Presentation by: Joel E. Miller

Update on Congressional Legislation

Presentation

for the

National Coalition on Mental Health & AgingJuly 14, 2015

The House Appropriations Committee has approved the draft fiscal year 2016 Labor, Health and Human Services (LHHS) funding bill on a vote of 30-21.

The legislation includes funding for programs within the Department of Labor, the Department of Health and Human Services, the Department of Education, and other related agencies.

In total, the draft bill includes $153 billion in discretionary funding, which is a reduction of $3.7 billion below the fiscal year 2015 enacted level and $14.6 billion below the President’s budget request. Funding within the bill is targeted to medical research, public health, and biodefense, as well as activities to ensure Social Security, Medicare, and Medicaid services.

In addition, the legislation defunds existing ACA programs & prohibits any new discretionary funding from being used to further implement the ACA.

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House LHHS Appropriations

To prevent the administration from diverting funds away from core CMS activities, the bill eliminates ACA funding and includes several provisions prohibiting any funds from being transferred to specific ACA activities that were never intended to be supported with discretionary funds.  In addition, several oversight provisions are included in the bill:

Risk Corridor – Bill language is included requiring the administration to operate the Risk Corridor program in a budget neutral manner by prohibiting any funds from the Labor-HHS-Education appropriations bill from being used as payments for the Risk Corridor program.

State-Based Exchanges – With the increasing number of State-Based Exchanges failing due to lack of revenue, the bill includes new language preventing the administration from using discretionary funds to pay for operational costs for these Exchanges.

Health Exchange Transparency – Bill language is included requiring the administration to publish ACA-related spending by category since the Act’s inception.

ACA Personnel – Bill language is included requiring the administration to publish information on the number of employees, contractors, and activities involved in implementing, administering, or enforcing provisions of the ACA.

Healthcare.gov Data Privacy – Report language is included directing CMS to encrypt and prevent future sharing of consumer information on Healthcare.gov, to review its current privacy guidelines, and to implement appropriate security measures.

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Affordable Care Act (ACA) Funding

Mental Health Programs of Regional and National Significance – $378.6 million, level with FY2015. 

These are competitive grant programs supporting different types of mental health services. 

In addition, the bill provides the same level of funding as in FY2015 for all the Now Is the Time activities including Project Aware, Mental Health First Aid, Minority Fellowships, and the Behavioral Health Workforce Education and Training grants.

Mental Health Block Grants – $482.6 million, level with FY2015.  These are formula grants distributed to States that provide flexibility to address local mental health needs.  The Block Grants represent the primary sources of mental health funding for State programs.

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MH Provisions

Older Americans Act Programs – These programs provide crucial social, nutritional, and caregiver support to our aging population.  The bill protects the core programs and provides the same level as in FY2015.  These include: Supportive Services, Preventative Health, and Protection Formula Grants at $388.2 million; Caregivers Support Formula Grants at $151.6 million; and the Senior Nutrition Program at $814.7 million.

  Elder Justice Initiative – $4 million, level with FY2015.  This competitive

grant program supports States’ efforts in testing and evaluating approaches to address elder abuse.

Alzheimer’s Disease Demonstration and Initiative – $18.5 million, level with FY2015.  This funding supports competitive grants to expand the availability of evidence based interventions and long term care services for individuals with Alzheimer’s disease.  In addition, funds support an Alzheimer’s Disease outreach campaign designed to educate caretakers on the resources available in the community.

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Older Adult Provisions

Although many in the mental health community applaud provisions in Rep. Tim Murphy’s (R-Pa.) long awaited revamped mental health reform bill, such as promoting early intervention and prevention programs, research advancement and tele-psychiatry use in hard-to-reach populations, and bolstering the federal parity law, many fear that reform of SAMHSA could mean its dismantling.

“The Helping Families in Mental Health Crisis Act of 2015” was introduced by Murphy in a different form in December 2013 following a year-long investigation, including public forums and hearings, of the country’s mental health system.

At that time, groups were divided on the merits of Murphy’s proposal.

Among its provisions, the bill, H.R. 2646 (formerly H.R. 3717), introduced June 4, would reauthorize the National Child Traumatic Stress Network and launch a new early childhood grant program to provide intensive services for children with SEDs in an educational setting.

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The Helping Families in MentalHealth Crisis Act of 2015

Murphy’s legislation is clearly a different bill from what he presented in 2013.

Some important changes from the last bill. The earlier legislation tied the receipt of block grants to states adopting assistant outpatient treatment (AOT).

Now, states will be incentivized by 2 percent if officials expand community treatment programs -- states will not be penalized.

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The Helping Families in MentalHealth Crisis Act of 2015, cont.

A provision regarding the interagency coordinating council will enable it to invest more heavily in research. Also, the inclusion of early identification and intervention provisions is very heartening.

The legislation designates an assistant secretary for mental health and substance use disorders in the Department of Health & Human Services.

The assistant secretary would promote, evaluate, organize, integrate & coordinate research, treatment & services across departments, agencies, organizations & individuals with respect to the problems of individuals suffering from substance use disorders or mental illness.

Many are concerned that the legislation would replace SAMHSA with the a new office headed by a government official overseen by Congress.

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The Helping Families in MentalHealth Crisis Act of 2015, cont.

“The Excellence in Mental Health Act” establishes a two-year demonstration program for eight states to offer a broad range of mental health and substance abuse services that would expand under the reform legislation.

The legislation, which certifies behavioral health clinics, passed in 2014. Under Murphy’s bill, the demonstration program would expand by an additional two years & increase the number of participating states from eight to 10.

The legislation includes provisions from the “Health Information Technology for Economic and Clinical Health Act.” It would extend meaningful use payments to a variety of BH treatment organizations as well as to clinical psychologists.

Additionally, the legislation clarifies that Medicaid can pay for physical health services and mental health services that are provided at the same time.

In some states, Medicaid does not allow recipients to receive both a mental health and a substance use service on the same day. There is no federal prohibition against this; it’s a state issue. The bill clarifies that would be the expectation.

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MH Pilot Program Expansion

In gearing up for implementing the Excellence in Mental Health Act, which establishes a two-year demonstration program for states to offer a broad range of BH services, SAMHSA has released applications for planning grants for states to certify behavioral health clinics.

CMS has issued a payment methodology for Medicaid reimbursable services at the clinics.

SAMHSA is accepting applications for up to $24.6 million in planning grants for states to help implement certification for Certified Community Behavioral Health Clinic (CCBHCs). The planning grants will be awarded in October.

SAMHSA plans to award up to 25 grantees amounts ranging from $1 million to $2 million. Each of the states selected for the planning grant will have a year to carry out the required planning activities. During this process states will select clinics to be certified.

Each state that applies for the demo must have at least two certified clinics in the demo. The demo program provides an opportunity for states to improve BH services providing community-based mental health and substance use disorder treatment, and by helping to further integrate BH with physical health care, utilize evidence-based practices on a more consistent basis, and improve access to high-quality care.

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Excellence in Mental Health Act, cont.

Reps. Glenn “GT” Thompson (R-Pa.) and Charles B. Rangel (D-N.Y.) on May 21 introduced H.R. 2516, “The Veterans E-Health and Telemedicine Support Act of 2015.”

The bipartisan bill would allow Veterans Affairs (VA) health professionals, including contractors, to practice telemedicine across state borders if they are qualified, and practice within the scope of their authorized federal duties.

Under current law, the VA can only waive the state license requirement for treatment if both the physician & patient are located in a federally- owned facility.

The legislation removes these barriers & allows the VA to provide treatment through physicians free of this restrictions. Vets will no longer be required to travel to a VA facility, but rather can receive telemedicine treatment from anywhere, including their home or a community center.

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Veterans E-health, TelemedicineBipartisan Bill Introduced

This legislation advances the development of new treatments for a broad range of illnesses including mental illness.

It also invests $10 million in new funding for biomedical research at the National Institutes of Health (NIH), including the National Institute of Mental Health, over the next 5 years.

Bill promotes patient-focused medication development, streamlines clinical trials & speeds up development of new treatments, such as for conditions like schizophrenia & bipolar disorder.

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21st Century Cures Act (H.R. 6)

On Friday, a health bill — which would spur biomedical innovation, change the way federal health officials approve drugs and medical devices, and increase funding for NIH — passed the House overwhelmingly, 344 to 77.

The compromise was so strong that lawmakers even agreed on a highly unusual way to pay for it: by ordering the Obama administration to sell enough oil from the nation’s strategic petroleum reserve to cover the cost.

The far-reaching measure drew praise from many physician and patient groups, and criticism from some consumer advocates who said the changes threatened to lower safety standards. But it was also a rare bipartisan compromise, hard fought with intense disagreements, largely over the role of pharmaceutical companies.

But it ended in significant accommodation, with strong Democratic support and praise for many of its provisions from the Obama administration.

A similar bill is under consideration in the Senate, where lawmakers hope to have legislation by the end of the year.

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Bipartisan Health Bill Passes House

U.S. Reps. Tim Murphy (R-Pa.), Earl Blumenauer (D-Ore.) and Michelle Lujan Grisham (D-N.M.) on June 2 introduced a bipartisan amendment to the Commerce-Justice-Science Appropriations bill.

Invests $2 million in crisis intervention training for state and local law enforcement, mental health and substance abuse treatment, and rehabilitation and community re-entry services.

The funding would be available as grants to law enforcement agencies through the Justice & Mental Health Collaboration Program.

Congressman Murphy’s Helping Families in Mental Health Crisis Act, H.R. 3717, would also help expand mental health courts.

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Bipartisan Amendment to Expand Mental Health Courts Introduced

Citing a crisis in the nation’s CJ system and its use of jails and prisons as a substitute for a “properly functioning mental health system,” lawmakers introduced bipartisan legislation that would bring together law enforcement, MH & criminal justice systems to work together to implement strategies to reduce imprisonment & improve treatment & services for offenders with mental illness.

“The Comprehensive Justice and Mental Health Act of 2015” (S. 93 and H.R. 1854) would reauthorize and improve the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA), which passed in 2004 and was reauthorized in 2008.

Sens. Al Franken (D-Minn.) and John Cornyn (R-Tex.) are the cosponsors of S. 993, and Reps. Doug Collins (R-Ga.) and Bobby Scott (D-Va.) are the lead co-sponsors of H.R. 1854.

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Bipartisan Bill Reauthorizes MH, Criminal Justice Collaboration Law

The identical legislation supports law enforcement training and partnerships such as Crisis Intervention Team (CIT) programs and programs to assist people transitioning out of corrections and re-entering communities.

A new provision highlights the needs of vets [and focuses] on veteran treatment courts and related programs reflecting the ongoing concerns of returning vets.

The legislation incorporates the “Sequential Intercept Model” (SIM) as a foundation for services.

SIM It is a comprehensive approach to services that emphasizes interventions at whatever stage of the criminal justice process a person is, whether pre-arrest, post-arrest, during incarceration, or upon discharge from the community.

The model is a multi-systemic approach, a comprehensive approach that emphasizes a very broad collaboration among agencies.

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Bipartisan Bill Reauthorizes MH, Criminal Justice Collaboration Law, cont.

New legislation representing the first federal ban of gay conversion therapy introduced in June would prohibit the practice of providing “conversion therapy” to any person in exchange for monetary compensation or advertising such services.

The practice, which advocates consider an “unfair” or “deceptive” act, would give the Federal Trade Commission the duty to enforce this provision in accordance with existing law.

Conversion therapy” is defined as seeking to change an individual’s sexual orientation or gender identity.

Many in the field believe that practitioners of conversion therapy charge large sums of money for services that are completely ineffective & have caused serious side effects, such as depression, self-harm & family rejection.

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Federal Ban on Conversion Therapy Legislation Introduced

As a number of bills essential to the mental health field continue to move forward, House lawmakers have re-established the House Mental Health Caucus, citing the need to address stigma, promote mental health wellness & examine current and future mental health legislation.

The caucus, chaired by Rep. Grace Napolitano (D-Calif.), was reestablished for the 114th Congress on May 13. It had remained dormant following a midyear lapse in the summer of 2014.

The House Mental Health Caucus is a bipartisan forum for sharing MH resources where members of Congress and staff are educated on critical mental health–related issues.

Specific challenges the caucus intends to address besides stigma will include increasing the access & availability of MH services & treatment for all.

The caucus will examine aspects of current and future legislation, including HIPAA, school-based MH services & suicide prevention.

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House Mental Health Caucus

Meanwhile, one of the bills Napolitano intends to continue pursuing is the Mental Health in Schools Act (H.R. 1211) to provide funding for public schools across the country to partner with local mental health professionals for on-site school-based mental health services for students.

Napolitano and Rep. Chris Gibson (R-N.Y.) reintroduced the bill in March.

The caucus currently has 15 Democrats and three Republicans

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Mental Health Caucus, cont.

The Government Accountability Office (GAO) has released a report related to the SAMHSA’s Center for Mental Health Services (CMHS) grants management.

The GAO looked specifically at CMHS’s criteria for awarding grants to grantees, and how CMHS documents the application of these criteria as requested by Reps. Tim Murphy (R-Pa.) and Diana DeGette (D-Colo.), chairman and ranking member, respectively, of the Committee on Energy and Commerce Subcommittee on Oversight and Investigations.

GAO reviewed information related to CMHS grants management; reviewed grant documentation from fiscal years 2012 and 2013 for a non-generalizable selection of 16 grantees within five grant programs: the Mental Health Block Grant (MHBG), Protection and Advocacy for Individuals with Mental Illness (PAIMI) and three selected discretionary grant programs that GAO selected based on factors such as size of award and type of grantee; and interviewed SAMHSA officials.

During the two-year period covered by its review, GAO found that CMHS did not document its application of the criteria it used to award grants to six of the 16 grantees reviewed.

Specifically, GAO found instances across the two years in which CMHS did not clearly document the application of its criteria for four MHBG grantees and two PAIMI grantees.

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GAO Report Examines Oversight of SAMHSA’s MH Grant Program

Federal health officials are proposing that Medicare begin paying doctors to discuss end-of-life issues with their patients, six years after the “death panel” controversy erupted in the early days of the debate over President Obama’s health-care legislation.

CMS released the new plan last week as part of its annual Medicare physician payment rule.

The proposed rule includes reimbursement for “advance care planning.” The final rule is due Nov. 1, and payments would start Jan. 1. The discussions would be voluntary.

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Payment for End-of-Life Discussions with Doctors

A new groundbreaking study from the American Mental Health Counselors Association (AMHCA) shows that nearly 570,000 people diagnosed with a serious mental health condition, would have received affordable, needed treatments, but were denied access to services because several states refused to participate in the new Medicaid Expansion Program.

The federal government would have paid 100 percent of the treatment costs; the monies were already included in the federal budget.

The comprehensive study also highlights that 458,000 fewer people would have avoided a depressive disorder mainly by securing health insurance through the Medicaid Expansion Program.

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AMHCA Study on Medicaid Expansion

The vast majority of people with a mental illness who would have accessed needed care under the Medicaid Expansion Program in 2014 were white adults.

Over 90 percent of the states (44 states) show that over 60 percent of the uninsured adults with mental health conditions who were eligible for Medicaid Expansion coverage and who would have sought needed care—were white Americans between the ages of 18 and 34 (Tables 9–10).

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Characteristics of Medicaid Expansion Population

About 2.3 million uninsured young adults—ages 18 to 34—with a serious mental health condition, were eligible for coverage under the Medicaid Expansion program in 2014 (Table 11).

Nearly 200,000 uninsured Veterans with a mental illness in the U.S were eligible for coverage in the 24 states that decided not to participate in the new Medicaid Expansion Program (Table 12).

Uninsured vets & their families were less likely to get the health and mental health care they needed in the past year in the 24 non-Medicaid Expansion states.

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Medicaid Expansion – Other Findings

In the states that have not expanded Medicaid, 6 million residents are projected to remain uninsured in 2016 as a result. These states are foregoing: $424 billion in federal Medicaid funds over 10 years, which will lessen economic activity and job growth.

Hospitals in these 24 states are also slated to lose: $168 billion (31%) boost in Medicaid funding that was originally intended to offset\ major cuts to their Medicare and Medicaid reimbursement (Figure 1).

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Medicaid Expansion Helps State Economies

Thank You and Questions

Contact:Joel E. Miller

Executive Director and CEOAMHCA

jmiller@amhca.org703-548-6002www.amhca.org

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