Public Policy Update: September 30, 2010
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September 30, 2010
The National Council would like to thank our members who responded to last week’s action alert by contacting your Senators in support of S. 3709, the Health IT Extension for Behavioral Health Services Act. Since the alert was issued last week, two additional cosponsors have signed on to the bill: Sen. Robert Menendez (D-NJ) and Sen. Olympia Snowe (R-ME). Both Sens. Snowe and Menendez are on the Senate Finance Committee, which has jurisdiction over health information technology incentive payments. Your advocacy makes a difference! The total number of cosponsors in the Senate is now up to 9, and 79 Representatives have signed on to the House version (HR 5040). If you have not already done so, please reach out to your Senators today and urge them to sign on to S. 3709!
The Patient Protection and Affordable Care Act (ACA) enacted changes to Section 1915(i), the Medicaid home- and community-based services (HCBS) option, which are designed to expand beneficiaries’ access to these services. The ACA established a new state Medicaid option by which states can offer HCBS to individuals who otherwise would require the level of care provided in an institution and broadens the allowable range of HCBS that may be covered. These provisions take effect on Friday, October 1, 2010.
In August, the Centers for Medicare and Medicaid Services released a letter to state Medicaid directors providing details on how the new provisions will be implemented for states choosing to take advantage of the new option. Effective Oct. 1:
- Individuals no longer have to meet an institutional level of care requirement in order to qualify for HCBS.
- States may provide a broadly defined range of community-based services to persons with chronic mental illnesses and/or substance use disorders.
- States may provide these community-based services to persons whose incomes are 300% of the SSI income benefit.
- Benefits can be targeted to specific population groups or specific functional needs groups without violating Medicaid’s comparability requirements – this means a state could target persons with chronic mental illnesses, for example.
On Tues, Oct. 12 from 2:00-3:30 eastern time, the Bazelon Center for Mental Health Law will host a webinar to provide information on Section 1915(i), discuss its relevance to state mental health systems today, and explore its implications for the new group of eligible individuals who will come into the expanded program in 2014. The webinar will provide detailed information on issues relating to eligibility, services and plan requirements. Registration and additional details are available online.
The National Council has won a competitive grant from the Department of Health and Human Services (HHS) to establish the National Training and Technical Assistance Center for Primary and Behavioral Healthcare Integration. The Center is funded jointly by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources Services Administration (HRSA) and will provide training and technical assistance to 56 community-based mental health and addictions treatment organizations that have collectively been awarded more than $34 million in grants for the co-location of primary care services in behavioral health settings. These grants are designed to address the comprehensive health needs of patients with mental illnesses and/or substance use disorders by improving the coordination of healthcare services in publicly funded community settings. The co-location grant program was created in 2009 with the strong support of the National Council.
As states, health providers, and insurance agencies prepare for the implementation of the Affordable Care Act, one of the crucial elements they will encounter is the application of the Wellstone-Domenici Mental Health Parity and Addictions Equity Act to insurance plans in a health reform environment. The Obama Administration this year issued regulations detailing how insurance plans must comply with parity, but many providers and consumers are not yet aware of how the law will change the benefits to which they are entitled – and insurance plans are still evaluating how they will redesign benefits packages to comply with the new requirements.
In this process, it is crucial for mental health providers and consumers to know how to respond to possible violations of the parity law. One issue that may frequently arise is a situation in which a plan refuses to cover or reimburse for a type of mental health or substance use treatment because there is no analogous medical/surgical treatment – for example, residential treatment for psychiatric or substance use disorders, intermediate levels of care such as assertive community treatment, or office-based diagnostic and treatment interventions like psychotherapy. Is this a violation of the parity law? Click here to view the answer to this and other frequently asked parity questions from the Parity Implementation Coalition, of which the National Council is a member.
The Centers for Medicare and Medicaid Services has made available a series of fact sheets offering detailed information and guidance on how providers may take advantage of federal incentive payments for the adoption of heath information technology. These fact sheets include a flow chart to help Medicare and Medicaid providers determine whether they are eligible to receive payments and a document with answers to frequently asked questions about the program. Question 15 from the FAQ document addresses eligibility for providers working in mental health or long-term care facilities:
“The setting in which a physician, nurse practitioner, certified nurse midwife, or dentist provides care is generally irrelevant to determining eligibility for the incentive program (except for purposes of determining whether an EP can qualify through “needy individual” patient volume). Setting is relevant for physician assistants, as they are eligible only when they are practicing at a Federally Qualified Health Center (FQHC) that is led by a PA or a Rural Health Center (RHC) that is so led. All providers must meet all program requirements prior to receiving an incentive payment (e.g. adopt, implement or meaningfully use certified EHR technology, patient volume, etc.).”
Additional fact sheets and other resources from CMS on the EHR incentive program are available online.
The Centers for Medicare and Medicaid Services has announced the release of several new tools and resources to prevent fraud, waste, and abuse in Medicare, Medicaid, and CHIP. These include:
- A fact sheet with information on the provisions of health reform relating to fraud and abuse
- A fact sheet with information on recently published regulations outlining how CMS will fight fraud and abuse
- A brochure informing Medicare beneficiaries of ways to protect their identity and personal information from fraud
CMS anticipates that the new fraud prevention tools and resources enacted in the Affordable Care Act will improve the government’s ability to identify and prevent fraud. You can read the full text of the CMS fraud-prevention regulations here.
Check out the National Council’s healthcare reform blog for the latest news about reform implementation, along with resources to help you learn about the law and take advantage of its many provisions. New this week on MentalHealthcareReform.org:
- Sept. 23 Coverage Milestones: Your Questions Answered
- Health Reform’s Implications for Behavioral Health Providers: Sept. 21 Webinar with SAMHSA
- And much more!
