Policy Issues & Resources: Our Legislative Initiatives
The National Council promotes a provider-focused public policy and legislative agenda that urges government leaders to improve and strengthen mental health and addictions treatment by acting to promote access to high-quality, cost-effective community-based treatment and supports.
Healthcare Reform I Federally Qualified Behavioral Health Centers I Health Information Technology I Mental Health Block Grant I Substance Abuse Prevention & Treatment Block Grant | Community Mental Health I Medicaid I Primary Care - Behavioral Health Collaboration I Social Security Disability I Expansion of Education & Prevention Practices I Parity I
In March 2010, President Obama signed into law two pieces of legislation that together comprise a large-scale reform of the American healthcare system: The Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act (P.L. 111-152). Healthcare reform has now entered the regulatory phase: over the coming years, the Department of Health and Human services and the Centers for Medicare and Medicaid Services will be issuing instructions to states, providers, insurers, and other stakeholders on how they should implement the provisions of the new law.Throughout this process, the National Council will be taking every opportunity to advocate for community mental health and addictions services and to keep you informed of opportunities to get involved.
Visit the National Council's healthcare reform blog to find comprehensive resources on the contents of the new law, get the latest information on healthcare reform implementation, and find out how you can get involved.
In order to address the increased demand for community mental health and addictions services as a result of the major coverage expansions included in healthcare reform, the National Council is supporting the creation of a new statutory definition for Federally Qualified Behavioral Health Centers (FQBHC). Such a definition would establish federal status for community-based mental health and addiction providers that volunteer to meet the standards for an FQBHC and would provide clearly defined treatment objectives and the minimum core services required.
A provision creating a definition for FQBHCs was included in the House version of healthcare reform; however, it was not included in the final version of reform enacted in March 2010. A stand-alone bill that would both establish the FQBHC definition and provide for cost-based reimbursement for FQBHCs was introduced in the House by Reps. Doris Matsui and Eliot Engel (HR 5636). The National Council is now working on the introduction of companion legislation in the Senate. Click here to read our fact sheet on FQBHCs.
The American Recovery & Reinvestment Act, signed into law on February 16, 2009, contains provisions which create various financial incentives for health care providers to support the adoption and sustained utilization of health information technology (HIT). These financial incentives are comprised of Medicare/Medicaid payments for HIT adoption and usage, and grants to states and provider agencies.
In April 2010, Reps. Patrick Kennedy (D-RI), Tim Murphy (R-PA), Gene Green (D-TX), and Alcee Hastings introduced the Health Information Technology Extension for Behavioral Health Services Act of 2010 (HR 5040). Companion legislation (S 3709) was introduced in the Senate in August 2010 by Sens. Sheldon Whitehouse (D-RI), Sherrod Brown (D-OH), Al Franken (D-MN), Frank Lautenberg (D-NJ), Jeanne Shaheen (D-NH), and Debbie Stabenow (D-MI). This legislation would ensure that behavioral and mental health professionals, psychiatric hospitals, behavioral and mental health treatment facilities, and substance abuse treatment facilities will be eligible for the ARRA incentive payments. By expanding HIT incentive payments to behavioral health providers, this legislation will provide crucial support for community behavioral health organizations as they seek to implement electronic health records.
The National Council worked closely with bill authors Kennedy and Whitehouse on the introduction of this legislation. Click here to read our fact sheet on this issue. If you have not done so already, please contact your Representative and Senators today, and urge them to sign on as a cosponsor to the HIT Extension for Behavioral Health Services Act!
Please visit the Health Information Technology page of our website for more information and resources on the HIT Extension for Behavioral Health Services Act, the "Meaningful Use" incentives included in ARRA, and more.
The Mental Health Services Block Grant (MHBG) has lost 50% of its purchasing power since 1983. In fact, the program has not received any additional federal funds in almost a decade and the severe economic crisis unfolding around the nation is imposing an unprecedented strain on the public mental health safety net. Due to this, the National Council strongly supports a $100 million increase in funding to the MHBG. This requested increase would bring its total funding to $520.7 million.
In March 2010, the National Council and the National Association of State Mental Health Program Directors co-hosted a congressional briefing on the impact of the financial crisis on the public mental health safety net. A panel of mental health experts urged the federal government to assist states that are facing deep cuts to their public mental health safety net systems by approving a $100 million increase to the MHBG and extending the federal Medicaid assistance originally enacted under the economic recovery act. In March 2009, the National Council, along with Senator Stabenow, hosted a similar Senate briefing on the needs of the public mental health system. The National Council has also prepared a fact sheet on the MHBG and Substance Abuse Prevention & Treatment Block Grant.
Additional information is available on the Federal Budget page of our website.
Administered by SAMHSA, the Substance Abuse Prevention & Treatment Block Grant (SAPTBG) is the foundation of the publicly supported prevention and treatment system in this country. In 2002, nearly 2 million people were served by SAPTBG formula funding. Increasing funding for the SAPTBG is critical to support and expand drug addiction prevention and treatment services and to close the 80% nationwide treatment service gap. For this reason, the National Council supports a $210 million increase to the SAPTBG.
- Community-based Mental Health Infrastructure Improvement Act
The Community-based Mental Health Infrastructure Improvement Act was originally introduced in the 110th Congress by Sen. Gordon Smith (R-OR) and Rep. Patrick Kennedy (D-RI). This legislation would provided much-needed funding to finance the construction or modernization of facilities to provide mental and behavioral health services. It would also provide for the construction and structural modification of facilities to permit the integrated delivery of behavioral health and primary care of specialty medical services to individuals with co-occurring mental illnesses and chronic medical or surgical diseases at a single service site.The bill has not yet been re-introduced in the current session of Congress, but the National Council is continuing to push for re-introduction.
- The Community Mental Health Services Improvement Act (S. 1188/ H.R. 1011)
The Community Mental Health Services Improvement Act was introduced in the Senate (S. 1188) by Senators Jack Reed (D-RI), Lisa Murkowski (R-AK), and Sheldon Whitehouse (D-RI). A companion bill has been introduced in the House (H.R. 1011) by Representatives Gene Green (D-TX) and Tim Murphy (R-PA).
S. 1188/H.R. 1011 would amend the Public Health Service Act to require the Health and Human Services (HHS) Secretary to award grants for the co-location of primary and specialty medical care in community-based mental and behavioral health settings, create discretionary grant programs for the integrated treatment of persons with co-occurring mental and addiction disorders, create new programs to address behavioral and mental health workforce needs in professional shortage areas, and tele-mental health in medically underserved areas.
The provisions of the CMHSI Act relating to co-location grants were included in the recently enacted healthcare reform law. The National Council continues to support the enactment of the remaining provisions of the CMHSI Act. The National Council has created a fact sheet on the CMHSI Act. Stay tuned to the Public Policy Update for the latest information.
- The Mental Illness Chronic Care Improvement Act of 2009 (S. 1136/ HR 3065)
The Mental Illness Chronic Care Improvement Act of 2009 was introduced by Senator Debbie Stabenow in the Senate and by Rep. Janice Schakowsky in the House. The legislation would authorize a new $250 million, four-year, Medicaid demonstration program in up to ten States to improve the health outcomes and satisfaction of individuals with chronic mental illness, "such as schizophrenia, schizoaffective disorder, bipolar disorder, major clinical depression, or such conditions with co-occurring substance abuse disorders". States also have the option to expand their demo to other populations with mental illness or substance use disorders. Providers such as Community Behavioral Health Organizations would serve as the care coordination and managing entity. The National Council has created a fact sheet on S. 1136/ H.R.3065.
The essential components of the MICCI Act were included in healthcare reform in a new demonstration program to promote coordinated care for chronically ill patients in Medicaid. The demonstration program specifically includes patients with chronic mental illnesses as a population eligible for participation.
- Medicaid Services Restoration Act (S. 1217/H.R. 4787)
Senator Debbie Stabenow (D-MI) and Rep. Tammy Baldwin have introduced the Medicaid Services Restoration Act, which clarifies and protects vital Medicaid services for vulnerable populations. The legislation also provides a transparent funding stream for therapeutic foster care and the evidence-informed and highly effective placement for children and youth with serious medical, psychological, emotional and social needs.
In part due to the assertive advocacy of the National Council, the FY10 budget includes a $14 million grant program to support the collaboration of primary and behavioral health services. This is double the allocation of FY09. The Primary and Behavioral Health Care Integration (PBHCI) program is aimed at improving the physical health status of people with serious mental illnesses (SMI) by supporting communities' efforts to coordinate and integrate primary care services into publicly funded community mental health and other community-based behavioral health settings.
For the FY2011 budget, President Obama requested level funding for the integration grants ($14 million). The National Council is advocating an additional $8 million increase in the grant program, bringing the total funding to $22 million. Click here for a fact sheet on this grant program.
The National Council has created a Resource Center for Primary Care and Behavioral Health Collaboration, which builds on more than six years of work in this area and serves as a valuable source for information and practical resources.
Addiction has come a long way from the days when it was perceived as merely a failure of will. Today, there is growing public awareness and acceptance of addiction as a chronic, relapsing condition that requires continual monitoring and management, as do other chronic illnesses like diabetes, asthma, and hypertension, and mental illness. However, in current practice, individuals with substance use disorders are often found ineligible to receive Supplemental Security Income benefits, even if they also suffer from a co-morbid condition (such as physical disability or mental illness) that would normally make them eligible for these benefits. In response to a request for comments issued by the Social Security Administration (SSA) this year, the National Council and the National Alliance on Mental Illness (NAMI) have submitted suggestions on federal policies related to substance use disorders and disability determinations. Our comments provide information and recommendations on the critical need among people disabled by mental illnesses, especially those with co-occurring disorders, for SSI income and insurance, and how SSA should evaluate the claims of people who have a combination of DAA and at least one other mental impairment.
There are mental health and addiction prevention and education programs that work. These include research-based prevention initiatives that reduce the risk of childhood serious emotional disturbance by treating maternal depression, the Nurse-Family Partnership Program that has an array of consistent positive effects across multiple trials, and Mental Health First Aid — an evidence-based mental health literacy program. Now we must adequately fund and support the spread of these interventions to communities across the country.
- Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008
On October 3, 2008, the Wellstone and Domenici Mental Health Parity and Addiction Equity Act was signed into law, significantly expanding upon the mental health protections of the 1996 mental health parity law. The National Council has created a fact sheet as well as a powerpoint presentation explaining the parity law.
In January 2010, the Departments of Health and Human Services, Labor, and Treasury issued an interim final rule (IFR) providing guidance on how the provisions of the Wellstone-Domenici law must be implemented. In conjunction with the Parity Implementation Coalition, the National Council enlisted the law firm Patton Boggs to write a comprehensive legal analysis on the requirements of the IFR. The Parity Implementation Coalition has also submitted official comments to the Departments in response to the IFR. Visit the Parity page of our website for additional resources, including a fact sheet on the components of the IFR, a link to provide us with feedback about the implementation of the law, and more.