November 19, 2009

CMS Withdraws Medicaid Rehabilitative Services Regulation

Details Emerge about Senate Healthcare Reform Bill, “The Patient Protection and Affordable Care Act”

National Council Survey Indicates Increased Use of Utilization Management and Cost Sharing for MH Prescription in Medicare Part D Plans

Campaign for Mental Health Reform Submits Support Letter for Pamela Hyde’s Nomination as Administrator of SAMHSA

Labor-HHS-Education and Other Remaining  Appropriations Bills Likely to be Combined into “Minibus” for Passage this Year

Obama Administration to Focus on Reducing Deficit in 2010

Bill to Establish Behavioral Telehealth Pilot Project Introduced in Senate

Criminal Justice Reinvestment Act of 2009 Introduced in House and Senate

CMS Withdraws Medicaid Rehabilitative Services Regulation

The Centers for Medicare and Medicaid Services (CMS) on Wednesday announced it is officially withdrawing the controversial rehabilitative services regulation proposed by the Bush Administration in 2007.  The National Council strongly opposed this regulation, which would have restricted services and payments for therapeutic foster care and other important mental health interventions.  In its explanation for the withdrawal of the proposed regulation, CMS cited the clear congressional opposition to its implementation and the 1,845 public comments it received about the regulation.  CMS said it plans to reevaluate the issues around rehabilitative services and explore possible alternatives to the regulation with experts and stakeholders.  The official notice will appear in the Federal Register on Nov. 23, 2009.

The National Council would like to thank our national coalition partners – the Bazelon Center for Mental Health Law, National Alliance on Mental Illness, Mental Health America, Foster Family-based Treatment Association, Child Welfare League of America, and the Alliance for Children and Families – as well as our members for their tireless advocacy against this proposed regulation.


Details Emerge about Senate Healthcare Reform Bill, “The Patient Protection and Affordable Care Act”

Details began emerging yesterday about the final version of the Senate healthcare reform bill, which will extend coverage to 31 million uninsured Americans, impose new regulations on private insurers, and expand Medicaid to cover more low-income families.  The Congressional Budget Office (CBO) reports that the bill will cost $849 billion over the next decade and will lower the budget deficit by $130 billion during that time.  These figures put the bill well within President Obama’s stated goal of passing a healthcare bill that costs no more than $900 billion and lowers the deficit.

The National Council is pleased to announce that the Senate healthcare reform bill includes the Community Living Assistance Services and Supports program, a voluntary long-term care insurance program for people with disabilities.  The bill also includes grants for the co-location of behavioral and physical health services as well as a Medicaid demonstration project to create medical homes for the treatment of chronic disease, including mental illness.  It expands Medicaid to 133% of the federal poverty level for families and childless adults, which is less than the House's Medicaid expansion to 150% of the federal poverty level (more details about the provisions in the House bill are available in the Nov. 5 issue of the PPU).  We would like to thank our members for their advocacy on these important provisions.

The bill also contains a publicly run insurance option, which states may opt out of joining.  Under the Senate bill, the overhaul would be paid for with a variety of taxes and fees, including an increase in the Medicare payroll tax for the highest earners and a tax on high-value insurance plans.

Before the bill can move to the Senate floor, Reid must secure 60 votes for a procedural vote to begin debate on the measure.  That motion may be filed as soon as today, which would allow the Senate to begin consideration of the bill next week.  Stay tuned to the Public Policy Update and the National Council’s healthcare reform update webinars to keep informed on the latest healthcare reform news.


National Council Survey Indicates Increased Use of Utilization Management and Cost Sharing for MH Prescription in Medicare Part D Plans

The National Council for Community Behavioral Healthcare recently conducted a survey among its membership to assess whether Medicare Part D clients are facing increasing challenges to accessing needed mental health prescription medications due to greater usage of cost-sharing and utilization management techniques. Overall, findings from this survey indicate that, in comparison to 2008, Medicare Part D clients (including those dually-eligible for Medicare and Medicaid) have faced increased barriers to accessing needed medications in 2009. Additionally, respondents’ comments emphasized the negative impact of the Medicare coverage gap – commonly referred to as the ‘doughnut hole’ – on the ability of clients to access medications.

Compared to 2008:

• 84.3% of provider respondents indicated that their Part D clients have been subjected to utilization management techniques at an increased rate this year.
• 92% of providers reported have specifically seen an increased use of prior authorization.
• 75% of respondents indicated that their clients have experienced an increased financial burden, primarily in the form of higher co-pays, when attempting to fill a needed mental health prescription in 2009.

The National Council would like to thank those that completed the survey. You can see more detailed results online.

Looking to the near future, data on Medicare Part D Plans (PDPs) for 2010 show that average premiums will rise from $35 to nearly $39 per month. In addition, more plans will charge a deductible in 2010, specifically, 60% of plans will charge a deductible, which is an increase of 15% from 2009. The number of plans that offer coverage in the doughnut hole will continue to shrink.

Given this information, clients that have Medicare Part D coverage may want to take advantage of the Medicare Part D Open Enrollment Period (Nov. 15-Dec. 31) and carefully evaluate their plan options in 2010 to choose a plan that best fits their needs. All current beneficiaries should have received a letter from their current plan, "Annual Notice of Change." Detailed information about each plan in each state can now be accessed through the Medicare Prescription Drug Plan Finder at www.Medicare.gov.  A list of national stand-alone prescription drug plans and state specific fact sheets providing 'fast facts' about each state's PDP enrollment and key dates are available online.

In addition, Medicare Access for Patients Rx (MAPRx), a coalition of which the National Council is a member, has created several useful fact sheets to assist providers, consumers, and families to understand the process of PDP enrollment. These fact sheets include:

• 2010 Medicare Prescription Drug Annual Open Enrollment
• Medicare Prescription Drug Plan Enrollment for People with Both Medicare & Medicaid
• The ABCs of LIS: Tips on Assisting People with Medicare to Apply for Help with Medicare Prescription Drug Plan Costs

You can also visit MAPRx's website to find useful resources in your state.

Sarah Lazarakis, Policy Intern at the National Council, contributed to this story.


Campaign for Mental Health Reform Submits Support Letter for Pamela Hyde’s Nomination as Administrator of SAMHSA

The Campaign for Mental Health Reform, of which the National Council is a member, has submitted a letter in support of Pamela Hyde’s nomination for the post of Administrator of SAMHSA to Chairman Tom Harkin (D-IA) and Ranking Member Michael Enzi (R-WY) of the Senate Health, Education, Labor, and Pensions (HELP) Committee.  The HELP Committee held a hearing on Hyde’s nomination on Nov. 18 and voted to approve her nomination.  Hyde’s nomination will now go to the full Senate for consideration.


Labor-HHS-Education and Other Remaining  Appropriations Bills Likely to be Combined into “Minibus” for Passage this Year

With healthcare reform dominating its schedule this fall, Congress has yet to approve seven of the twelve annual appropriations bills.  Four of these bills have been passed by both the House and the Senate and are awaiting a conference committee report, but three have not yet been passed out of the Senate, including the Labor-HHS-Education bill.  While congressional aides say there have been no decisions about how the appropriations process will proceed for the rest of the year, Senate Appropriations Chairman Daniel Inouye (D-HI) says he expects Congress will opt to enact a “minibus” bill made up of no more than four of the outstanding bills.  The Labor-HHS-Education bill will likely be included in the minibus package along with the other appropriations bills that have not yet been approved by the Senate.  See the Federal Budget page of our website for additional details about this year’s appropriations bills.


Obama Administration to Focus on Reducing Deficit in 2010

According to top White House aides, President Obama is planning to announce in his 2010 State of the Union Address that he will focus on sharply reducing the federal deficit next year.  The aides said that Obama will likely downplay any new domestic spending, with the exception of job creation initiatives.  The annual budget deficit is currently at $1.4 trillion, and Obama’s shift comes in part because of limited room for new federal spending.  A focus on fiscal responsibility and reducing the deficit could also help moderate Democrats facing difficult re-election battles next year in districts where independent voters may decide the outcome of any election.  Reducing the federal deficit has historically been difficult for presidents to achieve, and Congress’ hesitancy to reduce spending in entitlement and defense programs (the two biggest parts of the budget) may complicate Obama’s efforts.


Bill to Establish Behavioral Telehealth Pilot Project Introduced in Senate

Sen. Tom Udall (D-NM) this month introduced a bill to improve access to telemedicine and behavioral telehealth services in rural communities.  The Rural Telemedicine Enhancing Community Health (TECH) Act of 2009 (S. 2749) would establish three pilot projects in rural and underserved areas of the country to provide telehealth services and analyze their cost-effectiveness and clinical outcomes.  One of the pilot projects will be specifically for the provision of behavioral health services, with the aim of improving rural patients’ access to services and expanding collaborative and integrated models of care delivery.  The other two projects will focus on chronic diseases and treatment of stroke patients, respectively.  The Rural TECH Act of 2009 has been referred to the Senate Finance Committee, where it is awaiting a hearing.


Criminal Justice Reinvestment Act of 2009 Introduced in House and Senate

Senators Sheldon Whitehouse (D-RI), John Cornyn (R-TX) and Patrick Leahy (D-VT), along with Representatives Adam Schiff (D-CA) and Dan Lungren (R-CA), have introduced legislation to assist states with slowing their jail and prison population growth and reducing corrections expenditures.  Over two million adults in the United States are incarcerated in prisons and jails, and states have increased spending on corrections by $40 billion in the past 20 years.  The Criminal Justice Reinvestment Act of 2009 would provide grants to state and local governments to help them analyze trends in criminal justice and prison population growth, develop and implement policies to reduce corrections expenditures and enhance the effectiveness of current spending, and measure the impact of these changes.  The full text of the bill is available online.