July 3, 2008

Bush Administration Temporarily Delays Physician Payment Rate Cut

President Signs Iraq War Supplemental Bill; Delays Implementation of Six Medicaid Regulations for One Year

FY 2009 Appropriations Update: House, Senate Appropriations Committees to Mark Up Labor-HHS Bill Today; Timing of Future Appropriations Bills Remains Uncertain
 
Participate in National Call-In Day in Support of Parity July 9

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

Recently Released Resources from the National Council

Bush Administration Temporarily Delays Physician Payment Rate Cut

The Bush Administration has announced that it will temporarily stop processing new Medicare claims from physicians to delay the payment rate cut set to take effect on July 1. Congress adjourned for the weeklong Fourth of July recess without passing legislation to correct this scheduled 10.6 percent rate reduction.

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.

On June 24, the House passed its bill (HR 6331) to block the 10.6 percent cut to Medicare physician payment rate. HR 6331 would also end Medicare’s discriminatory 50 percent outpatient copayment for mental illness 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 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.

Introduced by Representative Charles Rangel (D-NY) on June 20, HR 6331 is very similar to the bill (S 3101) introduced in the Senate by Senator Max Baucus (D-MT) on June 6. Both bills would block the 10.6 percent cut to physician payment rates under Medicaid. Instead, they 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.
   
Look for updates on this important legislation in future editions of the Public Policy Update.

President Signs Iraq War Supplemental Bill; Delays Implementation of Six Medicaid Regulations for One Year

On June 30, President Bush signed the Iraq war supplemental appropriations bill into law. This legislation includes a one-year delay in the implementation of six of seven recent Medicaid regulations - including both case management and the rehabilitative service option. Thank you to all National Council members who contacted your Senators and Representatives to urge them to vote to preserve Medicaid. Your calls and e-mails have made a difference!

In addition to the regulations affecting case management, the rehabilitative services option and school-based services, language in the supplemental delays the following rules for one year:

• A portion of the Proposed Rule on Provider Taxes
• Proposed Rule on Graduate Medical Education
• Final Rule on Public Provider Cost Limit Regulation

The Proposed Rule to clarify the outpatient clinic and hospital facility services definition is no longer included in the bill.

The House of Representatives passed the supplemental spending bill on June 19. The bill was split into two votes - one on the war funding, which passed by a vote of 268-155, and one on domestic items included in the bill, which passed by a vote of 416-12. To see how your Representative voted in the first vote, click here. To see how your Representative voted in the second vote, click here.

The Senate approved the bills domestic items by a vote of 92-6 on June 26. To see how your Senators voted, click here.

The National Council will continue to work with Congress and with the next administration to straighten out final details on these Medicaid regulations. Check your e-mail for updates in the coming months.

FY 2009 Appropriations Update: House, Senate Appropriations Committees to Mark Up Labor-HHS Bill Today; Timing of Future Appropriations Bills Remains Uncertain

Before adjourning for the Fourth of July recess, both the House and Senate Appropriations Committees marked up the Commerce-Justice-State FY 2009 spending bill last week. While both chambers also took up their respective Labor-Health and Human Services (HHS)-Education and Related agencies bills, negotiations in the House broke off before the House Appropriations Committee could finish considering the bill.

Labor-HHS: Increased funding for SAPT Block Grant, CMHS’ PRNS

On June 19, the full Senate Appropriations Committee marked up the Labor-HHS spending bill, which funds HHS, the Substance Abuse and Mental Health Services Administration (SAMHSA), National Institutes of Health (NIH), and other important programs. $1.778 billion was allocated to the Substance Abuse Prevention and Treatment (SAPT) Block grant, level with the President’s FY 2009 request and $20 million more than final FY 2008 funding levels. $311.8 million was allocated to the Center for Mental Health Services’ (CMHS) Programs of Regional and National Significance (PRNS), $156.8 more than the President’s FY 2009 request and $12.8 million more than final FY 2008 funding levels.

On June 26, the full House Appropriations Committee began consideration of its Labor-HHS spending bill, but negotiations came to a halt when Republicans tried to force a vote on amendments to expand domestic oil production. The committee suspended its session before a final vote could be taken on the Labor-HHS spending bill, and numbers from the House Appropriations Committee’s markup have not yet been made public.

CJS: Funding for MIOTCRA, Second Chance Act

The House Appropriations Committee approved its Commerce-Justice-Science spending bill on June 25, with $10 million allocated to the Mentally Ill Offender Treatment Crime Reduction Act (MIOTCRA) program.  MIOTCRA is designed to facilitate collaboration among the criminal justice, juvenile justice, mental health and addiction treatment systems and to improve access to effective treatment for people with mental illnesses, including co-occurring substance use disorders, involved with the justice system. The program received $5 million in FY 2006 and FY 2007 and $6.5 million for FY 2008.  The Senate Appropriations Committee, which approved its Commerce-Justice-Science spending bill on June 19, allocated $12 million for MIOTCRA.

The House Appropriations Committee allocated a total of $45 million for the Second Chance Act, which 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.  The Senate Appropriations Committee allocated a total of $20 million for the Second Chance Act

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. 
 
The National Council continues to advocate for increased funding for behavioral healthcare in the FY 2009 budge – and we will need your help as the process moves forward in Congress. Watch your e-mail in the coming weeks for updates on the FY 2009 appropriations process and ways to take action in support of increased funding for mental illness and addiction prevention, treatment, and research programs.  

Participate in National Call-In Day in Support of Parity July 9

On July 9, Faces and Voices of Recovery urges advocates to participate in a National Call-In Day in support of legislation to extend parity to both mental health and addictions.

As the National Council reported on June 20, House and Senate negotiators have reached an agreement on the terms for legislation to extend parity to both mental health and addictions. While the compromise is expected to move quickly through both the House and Senate, negotiators are still working to find $4 billion over the next 10 years to pay for the bill. Faces and Voices of Recovery encourages advocates to participate in a National Call-In Day on July 9 to urge members on Congress to support this important legislation. For more information, visit Faces and Voices of Recovery’s website – details on how to participate in the National Call-In Day will be available soon. 
 
According to reports from the Mental Health Liaison Group, the final agreement between House and Senate negotiators was reached once three key outstanding issues were addressed:

Preemption: House negotiators accepted the Senates stronger preemption language, which defers to the current HIPAA standard and is extremely protective of state law. Under the language agreed upon by negotiators, stronger state parity and other consumer laws will remain in place.

Out-of-Network Services: Senate negotiators accepted the Houses stronger language that makes clear that out-of-network mental health and addictions services will be provided on an equal basis when a plan provides out-of-network services for physical health.

Covered Services: House negotiators agreed to drop their provision mandating coverage for all diagnoses listed in the DSM, but ensured that all mental health conditions and addictions would be covered by mirroring the standard for mental health under the current parity law.

The National Council has supported the passage of parity legislation that will expand parity for both mental health and addictions treatment in both chambers, and we will keep you informed as negotiations continue on this historic legislation.

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:
 
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.

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.

For federal policy questions, please contact Chuck Ingoglia, Vice President, Public Policy, 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.