June 26, 2008

House Passes Medicare Bill to Fix Physician Payment Rate, Includes Medicare Parity, Expands Eligibility in Medicare’s Tele-Health Program to CMHCs; Senate Vote Scheduled for Today

FY 2009 Appropriations Update: House, Senate Appropriations Committees to Mark Up Labor-HHS Bill Today; Appropriations Bills Expected to Hit House, Senate Floor in July

Senators Hold Press Conference to Introduce GAO Report, Legislation on Young Adults with Serious Mental Illness

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

Recently Released Resources from the National Council

House Passes Medicare Bill to Fix Physician Payment Rate

On June 24, the House passed a bill to block the 10.6 percent cut to Medicare physician payment rate, set to go into effect on July 1, 2008. The bill (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.

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.
   
On June 11, Senator Charles Grassley (R-IA), Ranking Member of the Senate Finance Committee, introduced his own Medicare bill, the Preserving Access to Medicare Act of 2008. Senator Grassley’s bill would also block the 10.6 percent cut to physician payment rates, replacing it with an 0.5 percent increase in payment rates in 2008, followed by an additional 1.1 percent increase to payment rates in 2009. The two Senate bills differ on how to pay for the fix to the physician payment rate - Senator Baucus’s bill is funded primarily by limiting growth in Medicare Advantage plans, while Senator Grassley’s bill also includes funds generated by making some small changes to Medicaid.
 
The Senate is expected to vote on HR 6331 today. The National Council set a letter in support of HR 6331 to Senate Majority Leader Reid (D-NV) and Senate Minority Leader Mitch McConnell (R-KY). To read the National Council's letter, click here.  The National Council encourages all members to contact their Senators in support of this important legislation. To find contact information for your Senators, searchable by your zip code and by state, click here.

Look for updates on this important legislation in future editions of the Public Policy Update.

FY 2009 Appropriations Update

Later today, both the House and Senate Appropriations Committees are expected to mark up the FY 2009 Labor-Health and Human Services (HHS)-Education spending bills. The Labor-HHS spending bill contains funding for a variety of key mental illness and addiction prevention, treatment, and research programs.

On June 24, the Senate Labor-HHS-Education and Related Agencies Appropriations Subcommittee approved its spending bill, which funds HHS, the Substance Abuse and Mental Health Services Administration (SAMHSA), National Institutes of Health (NIH), and other important programs. While numbers from the subcommittee’s markup will officially be released today, preliminary reports from staff and advocates indicate programs within the Center for Substance Abuse Prevention (CSAP) and Center for Substance Abuse Treatment (CSAT) will face reductions in funding. Reports indicate that the Substance Abuse Prevention and Treatment (SAPT) Block grant, slated to receive an increase of $20 million under the President’s proposal, would retain increased funding.

The House Appropriations Committee approved its Commerce-Justice-Science spending bill on June 24, 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 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. 
 
On February 4, 2008, President Bush released the Administration’s FY 2009 budget. Under the President’s proposal, the Substance Abuse and Mental Health Services Administration (SAMHSA) would receive $3.025 billion, a cut of approximately $200 million from the FY 08 funding level of $3.234 billion.  The SAPT Block grant would receive an increase of $20 million, but the Programs of Regional and National Significance across the three SAMHSA Centers, CSAT, CSAP and CMHS, would receive a combined reduction of $250 million.  Despite the trend to reduce spending in most SAMHSA programs, several programs within the Center for Mental Health Services would receive small increases, including $12 million for the Children’s Mental Health Grant and a $6 million for the Grants to State for Homelessness (PATH). The Safe and Drug Free Schools and Communities Grant within the Department of Education which funds critical school based prevention activities has been targeted again for a significant reduction of $195 million from the FY 08 budget level.
  
In a statement earlier this week, Representative David Obey (D-WI), Chairman of the House Appropriations Committee, said the House will spend most of July considering its FY 2009 spending bills. According to a report in CQ, Chairman Obey warned members of his committee to expect to meet in July even on days when the House isn’t in session. Senator Robert Byrd (D-WV), Chairman of the Senate Appropriations Committee, has also announced plans to have all of the Senate appropriations bills approved by the end of July.

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.  

Senators Hold Press Conference to Introduce GAO Report, Legislation on Young Adults with Serious Mental Illness

On June 25, a press conference was held by Senators Gordon Smith (R-OR) and Chris Dodd (D-CT) and Representative Pete Stark (D-CA) to introduce legislation based on a newly released report by the Government Accountability Office (GAO) about the challenges young adults with serious mental illness (SMI) face. 

The report, “Young Adults with Serious Mental Illness: Some States and Federal Agencies Are Taking Steps to Address Their Transition Challenges,” estimates that at least 2.4 million young adults (aged 18-26) had a serious mental illness in the year 2006, but concedes that this number may be very conservative since certain groups (i.e. the institutionalized) were not included. The GAO report found that, on average, this population has lower levels of education and experiences more barriers to employment than other young adults. The report also outlines the challenges young adults in transition age confront in finding services that facilitate their transition to adulthood. Services include, but are not limited to, health care, housing, and employment. Often, these individuals may decline these services since they are not always appropriate for their needs as young adults with SMI. The report selected four states—Connecticut, Maryland, Massachusetts, and Mississippi—to highlight multidimensional programs designed for young adults with SMI as they transition into adulthood.

The legislation based on this report, entitled The Healthy Transition Act of 2008, is modeled off of the Partnerships for Youth in Transition program (run by SAMHSA and the U.S. Department of Education from 2002-2006). The bill has three main components:

Planning Grants to States: planning grants for states would be established to develop coordination on a state level to help adolescents and young adults with SMI obtain the skills and resources they need for a healthy transition to adulthood. Youth and young adults who are in the child welfare and juvenile justice systems and those receiving services under the Individuals with Disabilities Education Act will be given particular consideration. Authorized at $6 million for fiscal years 2009-2013

Implementation Grants to States: a grant program would be established to help states implement the plan created under the “Planning Grants” section or to states that have a comparable plan approved by SAMHSA. Authorized at $6 million for fiscal years 2009-2010, $15 million for fiscal year 2011, $20 million for fiscal year 2012, and $25 million for fiscal year 2013

Committee of Federal Partners: a committee would be established that will coordinate service programs at the federal-level that help youth and young adults with mental illness. On a state-level, the committee will also offer assistance to states as they execute their plans. Authorized at $1 million in fiscal year 2009 and a similar amount may be required for fiscal years 2010-2013

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’s Hill Day efforts focused on five key issues for which fact sheets are available:

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

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.