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Ambassadors Brief: January 2015

In This Issue:

FROM CHUCK’S CHAIR

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Dear National Council Ambassadors,

It’s a new day in D.C., with the new year comes a new Congress, with divided government – Republicans are in control of both the Senate and House with President Obama still in the White House. Like the rest of Washington, we are watching for signs that will help us predict what will and will not happen in 2015 and beyond. Will House Speaker Boehner be able to manage his colleagues? Will new Senate Majority Leader Mitch McConnell develop relationships with moderate Senate Democrats to pass legislation? What will all of this mean to you and the communities you serve?

As always, the stakes are high. And as Ambassadors, you will be uniquely positioned to ensure legislators and staff understand how their choices will impact their constituents. Please stay engaged and watch closely.

I’m looking forward to working with you in the year ahead. Let’s go to work!

Sincerely,

Chuck Ingoglia
Senior Vice President, Public Policy and Practice Improvement


UPCOMING ACTIVITIES

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Ambassadors Network Quarterly Call

When: January 21, 3:00 PM EST
Where:  Register here

Get an insider’s look from the National Council’s Chuck Ingoglia! He will be joining us to kick off the New Year, share our forecast of the challenges and opportunities facing our field and more.

 

Ambassador Talking Points: Monthly Toolkit for Meeting with your Elected Officials

When: Starting January 28 and every month after

Where: Your inbox!

Each month, we’ll provide you with a deep dive into a priority issue to discuss with your elected officials. Ambassador Talking Points will provide you the information you need to set meetings, explain the issues and the materials you can leave behind after your meetings.


Ambassador Spotlight

 

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Congratulations to this month’s outstanding Ambassador, YOU!

As we start this New Year, we wanted to thank each and every one of you for your time and dedication to advocacy through the Ambassador Network.

Your efforts continue to help us advance behavioral health policy and increase the access and quality of behavioral health care for people across the country. 2015 will be a year filled with important health policy decisions and we look to you and your relationships with members of Congress to ensure our success.

Thank you!

 


DISPATCH FROM CAPITOL HILL

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When reconciliation is anything but happy

It’s surprising that a term with so many positive connotations could hold so many perils for behavioral health this year. Yet, the 2015 “budget reconciliation” process could bring forward a host of threats to Medicaid and other programs serving individuals with mental illness and addiction. Why is this yawn-inducing term is so important to our policy efforts this year?

 First, a quick review of the federal budget process. Each year, the President releases his proposed budget in early February. The House and Senate Budget Committees then craft their own budget plan, known as the budget resolution. The budget resolution requires only a majority vote to pass in each chamber, and it cannot be vetoed by the President. Because of this, it cannot change tax or spending law. Instead, it sets spending targets within which the Appropriations Committees must craft their 12 annual spending bills. These 12 bills allocate funding for discretionary spending programs – that is, programs whose funding must be appropriated each year at a level set by Congress (for example, the Substance Abuse and Mental Health Services Administration’s annual budget). Individual appropriations bills can move through the legislative process like any other bill, but more often, multiple spending bills are packaged together to pass both chambers at once.

So where does reconciliation come in? The budget resolution may also include instructions for a reconciliation bill. This is a package of changes that bring national tax and spending law into line with the budget resolution’s overall goals. A reconciliation bill needs only a simple majority vote for passage in the Senate, and because it cannot be filibustered, it’s an attractive vehicle for enacting major changes to Medicaid, Medicare, the tax code and other programs that are not subject to the annual appropriations process.

Wait, explain that again. Why do we care about reconciliation? For two reasons: 1) because the reconciliation bill is designed to enact major reforms to mandatory programs like Medicaid or the tax code; and 2) because it cannot be filibustered in the Senate, making it easier to pass than a typical bill.

Ok, so reconciliation is a fast-track way to pass big changes to important federal programs. Now, what are these threats to Medicaid you mention? A variety of proposals for reforming Medicaid have been put forward over the last few years. Of most concern to our field are proposals to convert Medicaid to a block grant or to impose a per capita cap on federal Medicaid spending.

Currently, states administer their own Medicaid programs and the federal government contributes a share of the total costs incurred, no matter how many enrollees are in the program and no matter how many benefits they use. If Medicaid were converted to a block grant, the federal government would contribute one lump sum to each state for its Medicaid program each year (which states would supplement with their own funding). States would then be permitted greater flexibility in enrollment and benefit design so as to be able to keep their costs within the scope of the total lump sum.

Under a per capita cap scenario, the federal government would provide a specified annual contribution to each state per Medicaid enrollee. This would still allow enrollment to grow as needed, but would not account for other cost drivers within the system, such as new technology or greater use of services.

Both types of financing reform put severe pressure on states to lower costs within their Medicaid programs – and past experience shows that cuts to provider pay, enrollee benefits and formulary coverage are some of the first places states look to cut when budget pressures emerge.

Is this a real threat? How often does a reconciliation bill actually pass? The use of reconciliation is not rare. In fact, it was used to pass substantial portions of the Affordable Care Act when Democrats controlled Congress and was used as the vehicle for the President George W. Bush-era tax cuts when Republicans were in charge. Because control of Congress has been divided over the last four years, reconciliation was not a viable legislative option. Now that we are back to single-party control, it could become more likely. However, the fate of any possible reconciliation bill remains in doubt, as the President has the authority to veto it.

What can I do about it? For now, hold tight. We’re still waiting for details to emerge about how and if congressional leadership will opt to use reconciliation this year. The National Council will be the first to update you when any threats to Medicaid materialize. Stay tuned to the Ambassadors Brief, Capitol Connector and emails from us with the latest opportunities to take action!


STATE OF PLAY

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Mental Health Parity and Addiction Equity Act. Proposed rules for the mental health parity law are now at the Office of Management and Budget (OMB). Approval from OMB is the last stop before the regulations are issued. We expect the regulation will be released soon. Earlier this month, the National Council’s Chuck Ingoglia was quoted in a Washington Post article discussing the challenges to accessing mental health services despite the parity law.

2015 Appropriations. In December, President Obama signed a $1.1 trillion spending bill, funding most of the government through September 30, 2015. In this year’s difficult funding environment, Congress largely preserved funding for important priorities such as the Substance Abuse Prevention and Treatment Block Grant, Primary-Behavioral Health Care Integration and Mental Health First Aid. To see the National Council’s chart comparing 3-year funding levels for selected SAMHSA, NIH and criminal justice programs, please click here.

Mental Health First Aid. The Mental Health First Aid Act is set to be reintroduced this month. The National Council is working with Congresswoman Lynn Jenkins (R-KS) and Senator Kelly Ayotte (R-NH) to reintroduce the bipartisan legislation from the 113th Congress. The bill authorizes $20 million in grants to organizations for training emergency services personnel, teachers/school administrators, primary care professionals, students, and police officers in Mental Health First Aid. Read more on Mental Health First Aid here.

Excellence in Mental Health Act.  In a public meeting last week, SAMHSA Administrator Pam Hyde shared that SAMHSA is aiming to have criteria for becoming a Certified Community Behavioral Health Center (CCBHC) published in the Federal Register in February for public comment. They are also working toward releasing the state planning grant RFA by May 1. Please stay tuned for more updates.


ADVICE AND COUNSEL

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Welcome to the 114th Congress!

The new Congress is underway and moving fast out of the gate with action on issues from Social Security Disability Insurance to veterans’ mental health. This fast pace is set to continue when the President’s budget is presented to Congress on February 2. Now is the time to start building those relationships that will be so critical over the next two years! Here’s how to get started.

Remember, as a National Council Ambassador, we need you to meet with your elected officials at least three times a year.  This Congress will provide plenty of opportunities for you to have a major impact. Be sure to check out our legislative preview for 2015, highlighting the top five health policy issues of the year. Your relationships give us the extra push we need when these votes come down to the wire.

To help you get started, here is our Post Election Toolkit. This set of materials is designed to make it easy for you to reach out to your elected official and invite them to tour your facility and/or sit down with you and your colleagues for a meeting. After you have these meetings, be sure to send us your feedback so we can follow up with their staff back here in DC!


BRIEFLY NOTED

briefly-noted-webHere are a few thought-provoking articles and resources that we’ve come across recently.  Happy reading!

Senate Majority Leader Mitch McConnell (R-KY) Finds His Go-To Democrats – Republicans have a 54-seat majority in the Senate – six votes short of overcoming Democratic filibusters and getting most legislation on President Obama’s desk. Leader McConnell is on the hunt! Find out who he is looking to partner with here.

GOP Aims to Find Middle Ground – As Republicans take control of both chambers of Congress they will be faced with a difficult task: tackling some of the biggest issues without exaggerating tensions from the left and the right. “Mr. McConnell is betting that running the Senate with a looser hand will defuse tensions and make it easier to find deals where he can.” Read more.

The Honeymoon is Over; the Real Work Begins Now – GOP leadership has big plans for the 114th Congress, but they also have big obstacles to overcome: “the legislative land mines range from tricky transportation issues to funding controversial slices of the government, to updating a pricey Medicare program and, of course, the ever-explosive debt ceiling.” Read the GOP game plan for 2015.

 

 

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