March 6, 2008

House Passes Paul Wellstone Mental Health and Addiction Equity Act

On March 5, the House passed the Paul Wellstone Mental Health and Addiction Equity Act (HR 1424) by a vote of 268-148.

Introduced by Representatives Patrick Kennedy (D-RI) and Jim Ramstad (R-MN) on March 7, 2007, HR 1424 expands upon the Mental Health Parity Act of 1996, which established parity for annual and lifetime dollar limits, requiring group health plans that offer benefits for mental health and addictions treatment to do so on the same terms as care for other diseases. It is modeled after the Federal Employees Health Benefit Program, which covers members of Congress and other federal employees and which implemented parity in mental health and addictions treatment coverage in 2001. The legislation closes the loopholes that allow plans to charge higher co-payments, coinsurance, deductibles, and maximum out-of-pocket limits and impose lower day and visit limits on mental health and addictions treatment.

In the Senate, Senators Edward Kennedy (D-MA), Michael Enzi (D-WY), and Pete Domenici (R-NM) introduced the Mental Health Parity Act of 2007 (S 558) on February 12, 2007. The bill would amend two laws - the Employee Retirement Income Security Act (ERISA) and the Public Health Service Act (PHSA) - and expand upon the existing 1996 federal parity law. The Senate bill also includes prohibitions on unequal financial requirements for mental health and addictions treatment such as co-payments and deductibles. The Senate passed S. 558 unanimously by voice vote.

The National Council has supported the passage of parity legislation in both chambers, and hopes that the subsequent conference process will produce a bill that will expand parity for both mental health and addictions treatment.

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, go to: www.house.gov. You can reach all members of Congress by contacting the Capitol Switchboard at 202-224-3121 and asking to be connected to the office you wish to contact.

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

one for associations and one 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.

MIOTCRA Considered by Senate Judiciary Committee Today

Today, the Senate Judiciary Committee is scheduled to consider legislation to reauthorize the Mentally Ill Offender Treatment Crime Reduction Act (MIOTCRA) program (S 2304).

MIOTCRA is designed to facilitate collaboration among the criminal justice, juvenile justice, mental health and addiction treatment systems and to improve access to effective treatment for people with mental illnesses involved with the justice system. The program received $5 million in FY 2006 and FY 2007 and $6.5 million for FY 2008.  On January 23, the House passed legislation to reauthorize MIOTCRA (HR 3992) by voice vote.

The National Council thanks members who have sent letters to their Senators and Representatives in support of MIOTCRA and urges those who have not already done so to send letters in support of this important program.
 
Using this sample letter as your guide, insert any state or local information that explains the impact of this issue on your community and the importance of such diversion programs, and please send it to you Senators and US House Representative.  To find your Representative, go to: www.house.gov. To find your Senators, go to: www.senate.gov.  You can reach all members of Congress by contacting the Capitol Switchboard at 202-224-3121 and asking to be connected to the office you wish to contact.

Please share the response you get from your members of Congress with the National Council. Contact Allison Fort at AllisonF@thenationalcouncil.org to let us know you participated and to share the response you received.

Reminder: New Medicaid Tamper-Resistant Prescription Pad Requirement Effective April 1, 2008

On April 1, 2008, a new policy requiring tamper-resistant prescription pads be used for all Medicaid prescriptions will go into effect, causing 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.

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. To listen to a recording of this presentation, click here.

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

GAO Releases New Report on VT, FL Medicaid Waivers

The Government Accountability Office (GAO) recently released a report that found the Department of Health and Human Services (HHS) approved Medicaid waivers for Vermont and Florida that failed to meet budget neutrality requirements.

In the report, “MEDICAID DEMONSTRATION WAIVERS: Recent HHS Approvals Continue to Raise Cost and Oversight Concerns,” the GAO finds that HHS approved spending limits in the 2005 Medicaid demonstration waivers in Florida and Vermont that were higher than the limits that would have been granted if HHS had held the states to limits based on benchmark growth rates, such as the lower of the state’s historical spending growth or nationwide estimates of Medicaid growth, without requiring the states to document that using these benchmarks would not provide accurate cost projections. In Florida, HHS approved a $52.6 billion spending limit for the 5-year demonstration— $6.9 billion more than the documentation supported. In Vermont, HHS approved a $4.7 billion spending limit—$246 million higher than supported.

GAO recommends that Congress consider: (1) requiring HHS to improve the demonstration review and approval process and (2) addressing HHS’s authority to approve demonstrations such as Vermont’s. GAO recommends that HHS reexamine Florida’s spending limit. In its comments, HHS stated that its process was sufficient. GAO believes that the limit allows spending that should not be allowed.

To read the complete report online, click here.

Save the Date for the National Council’s Fourth Annual Hill Day: June 18, 2008

Every day, the National Council places a high 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, is just six months away! Hill Day 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.

Please save the date and plan to join your fellow National Council members in Washington for two days of events, designed to provide Hill Day participants with in-depth information on key issues:

• On Tuesday, June 17, all Hill Day participants are invited to attend the National Council’s Public Policy Committee meeting for a detailed overview of the National Councils Hill Day policy priorities. One-on-one Hill visit coaching will also be available for interested participants.
• On Wednesday, June 18, Hill Day kicks off with an issue briefing before participants head to Capitol Hill to advocate for behavioral healthcare. The day concludes with a Capitol Hill reception honoring champions of mental health and addiction treatment services.

This year, the National Council will debut online appointment scheduling, allowing Hill Day participants to update and print out their customized Hill Day schedules online. Be on the lookout for online Hill Day registration, including online appointment scheduling!

Make your Hill Day reservations today - events will be held at the Marriott Wardman Park Hotel in Washington DC. There are two ways to make a hotel reservation in the National Council’s room block for the rate of $279:

• Make your reservation online at http://www.marriott.com/hotels/travel/wasdt-marriott-wardman-park-hotel  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”

Be sure to bookmark the National Council’s Hill Day 2008 web page - it will be updated regularly with the latest Hill Day information and materials for participants.

For more information about Hill Day, please contact Allison Fort at 301-984-6200, ext. 235 or AllisonF@thenationalcouncil.org

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 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’ 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 e-newsletter 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. 

On February 5, the National Council issued a new Election ’08 Update. With campaign positions already being formulated in the context of next year’s presidential election, no domestic issue is more important in the minds of the American people than the future of healthcare. The National Council is an important player in framing how and where mental health and addictions fit into the national healthcare agenda. The healthcare decisions made and the directions taken as a result of Election 2008 will likely affect our industry and our communities for years to come. The National Council offers you the opportunity to be involved by sending the message — on the national, state and local levels —  that mental health and freedom from addictions are integral to the health of all Americans.

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, “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.

In the fall of 2007, the Oregon Medicaid agency issued a Notice of Rulemaking that proposed an increase to copays for prescription medications. The National Council opposes copays for needed medications, particularly for low-income individuals who have chronic health conditions, such as mental illness.

The National Council's state association, the Association of Oregon Community Mental Health Programs, testified against this proposal at a hearing on November 16. In addition, the National Council filed written comments in opposition to the proposed rules to increase copays on November 21.

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.