April 10, 2008

Senate Hearing on Making VA Workplace of Choice for Healthcare Providers

On April 9, the Senate Veterans’ Affairs Committee held a hearing on recruitment and retention of Department of Veterans Affairs (VA) medical professionals and staff.

During his opening statements at the start of the hearing, Senator Richard Burr (R-NC), the committee’s Ranking Member, quoted testimony submitted for the record from Chuck Ingoglia, the National Council’s Vice President, Public Policy. In his statement, Senator Burr said that while the focus of the hearing was on recruiting and retaining VA staff, it was important for the committee to be aware of the impact VA hiring has on the health care system at large. “For example, VA has hired nearly 3,800 mental health workers since 2005 and may add an additional 500 in the near future,” he said. “We need to ask the question: What impact does this have on the available supply of mental health workers in the community both now and over the long haul?”

Senator Burr quoted Ingoglia’s testimony, suggesting that VA hiring is “exacerbating an existing mental health workforce shortage, and may not meet the long-term treatment and rehabilitation needs of returning veterans.” Ingoglia suggested that rather than competing with community-based mental health providers for available staff, the VA could “pursue a targeted strategy of cooperation and collaboration through service partnerships.”

Read Ingoglia’s full testimony.

Witnesses at the hearing included:

• Marisa Palkuti, M.Ed., Director, Health Care Retention and Recruitment Office, Department of Veterans Affairs
• Sheila M. Cullen, Medical Center Director, San Francisco VA Medical Center
• Steven P. Kleinglass, FACHE, Director, Minneapolis VA Medical Center
• Marjorie Kanof, Managing Director, Health Care, GAO
• John A. McDonald, M.D., Ph.D.,Vice President for Health Sciences and Dean of the University of Nevada School of Medicine and Member of the Association of American Medical Colleges Veterans Affairs-Deans Liaison Committee
• Valerie O’Meara, N.P., Professional Vice President, American Federation of Government Employees Local 3197; VA Puget Sound Health Care System
• Randy Phelps, Ph.D., Deputy Executive Director for Professional Practice, American Psychological Association
• Jennifer L. Strauss, Ph.D., Health Scientist Center for Health Services Research in Primary Care, Durham VA Medical Center and Assistant Professor in Psychiatry and Behavioral Sciences, Duke University Medical Center

Read the witnesses’ testimonies.

National Council Attends Presidential Ceremony Signing Historic Second Chance Act

On April 9, President Bush signed the Reducing Recidivism and Second Chance Act of 2007, also known as the Second Chance Act, into law.

The Second Chance Act reauthorizes the Adult and Juvenile Offender State and Local Reentry Demonstration Program, under which states craft programs focusing on housing, jobs, addiction treatment, mental health treatment, and services for families and children of incarcerated parents in order to help prisoners transition into life in their communities upon their release

It is extremely encouraging to see the bi-partisan support and excitement for passage of this law and to hear the President emphasize his belief in the importance of helping former prisoners who've paid for their crimes by helping them build new lives as productive members of our society. Passage of the Second Chance Act marks a significant moment in history for criminal justice reform.  

The House passed the Second Chance Act of 2007: Community Safety Through Recidivism Prevention (HR 1593) by a vote of 347 to 62 on November 13, 2007.  The Senate passed the Reducing Recidivism and Second Chance Act of 2007 (S. 1060) on March 11, 2008. The National Council is working with Congressional Appropriators to ensure that federal funding is allocated for the programs contained in this important legislation. 

The National Council has been part of a coalition of groups lobbying for support of this important legislation. The broad, bipartisan coalition includes groups such as the Legal Action Center, National Alliance to End Homelessness, American Correctional Association, Mennonite Central Committee, National Association of Counties and Volunteers for America.

Bill Passed to Delay Implementation of Seven Medicaid Regulations for One Year

On April 9, the House Energy and Commerce Health Subcommittee approved legislation that would delay seven recent Medicaid regulations proposed by the Bush Administration, including those affecting case management and the rehabilitative service option, for one year. The bill was approved by voice vote.

The bill was approved by voice vote after adopting a substitute amendment offered by Representative Dingell, Chairman of the full House Energy and Commerce Committee.  His amendment clarified language in the bill to ensure HR 5613 would only block the seven new Medicaid regulations listed in the bill. To read the text of this amendment, click here. 
 
Following adoption of this amendment, the Ranking Minority Member of the Energy and Commerce Committee, Representative Joe Barton (R-TX), said he would support the bill and urge the White House not to oppose it, a sign of the strong bipartisan support building in Congress to stop these Medicaid regulations.  The strong support of Representative Barton is an important indication that Congress is likely to stop these impending Medicaid regulations. To read the committee’s press release on its approval of HR 5613, click here.

Introduced on March 13, 2008 by Representatives John Dingell (D-MI) and Timothy Murphy (R-PA), the Protecting the Medicaid Safety Net Act of 2008 (HR 5613) would delay implementation of the following regulations for one year:

• Interim Final Rule on Case Management
• Proposed Rule on Clarification of Outpatient Clinic and Hospital Facility Services Definition and Upper Payment Limit
• A portion of the Proposed Rule on Provider Taxes
• Proposed Rule on Graduate Medical Education
• Final Rule on Public Provider Cost Limit Regulations

HR 5613 also extends the moratoria on the Rehabilitative Service Option and School-Based Services, until April 1, 2009.

HR 5613 is scheduled for consideration by the full Energy and Commerce Committee next week.

The National Council continues to work in collaboration with other advocacy groups to support moratoria for case management and a longer moratorium on the rehabilitation option rule in addition to supporting moratoria on other Medicaid-related regulations. Look for updates on this important legislation in future editions of the Public Policy Update.

Federal Medicaid Director Resigns

Dennis Smith, Director of the Center for Medicaid and State Operations at the Centers for Medicare and Medicaid Services, told a Senate panel he will be leaving CMS this week, according to an article published in Modern Healthcare on April 9, 2008.

Smith, who has been head of the Center for Medicaid and State Operations since 2001, has been the public face on a series of recent Medicaid regulations, including those to restrict case management and the rehabilitative service option.

Smith did not say where his next position will be.

Make Your Plans for Hill Day 2008: Register and Make Your Hotel Reservations Now!

The National Council places top priority on helping you do your job as a leader in the field of community behavioral healthcare by supporting you with new communications tools, increased emphasis on involving you in ongoing liaison with national decision-makers, and policy and research support for your efforts. The National Council's Fourth Annual Hill Day, scheduled for Wednesday, June 18, 2008, presents a wonderful opportunity to take the first step towards engaging your members of Congress and taking a lead role in shaping federal public policy in 2008.

We need YOU to help us lead. Click here to RSVP now for Hill Day 2008!

If you’d like help registering yourself or your delegation, or if you have difficulty registering online, please contact Allison Fort at 301-984-6200, x235 or AllisonF@thenationalcouncil.org.

Visit the National Council’s Hill Day web page for the latest information on Hill Day, including:

• Information on the National Council’s new online appointment-making tool
• Tips on bringing a team to Hill Day
• Schedule of Hill Day events
  
  Don’t forget to make your hotel reservation for Hill Day soon – there are two ways to make a hotel reservation at the National Council’s room block for the rate of $279:
• Make your reservation at the Marriott Wardman Park Hotel online and enter NCCNCCA as the group code to receive the National Council rate, or
• Call 1-800-228-9290 or 202-328-2000 and ask for the "National Council Room Block" or “NCC”
  
  We look forward to seeing you in Washington in June!

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.

A model letter, to be placed on your agency’s letterhead, is available online. There are two templates:

template for associations

template 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

Representatives Green and Murphy are currently circulating a Dear Colleague letter in the House, urging their fellow Representatives to cosponsor this important legislation. Offices interested in signing on as cosponsors should contact Abigail Pinkele in Representative Green’s office at 202-225-1688 or abigail.pinkele@mail.house.gov or Brendan Belair in Representative Murphy’s office at 202-225-2301 or brendan.belair@mail.house.gov.  

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.

Specific provisions of HR 5176 include:

• Creating a new federal grants program to support co-locating primary care/chronic care services at community mental health facilities funded at $50 million in FY 2009 and authorized through FY 2013.
• Integrating treatment for mental health and substance abuse co-occurring disorders funded at $14 million in FY 2009, $20 million in FY 2010 and authorized through FY 2013.
• Improving the mental health workforce through grants for the recruitment and retention of mental health professionals funded at $10 million in FY 2009 and authorized through FY 2013.
• Enhancing behavioral and mental health education and training program through a new grants program to establish or expand accredited programs funded at $4 million in FY 2009 and authorized through FY 2013.
• Establishing a new $20 million federal grants program to finance infrastructure costs for telecommunications technology supporting tele-psychiatry and patient education at community mental health facilities located in rural and other medically underserved areas.
• Requiring the Secretaries of the HHS and DVA collaborate with the Office of the National Coordinator of Health Information Technology and SAMHSA to develop and implement a plan for ensuring that various components of the National Health Information Infrastructure address mental health and substance abuse provider needs supported by $10 million in funding in FY 2009.
• Commissioning the Institute of Medicine to complete and submit to Congress a paperwork reduction study to be completed no later than a year after enactment that evaluates the combined paperwork burden of qualified community mental health programs funded at $550,000.
• Directing a nationwide analysis and submission of a report to Congress of the compensation structure of professional and paraprofessional mental health personnel as compared with that of other health safety net and private sector employers also funded at $550,000.

Full Text of HR 5176

On October 17, Senators Gordon Smith (R-OR) and Jack Reed (D-RI) introduced the Community Mental Health Services Improvement Act (S. 2182) in the Senate.

For more information on the Community Mental Health Services Improvement Act, including 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:
 
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.

Congress recently passed an economic stimulus package that includes payments between $300 and $600 for individuals and $600 to $1200 for joint filers. Many low-income people who are not required to file income tax returns may find that it makes sense to file this year in order to receive the stimulus payment. On March 12, the National Council released an Issue Brief on Federal Economic Stimulus Payments with information on who qualifies for these payments and where to find tax help and additional information.  

On February 27, Chris Copeland, Executive Director of Tri-County Mental Health Services in Lewiston, ME, testified at two briefings for House Senate staff to examine the potential impact of the Centers for Medicare and Medicaid Services’ (CMS) proposed rule on case management.  Copeland shared examples of case management services offered by community behavioral healthcare providers and concerns about the impact the proposed regulations may have on both providers and the people they serve. To read his testimony online, click here.

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.

On January 8, the National Council hosted a National Council Live webinar entitled, “The Role of State Policies in the Adoption of Naltrexone for Substance Abuse Treatment.”  Carolyn Heinrich from the University of Wisconsin-Madison presented on a recent study she co-authored with Carolyn Hill from Georgetown University that examined the state policies that affect treatment facilities' adoption of naltrexone, a pharmacotherapy for alcoholism treatment.  The webinar included an overview of their research and findings and a discussion about the state level practices and policies that play a role in treatment decisions that impact utilization of clinically proven cost-effective treatments for alcoholism.   

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 – Tammy Seltzer. Director of Public Policy – Alexa Eggleston.