course of any given year. These figures include 700,000 youth with Serious Emotional Disturbances, 3.8 million adults with Serious Mental Illness and an additional 3.1 million youth and adults with mild to moderate mental health and substance use conditions.

Confronted with this once-in-a-generation opportunity to secure the resources necessary to effectively serve those in need, the National Council is pursuing a federal healthcare reform agenda which not only takes into consideration the overarching principles of the current healthcare reform debate, but strongly advocates for greater resources to community behavioral health providers to better address the whole health concerns of individuals with mental illness and substance use disorders.

WHAT’S DRIVING US?

The National Association of State Mental Health Program Director’s report demonstrates that persons with serious mental illnesses served by public mental health agencies have the HIGHEST mortality rate of ANY population ANYWHERE in America’s public health system. Specifically, the average life expectancy for this population now rivals people living with HIV/AIDS. In addition, among psychiatric patients, the probability of dying is 55% higher for patients diagnosed as having substance use disorders than among those without a substance use diagnosis.

PROVIDER ACCOUNTABILITY

In order to stop the predicted cost growth in coming years, both the Obama Administration and Congress are committed to promoting evidence-based practices and increasing provider accountability. This trend is reflected in new federal commitments of $1 billion for comparative effectiveness research and $20 billion to encourage the adoption and utilization of electronic health records. Both of these initiatives are based on several themes of the current healthcare debate:

• Provider accountability for clinical outcomes
• Systemic application of evidenced-based interventions
• Reduced reimbursement for sub-optimal outcomes
• Specific reporting of detailed encounter data.
  

To help community behavioral health providers prepare for a new era of accountability in healthcare while attempting to stem the mortality rates cited above, we are pursuing four priority initiatives:

1. Mental Health/Substance Use Disorders Included in Benefit Packages in the Exchange

Like the Massachusetts healthcare reform program, the Obama Administration endorses an approach that finances private health insurance for low income uninsured individuals via a health insurance exchange. Many private insurance companies, such as Blue Cross/Blue Shield and Aetna, would participate in this new program/health insurance market place. The National Council seeks to ensure:

• Mental health and substance abuse benefits are part of any nationwide minimum benefit package.
• Comprehensive parity is applied to all benefit packages offered in the exchange or connector.
• Enhanced case management is provided to new enrollees with cognitive impairments to help them navigate the exchange/connector.

2. Federal Status for Behavioral Health Organizations

A new federal definition for Federally Qualified Behavioral Health Centers (FQBHC) that would

• Establish federal status for community behavioral health organizations volunteer to meet the standards of an FQBHC
• Provide a definition for such an entity that clearly identifies treatment objectives and updates the minimum core services required, and
• Establish clearly-defined national standards for this entity.

In return for this new federal status, providers working within FQBHCs will be asked to meet provider accountability standards.

3. SMI Healthcare Home Demo to Support Co-Location of Primary Care in CBHOs

The Mental Illness Chronic Care Improvement Act of 2009 was introduced in the Senate (S. 1136) on May 21, 2009 by Senator Debbie Stabenow and in the House on June 26, 2009 (H.R. 3065) by Representative Janice Schakowsky. This bill would among many other things, co-locate primary care capacity in Community Mental Health Centers and other community-based mental health and substance abuse providers. This integrated treatment approach is aimed squarely at reducing the mortality and morbidity rates among clients in the public behavioral health system. While the National Council was able to engineer a new $7 million SAMHSA program in 2008 with a similar structure and treatment goals, this demo, targeted to Medicaid beneficiaries, will more directly impact the single largest purchaser of mental health and addiction services.

4. Inclusion of CBHOs in Federal HIT Funding Initiatives

The Health Information Technology for Economic and Clinical Health Act (HITECH Act) was enacted as part of the economic recovery bill passed by Congress earlier this year. It creates a new $17 billion Medicare and Medicaid reimbursement system to help physicians, hospitals, and Community Health Centers purchase and maintain health information technology for the purpose of widespread adoption and utilization of electronic health records. Although psychiatrists may access these incentive payments, Community Behavioral Health Organizations, as facilities, are not eligible for this funding. The National Council is seeking inclusion of CBHOs in any federal HIT initiatives to ensure that individuals with mental illnesses and addictions have access to the benefits of HIT via the providers that serve them.

NEXT STEPS

The table has been set. The Obama Administration understands that change is most possible during crisis and is using the current harsh economic environment to move a healthcare agenda. All of the players pledged — and had their pictures taken — to put parochial interests aside for the greater good. And having learned the healthcare lessons of the Clintons, the Administration has turned the details of healthcare reform over to Congress. The National Council and our sister advocacy groups in the behavioral health community join many, many other healthcare stakeholders in working the halls of Congress to have our voices heard. And those of you that participated in Hill Day had your voices heard – sending a message about hope and recovery from mental illnesses and addictions coupled with an assertive, actionable policy agenda.

It is neither easy nor inexpensive to leave daily work behind and to travel to D.C. Your efforts benefit many, I again thank you. And I urge those who were not with us, to join us in 2010 and to bring your boards and the consumers and families you serve with you. All members need to prioritize establishing and nurturing relationships with elected officials in Washington D.C. and at home — it will pay off!

There are four immediate steps YOU can take

• Invite your members of Congress to visit your organization when they’re home for August recess — start planning now and coordinate with their home offices and with media to cover the visit.
• Participate in the National Council’s healthcare reform webinars – the next is scheduled for July 8 at 2 pm eastern for reform updates.
• Respond to the National Council’s Action Alerts you receive via email.
• Use the press release templates we’ll be sending you to generate local media attention on the critical need for expanded mental health and addiction services.

It will take every one of us, 1,600 National Council member organizations, your boards, the 250,000+ staff you employ and the 6 million+ people you serve to continue to advance our agenda. Together we will…