NYAPRS Note: The US Senate advanced mental health legislation that has garnered strong support from a broad array of mental health advocacy groups (see attached) and, as Tom pointed out yesterday, has a number of stark differences from House bill HR.2646. Controversy will rise as the Senate considers additional amendments including the removal of the IMD exclusion which will commit tens of billions of dollars to increase state and private psychiatric hospital beds, in place of a major commitment to grow our community mental health systems.
The National Association of County Behavioral Health & Developmental Disability Directors’ Ron Manderscheid is playing a major national advocacy role here (see attached letter) and, as he has for many decades, on issues across the broad range of mental health policy and programmatic advances. NYAPRS is very pleased that Ron will be our kickoff keynoter at our April 21-2 Executive Seminar in Albany. While his and our focus will be on population health, we’ll bet that Ron will for a few minutes on these national mental health legislative issues. You can see the latest program at https://rms.nyaprs.org/wp-content/plugins/files/civicrm/persist/contribute/files/2016%20NYAPRS%20AgendaFinal4a.pdf and register at https://rms.nyaprs.org/event/?page=CiviCRM&q=civicrm/event/info&reset=1&id=20.
Senate Panel Approves Mental Health, Substance Abuse Bills
By Nathaniel Weixel BNA March 16, 2016
A Senate panel approved a broad, bipartisan mental health bill and four bills relating to substance abuse treatment March 16.
The Mental Health Reform Act (S. 2680), sponsored by Sens. Lamar Alexander (R-Tenn.), Patty Murray (D-Wash.), Bill Cassidy (R-La.) and Chris Murphy (D-Conn.), seeks to improve the current mental health system by improving care coordination and increasing access to care.
The bill is narrower in scope than a similar effort under way in the House (H.R. 2646), which has been stalled for months.
Alexander chairs the Senate Health, Education, Labor and Pensions Committee, which approved the five bills March 16.
The issues of mental health and opioid abuse have been prevalent in Congress in recent months. The bipartisan support behind the Senate legislation makes it more likely to move forward than the House version.
The substance abuse bills (S. 1455, S. 2256, S. 480, and S. 2687) approved by the HELP Committee build on an already-passed piece of Senate legislation meant to tackle the prescription opioid and heroin epidemic. All five pieces of legislation were approved by voice vote and now move to the Senate floor.
Alexander praised the bipartisan nature of the negotiations and said the bills are ready to be considered by Senate Majority Leader Mitch McConnell (R-Ky.) whenever he chooses. Alexander said the hope is that the legislation may be considered shortly after the Senate returns from recess in early April.
The mental health reform bill would require the Substance Abuse and Mental Health Services Administration (SAMHSA), part of the Department of Health and Human Services, to hire a chief medical officer and report to Congress every two years on its activities. It would increase access to care for individuals including veterans, homeless individuals, women and children. It also would improve training for those who care for people with mental illnesses, and promote better enforcement of existing mental health parity laws—making insurance companies reimburse mental health treatment the same as for treating physical health.
A manager's amendment to the legislation would authorize block grants to states for mental health services, as well as for the prevention and treatment of substance abuse disorders, although the exact amount will be subject to appropriations.
Other provisions will be added to the bill once it gets to the floor. Alexander told reporters he expects an amendment from Sen. Roy Blunt (R-Mo.) expanding the number of community mental health centers from eight to 24.
Senators also will seek to include a repeal of the prohibition on Medicaid paying for the inpatient care of anyone over the age of 21 and under 65 who resides in an institution for mental diseases (IMD), even for treatment unrelated to mental illness. The so-called IMD exclusion would be very costly to repeal, but is seen by many advocates as a major barrier to treating mental illness.
“There are Republicans who support it. That's the next step in the process,” Alexander said.
Murphy said he's been speaking with the Senate Finance Committee to find a way to pay for the repeal. A repeal of the IMD exclusion was included in the House bill, and the Congressional Budget Office said the change would cost between $40 billion and $80 billion over 10 years. Murphy said the CBO is revising that figure after being informed of new details by House members.
“If you really want to take a bite out of the mental health crisis you ultimately have to address the massive shortage of inpatient beds and outpatient capacity. I think that'll be the big outstanding question we bring to the floor,” Murphy said after the markup.
Sen. John Cornyn (R-Texas) may also introduce the Mental Health and Safe Communities Act (S. 2002) as an amendment, or he could introduce it separately. Cornyn has said he will encourage Senate Judiciary Committee Chairman Charles Grassley (R-Iowa) to have a separate markup of S. 2002 and then find a way to merge it with the HELP bill.
That bill seeks to improve mental health treatment for people facing imprisonment. The measure is controversial because Democrats object to a provision they say would make it easier for mentally ill people to get guns.
Unlike the House legislation, the Senate bill steers clear of controversial areas like assisted outpatient treatment and large changes to the Health Insurance Portability and Accountability Act (HIPAA) privacy provisions. The House bill would provide funding incentives to encourage states to adopt assisted outpatient treatment (AOT) laws, which allow judges to force people with mental illnesses into treatment. It also would make it easier to for providers to share protected health information with caregivers.
The Senate legislation would direct the administration to provide resources to ensure providers, patients and families know what the HIPAA regulations are. It avoids any mention of AOT laws. Avoiding those issues should make the bill's passage smoother, but it has upset some mental health advocates who feel AOT is the only way to care for people with severe mental illnesses.
“I do think [the Senate bill] does diverge [with the House bill],” Alexander told reporters. “Sen. Murphy and Sen. Cassidy started out with much of the House bill, and they worked with their colleagues to come up with a bipartisan approach that's a consensus.”
“There's still a lot in common [with the House bill] and our hope is our action today gives a little push to the House process,” Murphy said.
Murphy Mental Health Bill Wins Big Bipartisan Support – After Some Changes
By Ana Radelat Connecticut Mirror March 16, 2016
Washington – A key committee on Wednesday voted unanimously to send a mental health bill sponsored by Sen. Chris Murphy to the Senate floor, but not until certain provisions were dropped.
The Mental Health Reform Act, which is co-sponsored by Sen. Bill Cassidy, R-La., would establish a new a new assistant secretary for mental health and substance abuse and establish a new grant program for early intervention aimed at helping children and young adults.
The bill that cleared the Senate Health, Education, Labor and Pensions (HELP) committee Tuesday by voice vote would also clarify medical privacy law to make it clear that health professionals can share information with family members of the mentally ill.
It also would establish a new federal office to encourage the adoption of evidence-based mental health programs.
“This is an important bill – this is going to make a difference,” Murphy said. “It’s rare that Republicans and Democrats can get together on something this comprehensive.”
But during what he called “negotiations on a knife-edge,” certain original provisions in the bill had to be abandoned.
One would have repealed the current Medicaid rule that excludes paying for inpatient mental health care for individuals between 22 and 64 years old. That would have burdened both the federal government and the states, which share the cost of the Medicaid program, with new costs.
Murphy said the HELP Committee isn’t an appropriation committee with jurisdiction over funding, “so we have to go to the floor with, I hope, a bipartisan commitment to come up with new resources to make sure that we’re addressing the severe lack of inpatient and outpatient capacity.”
HELP committee members also modified another provision that would have addressed the issue of mental health parity, that is a requirement that insurers cover mental health illnesses like they cover physical infirmities.
“What’s happened is that insurance companies put up a lot of barriers” to paying for mental health treatments, Murphy said.
The original bill required the federal government to audit insurers for compliance with a federal requirement that there be parity between insurance benefits for physical and mental illnesses.
Now the bill would give insurance companies new guidance on how to comply with the law and would limit the audit of insurers to plans that routinely show an inability to meet the requirements of the parity law.
“Little things were stripped away, but it was understood they would be stripped away,” said Angela Kimaball, policy director at the National Alliance for the Mentally Ill.
She said, “The bill as a whole is a step forward, but it isn’t everything."
Still, Kimball said, it will strengthen mental health parity, and it’s the first time in decades Congress has tackled the nation’s mental health issues in a comprehensive way.
Murphy hopes the full Senate will approve the bill.
“This is the first time a comprehensive mental health bill has gotten this far,” Murphy said. A similar bill in the U.S. House of Representatives sponsored by Rep. Tim Murphy, R-Fla., is stalled in the House Energy and Commerce Committee.
“Our hope is that the Senate action gives the House a little shove,” Murphy said.
HELP Committee Chairman Lamar Alexander said he expects a Senate vote on the Mental Health Reform Act in the spring.
“One in five adults in this country suffers from a mental illness, and nearly 60 percent aren’t receiving the treatment they need,” he said.