April 3, 2008

National Council Joins More than 60 Groups in Sending Letter in Support of Legislation to Delay Seven Medicaid Regulations for One Year; Contact Your Representative Today in Support of this Bill!

On April 1, the National Council joined more than 60 member organizations of the Consortium for Citizens with Disabilities (CCD) in sending a letter to Representatives John Dingell (D-MI) and Timothy Murphy (R-PA) in support of their legislation to delay seven recent Medicaid regulations proposed by the Bush Administration, including those affecting case management and the rehabilitative service option, for one year.

The Protecting the Medicaid Safety Net Act of 2008 (HR 5613) would delay implementation of the following regulations:

• Interim Final Rule on Case Management
• Proposed Rule on Clarification of Outpatient Clinic and Hospital Facility Services Definition and Upper Payment Limit
• A portion of the Proposed Rule on Provider Taxes
• Proposed Rule on Graduate Medical Education
• Final Rule on Public Provider Cost Limit Regulations

HR 5613 also extends the moratoria on the Rehabilitative Service Option and School-Based Services, which had been delayed by six months in December 2007.

“Moratoria will allow Congress, using its deliberative process to thoroughly examine the policy issues set forth in the regulations and determine what changes to the underlying Medicaid statute are needed,” said the groups in their letter. “We believe it vitally important for the Congress to affirm a simple principle: that the Medicaid program is a partnership involving the United States Congress, state governments, county and local governments and CMS. The federal government should not attempt to skirt the legislative process by imposing fiscal and policy decisions on its partners through administrative fiat.”

The National Council urges all members to contact their Representatives today to ask them to co-sponsor this important legislation.

Action Needed: Call your Representative and ask him or her to co-sponsor HR 5613. Click here to find your Representative and enter your zip code in the box marked “Find Your Officials.” To see if your Representative is among those who have already signed on as co-sponsors of HR 5613, click here.

What Should You Say?  Ask your Representative to become a co-sponsor of HR 5613. Let them know how recently proposed Medicaid regulations are affecting providers and people with mental illness and addiction disorders in your state.

Please let the National Council know if you contact your Representative in support of HR 5613 by contacting Allison Fort at AllisonF@thenationalcouncil.org so that we may track support for the bill.

National Council Submits Testimony to House Appropriations Subcommittee in Support of Increased Mental Illness and Addictions Funding in FY 2009 Budget

This week, the National Council submitted public testimony to the House Appropriations Labor, Health and Human Services (HHS), Education, and Related Agencies Subcommittee in support of increased funding for mental illness and addiction prevention, treatment, and research in the FY 2009 budget.

In its testimony, the National Council stressed the importance of investing in treatment for mental illness and addictions. Stressing that each year, millions of people need but do not receive treatment for mental illness and addiction disorders, the National Council encouraged the House Appropriations Labor, HHS, Education, and Related Agencies Subcommittee to support increased funding levels for a variety of programs, including:

• Substance Abuse Prevention and Treatment Block Grant (SAPTBG): $1,858.7 million
• Center for Substance Abuse Prevention (CSAP) Programs of Regional and National Significance: $215.06 million
• Center for Substance Abuse Treatment (CSAT) Programs of Regional and National Significance: $420.0 million
• CMHS, Community Mental Health Services Block Grant: $482.9 million
• CMHS, Projects for Assistance in Transition from Homelessness (PATH): $61.1 million
• CMHS, Programs of Regional and National Significance (PRNS): $343.3 million
• SAMHSA Integrated Treatment for Co-occurring Serious Mental Illnesses and Substance Abuse Disorders: $4.14 million  
• CMHS Jail Diversion Program Grants: $7.80 million
• Department of Education, State Grants portion of the Safe and Drug Free Schools and Communities (SDFSC) program: $346.5 million
• NIH, National Institute on Drug Abuse (NIDA): $1,067.7 million
• NIH, National Institute on Alcohol Abuse and Alcoholism (NIAAA): $465.5m
• NIH, National Institute on Mental Health: $1,498.6 million

Hospital Groups File Suit Against CMS to Prevent Implementation of Rule to Limit Medicaid Public Provider Payments

On March 11, 2008, a coalition of hospital groups filed a federal lawsuit to prevent implementation of a recent Medicaid regulation proposed by the Bush Administration that would limit Medicaid payments to public providers and reduce public hospital funding by $5 billion over 5 years.

The rule, issued in May 2007, would narrow the definition of a public provider and limits payments to those providers to the cost of treating Medicaid patients. A moratorium currently delays the implementation of this rule until May 25, 2008. Among those affected by this rule are National Council members in Michigan, Indiana, and Texas.

In their lawsuit, the Alameda County (CA) Medical Center, the National Association of Public Hospitals and Health Systems (NAPH), the American Hospital Association, and the Association of American Medical Colleges allege that the rule goes beyond the scope of the Centers for Medicare and Medicaid Services’ (CMS) regulatory power. The groups are asking the court to grant a preliminary injunction against the rule and to ultimately reject it.

The public provider rule is one of several recently released Medicaid rules that the National Council is working to stop. Look for updates on this and other Medicaid-related regulations in future editions of the Public Policy Update.

Make Your Plans for Hill Day 2008: Register and Make Your Hotel Reservations Now!

The National Council places top priority on helping you do your job as a leader in the field of community behavioral healthcare by supporting you with new communications tools, increased emphasis on involving you in ongoing liaison with national decision-makers, and policy and research support for your efforts. The National Council's Fourth Annual Hill Day, scheduled for Wednesday, June 18, 2008, presents a wonderful opportunity to take the first step towards engaging your members of Congress and taking a lead role in shaping federal public policy in 2008.

We need YOU to help us lead. Click here to RSVP now for Hill Day 2008!

If you’d like help registering yourself or your delegation, or if you have difficulty registering online, please contact Allison Fort at 301-984-6200, x235 or AllisonF@thenationalcouncil.org.

Visit the National Council’s Hill Day web page for the latest information on Hill Day, including:

• Information on the National Council’s new online appointment-making tool
• Tips on bringing a team to Hill Day
• Schedule of Hill Day events
  
  Don’t forget to make your hotel reservation for Hill Day soon – there are two ways to make a hotel reservation at the National Council’s room block for the rate of $279:
• Make your reservation at the Marriott Wardman Park Hotel online and enter NCCNCCA as the group code to receive the National Council rate, or
• Call 1-800-228-9290 or 202-328-2000 and ask for the "National Council Room Block" or “NCC”
  
  We look forward to seeing you in Washington in June!

New Medicaid Tamper-Resistant Prescription Pad Requirement Effective April 1, 2008; CMS Approves 72-Hour Emergency Fills of Prescriptions Submitted on Non-Compliant Forms

On April 1, 2008, a new policy requiring tamper-resistant prescription pads be used for all Medicaid prescriptions went into effect, requiring mental health and addiction treatment providers to make changes to their prescribing methods and supplies. Failure to comply with this requirement could result in the withholding of Medicaid reimbursements. This week, officials at the Centers for Medicare and Medicaid Services (CMS) announced that pharmacies will be permitted to provide 72-hour emergency fills of prescriptions presented on forms that do not meet this new requirement, provided that the prescribing physician gives his or her verbal or faxed permission.

The provision, part of the second FY 2007 emergency supplemental bill signed into law by President Bush on May 25, 2007, amends Section 1903(i) of the Social Security Act to include a new paragraph requiring all covered Medicaid outpatient prescriptions be written on tamper-resistant prescription pads. The provision applies to all prescriptions written after September 30, 2007.

On August 17, 2007, Dennis Smith, Director of the Center for Medicaid and State Operations issued a letter to State Medicaid Directors providing guidance on the new requirement. On September 29, 2007, President Bush signed legislation (HR 3668) to delay the implementation of the new tamper-resistant prescription pad requirement by six months, to April 1, 2008. This delay has given providers more time to meet the new requirements and states additional time to set standards and provide further guidance.

To be considered tamper resistant on April 1, 2008, prescription pads must contain at least ONE of the following characteristics:

1. One or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form;

2. One or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription by the prescriber; and

3. One of more industry-recognized features designed to prevent the use of counterfeit prescription forms.

By October 1, 2008, prescription pads must meet all THREE of these characteristics to be considered tamper-resistant.

Exceptions to the new requirement were also outlined in Smith’s letter. The tamper-resistant pad requirement does not apply to electronic prescriptions, prescriptions a sent directly to a pharmacy via fax or called in by a prescriber, or prescriptions paid for by a managed care entity.

States are free to exceed these baseline standards to make their own determination as to what constitutes an acceptable tamper-resistant prescription pad in their state. States are also encouraged to make their own determination whether to allow pharmacists to accept an out-of-State prescription that meets the tamper-resistant requirements of another State. States that do not enforce the tamper-resistant prescription pad requirement may lose Federal Medicaid funding. The National Council encourages all members to contact their State Medicaid agency for the most accurate and up to date information on the policies and standards that will be implemented in their state.

In February 2007, CMS provided two updates to its guidance on the tamper-resistant prescription pad requirement. In response to questions from several states, CMS clarified that providers cannot add features, such as embossed logos or using particular kinds of ink to write the prescription, to otherwise non-tamper resistant paper to make it compliant with the new requirements. CMS also clarified that during the period between April 1, 2008 and October 1, 2008, computer-generated prescriptions printed by a provider on plain paper, including electronic medical record computer-generated prescriptions, may meet CMS guidelines by containing one or more features to either prevent the erasure or modification of information on the prescription or to prevent the use of counterfeit prescription forms. However, CMS cautions that it does not believe that current prescription technology exists to allow computer-generated prescriptions printed on plain paper will be able to meet the first baseline requirement that prescription forms contain one or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form, meaning that beginning October 1, 2008, computer generated prescriptions printed on plain paper will not be able to meet all three baseline requirements outlined by CMS.

The National Council has worked to ensure that members are up to date on the latest guidance and requirements on the tamper-resistant prescription pad requirement. On December 11, 2007, the National Council hosted a National Council Live call on the topic to help members better understand the new requirements and how to comply with them. Speakers included Claudia Simonson, Senior Policy Analyst from CMS' Division of Field Operations/Medicaid Integrity Group, and Paul Kuczora and Helen Johnson from Grant-Blackford Mental Health, a National Council member agency in Indiana, a state that has already implemented some similar requirements. 

The National Council will continue to provide members with the most current information on this requirement.

Contact Your Representatives Today In Support of Legislation to Strengthen Community Behavioral Healthcare!

Executive Summary: On January 29, Representatives Gene Green (D-TX) and Timothy Murphy (R-PA) introduced the Community Mental Health Services Improvement Act (HR 5176) in the House. HR 5176 calls for the co-location of primary care services in community mental health settings and to support innovative programs for mental health workforce recruitment and retention. The National Council needs your help securing co-sponsors for the Community Mental Health Services Improvement Act in the House of Representatives – contact your Representative today in support of HR 5176!

Action Needed: The National Council urges all members to contact their Representative and ask them to sign on as a cosponsor of HR 5176.  To find your Representative and his or her fax number, go to: www.house.gov.  

A model letter, to be placed on your agency’s letterhead, is available online. There are two templates:

template for associations

template for individual agencies

The National Council urges you to contact your Representatives and to reach out to others in your communities and states to sign letters in support of HR 5176. People and organizations you may wish to contact include:

• State legislators
• Mayors
• State and local NAMI or MHA chapters
• Sheriffs and other law enforcement officials/organizations
• Chambers of Commerce and other business groups

Representatives Green and Murphy are currently circulating a Dear Colleague letter in the House, urging their fellow Representatives to cosponsor this important legislation. Offices interested in signing on as cosponsors should contact Abigail Pinkele in Representative Green’s office at 202-225-1688 or abigail.pinkele@mail.house.gov or Brendan Belair in Representative Murphy’s office at 202-225-2301 or brendan.belair@mail.house.gov.  

Please share your letters in support of HR 5176 with the National Council. Contact Allison Fort at AllisonF@thenationalcouncil.org to share copies of your letters with the National Council so that we may track support for the bill.

Background:

The Community Mental Health Services Improvement Act would amend the Public Health Service Act to include provisions to co-locate primary care and specialty medical care in community-based mental health and addiction treatment organizations. In addition, the bill includes training and loan assistance programs designed to address the recruitment and retention of qualified behavioral healthcare workers, particularly in health professional shortage areas.

Passage of this legislation will allow mental health providers to recruit qualified primary care professionals to provide essential health services to patients with serious mental illness. This is a critical need, given that we now know that patients with mental illness die on average 25 years earlier than the general population, largely due to chronic and unattended medical conditions.

HR 5176 also provides for innovative programs to address behavioral health workforce needs in designated mental health professional shortage areas. The act calls for loan forgiveness and repayment as well as expanded education and training to support the recruitment and retention of qualified mental health workers, especially for racial and ethnic minorities.

Specific provisions of HR 5176 include:

• Creating a new federal grants program to support co-locating primary care/chronic care services at community mental health facilities funded at $50 million in FY 2009 and authorized through FY 2013.
• Integrating treatment for mental health and substance abuse co-occurring disorders funded at $14 million in FY 2009, $20 million in FY 2010 and authorized through FY 2013.
• Improving the mental health workforce through grants for the recruitment and retention of mental health professionals funded at $10 million in FY 2009 and authorized through FY 2013.
• Enhancing behavioral and mental health education and training program through a new grants program to establish or expand accredited programs funded at $4 million in FY 2009 and authorized through FY 2013.
• Establishing a new $20 million federal grants program to finance infrastructure costs for telecommunications technology supporting tele-psychiatry and patient education at community mental health facilities located in rural and other medically underserved areas.
• Requiring the Secretaries of the HHS and DVA collaborate with the Office of the National Coordinator of Health Information Technology and SAMHSA to develop and implement a plan for ensuring that various components of the National Health Information Infrastructure address mental health and substance abuse provider needs supported by $10 million in funding in FY 2009.
• Commissioning the Institute of Medicine to complete and submit to Congress a paperwork reduction study to be completed no later than a year after enactment that evaluates the combined paperwork burden of qualified community mental health programs funded at $550,000.
• Directing a nationwide analysis and submission of a report to Congress of the compensation structure of professional and paraprofessional mental health personnel as compared with that of other health safety net and private sector employers also funded at $550,000.

Full Text of HR 5176

On October 17, Senators Gordon Smith (R-OR) and Jack Reed (D-RI) introduced the Community Mental Health Services Improvement Act (S. 2182) in the Senate.

For more information on the Community Mental Health Services Improvement Act, including fact sheets, model letters, and a list of supporting organizations, visit the National Council’s website.

Recently Released Resources from the National Council

The National Council’s website is frequently updated with issue briefs, letters, and other materials of interest to members. Please take notice of these recent updates:
 
On March 18, the National Council hosted a Congressional briefing for Senate staff highlighting mental health data from Arkansas and Colorado. Entitled “Arkansas and Colorado Community Mental Health Systems: Helping People in Need,” the briefing provided Congressional staff with a unique opportunity to see some of the most highly detailed public mental health care data available anywhere in the country.

Panelists included: Linda Rosenberg, President & CEO, National Council for Community Behavioral Healthcare; Kenny Whitlock, Executive Director, Mental Health Council of Arkansas; John Althoff, Deputy Director, Division of Behavioral Health Services, State of Arkansas Department of Human Services; George DelGrosso, Executive Director, Colorado Behavioral Healthcare Council; and David Lloyd, President, MTM Services, LLC.

Congress recently passed an economic stimulus package that includes payments between $300 and $600 for individuals and $600 to $1200 for joint filers. Many low-income people who are not required to file income tax returns may find that it makes sense to file this year in order to receive the stimulus payment. On March 12, the National Council released an Issue Brief on Federal Economic Stimulus Payments with information on who qualifies for these payments and where to find tax help and additional information.

On February 27, Chris Copeland, Executive Director of Tri-County Mental Health Services in Lewiston, ME, testified at two briefings for House Senate staff to examine the potential impact of the Centers for Medicare and Medicaid Services’ (CMS) proposed rule on case management.  Copeland shared examples of case management services offered by community behavioral healthcare providers and concerns about the impact the proposed regulations may have on both providers and the people they serve.

On February 15, the National Council released the first edition of Addiction News Now. This monthly publication will keep you up to date on federal addiction policies, ground breaking research, and issues and events that are making headlines across the country. The National Council is committed to strengthening and expanding addiction prevention, treatment, and recovery services nationwide and providing the information necessary to effect change on the local, state, and federal level. 

In partnership with over 40 national organizations, the National Council has formed the Whole Health Campaign and issued a call to the candidates to support wellness of mind and body for a healthier America. You can learn more about the Whole Health Campaign at www.wholehealthcampaign.org, where you can also comment on the blog entries, order copies of the WHC brochure, and sign up to become an endorsing organization. We encourage your organizations to endorse the work and the principles of the Whole Health Campaign. Together, we can have an impact.

On January 8, the National Council hosted a National Council Live webinar entitled, “The Role of State Policies in the Adoption of Naltrexone for Substance Abuse Treatment.”  Carolyn Heinrich from the University of Wisconsin-Madison presented on a recent study she co-authored with Carolyn Hill from Georgetown University that examined the state policies that affect treatment facilities' adoption of naltrexone, a pharmacotherapy for alcoholism treatment.  The webinar included an overview of their research and findings and a discussion about the state level practices and policies that play a role in treatment decisions that impact utilization of clinically proven cost-effective treatments for alcoholism.  

The Public Policy Update is a weekly e-newsletter published by the National Council for Community Behavioral Healthcare. Managing Editor - Allison Fort.  Vice President, Public Policy - Chuck Ingoglia. Director of State Policy - Tammy Seltzer. Director of Public Policy – Alexa Eggleston.