Capitol Connector

Shelley Starkey

The Trump administration on Wednesday officially published a final rule from the Department of Homeland Security (DHS) that greatly expands the definition of “public charge” when considering immigrants’ applications to enter or become permanent residents of the United States. This rule has already had a chilling effect on lawfully present immigrants utilizing public assistance programs for which they are eligible, including Medicaid, for fear of being denied the chance to stay in the United States. The National Council stands strongly opposed to this rule, which will result in significant harm to the health and welfare of immigrant families.

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Michael Petruzzelli

Director, Federal Policy and Advocacy

New legislation introduced in Congress this week would expand access to telemedicine for mental health and substance use disorder treatment. The Improving Access to Remote Behavioral Health Treatment Act of 2019 (S. 2244/H.R. 4131) would amend regulations for the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 and specifically name community mental health centers and addiction treatment centers as eligible sites to prescribe controlled substances via telemedicine.

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Michael Petruzzelli

Director, Federal Policy and Advocacy

On Tuesday, the House approved a short-term extension of the Certified Community Behavioral Health Clinic (CCBHC) demonstration in Medicaid. The legislation now heads to the White House for President Trump’s review and signature. The bill would extend the program until Friday, September 13, 2019. This extension is yet another legislative victory for the CCBHC program and one on which we will look to build momentum for a long-term extension and expansion in the fall. The National Council thanks Congress and the countless advocates whose work has expanded access to high-quality, community-based treatment through the CCBHC program.

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Rebecca Farley David, VP, Policy & Advocacy

Sara Howe, CEO, Illinois Association for Behavioral Health

The National Council for Behavioral Health Board of Directors has determined to support the bipartisan Mainstreaming Addiction Treatment (MAT) Act (H.R. 2482), which would expand access to medication-assisted treatment, the “gold standard” of addiction treatment when prescribed in conjunction with regular counseling. The National Council thanks the bill authors Reps. Paul Tonko (D-NY), Antonio Delgado (D-NY), Ben Ray Luján (D-NM), Ted Budd (R-NC), Elise Stefanik (R-NY) and Mike Turner (R-OH) for their work on this critical issue.

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Malka Berro

Policy Associate

Late last month, a federal judge upheld a Trump Administration regulation to allow the sale of bare-bones, short-term health plans that are exempt from critical health coverage provisions in the Affordable Care Act (ACA). The 2018 regulation, which went into effect in August that year, promotes the sale and allows for an extended duration of these short-term plans. These plans will continue to be sold in direct competition with ACA-compliant marketplace plans.

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Shelley Starkey

Congressional leaders and White House officials reached a sweeping deal on Monday that would address pressing deadlines for the federal debt ceiling and budgetary spending caps. The Bipartisan Budget Act (H.R. 3877) represents the largest-ever increase in base funding above sequestration levels for both defense and nondefense spending. The deal also effectively ends the threat of sequestration – a mandatory automatic spending cuts put in place in 2011.   The House passed the bill on Thursday, and the Senate is expected to hold its vote next week.

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Katiri Zuluaga

Manager, State Initiatives

More than 50 percent of incarcerated individuals in the U.S. meet criteria for substance use disorder (SUD), including opioid use disorder (OUD). Last month, Senators Edward Markey (D-MA) and Lisa Murkowski (R-AK) introduced a bill to increase treatment for OUD among incarcerated individuals and address the issue that inmates are 40 times more likely to die from a fatal opioid overdose in the first two weeks following release. The Community Re-Entry through Addiction Treatment to Enhance (CREATE) Opportunities Act (S. 1983) would establish a grant program to provide more medication-assisted treatment (MAT) options while incarcerated and continued access to care upon release.

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Malka Berro

Policy Associate

On Tuesday, the Bipartisan Opioid Task Force held a roundtable discussion on an increasing threat within the opioid epidemic: fentanyl and other synthetic opioids. Synthetic opioids are the leading cause of overdose deaths in the United States, causing over 28,000 deaths in 2017. The roundtable meeting focused on expanding the behavioral health workforce, new criminal justice interventions, innovative pharmacological treatments, and recently proposed legislation.

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Shelley Starkey

Congress has the authority to review and overturn Trump Administration guidance on state innovation waivers according to a report released this week by the Government Accountability Office (GAO). The guidance from the Department of Health and Human Services (HHS), issued last October, relaxed requirements around Section 1332 waivers, the Affordable Care Act’s (ACA) vehicle for states to make changes to their individual insurance markets. GAO’s opinion states that the guidance is subject to review by Congress and can be overruled with a simple majority vote in both chambers.

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Ranjani Sudarsan

Intern, Policy and Practice Improvement

Last week, the Partnership for Medicaid, a nonpartisan advocacy coalition including the National Council, hosted a congressional staff briefing to discuss and unravel some of the most common misconceptions about the Medicaid program and its beneficiaries. The briefing focused specifically on individuals who receive health care via Medicaid and its impact on their lives. The diverse panel of speakers provided an overview of how millions of Americans benefit from the Medicaid program and how Medicaid expansion has led to increases in coverage, access to care and improved health outcomes for beneficiaries.

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Shelley Starkey

The Campus Prevention and Recovery Services for Students Act of 2019 (H.R. 3591), introduced late last month, would help institutions of higher education support students experiencing substance use disorder (SUD). The bill aims to implement evidence-based programs, promote collaboration between schools and state treatment agencies, and encourage integration between primary care, mental health and SUD services in campus-based health centers. The National Council applauds Representatives David Trone (D-MD), Dusty Johnson (R-SD), Chris Pappas (D-NH), John Joyce (R-PA), Lucy McBath (D-GA), and Michael Guest (R-MS) for their leadership on this issue.

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Shelley Starkey

Policy & Advocacy Coordinator

Last week, the House passed its fiscal year 2020, Defense-Labor, Health and Human Services, Education (Labor-HHS) appropriations bills, which include funding for federal mental health and addiction programs. The $1 trillion package would prioritize funding to address the opioid crisis and increase medical research. The minibus passed largely along party lines and is unlikely to pass the Republican-controlled Senate as currently written. Importantly, Congressional leaders from both parties and President Trump will need to work out a larger deal to lift impending budget caps before September 30th, 2019 for any spending bill to become law.

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Shelley Starkey

The Department of Veterans Affairs (VA) this week announced improvements to the way the agency collaborates with non-VA, community health providers by ending the Veterans Choice Program and establishing a new Veterans Community Care Program. The new changes aim to provide better access to high-quality health care for the 9 million veterans served by the VA by expanding eligibility for community care, providing a new urgent care benefit, and modernizing and streamlining certain processes.

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Wendolyn Ebbert

Intern, Policy & Practice Improvement

On Tuesday, the MAPRx Coalition, which includes the National Council, hosted a Congressional staff briefing featuring a panel of advocates representing the AIDS Institute, the American Cancer Society, the National Council on Aging and Avalere Health. Speakers provided an overview of how Medicare Part D offers access to prescription drugs and the need for legislation that would place a cap on out-of-pocket costs for these medications. Currently, costs for medications that treat life-threatening illnesses such as cancer, HIV/AIDS, autoimmune diseases, which often co-occur with mental illness and substance use disorder, amount to tens of thousands of dollars per year per person. If Congress does not act, these expenses are set to increase in 2020, having a devastating impact for over 1 million Medicare enrollees.

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Wendolyn Ebbert

Intern, Policy & Practice Improvement

On Tuesday, the House voted to pass the “Empowering Beneficiaries, Ensuring Access, and Strengthening Accountability Act of 2019 (H.R. 3253),” which would extend funding for certain Medicaid programs. Under the provision, funding for the eight-state Certified Community Behavioral Health Clinic (CCBHC) demonstration program would be extended for another two and a half years until December 21, 2021. There was overwhelming bipartisan support of H.R. 3253, passing with a vote of 371-46. The bill must now go to the Senate for a vote before the CCBHC demonstration program expires on June 30th, 2019.

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Wendolyn Ebbert

Intern, Policy & Practice Improvement

On Tuesday, Mary-Catherine Bohan of Rutgers University Behavioral Health Care (UBHC), a National Council member and Certified Community Behavioral Health Clinic, testified before the House Energy and Commerce Subcommittee on Health in support of the Excellence in Mental Health and Addiction Treatment Expansion Act (S. 824/ H.R. 1767). The legislation would extend the Certified Community Behavioral Health Clinic (CCBHC) Medicaid demonstration program in its original eight states for two years and expand the program to 11 other states that applied but were not originally selected. The CCBHC program is set to expire on June 30th, 2019 if Congress does not act. 

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Shelley Starkey

Both the House and Senate have released bipartisan proposals in the last week to lower out-of-pocket health care costs across the country. The Senate Health, Education, Labor, and Pensions (HELP) Committee has released a sweeping proposal to address surprise medical billing, increase transparency within the health care industry, and bring down drug costs. Meanwhile, leaders of the House Ways and Means and Energy and Commerce Committees are seeking input on draft legislation to cap out-of-pocket costs under Medicare Part D, the program’s prescription drug benefit.

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Stephanie Pellitt

, National Council for Behavioral Health

Earlier this week, Senator Elizabeth Warren (D-MA) and Representative Joe Kennedy III (D-MA) reintroduced the Behavioral Health Coverage Transparency Act (H.R. 2874/S. 1576) with the aim of strengthening Americans’ access to mental health and substance use disorder (SUD) treatment. Specifically, the bill would increase oversight and enforcement of the federal parity law, which requires that insurance coverage of mental health and SUD services be equal to the coverage of medical and surgical health services. 

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Michael Petruzzelli

, National Council for Behavioral Health

On Thursday, the National Council hosted nearly 100 advocates from 16 states to build support for legislation to extend and expand the Certified Community Behavioral Health Clinic (CCBHC) demonstration program in Medicaid. The Excellence in Mental Health and Addiction Treatment Expansion Act (S. 824/ H.R. 1767) would extend the demo in the original eight states for two years, while expanding the program to the other 11 that applied but were not originally selected. The CCBHC program will expire on June 30, 2019 without Congressional action.

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Shelley Starkey

The Centers for Medicare and Medicaid Services (CMS) released a final rule on Thursday aimed at addressing rising drug prices and out-of-pocket expenses under Medicare Part D and Medicare Advantage. Notably, the final rule did not include previously-proposed measures that would have provided exceptions to Medicare’s “six protected classes,” a policy that ensures beneficiaries with complex health conditions, including mental illness, have access to a full range of medication treatment options. The announcement comes after six months of opposition to the proposals from Members of Congress and patient and provider advocates, including the National Council for Behavioral Health.

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