Update on Congressional Legislation
Presentation
for the
National Coalition on Mental Health & Aging
July 14, 2015
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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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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-HHSEducation 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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Mental Health Programs of Regional and National Significance –
$378.6 million, level with FY2015.
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These are competitive grant programs supporting different types
of mental health services.
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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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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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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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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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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 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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In gearing up for implementing the Excellence in Mental Health Act, which establishes a twoyear 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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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 federallyowned 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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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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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.
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But it ended in significant accommodation, with strong Democratic support and
praise for many of its provisions from the Obama administration.
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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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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.
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The funding would be available as grants to law enforcement
agencies through the Justice & Mental Health Collaboration Program.
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Congressman Murphy’s Helping Families in Mental Health Crisis
Act, H.R. 3717, would also help expand mental health courts.
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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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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.
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A new provision highlights the needs of vets [and focuses] on veteran treatment
courts and related programs reflecting the ongoing concerns of returning vets.
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The legislation incorporates the “Sequential Intercept Model” (SIM) as a foundation
for services.
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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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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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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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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 schoolbased 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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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 (RPa.) 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.
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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.
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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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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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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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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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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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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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Thank You and Questions
Contact:
Joel E. Miller
Executive Director and CEO
AMHCA
jmiller@amhca.org
703-548-6002
www.amhca.org
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