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.
Health Care Reform I Community Mental Health I Medicaid I Mental Health Block Grant I Primary Care - Behavioral Health Collaboration I Substance Abuse Prevention & Treatment Block Grant I Health Information Technology I Social Security Disability I Expansion of Education & Prevention Practices I Parity I
Health Care Reform
In November, the House voted to approve its version of healthcare reform, the Affordable Health Care for America Act (H.R. 3962). The Senate is currently debating its reform legislation, the Patient Protection and Affordable Care Act (H.R. 3590). If the Senate votes to pass its legislation, the two versions of healthcare reform must be reconciled into one bill that must be voted on by both chambers of Congress. Through this process, the National Council is taking every opportunity to advocate for community mental health and addiction services and to keep you informed of opportunities to get involved.
Visit the National Council's health care reform page to get the latest information on health care reform and find out how you can get involved.
Community Mental Health Services
- The Community Mental Health Services Improvement Act (S 1188/ HR 1011)
The Community Mental Health Services Improvement Act was introduced in the Senate (S 1188) on June 4, 2009 by Senator Jack Reed (D-RI) and co-sponsored by Senators Lisa Murkowski (R-AK) and Sheldon Whitehouse (D-RI). This bill was also introduced in the House (HR 1011) by Representatives Gene Green (D-TX) and Tim Murphy (R-PA) on February 12, 2009.
S 1188/HR 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 Community Mental Health Services Improvement Act was added to the Senate Health, Education, Labor and Pensions Committee's healthcare reform legislation, Affordable Health Choices Act, by an amendment. The amendment was introduced by Sen. Reed and was passed 14-9.
The provisions of the CMHSI Act relating to co-location grants have been included in the version of healthcare reform legislation currently being debated by the full Senate.
The National Council has created a fact sheet on the CMHSI Act and stay tuned to the Public Policy Update for the latest information.
Medicaid
- The Mental Illness Chronic Care Improvement Act of 2009 (S. 1136/ HR 3065)
The Mental Illness Chronic Care Improvement Act of 2009 was introduced on May 21 by Senator Debbie Stabenow in the Senate and on June 26 by Rep. Janice D. 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/ HR3065.
- Medicaid Regulations
The National Council is pleased that the Department of Health and Human Services (HHS) has rescinded several harmful Medicaid regulations including: rehabilitation, parts of targeted case management, outpatient hospital and clinic services upper payment limit, and school-based services.
Please note: The definition of case management and allowable case management activities are the same as they have been since 2001. Case management includes only: assessment, development of a specific care plan, referral and related activities and monitoring and follow up activities.
On June 9, 2009, Senator Debbie Stabenow (D-MI) introduced the Medicaid Services Restoration Act (S 1217) 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. The National Council has supported Senator Stabenow’s efforts since 2008; most recently, the National Council submitted a letter of support for S 1217.
Mental Health Block Grant
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.
Senator Debbie Stabenow is leading an effort in the Senate to increase funding for the Mental Health Services Block Grant by at least $100 million in FY2010. The Senator recently circulated a Dear Colleague Letter, asking for signatures in support of a $100 million increase to the MHBG. Thanks to the Senator's efforts and the advocacy of the National Council and its membership, 18 Senators signed onto this letter.
At the end of March, the National Council, along with Senator Stabenow, hosted a Senate briefing on the needs of the public mental health system. The National Council has also prepared a fact sheet on the MHBG.
The House approved Labor-HHS-Education appropriations bill (HR 3293) does not allocated any additional funds for the Mental Health Block Grant for FY10. HR 3293 has to be considered by the Senate.
Stay tuned to the Public Policy Update for the latest news.
Primary Care - Behavioral Health Collaboration
In part due to the assertive advocacy of the National Council, the FY10 Labor-HHS-Education budget bill approved by the House Appropriation Committee, 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.
Click here for a fact sheet on this grant program.
The National Council 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.
Substance Abuse Prevention & Treatment Block Grant
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.
The House approved Labor-HHS-Education appropriations bill (HR 3293) does not allocated any additional funds for the SAPTBG for FY10. HR 3293 still has to be considered by the Senate.
Click here for a fact sheet on the SAPTBG and click here to take action now in support of the SAPTBG.
Health Information Technology
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.
Due to the National Council and other advocacy organizations' efforts, community behavioral health organizations are explicitly included as eligible entities within the state grants provisions; however, CBHOs are not explicitly included in the Medicaid/Medicare incentive provisions.
On May 4, the National Council and other advocates submitted a letter to Chairman Baucus, of the Senate Finance Committee, urging him to include psychiatric hospitals, community mental health centers (CMHCs) and other behavioral health organizations in any HIT programs.
On July 28, the National Council hosted a webinar on the HIT provisions of the ARRA. For more information on what HIT funding your organization maybe eligible for view the presentation and recording from the webinar.
The National Council has created a fact sheet on the HIT provisions of the American Recovery & Reinvestment Act and a fact sheet on inclusion of community behavioral health providers in federal HIT initiatives.
Stay tuned to the Economic Recovery Page to get the latest updates.
Social Security Disability
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 yes, mental illness. If we accept addiction as a chronic illness, then we must advocate that people with addiction disorders be eligible for disability support.
Expansion of Education & Prevention Practices
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.
Parity
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 April, the Administration released the Request For Information (RFI)regarding comments on the Mental Health Parity and Addiction Equity Act of 2008. The National Council convened a Parity Work Group and submitted comments in response to the RFI. These comments may be used as the basis for future advocacy regarding implementation of the regulations.
Since submitting comments, the National Council and other advocates have been encouraging the Departments of Labor, Health and Human Services and Treasury to issue regulations. To that end, two sign on letters have been submitted on behalf of 72 Representatives and 26 Senators, requesting the issuance of regulations in a timely manner. In reponse, the Agencies have stated they will issue the regulations by Jan. 2010.
- House Sign On Letter
- Senate Sign On Letter
To keep up to date on the National Council's parity efforts, visit the parity webpage.
