Senate Passes Medicare Bill to Fix Physician Payment Rate, Includes Medicare Parity, Expands Eligibility in Medicare’s Tele-Health Program to CMHCs

FY 2009 Appropriations Update: House Appropriations Bills on Hold

House Passes Bill Aimed at Stopping Abuse of Teens in Residential Programs; Amendment May Affect Psychiatric Residential Facilities

Bill to Reauthorize Juvenile Justice and Prevention Act Introduced in the Senate

Contact Your Representatives Today In Support of Legislation to Strengthen Community Behavioral Healthcare!

Recently Released Resources from the National Council

Senate Passes Medicare Bill to Fix Physician Payment Rate, Includes Medicare Parity, Expands Eligibility in Medicare’s Tele-Health Program to CMHCs

On July 9, the Senate passed a bill to block the 10.6 percent cut to Medicare physician payment rate, set to go into effect on July 1, 2008. Most importantly, the bill (HR 6331) also ends Medicare’s discriminatory 50 percent outpatient copayment for mental illness and addiction treatment and would achieve parity with other medical/surgical conditions in a phased-in plan over a number of years. The National Council has advocated for this provision as a member of the Medicare Equity Coalition. HR 6331 passed by voice vote after the Senate passed a key procedural vote by a margin of 69-30. To see how your Senator voted, click here.  The National Council thanks all members who made calls in support of this important bill!

Senator Edward Kennedy (D-MA), who is recovering from brain tumor surgery and had not been to the Capitol for more than a month, returned to the Senate floor to applause to cast his vote in support of HR 6331. “I’m glad to be back in the Senate. It’s enormously important,” Senator Kennedy said in a quote reported by CQ Today. “I didn’t want to miss the opportunity to be able to express my voice and my vote.”

Introduced by Representative Charles Rangel (D-NY) on June 20, HR 6331 would block the 10.6 percent cut to physician payment rates under Medicaid. Instead, it would give physicians a 0.5 percent increase in payments in 2008, followed by an additional 1.1 percent increase to payment rates in 2009.

The bill would make several other important changes to Medicare, including:

• Improving the Part D prescription drug program by limiting out-of-pockets costs for so-called dual eligibles - individuals who are eligible for both the Medicare and Medicaid programs; and
• Expanding access to mental health care in rural America by making Community Mental Health Centers eligible to participate in the Medicare tele-health program. The National Council advocated for the inclusion of this language in S 3101 and will continue to work to build support for this provision.

In addition, Section 121 of HR 6331 incorporates the Relief for Rural Veterans in Crisis Act of 2008 (S 3095), introduced by Senators Baucus and Jon Tester (D-MT) on June 5, 2008. This provision would expand Medicare’s existing Rural Hospital Flexibility program to enable states to apply for $100 million in grant funding to increase the ability of rural hospitals and clinics to provide mental health services to veterans returning from Iraq and Afghanistan.

On June 24, the House passed HR 6331 by a vote of 355-59. To see how your Representative voted, click here.

On June 26, the Senate failed to pass HR 6331 by the necessary 60 vote margin needed under the unanimous consent agreement that brought the bill to the Senate floor.

In a notice sent to Congress on June 27, the Centers for Medicare and Medicaid Services (CMS) said it would hold physicians’ new claims for 10 business days, giving Congress until July 15 to pass a bill addressing the payment rate issue.

Following last night’s vote, the Bush Administration reiterated its opposition to the bill. Look for updates on this important legislation in future editions of the Public Policy Update.

FY 2009 Appropriations Update: House Appropriations Bills on Hold

While Congress has returned to session following the Fourth of July recess last week, House action on the FY 2009 spending bills remains on hold. According to a report in CQ Today, House Democrats said they had no plans to hold any committee meetings or bring any spending bills to the floor this week. Representative David Obey (D-WI), Chairman of the House Appropriations Committee, said he does not intend to hold further full committee markups on any of the FY 2009 spending bills unless Republicans agree to follow “regular order.”

Work on the FY 2009 Labor, Health and Human Services (HHS), Education and Related Agencies bill came to a halt in the House on June 26 when Representative Jerry Lewis (R-CA) offered the FY 2009 Interior-Environment spending bill as a substitute amendment to the Labor-HHS bill. Republican members of the House want to offer an amendment to the Interior-Environment spending bill that would allow for more offshore oil drilling. It is unclear when work will resume on any of the FY 2009 spending bills in the House. Look for updates on the appropriations process in future editions of the Public Policy Update.

Before adjourning for the Fourth of July recess, both the House and Senate Appropriations Committees marked up their respective FY 2009 Commerce-Justice-State spending bills. The Senate Appropriations Committee also marked up its FY 2009 Labor-HHS bill. The National Council has prepared a chart comparing FY 2009 proposed funding levels to FY 2008 and FY 2007 levels. To see this chart, click here. To see the National Council’s fact sheet on addictions appropriations, including field requests for specific programs, click here.

House Passes Bill Aimed at Stopping Abuse of Teens in Residential Programs; Amendment May Affect Psychiatric Residential Facilities

On June 25, the House passed a bill designed to prevent child abuse and neglect at public and private residential programs, such as therapeutic boarding schools and wilderness or boot camps, that are focused on serving teens with mental health and substance use disorder treatment needs. The bill passed by a vote of 318-103. To see how your Representative voted, click here. 

Introduced on June 24 by Representative George Miller (D-CA), the Stop Abuse in Residential Programs for Teens Act of 2008 (HR 6358) incorporates earlier similar legislation (HR 5876) also introduced by Representative Miller on April 23, 2008. HR 6358 was drafted in response to a series of reports released by the Government Accountability Office (GAO) in April and May of 2008 detailing reported incidents of abuse and neglect of teens in these types of residential programs. The bill would create new national standards for private and public residential programs, require the Department of Health and Human Services to conduct unannounced site inspections of facilities every two years and impose civil penalties for violations, and provide grants to states to develop individual state standards.

During consideration of HR 6358, a manager’s amendment was added to the bill that adds psychiatric residential facilities to the list of types of facilities it would affect. The National Council is concerned that this amendment means HR 6358 may apply to residential facilities that are already licensed, regulated, and accredited.

The National Council continues to work with Congressional offices to understand the impact of this bill, to educate them about the implications of over-regulation, and to modify the bill accordingly. Look for updates on this legislation in future editions of the Public Policy Update.

Bill to Reauthorize Juvenile Justice and Prevention Act Introduced in the Senate

On June 18, Senators Patrick Leahy (D-VT), Arlen Specter (R-PA), and Herb Kohl (D-WI) introduced legislation to reauthorize one of the main federal laws dealing with juvenile justice issues.

The Juvenile Justice and Delinquency Prevention Reauthorization Act of 2008 (S 3155) would reauthorize the Juvenile Justice Prevention Act, which provides states and localities with federal supports and standards for improving juvenile justice and delinquency prevention practices.

The bill would make several important improvements, including:

• Extending the jail removal and sight and sound requirements to keep youth awaiting trial in criminal courts out of adult lock-ups under certain circumstances;
• Allowing states to place youth convicted in adult court in juvenile facilities without jeopardizing federal funding;
• Improving assessments and treatments for youth with mental health issues and substance use disorders; and
• Creates incentive grants aimed at expanding evidence-based and promising intervention and prevention programs.

S 3155 has been referred to the Senate Judiciary Committee, and it is expected to be considered on July 17. The National Council supports passage of S 3155, particularly its inclusion of  language to promote alternatives to detention, improve assessments and treatments for mental health and substance use, and improve case management and transitional care for youth upon re-entry. We will continue to keep you updated on its progress. 

Contact Your Representatives Today In Support of Legislation to Strengthen Community Behavioral Healthcare!

Executive Summary: On January 29, Representatives Gene Green (D-TX) and Timothy Murphy (R-PA) introduced the Community Mental Health Services Improvement Act (HR 5176) in the House. HR 5176 calls for the co-location of primary care services in community mental health settings and to support innovative programs for mental health workforce recruitment and retention. The National Council needs your help securing co-sponsors for the Community Mental Health Services Improvement Act in the House of Representatives - contact your Representative today in support of HR 5176!

Action Needed: The National Council urges all members to contact their Representative and ask them to sign on as a cosponsor of HR 5176.  To find your Representative and his or her fax number, go to: www.house.gov.  

Currently, 13 Representatives have signed on as cosponsors:

• Representative Bruce Braley (D-IA)
• Representative Andre Carson (D-IN)
• Representative Yvette Clarke (D-NY)
• Representative Jerry Costello (D-IL)
• Representative Lloyd Doggett (D-TX)
• Representative Ruben Hinojosa (D-TX)
• Representative Sheila Jackson-Lee (D-TX)
• Representative Eddie Bernice Johnson (D-TX)
• Representative James McGovern (D-MA)
• Representative Michael McNulty (D-NY)
• Representative Donald Payne (D-NJ)
• Representative Ciro Rodriguez (D-TX)
• Representative Robert Wexler (D-FL)

Thank you to National Council members who reached out to these Representatives in support of HR 5176!

A model letter, to be placed on your agency’s letterhead, is available online. There are two templates: one for associations and one for individual agencies.  

The National Council urges you to contact your Representatives and to reach out to others in your communities and states to sign letters in support of HR 5176. People and organizations you may wish to contact include:

• State legislators
• Mayors
• State and local NAMI or MHA chapters
• Sheriffs and other law enforcement officials/organizations
•  Chambers of Commerce and other business groups

Please share your letters in support of HR 5176 with the National Council. Contact Allison Fort at AllisonF@thenationalcouncil.org to share copies of your letters with the National Council so that we may track support for the bill.

Background:

The Community Mental Health Services Improvement Act would amend the Public Health Service Act to include provisions to co-locate primary care and specialty medical care in community-based mental health and addiction treatment organizations. In addition, the bill includes training and loan assistance programs designed to address the recruitment and retention of qualified behavioral healthcare workers, particularly in health professional shortage areas.

Passage of this legislation will allow mental health providers to recruit qualified primary care professionals to provide essential health services to patients with serious mental illness. This is a critical need, given that we now know that patients with mental illness die on average 25 years earlier than the general population, largely due to chronic and unattended medical conditions.

HR 5176 also provides for innovative programs to address behavioral health workforce needs in designated mental health professional shortage areas. The act calls for loan forgiveness and repayment as well as expanded education and training to support the recruitment and retention of qualified mental health workers, especially for racial and ethnic minorities.

For more information on HR 5176, including an overview of specific provisions, fact sheets, model letters, and a list of supporting organizations, visit the National Council's website.

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:
 
The National Council for Community Behavioral Healthcare and the National Alliance for Mental Illness (NAMI) recently released a joint report entitled, “Coverage for All: Inclusion of Mental Illness and Substance Use Disorders in State Healthcare Reform Initiatives”. This paper is based on research on 18 state initiatives and proposals and is focused on the mental health and substance use disorder benefits available through state health care reform. Key findings include: 1) Approximately 60% of states evaluated have equal coverage for serious mental illness or mental illness and other conditions; 2) Only 28% of the states evaluated have an equal benefit for substance use disorders and other health conditions in at least one of their programs; 3) Federal waivers are a component of reform in approximately 75% of the states with implemented programs, highlighting the importance of federal dollars and policy in future health care expansion efforts.

Copies of the executive summary, full report, and additional information are available at www.HealthcareforUninsured.org. For hard copies or questions about the report, please contact Mary Giliberti at maryg@nami.org or Christopher Loftis at ChrisL@thenationalcouncil.org.

On June 17-18, more than 300 National Council members joined us in Washington, DC for the Fourth Annual Capitol Hill Day, making this year's event the largest to date. This year’ Hill Day efforts focused on five key issues:

• Medicaid: Case Management
• Medicaid: Rehabilitative Services Option
• Veterans Mental Health Outreach and Access Act
• Addictions Appropriations
• Community Mental Health Services Improvement Act

To see copies of the National Council’s fact sheets on each of these issues, click here: www.thenationalcouncil.org/cs/hill_day_2008

In May, the National Council began running ads in support of the Medicaid moratoria legislation in several prominent Capitol Hill publications - Roll Call, The Hill, and CQ Today. The Child Welfare League of America, Mental Health America, and NAMI joined the National Council on the ads.

In April, two new joint statements on important medications access issues were released by the National Council, American Psychiatric Association (APA), Mental Health America (MHA), and NAMI. Each of these joint statements is now available online.

Joint Statement on Therapeutic Substitution explores the risk of serious adverse outcomes when one medication in a therapeutic class is substituted for another and recommends policies on therapeutic substitution provide patient protections that promote appropriate access to medications and acknowledge the necessity of shared patient-physician decisions based on the unique needs of individuals.

Joint Statement on Medication Cost Sharing in State Medicaid Programs discusses the burden of copayments on individuals with chronic or ongoing health problems, like major mental illnesses, while increasing administrative costs for states and providers. In this paper, the four organizations recommend states follow the lead of corporate America to reduce or eliminate medication copayments for those with chronic diseases such as mental illness.

In addition, the National Council, MHA, and NAMI released a third joint statement. Joint Statement on Appropriate Utilization Management Approaches examines utilization management practices and highlights several utilization management programs that promote cost-efficiency through improved patient care and outcomes, particularly for individuals with serious or complicated health needs. 

In April, the National Council released a new State Policy Focus on state initiatives to provide community-based services to individuals with Autism Spectrum Disorders (ASDs). This State Policy Focus describes various service categories utilized by individuals with ASDs, barriers providers and states face in providing services, and state efforts to mitigate these barriers. Featured initiatives include Wisconsin, Massachusetts, and Connecticut.

On March 18, the National Council hosted a Congressional briefing for Senate staff highlighting mental health data from Arkansas and Colorado. Entitled Arkansas and Colorado Community Mental Health Systems: Helping People in Need, the briefing provided Congressional staff with a unique opportunity to see some of the most highly detailed public mental health care data available anywhere in the country.

Panelists included: Linda Rosenberg, President & CEO, National Council for Community Behavioral Healthcare; Kenny Whitlock, Executive Director, Mental Health Council of Arkansas; John Althoff, Deputy Director, Division of Behavioral Health Services, State of Arkansas Department of Human Services; George DelGrosso, Executive Director, Colorado Behavioral Healthcare Council; and David Lloyd, President, MTM Services, LLC.

On February 15, the National Council released the first edition of Addiction News Now. This monthly publication will keep you up to date on federal addiction policies, ground breaking research, and issues and events that are making headlines across the country. The National Council is committed to strengthening and expanding addiction prevention, treatment, and recovery services nationwide and providing the information necessary to effect change on the local, state, and federal level. 

In partnership with over 40 national organizations, the National Council has formed the Whole Health Campaign and issued a call to the candidates to support wellness of mind and body for a healthier America. You can learn more about the Whole Health Campaign at www.wholehealthcampaign.org, where you can also comment on the blog entries, order copies of the WHC brochure, and sign up to become an endorsing organization. We encourage your organizations to endorse the work and the principles of the Whole Health Campaign. Together, we can have an impact.

Please contact Chuck Ingoglia, Vice President, Public Policy, with federal policy questions at ChuckI@thenationalcouncil.org.  

The Public Policy Update is a weekly e-newsletter published by the National Council for Community Behavioral Healthcare. Managing Editor - Allison Fort.  Vice President, Public Policy - Chuck Ingoglia. Director of State Policy - Chris Loftis. Director of Public Policy - Alexa Eggleston. Director of Policy and Advocacy – Laura Galbreath.