Mental Health Legislative Proposals and their Impact on Counties

Transcription

1 Mental Health Legislative Proposals and their on Counties An Analysis of Key Provisions in the Helping Families in Mental Crisis Act of 2013 (H.R. 3717) and the Communities Act of 2014 (H.R. 4574) Counties play an important role in ensuring access to and providing quality behavioral healthcare for the more than 43 million Americans who suffer from a mental, behavioral or emotional disorder. More than 750 county behavioral health authorities and other community providers provide direct behavioral services to those in most need, including pregnant and parenting women, adults and children with serious mental illnesses, emotional disturbances, substance abuse issues and HIV/AIDS. In 32 states, counties are required by states to provide behavioral health services. The local provision of behavioral health services is made possible through federal funding, including Medicare, Medicaid, and the Community Mental Health Services (CMHS) and Substance Abuse Prevention and Treatment (SAPT) block grants administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the U.S. Department of Health and Human Services. Reducing funding for SAMHSA or any other federal or state financial contributions for financing and delivering state-mandated mental health services would put counties at risk for absorbing shifted costs. As a consequence, counties would potentially have to raise local taxes or cut other local budget line items. Legislation introduced in the House has the potential to transform the mental health delivery system in the U.S., with significant impact on counties. In December 2013, Rep. Tim Murphy (R-Pa.) introduced the Helping Families in Mental Health Crisis Act (H.R. 3717). In May 2014, Rep. Ron Barber (D-Ariz.) introduced an alternative version, the Strengthening Mental Health Issues in Our Communities Act (H.R. 4574). Both propose substantial changes, and neither stand-alone bill has gained necessary support for adoption. Therefore, House Energy and Commerce Committee leaders have indicated that they may combine components of proposed legislation which can command broad support and attempt to pass a bipartisan consensus mental health package. As final language is being considered, NACo supports the final adoption of the following four key provisions, in particular: 1. Expanding access to the Health Information Technology for Economic and Clinical Health (HITECH) Act s incentives to behavioral health providers, including more than 750 county behavioral health authorities; 2. Reauthorizing the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA), a priority of NACo and its affiliate, the National Sheriffs' Association; 3. Easing Medicaid's Institutes of Mental Disease (IMD) restriction, which would permit states to use Medicaid to fund inpatient psychiatric hospital services and psychiatric residential treatment facility services for individuals between the ages of if such facilities demonstrate an average stay of less than 30 days; and 4. Investing in programs to expand and develop the behavioral health workforce. Provisions such as these can enhance and sustain services that improve population health status, reduce counties healthcare and justice system costs and provide savings to local taxpayers. To help county officials evaluate key components of these large complex pieces of legislation, the following analysis was developed to compare and contrast key provisions of the two bills and their potential impact on counties. NATIONAL ASSOCIATION OF COUNTIES 25 MASSACHUSETTS AVENUE, N.W. SUITE 500 WASHINGTON, D.C FAX FB.COM/NACODC TWITTER.COM/NACOTWEETS YOUTUBE.COM/NACOVIDEO LINKEDIN.COM/IN/NACODC

2 Majority: Fred Upton (R-MI), Chairman* Ralph Hall (R-TX)* Joe Barton (R-TX), Chairman Emeritus* Ed Whitfield (R-KY)* John Shimkus (R-IL)* Joseph R. Pitts (R-PA)* Greg Walden (R-OR) Lee Terry (R-NE) Mike Rogers (R-MI)* Tim Murphy (R-PA)* Michael C. Burgess (R-TX)* Marsha Blackburn (R-TN), Vice Chairman* Phil Gingrey (R-GA)* Steve Scalise (R-LA) Bob Latta (R-OH) U.S. House Energy and Commerce Committee Cathy McMorris Rodgers (R-WA) Gregg Harper (R-MS) Leonard Lance (R-NJ)* Bill Cassidy (R-LA)* Brett Guthrie (R-KY)* Pete Olson (R-TX) David McKinley (R-WV) Cory Gardner (R-CO) Mike Pompeo (R-KS) Adam Kinzinger (R-IL) Morgan Griffith (R-VA)* Gus Bilirakis (R-FL) Bill Johnson (R-OH) Billy Long (R-MO) Renee Ellmers (R-NC)* Minority: Henry Waxman (D-CA), Ranking Member* John D. Dingell (D-MI)* Frank Pallone Jr. (D-NJ)* Bobby L. Rush (D-IL) Anna G. Eshoo (D-CA) Eliot L. Engel (D-NY)* Gene Green (D-TX)* Diana DeGette (D-CO) Lois Capps (CD-A)* Michael F. Doyle (D-PA) Jan Schakowsky (D-IL)* Jim Matheson (D-UT)* G. K. Butterfield (NC)* John Barrow (D-GA)* Doris O. Matsui (D-CA) Donna Christensen (D-VI)* Kathy Castor (D-FL)* John Sarbanes (D-MD)* Jerry McNerney (D-CA) Bruce Braley (D-IA) Peter Welch (D-VT) Ben Ray Lujan (D-NM) Paul Tonko (D-NY) John Yarmuth (D-KY) *Member of Health Subcommittee For further information, contact: Paul Beddoe at or NATIONAL ASSOCIATION OF COUNTIES 25 MASSACHUSETTS AVENUE, N.W. SUITE 500 WASHINGTON, D.C FAX

3 Mental Health Legislative Proposals and their on Counties (1) To improve the responsiveness, coordination, accountability, accessibility, and integration of person-centered behavioral health services to provide timely and appropriate help to individuals, families, and communities; (2) To reduce mental health crises, homelessness, and incarceration by strengthening community based services...; (3) To advance the principles of the Americans with Disabilities Act that support people to fully participate in the most integrated settings within their chosen communities; (4) To develop an integrated behavioral health workforce..; (5) To increase mental health awareness and reduce stigma and discrimination ; and (6) To ensure the full implementation and enforcement of mental health parity for all Americans. Creates new White House Office of Mental Health Policy in Executive Office led by a Director Appointed by President with Senate consent Provides recommendations to HHS Secretary Does not supervise SAMHSA Administrator Establishes new National Mental Health Policy Council, which would include representatives from various federal agencies including SAMHSA Stated Purpose To make needed psychiatric, psychological, and supportive services for individuals diagnosed with mental illness and families in mental health crisis, and for other purposes. Establishes new HHS Assistant Secretary for Mental Health and Substance Use Disorders Appointed by HHS Secretary with Senate consent Directly supervises SAMHSA Administrator Establishes an Interagency Serious Mental Illness Coordinating Committee, which would include representatives from various federal agencies Federal Leadership Federal Coordination Barber bill has a broader focus on comprehensive mental health and community-based services. JULY 2014 PAGE 1

4 Overseen by Director of White House Office of Mental Health Policy Responsible for developing and annually updating comprehensive plan for individuals with comprehensive mental illness on how best to access community-based services Establishes new Office of the National Mental Health Advisory Board in White House Office of Mental Health Policy appointed by Director, including: At least one member from law enforcement At least one member who has served in senior position in local mental health system including SAMHSA Overseen by HHS Asst. Secretary for Mental Health and Substance Use Disorders Responsible for developing and annually updating summary of advances in and strategic plans for serious mental illness research Specifies that at least 9 members of Interagency Committee (or 1/3) should be non-federal public members appointed by HHS Asst. Secretary, including: At least one member from law enforcement At least one member who is a judge At least one member who is a corrections officer Murphy bill has a sharp focus on serious mental illness. County mental health and law enforcement officials would be eligible for appointment to the advisory committees. Non-Federal Leadership Requires that 50 percent or more of all federal advisory panels and peer review groups hold an MD or PhD in clinical psychology. Barber specifies member from local mental health system. Murphy specifies a corrections officer and judge who could be county officials. MD or PhD requirement could limit eligibility of highly qualified county officials. Barber s National Strategy for Mental Health would include recommendations designed to promote community integration e.g., expansion of Medicaid-financed intensive community-based services. National Policy Analysis and Development Establishes a National Mental Health Policy Laboratory in Asst. Secretary s office to: Identify and implement policy changes Disseminate information about evidence-based practices Collect information from grantees under programs established or amended by Helping Families in Crisis Act of 2013 (via Director) Calls for the National Mental Health Policy Council to develop, annually update, and submit to Congress a National Strategy for Mental Health containing recommendations including: Improved coordination between Federal Government and State, local, and tribal entities Ensuring appropriate access to intensive community-based services for Medicaid beneficiaries Reauthorizes major SAMHSA programs and services through FY 2019 for community-based mental health services. NACo supports community-based behavioral health care and services. Murphy makes significant cuts to SAMHSA funding for programs, which would likely shift costs for the local provision of behavioral services Major on SAMHSA Removes or restricts numerous SAMHSA programs and services; for instance: Moves numerous duties from SAMHSA Administrator to Asst. Secretary, including JULY 2014 PAGE 2

5 Puts into place new oversight and reporting requirements to ensure programs deliver measurable outcomes for individuals and families. oversight over Center for Mental Health Services Terminates all SAMHSA funding not authorized in statute Cuts SAMHSA Projects of Regional and National Significance (including consumer and family support technical assistance centers and statewide networks) in half and requires them to be submitted to Congressional committees Prohibits SAMHSA from hosting or sponsoring any conference without giving at least 90 days notice to congressional committees Would only be given to states that advance court ordered treatment, notably Assisted Outpatient Treatment (AOT). to counties. Barber reauthorizes major SAMHSA programs which provide funding for county-based services. NACo supports reauthorization and full funding of SAMHSA programs. Community Mental Health Services (CMHS) Block Grants Transfers responsibility of CMHS to new Acting Secretary for Mental Health and Substance Use Disorders. CMHS stays under authority of SAMHSA Administrator. Murphy would not permit states that do not have court ordered treatment to receive CMHS block grants, potentially shifting additional costs to counties in these states. CMHS block grant funding is a NACo appropriations priority. Counties have experienced mixed results with AOT. NACo does not have a policy on the subject. Could simplify health information sharing among county agencies in the interest of serving individuals experiencing mental health crisis and promoting public safety. Patient Privacy Amends HIPPA allowing: Caregivers to provide and obtain protected health information (even without the individual s consent) when the individual's service provider believes it is necessary in order to protect the individual's health, safety, or welfare or the safety of one or more other individuals JULY 2014 PAGE 3

6 Educational agencies or institutions to disclose individual s records to caregivers Eases Medicaid s Institutes of Mental Disease (IMD) restriction, which would permit states to use Medicaid to fund inpatient psychiatric hospital services and psychiatric residential treatment facility services for individuals between the ages of if such facilities demonstrate an average stay of less than 30 days. NACo supports lifting restrictions on Medicaid funding for inpatient psychiatric treatment for adults, which could reduce the burden on county agencies. Maintains in law that Medicare Part D will cover anti-psychotic and anti-depressant medications. SAME provision. NACo supports full mental health parity, regardless of payer. Allows for same day behavioral health and primary care services. SAME provision. This provision could significantly improve the integration of behavioral health and primary care. Medicaid and Medicare Reimbursement Extends funding eligibility for Medicare and Medicaid Health Information Technology (HIT) to behavioral health providers. SAME provision. NACo supports extending Health IT incentives to behavioral health providers, including county providers. Extends Medicaid Home and Community-based Services to include youth in need of services provided in psychiatric residential treatment facilities. Eliminates Medicare s 190-day lifetime limit on inpatient psychiatric care services. Barber extends Medicare and Medicaid reimbursement which could provide needed revenue streams for providing county services to vulnerable populations. Provides for Medicare reimbursement for marriage and family therapist services. JULY 2014 PAGE 4

7 Requires HHS to issue a final rule on Medicaid and Children s Health Insurance Program (CHIP) plans by January 1, Creates a demonstration for Federally-qualified community behavioral clinics. NACo supports the option for county behavioral health authorities to be Federally-qualified community behavioral health clinics. Murphy makes cuts to SAMHSAadministered advocacy program funding which could undermine an avenue for reporting abuse and promoting accountability in care. Reducing stigma access to services may help individuals seek needed services in a timely fashion and avoid escalating and requiring more intensive county services later. Protection and Advocacy Programs for Individuals with Mental Illness Cuts funding from $35 million to $5 million (85% reduction) and puts into place certain prohibitions. Reauthorizes and maintains current program and funding. Calls for a national awareness campaign to reduce stigma aimed at college students. Reauthorizes and revises a grant program to enhance services for students with mental health or substance use disorders at institutions of higher education. Also calls for a national media campaign focused on the same age group with slightly different caveats. Programs for Students and Young Adults Increases funding for: The Safe Schools-Healthy Students program Increased access to school employment mental health professionals Comprehensive staff development for school and community service personnel working in the schools Mental health training for children, parents and family members Same provision, but also adds grants to improve responses to high utilizers of emergency, housing, Criminal Justice Programs Reauthorizes Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA). NACo and the National Sheriffs Association support reauthorization JULY 2014 PAGE 5

8 judicial, corrections and law enforcement services through up to 6 demonstrations. and funding for MIOTCRA. Suicide Prevention Programs Reauthorizes and revises the Suicide Prevention Technical Assistance Center. SAME provision. May support county behavioral health authorities. Children s Programs Reauthorizes grants for community mental health services to children and the National Child Traumatic Stress Network. SAME provision. May support county behavioral health authorities. Awards funding for veteran peer to peer programs. Creates a number of new provisions including: Requires mental health assessments before enlistments or commissions to officer status unlimited eligibility for mental healthcare for combat veterans NACo supports fully funding veterans services, especially those that support community treatment for mental illness and that allow for reimbursement to community agencies for services provided to veterans. Veterans Programs timelines to create integrated healthcare records for veterans a pilot educational loan repayment program for VA psychiatrists Improves collaboration between the VA and DOD. Increases the number of mental health professionals in the VA. Provides for training on youth suicide early intervention and prevention strategies. Behavioral Health Workforce Provides for a primary care physician training grant program. Provides new funding for: scholarships and loan repayment funding for behavioral health workforce Both measures authorize additional investment in developing the behavioral workforce, which could JULY 2014 PAGE 6

9 developing and sharing education and training to healthcare professionals on identifying, referring and treating individuals with serious mental illnesses help county behavioral health authorities recruit and retain qualified workers. Enhancing psychiatrist services in Indian health programs Adds occupational therapists to the list of behavioral and mental health professionals" under the National Health Service Corps. Increases funding for the brain initiative at the National Institute of Mental Health (NIMH). Advances grants to expand tele-psychiatry and primary care. NACo supports expanding telemedicine in general. Evaluates the combined paperwork burden of certain community mental health centers as well as of certified federally qualified community mental health clinics. Other Notable Provisions Creates incentives for meaningful use of certified electronic health records (EHR) technology. NACo supports extending EHR technology to county providers. Expand research on models like the Recovery After an Initial Schizophrenia Episode research project at NIMH and the North American Prodrome Longitudinal Study, as well as on the determinants of self and other directed violence and brain related research. Encourages and provides new funding for collaborative and integrated behavioral and medical NACo supports greater integration and coordination between JULY 2014 PAGE 7

10 health services and for efforts to assess barriers to behavioral health integration. behavioral and medical health services. Recommends that technical assistance be provided to expand use of evidence based practices for the prevention and treatment of geriatric mental health disorders. Technical assistance could support county agencies providing services to aging population. Stipulates HHS can require hospitals that on multiple occasions do not demonstrate effective discharge planning processes to enter into a system improvement agreement. This requirement could be an unfunded mandate on some county hospitals. Requires a federal study to detail enforcements in implementing the federal mental health parity act and to describe federal and state government efforts to ensure compliance with the parity act. NACo supports full implementation and expansion of mental health parity. JULY 2014 PAGE 8