Public Policy Update: February 25, 2010
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February 25, 2010
This week, the Obama Administration released the details of its compromise healthcare reform proposal. The proposal is intended to bridge the gap between earlier House and Senate versions of healthcare reform; it will be presented as the starting point for discussion at the bipartisan healthcare reform summit that takes place today in Washington. You can watch the summit live online at: http://www.whitehouse.gov/live
Although the President’s proposal is designed to build off the Senate-passed bill and does not directly deal with all elements of a comprehensive healthcare reform package, provisions of interest include:
- Improved cost sharing assistance for low-income families relative to the Senate bill (p. 2)
- Closure of the Medicare Prescription Drug “Donut Hole” (p. 2-3)
- Strengthening the CLASS Act relative to the Senate bill (p. 10)
- Strengthening federal and state oversight of insurance premium increases (p. 3)
Liberal and moderate Democrats in Congress have expressed cautious support for the President’s proposal. Although legislators are waiting to see the outcome of the Feb. 25th summit before committing to a path forward on health reform, there appears to be growing support among Democrats for the use of a legislative procedure known as reconciliation to pass the bill if bipartisan support does not materialize. Under reconciliation, the healthcare bill would need only a majority vote in the Senate to pass, instead of the usual 60 votes needed to forestall a filibuster. The Alliance for Health Reform has created a useful document explaining in more detail how the reconciliation process works.
The National Council would like to thank our members who signed on to our letter to the President in support of moving forward on healthcare reform, which was submitted to the Administration earlier this week. Thank you for your strong show of support and stay tuned to the Public Policy Update and Action Alerts to find out how you can stay involved!
National Council, NASMHPD Hold Congressional Briefing on the Impact of the Financial Crisis on the Public Mental Health Safety Net
A panel of mental health experts spoke at a Congressional staff briefing in Washington, D.C. to urge the federal government to assist states that are facing deep cuts to their public mental health safety net systems. The briefing, hosted by Congresswoman Grace Napolitano (D-CA), was organized by the National Association of State Mental Health Program Directors (NASMHPD) and the National Council.
The briefing speakers included John Easterday, Administrator of the Wisconsin Division of Mental Health and Substance Abuse Services in Madison, WI; Richard Leclerc, President and CEO of Gateway Healthcare, Inc., in Pawtucket, RI; Dr. David Shern, Executive Director, Mental Health America, in Alexandria, VA; and Kevin Sullivan, former Lieutenant Governor of Connecticut.
Easterday, Leclerc, Shern, and Sullivan spoke about the impact of state budget cuts on mental health services. A recent survey by NASMHPD found that states have been forced to cut mental health agency budgets by a combined total of $1.6 billion over the last three fiscal years. The speakers concluded that federal assistance is urgently needed to serve an increasing number of some of the nation’s most vulnerable citizens, and requested federal assistance to:
- Extend the current higher federal match for Medicaid in the American Recovery and Reinvestment Act (ARRA).
- Provide a $100 million increase in funding for the Mental Health Block Grant, the only federal program available to help public mental health agencies recover state and county service dollars lost during the current fiscal crisis.
- Reject proposed reductions in HUD Section 811 funds for supportive housing.
The Senate on Wednesday voted 70-28 to approve its jobs creation bill. 13 Republicans joined 57 Democrats in voting for the bill, which will now be sent to the House. Although the final bill did not include an extension of the increase in the Federal Medical Assistance Percentage (FMAP), Senate Majority Leader Harry Reid (NV) has announced that the Senate will almost immediately begin work on a new fiscal relief/jobs package, which will include the six-month FMAP extension.
This extension is needed more than ever as states work their way through crafting their budgets for the coming fiscal year. With continued high unemployment causing increased Medicaid enrollment, many states are facing the likelihood of major spending cuts to Medicaid, and several have already announced cutbacks. 47 Governors have signed a letter to Congress urging them to enact the FMAP extension, and 44 Senators have signed on to a Dear Colleague letter expressing their support for the extension. If you have not already contacted your Senators in support of extending the FMAP increase, please visit our Action Center and write them an email today! The outpouring of public support for the FMAP extension has been a driving factor in building support for the extension among lawmakers; keep up the pressure on Congress to enact the extension!
As a result of the advocacy of National Council members and other advocates, Congress passed the Veterans Mental Health and Other Care Improvements Act in 2008. This statute directs the Secretary of Veterans Affairs to establish a pilot program to make mental health care more accessible to returning service members of the Iraq and Afghanistan wars by utilizing Community Behavioral Health Organizations. The legislation specified that the pilot program shall be carried out within areas selected by the Secretary for the purpose of the pilot program in at least three Veterans Integrated Service Networks (VISNs).
The VA has selected the following VISNs for participation:
- VISN 1: Maine, Vermont, New Hampshire, Massachusetts, Connecticut and Rhode Island
- VISN 19: Montana, Wyoming, Colorado, Utah (and parts of Kansas, Nebraska and Nevada)
- VISN 20: Washington, Oregon, Idaho, and Alaska
The VA has posted a “Pre-Solicitation” notice on its website that describes the following scope of services and expected release date:
“Contracted outpatient services will be provided at the contractor's facilities/locations. Services are expected to include peer outreach and peer support services to Veterans by Veterans, outpatient mental health services and readjustment counseling services (as described in Section 1712A of Title 38, United States Code), and mental health day treatment services. The electronic solicitation is expected to be released on February 26, 2010. The procurement is being issued under full and open competition procedures. Single or multiple awards may result from this solicitation.”
You can access the “Pre-solicitation” notice on the FedBizOpps website. While there, you can sign up to be notified when the final solicitation is released.
On Feb. 18, Health and Human Services Secretary Kathleen Sebelius announced that HHS provide $4.3 billion in fiscal relief to states for providing prescription drug coverage to residents who are eligible for both Medicare and Medicaid. The Obama Administration will apply the enhanced Federal Medical Assistance Percentage (as included in the American Recovery and Reinvestment Act) to state “clawback payments.” This will reduce the amount of money states will pay the federal government to offset the cost of Medicare coverage for prescription drugs for dually-eligible state residents. The reduced payments will be applied for the period October 1, 2008 through December 31, 2010. A list of the reduced payments and savings for each state is included in the HHS announcement.
The University of Wisconsin Population Health Institute, in collaboration with the Robert Wood Johnson Foundation, has released the first-ever county-by-county ranking of population health. The report ranks all counties in each state on a variety of health indicators, including self-reported levels of health and mental health, infant birthweight, life expectancy, and premature death. It also analyzes several secondary factors that affect health, such as obesity, smoking, binge drinking, number of uninsured adults, homicide rates, high school graduation rates, unemployment rates, number of children living in poverty, and air pollution levels. The rankings are available online, along with a breakdown of the health indicators in each county, state-level analyses of the data, links to state health agency websites, and much more.
Earlier this month, the Centers for Medicare and Medicaid Services released a State Health Official Letter providing guidance to states on implementing the “express lane” eligibility options included in the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). The express lane eligibility procedures are designed to facilitate children’s enrollment in CHIP and Medicaid by using simplified eligibility determinations and automatically enrolling or renewing eligible children in certain cases. Under CHIPRA, states may use eligibility for other state assistance programs to refer potentially eligible individuals to the Medicaid and CHIP programs. Express lane agencies are limited to public agencies/programs such as TANF, food stamps, WIC, head start programs, and others. The full text of the State Health Official letter is available online.
The entire House and one-third of the Senate are up for re-election in 2010, and a recent spate of retirement announcements has added new uncertainty to the outcomes of the elections and the future of many federal MH/SUD policy issues. In this competitive political environment, there’s no better time to increase your political engagement. Join us for the National Council’s 6th Annual Public Policy Institute and Hill Day on June 29-30 and leverage your political influence by making your voice heard at this crucial time in the midterm election cycle. In addition to meeting with your state and federal elected officials, the 2010 Public Policy Institute and Hill Day will give you the opportunity to learn the most up-to-date information about the 2010 elections. The National Council has invited members of the Obama administration, key congressional staff, and political analysts to speak to you about the current political climate and help you align your message with anticipated political events in 2010. Stay tuned to the Hill Day page of our website for the latest information about speakers, presentations, and the schedule of events.
Registration for Hill Day is free and open to all members. Register today, and start setting up your June 30th appointments with your Senators, Representative, and the Washington branch of your Governor’s office!
