October 7, 2008

President Bush Signs Parity Bill into Law; Culminates Years of Effort by Advocates

Senator Stabenow Introduces the Medicaid Services Restoration Act of 2008

Save the Date for Hill Day 2009: June 9-10

Recently Released Resources from the National Council

President Bush Signs Parity Bill into Law; Culminates Years of Effort by Advocates

On October 3, President Bush signed the Emergency Economic Stabilization Act of 2008, which included the Paul Wellstone and Pete Domenici Mental Health Parity & Addiction Equity Act of 2008 as an amendment. On October 1, the Senate voted 74-25 in favor of the Emergency Economic Stabilization Act of 2008, while the House voted on October 3, passing the bill by a 263-171 margin. You can see how your Senators and Representative voted online. Please keep in mind that how your Senators and Representative voted on this bill does not indicate his/her position on parity because many other issues were voted on during passage of the Emergency Economic Stabilization Act of 2008.

The text of the Paul Wellstone and Pete Domenici Mental Health Parity & Addiction Equity Act of 2008 is located on pgs. 310-344 of the Emergency Economic Stabilization Act of 2008.

The National Council for Community Behavioral Healthcare commends Congress for the passage of legislation that calls for equitable insurance coverage for mental health and addiction disorders. The National Council thanks Senators Domenici, Kennedy and Enzi, and Representatives Kennedy and Ramstad, who have been passionate champions of parity for many years and brought the bill to pass. We also commend members of the Ad Hoc Coalition on Mental Health Parity, the Coalition for Fairness in Mental Illness Coverage, Mental Health Liaison Group, and Parity Now Coalition, for their advocacy in support of the parity legislation.

The National Council and its membership have been actively involved in parity advocacy efforts. Thank you to our members that participated in National Parity Call-In Days on July 9 and September 25 and sent letters and emails of support to your members of Congress. In addition, the National Council, in coalition with the Ad Hoc Coalition on Mental Health Parity, the Coalition for Fairness in Mental Illness Coverage, Mental Health Liaison Group, and Parity Now Coalition, ran ads in support of parity in CongressDaily AM.

The National Council has also created a fact sheet on the provisions of the Paul Wellstone and Pete Domenici Mental Health Parity & Addiction Equity Act of 2008 and did a press release after passage in the Senate and House.

The passage of this mental health and addiction parity has been featured in many media articles, such as The New York Times and Kaiser Daily Health Policy Report.

Recent History Behind Passage:

In April of this year, both Houses of Congress passed legislation to provide parity for addiction and mental health treatment. However, differences between the two bills – the Paul Wellstone Mental Health and Addiction Equity Act (HR 1424) and the Mental Health Parity Act of 2007 (S 558) - stalled further progress. Among the major differences between the two bills was a provision in the S 558 that would have allow insurers to determine which conditions the parity provisions covered, while HR 1424 would extend parity to all conditions listed in the DSM-IV.

In June, House and Senate negotiators reached an agreement on the terms for legislation to extend parity to both mental health and addictions. Among other agreements, House negotiators accepted the Senate’s stronger preemption language, which defers to the current HIPAA standard and is extremely protective of state law. Under the language agreed upon by negotiators, stronger state parity and other consumer laws remain in place. In addition, Senate negotiators accepted the House’s stronger language that made it clear that out-of-network mental health and addictions services will be provided on an equal basis when a plan provides out-of-network services for physical health.

On September 23, both the House and Senate passed legislation to extend parity to both mental health and addictions. The Senate passed the parity compromise reached by House and Senate negotiators as part of a package (HR 6049) that would extend expiring tax breaks. After voting 83 to 12 to waive a Budget Act point of order and pass an amendment offered by Senators Max Baucus (D-MT) and Chuck Grassley (R-IA) to combine the parity compromise with the tax extenders bill, the Senate passed the combined legislation by a vote of 93 to 2. The House passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 HR 6983) by a vote of 376 to 47. However, because the House and Senate passed the parity compromise in different forms, additional voting was necessary.

This led to the inclusion of the Paul Wellstone and Pete Domenici Mental Health Parity & Addiction Equity Act of 2008 as an amendment to the Emergency Economic Stabilization Act of 2008 and the subsequent passage in early October.

On September 25, Senator Debbie Stabenow (D-MI) introduced S. 3611, the Medicaid Services Restoration Act of 2008, which amends the definition and scope of Targeted Case Management (TCM) and Rehab services in order to address the Administration’s underlying concerns with these services, as expressed in the TCM and Rehab Option Proposed Rules. By working in close coordination with Senator Stabenow’s office, the National Council hopes that the passage of this legislation will make improvements to TCM and Rehab services, while avoiding the honorous provisions of the proposed rules.

More specifically, this bill:

-Creates a new service category to finance therapeutic foster care services for children in the child welfare system with serious mental and emotional disturbances,

-Allows states to employ bundled rates in paying for services,

-Authorizes Medicaid to pay for standard pediatric medical care for kids with mental disorders served in 24-hour residential treatment centers and psychiatric hospitals,

-Clarifies that existing Medicaid third party liability law and regulation applies to community services financed under the rehab option; this provision eliminates the weaker, ill-defined "intrinsic element" and "integral to" tests that CMS floated during DRA deliberations and the regulatory process.

Specific to Targeted Case Management:

-Authorizes states to assign case managers to individual Medicaid beneficiaries,

-Codifies the Olmstead case management standard (now contained only sub-regulatory guidance) and authorizes 180 days of intensive case management services for Medicaid eligibles with disabilities transitioning from institutions to the community.

-Authorizes states to employ multiple case managers primarily for Medicaid eligibles with co-occurring chronic medical conditions, and children and adults with severe disabilities.

To see the full text of this legislation, click here.

Stay tuned to the Public Policy Update and other announcements from the National Council for further updates on this legislation and opportunities to get involved.   

Save the Date for Hill Day 2009: June 9-10

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 Fifth Annual Hill Day is scheduled for June 9-10, 2009 - 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 9, all Hill Day participants are invited to attend the National Council’s Public Policy Committee meeting for a detailed overview of the National Council’s Hill Day policy priorities. One-on-one Hill visit coaching will also be available for interested participants.

On Wednesday, June 10, 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.

Make your Hill Day 2009 hotel reservations today!

Most Hill Day 2009 events will take place at the Washington Court Hotel, located on Capitol Hill. There are two ways to make your reservations at the Washington Court Hotel:

1. By phone: 202-628-2100
2. Online: www.washingtoncourthotel.com

Be sure to ask for the National Council for Community Behavioral Healthcare room block to get our special group rate of $269 per night.
Bookmark the National Council’s Hill Day 2009 web page for the latest Hill Day information – be on the lookout online Hill Day registration, including online appointment scheduling, in the coming months!

We look forward to seeing you in Washington for Hill Day 2009!

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 September 2, the National Council submitted comments on the Centers for Medicare and Medicaid Services (CMS) proposed rule updating payments for hospital outpatient services. The proposed rule, published in the Federal Register on July 18, 2008, includes a rate cut for partial hospitalization program (PHP) per diem payment rates and would create two separate payment rates – one for days with up to three services and one for days with four or more services. 

In August, the National Council has sent several updates to members and association executives on recent policy developments and resources.

Opportunities for contracting with the Department of Veterans Affairs

On June 11, 2008, the VA’s Veterans Health Administration released a new guidance on Uniform Mental Health Services in VA Medical Centers and Clinics. This new guidance outlines the minimum requirements for mental health and addictions services provided by VA medical centers and clinics across the country. In cases where VA medical centers and clinics are unable to meet the expectations outlined, they are encouraged to consider collaborating with outside entities, either through contracting, fee-basis arrangements, or sharing agreements.

Implementation of the Targeted Case Management Moratorium

In early August, the National Council shared several documents related to the implementation of the Targeted Case Management with its association executives:

• The Centers for Medicare and Medicaid Services’ (CMS) August 1, 2008 guidance to States regarding the implementation of the Targeted Case Management moratorium;
• CMS’ new template for state plan amendments;
• A final version of a memo prepared by the Center on Budget and Policy Priorities and Jeff Crowley at Georgetown Health Policy Institute that sets out their understanding of the moratorium; and
• Letter sent August 7, 2008 by Senator Max Baucus (D-MT), Chairman of the Senate Finance Committee, and Representative John Dingell (D-MT), Chairman of the House Energy and Commerce Committee, to CMS clarifying Congressional intent on the application of the intrinsic element/integral component standard that CMS introduced in the Interim Final Rule.   

In August, the National Council released a new issue brief on continuity of care for individuals with mental illness involved in the criminal justice system.

The National Council debuted several new fact sheets at the National Conference of State Legislators’ 2008 Legislative Summit, July 22-26 in New Orleans. Fact sheet topics include:

• Access to addiction treatment for justice involved individuals
• Medication copays in state Medicaid programs
• Mental illness and addictions in state healthcare reform
• Linking addictions treatment to child welfare
• Access to medications for people with mental illness