Public Policy Update: November 4, 2010
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November 4, 2010
By Chuck Ingoglia, Vice President, Public Policy
I am sure that most of us have had our fill of pundits offering opinions about why the elections went the way that they did, and what this means about the mood of the American people. You will not find any of that in this short piece. Instead, I will focus on what might the election mean for our community in terms of policy and funding.
I must begin this process with the acknowledgement that I do not own a crystal ball, and my ability to predict the future is cloudy at best. Therefore, I will confine myself to areas that have greater certainty than others...
Discretionary Spending Will Not Grow
Government agencies have already submitted Federal Fiscal Year 2012 budget figures to the Office of Management and Budget. Earlier this year, the President issued guidance to all federal agencies requested that each non security agency submit a budget request five percent below the discretionary total provided for that agency for FY 2012 than in the FY 2011 Budget.
It is safe to assume that discretionary programs in the Department of Health and Human Services, Justice, and Education will likely remain level or shrink.
The Increase in Federal Medicaid Payments will not be Extended
In light of revenue shortfalls in almost all of the States, the federal government provided a temporary increase in the Federal share of Medicaid spending that was scheduled to end on December 31, 2010 and was extended until June 30, 2011, albeit at a reduced rate. The combination of concern over federal spending, combined with changes in Congressional composition would suggest that chances of extending this federal support to states is unlikely to be extended again.
It will be Difficult to Repeal Healthcare Reform
The political realities of repealing a law make this scenario very unlikely, principally because of President Obama's veto power. Another complication is that some parts of health care reform already in effect are pretty popular. Among them are provisions forcing insurers to cover children with pre-existing conditions and allowing parents to keep kids up to age 26 on their policies. That's why congressional veterans predict that any potential rollbacks would be more piecemeal rather than a full-scale discard.
While we will likely see many proposals related to changing the healthcare reform law, most concerning to the addiction and mental health community will be efforts to scale back, or delay the Medicaid expansion scheduled for 2014. We have already discussed that federal discretionary funding will not be growing, and that additional federal Medicaid assistance is unlikely. The consequences of these actions is to put further pressure on STATE and COUNTY appropriations, further eroding addiction and mental health funding, especially for indigent populations.
There will also be efforts to take money away from funded programs, and the new Prevention and Wellness Fund is already seen as the prime target to steal from.
The National Council will continue to provide you with timely updates as the 112th Congress unfolds. Your continued advocacy will be essential as we move forward.
The National Council has published two new resources to help states, providers, and consumers prepare for upcoming changes under healthcare reform:
- Our updated health reform summary chart describes the major provisions that will affect behavioral health organizations and consumers. This chart has been updated to include information about the effective date of each provision and the levels of appropriated or authorized funding for each program.
- Our new Roadmap for State Associations provides tools, strategies, and resources that advocates can use in their efforts to influence the implementation of the ACA in the states. Focusing on six areas of health reform, the Roadmap provides a brief summary, a list of action items for advocates, and helpful resources in each area. The Roadmap is designed to help advocates and state associations position themselves as key resources for state agencies, state legislators, and other advocacy groups.
For more information and resources on health reform, visit the National Council’s blog, MentalHealthcareReform.org.
The National Council has launched a new eight-month pilot program designed to advance standards of care for people living with schizophrenia. The “Advancing Standards of Care for People with Schizophrenia” pilot program sites will work to help individuals with schizophrenia improve their day-to-day functioning. According to mental health experts, this is a critical first step towards more complete self directed disease management. To help each of the pilot sites shift towards a more complete evaluation of functioning, the National Council will provide ongoing technical assistance that will draw on the expertise of an advisory panel of national thought leaders in behavioral healthcare. This approach will rely on a consistent use of the Daily Living Activities (DLA-20) tool — an interactive assessment that the mental health professional and patient will complete together to track how each individual is functioning.
The ten pilot sites in the program are: AltaPointe Health Systems in Mobile, AL; AtlantiCare Behavioral Health in Egg Harbor Township, NJ; Cobb & Douglas Community Services Board in Smyrna, GA; Family Guidance Center for Behavioral Healthcare in Saint Joseph, MO; Gallahue Mental Health Services in Indianapolis, IN; Hill Country Community MHMR Center in Kerrville, TX; Mental Health Centers of Central Illinois in Springfield, IL; Recovery Resources in Cleveland, OH; Seminole Behavioral Healthcare in Fern Park, FL; and Spokane Mental Health, Spokane, WA. Sunovion Pharmaceutical Inc. provided financial support for the Advancing Standards of Care pilot program.
The National Council invites you to join us for the first in a series of webinars brought to you in collaboration with the Georgetown University National Technical Assistance Center for Children’s Mental Health. The webinar, “Making Evidence-Based Practices (EBPs) Stick: Strategies to Prepare Your Organization for Change,” will help you prepare your organization for the adoption of EBPs. Recent research shows that an organization’s unique culture and work environment have a strong effect on the success or failure of EBP implementation. In fact, your organizational culture is as important as the clinicians you hire in making EBPs successful. Webinar attendees will learn:
- How your organization’s culture and work environment impact your ability to effectively implement EBPs
- Details about the only nationally-normed tool for assessing your organization’s readiness for implementation
- Proven strategies to help your organization prepare for EBP adoption and maximize positive treatment outcomes
The webinar will take place on Nov. 16 at 2:00 p.m. Eastern. Registration and additional details are available online.
Has your insurance plan denied coverage of addictions treatment services? Are your clients unable to access psychiatric medications because of restrictive insurance policies? Do you know whether these denials constitute a violation of the 2008 Mental Health Parity and Addictions Equity Act?
If you or your clients have had difficulty accessing coverage for mental health and addictions services, you can find out whether this is a likely violation of the law in the Parity Implementation Coalition’s Frequently Asked Questions and Answers about Parity Compliance. This document provides common examples of insurance company denials and evaluates them in light of the parity law. For example:
- If a plan offers to reimburse a range of disease management interventions such as phone-based case management, disease monitoring technology, diagnostic and tests for medical conditions but refuses to reimburse these same services for any or most mental health/substance use (MH/SU) health conditions, is this a violation of parity?
- If a plan has a prior authorization requirement for outpatient MH/SU services provided by MH/SU practitioners but there is no similar requirement for primary care doctors or other specialty physicians, is this a violation of parity?
Find the answers to these and other questions in our FAQ document. Then, check out the Parity Toolkit to find out how to appeal denials and enforce your rights under the law.
