Public Policy Update: October 8, 2009
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October 8, 2009
Pamela Hyde Nominated for Post as Administrator of SAMHSA
CMS Clarifies Policy on 15-minute Billing Increments for Rehabilitation and Targeted Case Management
National Mental Health & Addiction Advocacy Community Issues Statement on the One Year Anniversary of the Passage of the Wellstone Domenici Parity Act; Regulations Will Be Issued by January 2010
Earlier this week, a statement was released from a broad coalition of national mental health and addiction advocacy groups, including the National Council. The statement reads as follows:
“October 3, 2009 marked the one year anniversary of the enactment of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. Thanks to the tireless work of advocates around the country, one short year later we have built upon our parity victory by including mental health and addictive disorder benefits in every key health care reform bill pending in Congress.
While regulations have not yet been released by the Departments of Labor (DOL), Health and Human Services (HHS) and Treasury, we expect they will release interim final regulations by January 1, 2010.
As you may recall, in August, Sen. Franken (D-MN) was joined by 25 Senators in sending a letter to the Agencies asking the Agencies to promulgate the regulations in a timely fashion and according to Congressional intent. In September, Rep. Kennedy (D-RI) was joined by 71 Members of Congress in sending a similar letter. The responses from HHS Secretary Sebelius are attached.
As a result of the Congressional inquiries, we are pleased that this week Agency officials will be meeting with Rep. Kennedy and Congressional staff to discuss the regulatory process. Our hope is that these meetings will help ensure the regulations are promulgated according to Congressional intent.
We will keep you apprised of the Agencies’ efforts to educate plans about their compliance expectations.”
In addition, BNA covered this issue in its Healthcare Policy Report. BNA cited Chuck Ingoglia, Vice President for Public Policy of the National Council, as saying it is essential for the agencies to provide clear guidance to health plans and employers: “It would be our hope that the regulators would take the letters into account,” he said (BNA Healthcare Policy Report, Oct. 6, 2009).
You can see Secretary Sebelius’ letters to Senator Al Franken and Representative Patrick Kennedy online. The National Council would like to extend our gratitude to the Members of Congress who have shown great leadership regarding parity implementation. We would also like to thank our members for responding to an Action Alert regarding this issue; over 700 advocacy messages were sent to Representatives and Senators encouraging them to sign on to the parity regulations letters.
Pamela Hyde Nominated for Post as Administrator of SAMHSA
President Obama on Friday announced his nomination of Pamela Hyde for the post of SAMHSA Administrator. Hyde has served as Secretary of the New Mexico Human Services Department since 2003. She has also served as Director of several other public agencies, including the Ohio Department of Mental Health, the Ohio Department of Human Services, and the Seattle Department of Housing and Human Services. Much of Hyde’s 30 years of experience in management and consulting has been in the behavioral health arena, including her position as CEO of the non-profit behavioral healthcare organization Comcare.
The National Council congratulates Pamela Hyde on her nomination. With the potential passage of health care reform, and as the work of implementation begins, her experience and expertise will serve our community well. We are confident she will provide strong leadership in the mental health and substance abuse arena.
CMS Clarifies Policy on 15-minute Billing Increments for Rehabilitation and Targeted Case Management
The National Council recently attended a conference in which staff from the Centers for Medicare and Medicaid Services (CMS) gave a presentation on CMS policy on Medicaid Rehabilitation and Targeted Case Management Services. During the presentation, CMS staff stated that the central office had communicated with regional offices that there is no requirement for states to bill for these services in 15-minute increments. States may require 15-minute increments if they choose, but CMS will allow up to weekly rates. For bundled rates longer than a week, CMS is suggesting that states use a waiver or other managed care arrangement. The slides from the CMS presentation are available on our website.
The requirement for 15-minute increments was included in the targeted case management regulation promulgated by CMS under President Bush, and was often applied to rehabilitation services in many states. The Obama Administration has rescinded the portions of the targeted case management rule relating to 15-minute increments and has indicated that this applies to rehabilitative services as well.
Health Care Reform Bills Continue Moving Through Congress; Public Support for Reform Rises in September
The Senate Finance Committee, which completed consideration of amendments to its health reform proposal last week, has gained new momentum for its bill after the Congressional Budget Office (CBO) yesterday provided a preliminary score of the revised legislation. The CBO analysis concluded that the bill would cost $829 billion over 10 years and would extend insurance coverage to 94 percent of legal U.S. residents. Moreover, the bill would reduce the national deficit by $81 billion over 10 years. While the favorable CBO score is expected to increase the chances the bill will be approved by the Finance Committee, a date has not yet been scheduled for the Committee’s final vote on the bill.
Meanwhile, Senate Majority Leader Harry Reid has begun facilitating the process of merging the Health, Education, Labor, and Pensions (HELP) Committee and Finance Committee proposals into one bill, to be voted on by the entire Senate. While Reid has stated he would like Senate floor debate to begin next week, the schedule will depend on how soon the Finance Committee approves its version of the legislation.
The three House Committees of jurisdiction (Education & Labor, Ways & Means, and Energy & Commerce) have each passed slightly different versions of HR 3200 (“The Affordable Health Choices Act”); these differences must be reconciled by the House Rules Committee before floor debate. Speaker Pelosi has also been meeting with several Representatives to reduce the overall cost of the House proposal from $1.1 trillion to $900 billion (the benchmark set by Obama). The final proposal that emerges from these negotiations will also need to be scored by CBO. The National Council has created a resource which describes key amendments in HR 3200.
When a health care reform bill passes out of both the Senate and House, these two bills must be reconciled in Conference Committee. This reconciled version must then be approved by both the House and Senate and then signed into law by President Obama.
In related news, a recent Kaiser poll found that public support for health reform is once again rising after a slight decline during the summer months. 57 percent of Americans now believe that taking on health reform is more important than ever, compared to 39 percent who say the country cannot afford to tackle health reform. Opposition to reform also dropped significantly among seniors, according to an AP poll.
