May 7, 2009

Just Released: Obama Cuts $17 billion in Federal Budget; Programs within the Substance Abuse and Mental Health Services Administration Mostly Level Funded

CMS Rescinds Harmful Medicaid Rules

National Council Continues to Advocate for Inclusion in HIT Initiatives

19 Senators Sign onto MHBG Letter After NC Members Send 200 Letters

Administration Seeks Equalized Sentencing for Crack and Powdered Cocaine; Legislation Introduced

Baucus and Grassley Release Paper on Healthcare Overhaul; Several Caucuses Support Public Plan Option

New Funding Available for the National Health Service Corps Loan Repayment Program

COPAA Files Amicus Brief in Supreme Court Case Forest Grove School District v. T. A.

Reserve Your Hotel Room For Hill Day Now!

Recently Released Resources from the National Council

Just Released: Obama Cuts $17 billion in Federal Budget; Programs within the Substance Abuse and Mental Health Services Administration Mostly Level Funded

On May 7, President Obama released the initial details of his Administration’s FY 2010 $3.4 trillion budget.   In general, the budget would cut $17 billion from 121 federal programs.  The FY 2010 Budget requests $3.5 billion for the Substance Abuse and Mental Health Services Administration (SAMHSA), an increase of $59 million over FY 2009.  The funding for both the Substance Abuse and Treatment Block Grant (SATBG) and the Mental Health Services Block Grant (MHBG) would both remain level to FY2009 with the Administration failing to ask for an increase in either program.  The Center for Mental Health Services (CMHS) Programs of Regional and National Significance (PRNS) would receive $336 million, $9 million less than FY 2009.  Although the PRNS program would lose funding, an Administration official has indicated that the reduction is in earmark funding, not authorized programs.  The Center for Substance Abuse Treatment (CSAT) PRNS would receive $458 million, an increase of $46 million, of which $35 million is designated for drug courts.  CMHS Projects for Assistance in Transition from Homelessness (PATH) would receive $68 million, an increase of $8 million over FY 09 and the Children’s Mental Health Services would receive $125 million, an increase of $17 million.  The Administration’s proposal also includes $29 million for CSAT’s Screening and Brief Intervention program and would support a new cohort of Access to Recovery grants through $99 million in funding.  The National Institute of Health (NIH) and National Institute on Alcohol Abuse and Alcoholism (NIAAA) would receive $455 million, an increase of $5 million. The National Institute on Drug Abuse (NIDA) would receive $1.045 billion, an increase of $13 million and the National Institute of Mental Health (NIMH) would receive $1.475 billion, an increase of $24 million.  Primary and Behavioral Healthcare Integration would receive $7 million.  The National Council is working to increase funding for this program to $35 million.

Highlights from the Department of Justice: 

• Second Chance Act: $75.0 million to reduce the rate of criminal recidivism
• Residential Substance Abuse Treatment Program: $20 million to provide grants to develop residential substance abuse treatment programs in correctional facilities and community-based aftercare services for probationers and parolees
• Drug, Mental Health and Problem-Solving Courts: $9 million to develop system-wide responses to offenders affected by underlying social and psychological issues, such as substance abuse and mental disorders, that the traditional court system is not designed to effectively address.

The National Council will continue to review the details of the Obama budget, including funding levels within the Department of Justice, and will provide updates on advocacy targets.  Stay tuned to the Public Policy Update to receive the latest news on the federal budget process.

CMS Rescinds Harmful Medicaid Rules

The National Council is pleased that several of the Centers for Medicare and Medicaid (CMS) interim final rules (IFR) have been rescinded including: parts of targeted case management, outpatient hospital and clinic services upper payment limit, and school-based services.  Currently, the provider tax regulation is being delayed for an additional year while more information is gathered.  The regulations were issued in response to the Deficit Reduction Act of 2005.

Targeted Case Management

The IFR for case management and targeted case management was published on December 4, 2007.  The rule would cause a disruption in the community mental health system and hurt Medicaid recipients.  The National Council is happy to report that the portions of the target case management IFR to be rescinded include all of the most harmful and restrictive aspects of the regulation, including:

• Reduction in the number of days case management services are reimbursable during the transition period out of institutional care to a community setting and only allowed payment if the transition was successful
• Case management services are to be furnished by only one case manager for each individual
• Required billing in 15-minute increments
• Required providers to bill for services separately that are a part of a “package of services”
• Denied reimbursement for case management activities that are an integral component of another covered Medicaid service
• Denied reimbursement for case management activities that are integral to the administration of another non-medical program, such as guardianship, child welfare/child protective services, parole, probation or special education programs
• Denied reimbursement for administrative activities
• Denied reimbursement for case management activities that constitute the direct delivery of underlying medical, educational, social or other services under parole, probation, public guardianship, special education programs and child welfare/child protective services. Reimbursement will still be denied for these services provided in a foster care program.

Please note: The definition of case management and allowable case management activities are the same as they have been since 2001.  Case management includes only: assessment, development of a specific care plan, referral and related activities and monitoring and follow up activities.

Outpatient Hospital and Clinic Services Upper Payment Limit

The IFR for outpatient hospital services was published on November 7, 2008.  The rule would have changed the definition of outpatient hospital and rural health clinic services and change the methods states must use to demonstrate compliance with the federal upper payment limit on outpatient hospital services provided in private outpatient facilities.  This regulation would have hurt community behavioral health centers ability to provide rehabilitative services and services helping individuals transition to the community. 

School-based Services

The IFR for school-based services was issued on December 28, 2007.  Under the rule, federal Medicaid payments would no longer be available for administrative activities performed by school employees or contractors, or anyone under the control of a public or private educational institution. Transportation from home to school and back for school-aged children with an Individualized Education Program or an Individualized Services Plan established under the Individuals with Disabilities Education Act would not receive federal Medicaid payments. 

Provider Tax

Under the provider tax regulations that were implemented in 1992, states can raise part of their Medicaid matching funds by using revenue from taxes on hospitals, nursing homes, managed care organizations and other healthcare providers.  The regulation stated that the funds raised could not exceed six percent of a health facility's gross revenue.  Provider taxes equal to between 3 percent and 6 percent of a facility’s gross revenues would no longer count toward a states matching contribution, if the regulation is implemented.  States that now rely on revenue from provider taxes set at more than 3 percent of providers' gross revenues will have to find other sources of revenue to help fund their state share of Medicaid or cut back eligibility, covered benefits, or provider payment rates.  Currently there is a one year delay in implementation of this regulation while CMS studies the effect it would have on Medicaid services.  The National Council will continue to work to ensure this regulation is not implemented.

Other harmful Medicaid regulations, including the rehabilitative services rule, were in the "proposed" rather than the "final" phase, and therefore do not need to be rescinded.  The Obama Administration has given every indication that it does not plan to implement them.

The National Council is pleased the Administration has rescinded the harmful Medicaid regulations.  This action can be traced to the determined efforts of the National Council's members and other advocacy organizations over the past two years.  To receive the latest information and CMS rules and regulations sign up to receive the Public Policy Update and watch the Medicaid section of the National Council's webpage.

National Council Continues to Advocate for Inclusion in HIT Initiatives

The American Recovery & Reinvestment Act (ARRA), signed into law on February 16, 2009, creates various financial incentives to support the adoption of health information technology (HIT) including: Medicare/Medicaid payments for HIT adoption and usage and discretionary grants to states. Due to the National Council and its membership, community behavioral health organizations (CBHOs) are explicitly included as eligible entities within the state discretionary grants.

The National Council has been pursuing every opportunity to ensure community behavioral health providers have access to the HIT funding that will be available via the ARRA or any other potential health care reform activities. On March 17th, U.S. Representatives Napolitano (CA), Murphy (PA), Kennedy (RI), and Bono Mack (CA) submitted a letter to Department of Health and Human Services (HHS) Secretary Kathleen Sebelius, urging her to keep community behavioral health organizations in mind when developing an implementation plan for the state discretionary funding for HIT utilization.

Additionally, the Senate Finance Committee recently released the first of a series of documents on health care reform policy options and discussed the possibility of extending the ARRA Medicare HIT incentive payments to providers that were not included in the ARRA.  In light of this, the National Council and other advocates submitted a letter to Chairman Baucus, of the Senate Finance Committee, urging him to include psychiatric hospitals, community mental health centers (CMHCs) and other behavioral health organizations in any HIT programs.

The National Council strongly encourages you to send similar letters to key Members of Congress, based on the attached template, telling them to include community mental health and addiction providers in any HIT funding initiatives.  Please email your letters to the National Council and to the following individuals:

• Senator Baucus: paul_wilkins@baucus.senate.gov
• Senator Grassley: kathy_nuebel@grassley.senate.gov 
• Representative Barton: michael.taylor@mail.house.gov  
• Representative Waxman: Becky.Claster@mail.house.govPlease

Stay tuned to the Public Policy Update and the National Council's Recovery Page for the latest information on the implementation of the HIT provisions of the ARRA.  Watch out for Action Alerts from the National Council, asking you to contact your members of Congress to ensure inclusion of CBHOs in HIT and other key components of health care reform.

19 Senators Sign onto MHBG Letter After NC Members Send 200 Letters

Senator Debbie Stabenow is pleased her Dear Colleague Letter in support of a $100 million increase in the Mental Health Services Block Grant (MHBG) in FY2010 was signed by 18 Senators besides herself.  The letter will be sent to Senators Harkin and Specter, the Chair and Ranking Member of the Labor-HHS subcommittee of the Senate Appropriations Committee.  The National Council would like to thank Sen. Stabenow for her work on this issue and all of our members who took action on this issue this month.  Over 200 letters were sent to Senators in support of this important initiative.  If you would like to help advocate in the future, sign up now to receive Action Alerts from the National Council.

Administration Seeks Equalized Sentencing for Crack and Powdered Cocaine; Legislation Introduced

At a recent Judiciary hearing, the Obama Administration called on Congress to equalize federal sentences for offenses involving crack and powdered cocaine.   Under current law, the possession of 5 grams of crack triggers a mandatory five-year prison sentence, while it takes 500 grams of powdered cocaine to bring on the same sentence.  This creates a 100-to-1 disparity resulting in an average difference of 40 months in jail time for two drugs which experts say have no significant differences; a disparity that has disproportionately affected African-Americans.  President Obama endorsed treating the two forms of cocaine equally during his presidential campaign, and Vice President Joseph R. Biden Jr. sponsored legislation aimed at doing so when he was a Senator.  Several bills have been introduced in the House and Senate to address the disparity, the most recent by Congressman Charles B. Rangel (HR 2178) which would eliminate the disparity in the federal sentencing of crack cocaine and powder cocaine offenses, echoing President Obama's call.  HR 2178 was introduced on April 29 and referred to the appropriate committees.  For more information on the campaign to eliminate the sentencing disparity between crack and powder cocaine click here.

Baucus and Grassley Release Paper on Healthcare Overhaul; Several Caucuses Support Public Plan Option

On April 28, Senate Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Chuck Grassley (R-IA) released policy options for reducing costs and improving quality in the health care delivery system.  The paper released by Senators Baucus and Grassley focused on making the health care delivery system more effective, higher quality, and efficient.  Several ideas promoted in the paper include: quality of care instead of quantity of care, primary care, care coordination and provider collaboration, infrastructure investments, quality, efficiency and care management in Medicare Advantage and combating fraud, waste, and abuse in Medicaid.

The Senate Finance Committee will be holding another meeting this week to discuss various public plan options.  This comes after members of several Congressional Caucuses sent a letter to Democratic Congressional leaders and President Obama demanding a public plan option as part of any healthcare reform.

The National Council would encourage you to send your comments, suggestions and best practices to the Senate Finance Committee at Health_Reform@finance-dem.senate.gov.  Comments should be short and concise and include methods that behavioral healthcare can and should be included in healthcare reform.  Comments on the delivery system reform options are due by May 15.

See the National Council’s webpage "Covering the Uninsured" and stay tuned to the Public Policy Update for the latest information on healthcare reform.

New Funding Available for the National Health Service Corps Loan Repayment Program

The American Recovery and Reinvestment Act of 2009 (ARRA) provides almost $200 million for the National Health Service Corps (NHSC) loan repayment program (LRP). This new money could potentially double the number of clinicians eligible for NHSC loan repayment, adding an additional 4,000 clinicians to underserved areas. Currently, mental health professionals account for 30% of the NHSC workforce, which indicates that the ARRA funds could support an additional 1200 behavioral health professionals.

$75 million has been reserved for renewals in 2011, which will in effect allow clinicians to obtain 3 years of LRP funding. ARRA also allocated $24 million for new NHSC Scholarships and $20 million for state loan repayment programs to be allocated by states.

The Health Resources and Services Administration (HRSA) must spend these funds within 18 months.  Staff currently report that applications will open in June and awards will be made on a rolling basis throughout the year. Members are strongly encouraged to begin the application well in advance of June, especially if your organization will need to recruit new clinicians or to obtain approval for new NHSC sites located within a Health Professional Shortage Area (HPSA).

The ARRA funds will allow HRSA to accept very low HPSA, much lower than in previous years.  In 2008, HPSA scores as low as 8 were funded, and HRSA hopes to fund lower HPSA scores this year.

In addition, limits on the number of health professionals per site will be significantly raised to allow many more clinicians to serve within the same site. Currently, sites are limited to no more than 2 Psychiatrists (MD or DO), and no more than a combined total of 2 Clinical or Counseling Psychologists, Licensed Clinical Social Workers, Licensed Professional Counselors, Marriage and Family Therapists, or Psychiatric Nurse Specialists.  Visit the NHSC website to see more information on eligibility.

If you have questions, please contact Chris Loftis at 202-684-7457 x 234.

COPAA Files Amicus Brief in Supreme Court Case Forest Grove School District v. T. A.

The Council of Parent Attorneys and Advocates (COPPA), a nonprofit organization of attorneys, special education advocates and parents, has filed an amicus brief in the Supreme Court case Forest Grove Sch. Dist. v. T.A.  This case involves the important legal question of how the courts should interpret the Individuals with Disabilities Education Act (IDEA), and whether a school district may avoid its obligations under the IDEA when it fails to identify a child as having a disability and as a result fails to provide the required free appropriate public education.  COPAA's brief focuses on the need for the Court to interpret the IDEA broadly.

In Forest Grove School District v. T.A., the parents are seeking reimbursement for private school tuition they paid.  The parents sent their child to the private school after the school district failed to identify the child as needing additional help due to a disability.  A copy of COPAA’s brief can be found online. 

Reserve Your Hotel Room For Hill Day Now!

Although our room blocks at the Washington Court Hotel and the Liaison Hotel have only a few rooms left, the National Council has arranged for rooms in a third wonderful hotel to try and meet the great demand for rooms.  Rooms can be reserved for only $269/night at any of the hotels when reservations are made by May 15, 2009.

• Washington Court Hotel: 202-628-2100, Group Code "National Council for Community Behavioral Health Care"
• Liaison Hotel: 866-233-4642, Group Code "NATCO"
• Phoenix Park Hotel: 800-824-5419, Group Code "13459

Already made your hotel reservations?  Don't forget to register for Hill Day online.  And remember to call your Members of Congress today to make an appointment for June 10th.

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:

The National Council has put together a multitude of informational resources for people applying for the Primary and Behavioral Health Care Integration RFA from SAMHSA.  Members can access the materials via our Members Only section of the website.

The National Council just released three fact sheets on the American Recovery and Reinvestment Act of 2009.

• Medicaid
• Health Information Technology
• Other Key Provisions

The National Council just released a chart comparing the Omnibus Budget Bill introduced in the House with the FY08 budget and the FY09 budget released by former President Bush.

The National Council recently released a summary of the SCHIP Bill.

The National Council recently released a fact sheet on the Final Rule for the Federal Cost Sharing Rules. The rule gives states broader authority to charge premiums and higher co-payments for Medicaid.

The National Council recently released a resource guide, Veterans on the Road Home”, which equips you to reach out and to effectively serve Iraq and Afghanistan veterans and their families. The book describes the physical, mental, economic, and social effects of the wars in Iraq and Afghanistan. It presents detailed case studies of treatment organizations and associations with special expertise in and commitment to serving veterans and their families.

At the end of October, the National Council released a series of fact sheets on the Deficit Reduction Act of 2005:

-Overview of the DRA

-Expanded Medicaid Coverage Under the DRA

-Medicaid Services for Children Under the DRA

-State Implementation of the DRA

Meaningful Employment for Individuals with Mental Illness, a backgrounder from the National Council, provides information on the current employment status of individuals with mental illness, opportunities for career development, and federal initiatives to improve the chances of individuals with mental illness obtaining and keeping jobs.

The National Council recently released a fact sheet on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 which provides a detailed explanation of the impact of this bill.

Please contact Chuck Ingoglia, Vice President, Public Policy, with federal policy questions.

The Public Policy Update is a weekly e-newsletter published by the National Council for Community Behavioral Healthcare. Managing Editor - Christina Hammond. Vice President, Public Policy - Chuck Ingoglia. Director of State Policy - Chris Loftis. Director of Public Policy - Alexa Eggleston. Director of Policy and Advocacy - Laura Galbreath.