April 18, 2008

Bill to Delay Implementation of Seven Medicaid Regulations for One Year

On April 16, the House Energy and Commerce Committee 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 unanimously approved by a vote of 46-0.

The committee approved one amendment offered by Representatives John Dingell (D-MI), Chairman of the Energy and Commerce Committee. Representative Dingell’s amendment made several changes to the bill, including a phased-in implementation for an electronic asset verification program. An amendment offered by Representative Nathan Deal (R-GA), which would have raised the minimum Medicaid payment to pharmacists, was defeated by a vote of 15-26.

Introduced on March 13, 2008 by Representatives Dingell 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.

On April 9, the House Energy and Commerce Health Subcommittee approved the bill by voice vote.

HR 5613 must next be considered by the full House of Representatives. Because several of the regulations in question are set to go into effect on May 25, Representative Dingell expressed a desire to get the bill to the floor as quickly as possible.

On April 15, Michael Leavitt, secretary of the Department of Health and Human Services (HHS), sent a letter to the leaders of the Energy and Commerce Committee indicating that President Bush’s senior advisers would recommend a veto of the bill in its current form, arguing that HR 5613 “…puts billions of dollars of federal funds at risk, and may turn back progress that has already been made to stop abusive state practices.”

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.

Three New Resources from the National Council, APA, MHA, and NAMI

This week, three new joint statements on important medications access issues were released by the National Council, American Psychiatric Association, Mental Health America, and NAMI. 

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 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. 

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.

House Veterans Affairs Health Subcommittee Holds Hearing on Legislation to Increase Veterans' Access to Substance Use Disorders Treatment

On April 15, the House Veterans Affairs Health Subcommittee held a hearing on a variety of bills relating to veterans’ healthcare needs, including legislation to expand health care services to veterans from the Department of Veterans Affairs (VA) for substance use disorders.

The Veterans Substance Use Disorders Prevention and Treatment Act of 2008 (HR 5554), introduced on March 6, 2008 by Representatives Michael Michaud (D-ME), Bob Filner (D-CA), Jeff Miller (R-FL), Corrine Brown (D-FL), Thomas Allen (D-ME), Rob Bishop (R-UT), John Lewis (D-GA), and Stephen Cohen (D-TN), would propose that VA medical centers provide ready access to a full continuum of care for substance use disorders for veterans in need of such care.  HR 5554 also proposes a pilot program for internet-based substance use disorder treatment for veterans returning from Iraq and Afghanistan.

Representative Michaud testified that according to the VA Health Care Utilization Among US Global War on Terrorism (GWOT) Veterans, VA Office of Public Health and Environmental Hazards January 2008, 48,661 veterans returning from Iraq and Afghanistan have met criteria for substance use disorder. “This number only reflects veterans who have been seen by the Veterans Health Administration, which means that the total number of veterans with substance use disorder is likely higher,” said Representative Michaud.

Joy J. Ilem, Assistant National Legislative Director, Disabled American Veterans, also spoke in support of HR 5554. “We owe our nation’s disabled veterans access to timely and appropriate care, including specialized treatment programs for those suffering with post deployment mental health and related substance use disorders,” Ilem said.

Other witnesses at the hearing included

• The Honorable Bob Filner, California, U.S. House of Representatives
• The Honorable Ginny Brown-Waite, Florida, U.S. House of Representatives
• The Honorable Ed Perlmutter, Colorodo, U.S. House of Representatives
  The Honorable Christopher P. Carney, Pennsylvania, U.S. House of Representatives
• The Honorable Brad Ellsworth, Indiana, U.S. House of Representatives
•  Joseph L. Wilson, Deputy Director, Veterans Affairs and Rehabilitation Commission, The American Legion
• Christopher Needham, Senior Legislative Associate, National Legislative Services, Veterans of Foreign Wars of the United States
• Richard F. Weidman, Executive Director for Policy and Government Affairs, Vietnam Veterans of America
• Bernie Edelman, Deputy Director, Vietnam Veterans of America
•  Gerald M. Cross, MD, FAAFP, Principal Deputy Under Secretary for Health, Veterans Health Administration, U.S. Department of Veterans Affairs
• Accompanied by: Walter Hall, Assistant General Counsel, U.S. Department of Veterans
  

Make Your Plans for Hill Day 2008: RSVP and Sign Up for One-On-One Hill Visit Coaching!

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

Among the events planned for Hill Day is an opportunity for one-on-one Hill visit coaching. As we prepare for these coaching sessions, it is important that we have a sense of the number of people who plan to participate in these sessions, scheduled for June 17 from 4:30 – 6:00 pm. If you have not already RSVPed for Hill Day, please do so today and let us know whether you plan to participate in one-on-one coaching.

If you are organizing a group for Hill Day and plan to have your group attend the coaching session, please contact Allison Fort at AllisonF@thenationalcouncil.org and let us know how many people from your group will participate in coaching.

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:
 
On April 9, testimony submitted by Chuck Ingoglia, the National Council's Vice President, Public Policy, was quoted during the opening statement of Senator Richard Burr (R-NC) at a Senate Veterans Affairs Committee hearing on recruitment and retention of Department of Veterans Affairs (VA) medical  professionals and staff.

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.