National Council Hosts Congressional Briefing on Mental Health Data in CO, AR

Online Registration for Hill Day 2008 Now Open!

Reminder: Submit Comments to CMS on Cost Sharing, Benchmark Plans; Senators Baucus, Grassley Send Letter to HHS on Cost Sharing Concerns

Bill to Delay Implementation of Seven Medicaid Regulations for One Year Introduced in the House

Update on Federal Parity Efforts

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

Recently Released Resources from the National Council

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.

In the early 1980’s, Congress rolled most direct federal discretionary spending on community-based mental health services  -- including funding for Community Mental Health Centers – into a block grant. In turn, that policy decision led to a radical reduction in the data available to track the success of public sector mental health programs. By the early 1990’s, it became impossible to answer straight-forward questions like: How many people with schizophrenia are served in state mental health systems?  What types of services are typically furnished to children with serious mental and emotional disturbances? Providers in Arkansas and Colorado took the initiative to gather their own data in order to better answer these and other questions.

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
• David Lloyd, President, MTM Services, LLC

Read the panelists’ presentations.

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
• Details on making your Hill Day hotel reservation

We look forward to seeing you in Washington in June!

On February 22, 2008, the Centers for Medicare and Medicaid Services (CMS) published two new proposed rules that would implement provisions of the Deficit Reduction Act of 2005 (DRA) and the Tax Relief and Health Care Act of 2006 and are the latest in a series of regulations intended to implement the Administrations goals of aligning Medicaid more closely with private insurance and giving states more control over their Medicaid benefits packages. The National Council has prepared comments on both proposed rules and encourages all members to submit their own comments to CMS using these comments as templates. Comments on both rules are due by 5:00 pm Eastern on Monday, March 24, 2008.

Benchmark Plans

The first newly proposed rule (CMS-2232-P) would implement provisions of section 6044 of the DRA, which gives states the option to define the scope of covered medical assistance by offering coverage of benchmark or benchmark-equivalent benefit packages to certain Medicaid recipients. These benchmark plans are similar to the flexibility currently provided to states under the State Children’s Health Insurance Program (SCHIP). Benchmark coverage includes: 

• The standard Blue Cross/Blue Shield preferred provider option service benefit plan under the Federal Employees Health Benefit Plan;
• State employee coverage;
• Coverage that is offered by the largest commercial health maintenance organization in the state; or
• Coverage that the Secretary of Health and Human Services approves. 

The DRA does not require that states offer the same Medicaid benefits statewide, meaning states could design different benefit packages for rural and urban areas, for example. States may also tailor packages for different populations, although certain groups are exempt from mandatory changes to their Medicaid benefits package. Some states - Kentucky, Idaho and West Virginia - have already implemented benchmark plans, which have been criticized by advocates.

This proposed rule would also no longer require states to assure transportation to Medicaid-covered services. This provision is of particular concern to providers and the National Council – taking away transportation for individuals with mental illness and other conditions will create an insurmountable barrier to needed services for many individuals, leading to poor health outcomes.

In its comments, the National Council also suggests that CMS use its discretion to expand the categories of exempt individuals to include adults with serious mental illness and children with serious emotional disturbance.  We also urge CMS to require states to provide more information to exempt individuals who are given the option to enroll in alternative coverage, and to clarify that plans cannot use actuarial methods that further reduce benefits because of statutory cost sharing limits.

Read the National Council’s comments on this proposed rule

Read the State Flexibility in Benefit Packages Notice of Proposed Rulemaking

To comment on this proposed rule, go to:
www.regulations.gov/fdmspublic/component/main?main=DocumentDetail&o=09000064803baf64

Cost Sharing

CMS also released proposed regulations (CMS-2244-P) on sections 6041, 6042, and 6043 of the DRA and section 405(a)(1) of the Tax Relief and Health Care Act of 2006. These sections amend the Social Security Act by adding a new Section 1916A, which gives state Medicaid agencies increased flexibility to impose premiums and other cost sharing requirements on certain Medicaid recipients. This new authority will not change existing cost sharing rules for Medicaid beneficiaries with family income below 100 percent of the federal poverty level (FPL). Individuals with family incomes between 100 and 150 percent of the FPL, however, may see some cost sharing and monthly premiums can be charged to individuals with incomes above 150 percent of the FPL.  As in SCHIP, all cost sharing must be limited to no more than five percent of the family's income.  

On March 18, Senators Max Baucus (D-MT) and Charles Grassley (R-IA) sent a letter to Department of Health and Human Services (HHS) Secretary Michael Leavitt expressing their concern over the newly proposed cost sharing regulations. In their letter, Senators Baucus and Grassley state that the new policy would increase copayments beyond what Congress intended in the DRA and ask HHS to correct its calculations of cost sharing to avoid this outcome.

“We are concerned that the approach that the rule takes may harm the health of some of the nation’s poorest individuals,” said the Senators in their letter to Secretary Leavitt. “Research shows that co-payments can cause some low-income people to go without necessary health care services. Poor people with chronic health conditions are the most vulnerable, as they use the most health care services. People who go without needed care may end up using more expensive forms of care later, such as emergency services.”

Read the full letter from Senators Baucus and Grassley

Read the National Council’s comments on this proposed rule

Read the Premiums and Cost Sharing Notice of Proposed Rulemaking

To comment on this proposed rule, go to:
www.regulations.gov/fdmspublic/component/main?main=DocumentDetail&o=09000064803bafae  

How to submit your comments to CMS

To submit your comments electronically:
 

• Click on the appropriate link to submit comments on the rule you wish to comment on. 
• Click on the yellow button next to “Add Comments” at the top of the page.
• Enter your information (zip code, country, and type of organization are required; organization name and commenter's name are optional) and click "continue".
  
• Type "See Attachment" under "General Comments" and click "Attach Comments". Note: while a variety of file types are accepted, submitting a Microsoft Word or PDF version of your document is preferred. After you have attached your comments, click “Next Step” at the bottom of the page.
• Click “Submit” at the bottom of the next page to submit your comments to CMS.

To submit comments by regular or overnight mail, please see the instructions in the Federal Register announcements.

Please share the comments you submit to CMS with the National Council. Send a copy of your comments to Allison Fort at AllisonF@thenationalcouncil.org.

On March 13, Representatives John Dingell (D-MI) and Timothy Murphy (R-PA) introduced legislation that would 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.

“The cuts to Medicaid target those who need help the most: children, and the mentally and physically disabled,” said Representative Murphy in a press release. “By eliminating preventative healthcare programs and assistance, there could be a devastating effect on the long-term healthcare of Medicaid patients. This would only lead to higher costs in the future, and put the health of millions at risk.”

The National Council continues to work in collaboration with other advocacy groups to support moratoria for case management and a longer moratorium on the rehabilitation option rule in addition to supporting moratoria on other Medicaid-related regulations. Look for updates on this important legislation in future editions of the Public Policy Update.

With the passage of parity by the House of Representatives on March 5, 2008, Congress moved one step closer to providing equity in insurance coverage for addiction and mental health treatment.  As you know, in order for legislation to become a law, each house of Congress must pass the exact same bill and it must be signed by the President.

The process for reconciling differences in bills between the House of Representatives and the Senate is usually handled through a conference committee.  The Senate has not appointed conferees and therefore there is no formal conference process occurring.

However, the National Council has learned that on May 18, the Senate made a formal compromise offer to the House in the hopes of reaching agreement on a bill in what is left of the 110th Congress.  It is our understanding that the offer is not the Senate (S. 558) or the House Bill (HR 1424), but a new bill that includes provisions from both. 

It is unclear if the House will accept this offer, or what the trajectory will be.  The National Council staff will keep you informed as negotiations continue.

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:

For associations

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.