Public Policy Update: February 4, 2010
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February 4, 2010
On Jan. 29th, the Departments of Health and Human Services, Labor, and Treasury released an interim final rule (IFR) providing guidance on how the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act must be implemented. The IFR is available online at http://edocket.access.gpo.gov/2010/pdf/2010-2167.pdf
Following is a brief summary of the provisions of major interest to mental health and substance use disorder providers.
- Effective Date: This IFR goes into effect on Apr. 5 and applies to insurance plan years starting on July 1 or later.
- Plans that Must Comply with the IFR: The IFR applies to group insurance plans of more than 50 people. Although the Wellstone-Domenici law also applies to Medicaid managed care plans, these plans are NOT included in the IFR. Additional guidance on how parity will apply to Medicaid managed care will be released by the Department of Health and Human Services in the future.
- Scope of Service: The IFR divides benefits into six classifications: Inpatient, in-network; Inpatient, out-of-network; Outpatient, in-network; Outpatient, out-of-network; Emergency Care; and Prescription Drugs. Within each classification, if a plan provides MH/SU benefits, those benefits must be provided at parity with the medical/surgical benefits provided in that classification.
- Medical Management: The IFR distinguishes between two types of limits on services: “quantitative limits” (for example, limits on dollar amounts or number of sessions), and “non-quantitative limits.” The IFR expressly prohibits plans from making use of the following non-quantitative limits, unless similar restrictions exist for medical/surgical benefits: medical management, prescription formulary design, “fail-first” or step therapies, and prior authorization.
- Cumulative Financial Requirements: The IFR prohibits plans from instituting separate deductibles, copayments, and out-of-pocket limits for MH/SU and medical/surgical benefits. Any deductibles, copayments, and out-of-pocket limits required by the plan must be integrated and cumulative for all services.
- Exemptions: The statute allows for health insurance plans to be granted a 1-year exemption from the parity requirements if they experience total increased costs of 2% in the first year after implementation and 1% in subsequent years. The criteria for this exemption are not included in this IFR. They will be released in the future.
- Enforcement: The Centers for Medicare and Medicaid Services has established a helpline for reports of violations of the parity law. The phone number is 877-267-2323, x61565. We encourage members to inform us of suspected violations of the law as well. Please email Chuck Ingoglia at chucki@thenationalcouncil.org.
- Comments: Public comments on the IFR will be accepted through May 3, 2010. Instructions for how to comment are included in the official notice, published in the Federal Register on Tues, Feb. 2. The National Council will be working with the Parity Implementation Coalition to create model comments for our members to use as a resource. We encourage you to send us any comments that you have. Please email Chuck Ingoglia.
- Additional Information: Click here to access the National Council’s fact sheet on the Wellstone-Domenici Mental Health Parity and Addiction Equity Act. Additional information about the IFR can be found in the slides and recording from our latest healthcare reform update webinar. Also see this IFR fact sheet by the Departments of Health and Human Services, Labor, and Treasury.
On Feb. 1, President Obama released his budget requests for fiscal year 2011. Of major interest to behavioral health providers, the proposed budget includes a 6-month extension of the FMAP increase that was originally enacted under the American Recovery and Reinvestment Act. Other major provisions include:
- Mental Health Block Grant: $421 million, level to FY 2010
- Substance Abuse Prevention and Treatment Block Grant: $1.799 billion, level to FY 2010
- Center for Mental Health Services, Programs of National and Regional Significance: $374 million, a $13 million increase over FY 2010
- Center for Substance Abuse Treatment (CSAT), Programs of National and Regional Significance: $487 million, a 34 million increase over FY 2010
- Primary and Behavioral Healthcare Integration: $14 million, level to FY 2010
- Children’s Mental Health Services: $126 million, a $5 million increase over FY 2010
- Treatment Drug Courts (CSAT program): $56 million, a $12 million increase over FY 2010
- Ex-offender Reentry (CSAT program): $23 million, a $5 million increase over FY 2010
- Indian Health Services: $23 million for substance abuse prevention services
The National Council has updated our budget comparison chart to include the President’s FY 11 numbers. Now that the proposed budget has been released, Congress will begin holding hearings on the proposals and amending the budget, a process that will take many months before a final budget will be approved. Stay tuned to the Public Policy Update for future news about budgeting and the appropriations process.
As the President and the Congress continue to strategize on how to move forward on healthcare reform, it is vital that the President hears support for reform from community providers. We are so close to passing a comprehensive healthcare reform bill out of Congress. The President needs to know that we are grateful for the leadership he has shown thus far, and we want reform NOW!
Many people have become disheartened after all the hard work and advocacy we put in over the last year, but the window of opportunity is still open on reform if we show vocal support!
The National Council has created a sign on letter to President Obama which urges him to continue to push for a comprehensive bill that makes much-needed reforms to better ensure access to high-quality, cost-effective care for all Americans, including individuals with mental illness and addictions.
SIGN ON to this letter by COB on Monday, February 8th!
Congress would have to offset future tax cuts and mandatory spending under a restoration of the “pay-as-you-go” (PAYGO) rule that is expected to be approved this week. This measure is intended to rein in federal spending by requiring that Congress find ways to fully pay for any increases in spending or new programs. However, this measure contains a five-year exemption from the offset requirements for the annual “fix” Congress uses to prevent Medicare payment cuts to doctors and a two-year exemption for the Alternative Minimum Tax patch that keeps millions of middle-class families from paying higher tax rates. The Senate passed the measure on Jan. 28, and the House is expected to approve the bill today. It will then be sent to President Obama for his signature.
SAMHSA and the Administration on Children and Families (ACF) have issued a notification with information on how states may use Temporary Assistance for Needy Families (TANF) emergency funds to assist families needing short-term mental health and substance use treatment. According to the notification, TANF funds may be used to develop short-term assistance programs for a wide range of services, including mental health and substance use disorder services for struggling families. Additional information is available from SAMHSA and from the Office of Family Assistance at the Welfare Peer TA network.
The Coordinating Council on Juvenile Justice and Delinquency Prevention (CCJJDP), which works to improve the coordination of federally funded youth programs, has announced its workplan and priority issues for 2010. The four issues CCJJDP plans to focus on in 2010 are:
- Juvenile reentry
- Education and at-risk youth
- Tribal youth and juvenile justice
- Racial/ethnic disparities in the juvenile justice system and related systems
Work on each of the issues will be led by issue teams that will analyze policies, legislation, budgets, regulations, and practices to identify those that are most effective in promoting collaboration between federal, state, and local partners. The teams will incorporate these findings into recommendations for improvement in each issue area, which will be issued to Congress in CCJJDP’s next annual report.
Register Today for the National Council’s 6th Annual Public Policy Institute and Hill Day, June 29-30th 2010
Recent policy developments in healthcare reform, mental health parity, and the federal budget will have many repercussions for behavioral health providers. There’s no better time to increase your political engagement and make your voice heard on Capitol Hill! The National Council's 6th Annual Public Policy Institute and Hill Day will be held on June 29-30, 2010 at the Hyatt Regency hotel in Washington, D.C. Registration for Hill Day is free and now open. Check out our new Hill Day 2010 website for helpful resources on what to expect from Hill Day, how to plan visits with your elected officials, how to successfully communicate your priorities to your Members of Congress, and much more! If you have questions about Hill Day, please contact Rebecca Farley at rebeccaf@thenationalcouncil.org or 202-684-7457 ext. 235.
The National Council is pleased to seek applications for a Senior Policy Analyst. This position, in collaboration with the Vice President of Public Policy, identifies policy trends and regulatory issues for further research, analysis, and product development. The Senior Policy Analyst contributes to defining departmental issue priorities and staff resource allocation and also provides leadership, coordination and administrative responsibility for the development, planning, and management of projects, programs and contracts in the areas of Performance Improvement, Leadership Development, and Workforce Initiatives. The Senior Policy Analyst performs tasks in conjunction with Policy, Communication, and Conference staff in an efficient manner with minimal supervision and works with staff to develop proposals, reports, papers, conference programs, and policy statements, as requested. Additionally, the Senior Policy Analyst serves as staff contact for members and individual participants of practice improvement projects.
Minimum Qualifications and Experience: Master’s degree preferred. A minimum of five years of professional work experience is preferred. Expected to have working knowledge of issues pertaining to mental health financing and service delivery. An ability to work cooperatively with diverse groups and individuals, attention to detail, demonstrated writing and verbal communication skills, a professional demeanor and ability to handle multiple tasks simultaneously are required.
If interested, please submit a cover letter and resume to:
Chuck Ingoglia MSW
Vice President, Public Policy
