May 15, 2008

Update on Efforts to Delay Implementation of Seven Medicaid Regulations for One Year
National Council Runs Ads in Support of Medicaid Moratoria Legislation

The House of Representatives is expected to vote today on an amendment to add legislation to delay seven Medicaid regulations for one year to the Iraq War Supplemental spending bill. This bill is expected to be the next piece of legislation sent to the President for his signature.

This week, 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. To see a copy of the ad, click here.

According to a report in CQ Today, consideration of the spending bill has been held up in the House because of objections of conservative Democrats – the so-called Blue Dog Democrats – over plans to include a veterans’ education benefit without offsetting the cost. Democratic leaders plan to meet the group’s demand for an offset by including a surtax on adjusted gross income for individuals above $500,000 and joint filers above $1 million.

On April 23, the full House of Representatives passed legislation (HR 5613) 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 passed by a vote of 349-62 – a margin large enough to defeat a presidential veto. The National Council thanks all members who made calls in support of HR 5613 in the days leading up to the vote.

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.

In the Senate, legislation to delay these Medicaid regulations is most likely to be attached to the next supplemental appropriations bill. It is the National Council’s understanding that if language to delay these regulations is included in this bill, the President will veto it. We will need your continued efforts to keep the pressure on in the Senate – be on the lookout for alerts from the National Council on this important issue!

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.

We will keep you updated as new developments on efforts to delay these seven Medicaid regulations occur.

New Supportive Housing Program Legislation Introduced in the House

On April 10, 2008, Representatives Christopher Murphy (D-CT) and Judy Biggert (R-IL) introduced legislation to spur construction of new affordable housing to meet the demand for affordable supportive housing for people with disabilities.

The Frank Melville Supportive Housing Investment Act of 2008 (HR 5772) would authorize a new Section 811 Demonstration program, allowing for the funding of new permanent supportive housing units. HR 5772 would also make reforms and improvements to the existing Section 811 program. Section 811 is the only program at HUD that provides supportive housing for non-elderly, low-income people with disabilities. To read the full text of HR 5772, click here.

"We’ve got to do better to provide for the housing needs of people with disabilities,” said Representative Murphy in a press release. “It should be a national responsibility to help people live independently, with optional services if they choose.”

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

Submit Comments to CMS on the State Plan HCBS Benefit Proposed Rule

Recently, the Centers for Medicare & Medicaid Services (CMS) put on display at the Office of the Federal Register a Proposed Rule for the Optional State Plan HCBS Benefit. This proposed rule implements Section 6086(a) of the Deficit Reduction Act. The National Council has prepared a summary of this proposed rule. 

Official comments must be submitted no later than 5 PM on June 3, 2008. The National Council has prepared draft comments – we encourage you to submit your own comments to CMS using this template.

For your convenience, we have included information on how to submit your comments below. Please share your comments with us – e-mail your comments to Mohini Venkatesh at MohiniV@thenationalcouncil.org.  If you have any questions, please contact Mohini Venkatesh.
 
To submit your comments electronically:
 
1. Click on the following link: www.regulations.gov  
 
2. Under "Comments or Submissions", search for "Medicaid program: Home and Community-Based State Plan Services". 
 
3. Click on the "Send a Comment or Submission" link and follow instructions to submit your comments.
 
To submit comments by regular or overnight mail, please see the instructions in the Federal Register announcements.

Clarification: Federal Parity Negotiations Continue; House Developing Counteroffer to Senate

House negotiators are in the process of developing a counteroffer to Senate negotiators in an attempt to reach a deal on differences over the terms of legislation to provide equity in insurance coverage for addiction and mental health treatment.

While legislation to provide parity for addiction and mental health treatment has passed in both chambers, differences between the two bills – the Paul Wellstone Mental Health and Addiction Equity Act (HR 1424) and the Mental Health Parity Act of 2007 (S 558) - have stalled further progress. Among the major differences between the two bills is a provision in the S 558 that would allow insurers to determine which conditions the parity provisions covered, while HR 1424 would extend parity to all conditions listed in the DSM-IV. As you know, in order for legislation to become a law, each house of Congress must pass the exact same bill and it must be signed by the President.

On March 18, the Senate made a formal compromise offer to the House in the hopes of reaching agreement on a bill in what is left of the 110th Congress.  It is our understanding that the offer was not the Senate (S. 558) or the House Bill (HR 1424), but a new bill that includes provisions from both.

The National Council has supported the passage of parity legislation in both chambers, and hopes that the subsequent conference process will produce a bill that will expand parity for both mental health and addictions treatment. We will keep you informed as negotiations continue.

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.

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:
 
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. 

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.

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.