Public Policy Update: September 29, 2011
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September 29, 2011
House, Senate Committees Draft Competing 2012 Health and Human Services Budgets; Include Cuts to SAMHSA, Second Chance Act
The Senate Appropriations Committee has voted to approve its version of the 2012 Labor-HHS-Education budget bill, which includes a $27 million reduction to the Substance Abuse and Mental Health Services Administration (SAMHSA). Of note among the line items in the Senate committee-approved bill:
- Center for Mental Health Services: $970.6 million (a $7 million reduction from FY 11)
- Primary Care-Behavioral Health Integration: $62.8 million (level to FY 11)
- Community Mental Health Services Block Grant: $420 million (level to FY 11)
- Center for Substance Abuse Treatment: $2.194 billion (a $5 million increase from FY 11)
- Screening, Brief Intervention, and Referral to Treatment: $53.2 million
- Center for Substance Abuse Prevention: 186.3 million (level to FY 11)
Meanwhile, the House Appropriations Committee has issued a draft version of the Labor-HHS-Education bill. The draft would reduce SAMHSA funding by $283 million. It also level-funds the Community Mental Health Block Grant, includes $2.16 billion for the Center for Substance Abuse Treatment ($34 million less than the Senate version), and $118.9 million for the Center for Substance Abuse Prevention ($67.4 million less than the Senate version). The draft has not been approved by the House Appropriations Committee but may offer a competing platform for negotiations as the House and Senate work to reconcile their budget bills.
In related FY 2012 budget news, the Senate Appropriations Committee has approved its version of the Commerce-Justice-Science budget bill, which includes the complete elimination of Second Chance Act funding. The Second Chance Act supports state and local programs that reduce recidivism and coordinate reentry services, including mental health and drug abuse treatment services. In contrast, the House-passed version of this appropriations bill includes $70 million for Second Chance Act programs. The National Council has signed on to a letter to Congress urging lawmakers to support to House level of appropriations for these programs. In addition, the Legal Action Center has issued an action alert urging individuals to contact their Members of Congress in support of Second Chance Act funding. Click here to view the alert and take action.
With Fiscal Year 2012 set to begin Oct. 1, the House and Senate this week agreed to a short-term bill that will keep the government operating until both chambers are able to reach agreement all of the 2012 budget bills.
Members of the Joint Select Committee on Deficit Reduction this week refused to release details on the progress of their talks to produce $1.2-1.5 trillion in federal budget savings. After a closed meeting on Tuesday, Members would say only that they had received briefings from budget experts and that they were making progress. So far, the Committee has held three public meetings and four private ones. As the Capitol Hill publication Roll Call noted this week, the conventional wisdom around difficult congressional negotiations holds that the more lawmakers and aides keep quiet, the more productive the negotiations are.
The Committee’s refusal to discuss the details of its discussions left Medicaid and healthcare advocates in the dark about potential changes to health programs that might impact states, providers, and consumers. As noted previously in the Public Policy Update, several proposals to overhaul Medicaid could be on the table, including converting Medicaid to a block grant, creating “blended” federal match rates for each state, and repealing health reform’s Maintenance of Effort requirements. In addition, Representative Paul Ryan this week urged Congress to reconsider his plan for cutting healthcare spending by (among other things) converting Medicare to a system of premium support payments that seniors would use to shop for private insurance on a Medicare exchange. Should the debt negotiations fail, Medicaid would be protected from the automatic budget cuts that would be triggered beginning in 2013. However, Medicare provider payment and federal discretionary spending on other healthcare programs would be at risk in such a scenario.
If you have not already done so, click here to read the National Council’s full analysis of the impact that the deficit negotiations could have on behavioral health providers and find out what you can do today to prevent losses to behavioral health funding. The consumer group Families USA has also released new resources for advocates in the ongoing deficit committee negotiations. Visit Families’ “Keeping an Eye on the Super Committee” website to view reports on the issues at play in the negotiations and sample advocacy activities that you can engage in to influence the outcome of the talks.
The Centers for Medicare and Medicaid Services (CMS) announced Wednesday the launch of a new initiative to support comprehensive primary care and improve the coordination of primary and specialty care. The four-year demonstration project will test payment and delivery system reforms that promote teamwork across the “medical neighborhood,” with a particular focus on preventive care and management of chronic disease.
Five to seven healthcare markets will be selected for the demonstration, which requires cooperation and participation from both public and private payers in each market. Participating provider organizations will receive an extra $20 per Medicare beneficiary per month to support the cost of providing care management, improved access to care, coordination and continuity of services, and patient/caregiver engagement. Eligible entities are limited to payers (who may be commercial insurers, state Medicaid programs, managed care plans, or others). In turn, payers must agree to establish special contracts with primary care practices for the purposes of the project. Payer participants will be selected for their participation in community-based systems of multiple stakeholders.
Initial letters of intent are due by November 15, with a final application deadline of January 17. For more information, visit the Comprehensive Primary Care Initiative website.
The Centers for Medicare and Medicaid Services this week announced it is extending the public comment period on its proposed rulemaking for the establishment of state health insurance exchanges. Under the Affordable Care Act (ACA), the exchanges must be operational by January 1, 2014. However, the ACA did not fully elaborate all federal requirements for the design and operation of exchanges.
The current proposed regulation comes after three previous opportunities for individuals and organizations to submit comments to the Department of Health and Human Services (HHS) on how the exchanges should be structured. This proposed rule: (1) Sets forth the Federal requirements that States must meet if they elect to establish and operate an Exchange; (2) outlines minimum requirements that health insurance issuers must meet to participate in an Exchange and offer qualified health plans; and (3) provides basic standards that employers must meet to participate in the Small Business Health Options Program. HHS stated that its intent with this proposed rule is to afford States substantial discretion in the design and operation of an Exchange. Click here to view the proposed regulation.
The National Council has reviewed the proposed Exchange regulation and is preparing comments. When our comments are finalized, we will disseminate them as a template for other interested organizations to use as their basis of their own comments. Stay tuned to the Public Policy Update and other National Council communications to see the comment template. Comments are now due by Oct. 31, 2011.
On Thursday, October 27 from 12:30-2:00 pm eastern time, CMS will hold a National Provider Call to discuss the revalidation of Medicare provider enrollment information. Most providers and suppliers who are enrolled in the Medicare program will have to revalidate their enrollment, which will be reviewed under the new risk screening criteria required by the Affordable Care Act Section 6401(a). The call will cover what you can expect and how to prepare for this process. The agenda will include:
- What is Revalidation?
- ACA Screening Requirements
- Electronic Funds Transfer
- Streamlining the Process
- Phased Revalidation
- Tips on Revalidation
- Question and Answer Session
Information on how to register for the call will be made available soon on the CMS website. More information about provider enrollment revalidation is available in the Medicare Learning Network’s article “Further Details on the Revalidation of Provider Enrollment Information.”
The National Council for Community Behavioral Healthcare, in partnership with MTM Services and Hazelden, is pleased to announce the launch of the Co-Occurring Disorder Learning Community. This exciting initiative is an opportunity for mental health and substance use organizations to improve care for individuals with co-occurring mental health and substance use disorders. Through this learning community, participating organizations will enhance their ability to provide effective integrated and comprehensive care.
Key elements of the Co-Occurring Disorder Learning Community include:
- Access to curriculum and leading experts in the integrated treatment of co-occurring disorder treatment and organizational change management
- Baseline and follow-up administration of a co-occurring treatment capacity assessment: the Dual Diagnosis Capability in Addiction Treatment (DDCAT) and the Dual Diagnosis for Mental Health Treatment (DDCMHT)
- Implementation of a Rapid Cycle Change quality improvement process which will provide goals and action steps to address co-occurring disorder service delivery capacity needs
Organizations will be chosen for participation by the National Council through a competitive application process. Participating organizations will agree to contribute $5,000 per site. For more information, please review the application packet.
Applications must be submitted to Laira Kolkin (lairak@thenationalcouncil.org) by 5:00 PM, Eastern time on October 14, 2011. Please contact Laira Kolkin with any questions about the application process.
As healthcare payment and delivery reforms are implemented in your state, more people than ever before will have access to treatment for mental health and addiction services through expanded public and private insurance coverage. Specialty behavioral healthcare organizations must expand capacity to meet increased demand and offer measurable, high-performing prevention, early intervention, recovery, and wellness services and supports. We must also be ready to work with new Medicaid systems and to bill through the new health insurance exchanges, adapting to healthcare environments that demand greater accountability, increased efficiency in service delivery, and reduced variations in care.
As organizations prepare for what’s ahead, it’s critical to identify priority areas to focus on in a strategic manner. To facilitate this, the National Council and MTM Services have jointly created a Healthcare Reform Provider Readiness Assessment. Join us on September 30th from 2:00-3:30 pm eastern time to hear from the founder of MTM Services, David Lloyd, who will provide contextual commentary and walk us through the basics of the readiness assessment. Registration is available online.
A free report on the provider readiness assessment is available here. To purchase an online readiness assessment survey customized to your organization (National Council member price: $100, Guest price: $150), go to our online store.
