NYAPRS Note: Earlier today, the House Energy and Commerce Committee unanimously advanced a compromise version of Rep Tim Murphy’s mental health proposal. Some key provisions:
- Codifies into law newly adopted federal rules permitting Medicaid to pay for stays of up to 15 days a month in IMDs, a term that includes state and private psychiatric hospitals and SU treatment facilities (original bill would have funded unlimited stays in facilities that averaged less than 30 days an admission
- Extends outpatient commitment (assisted outpatient treatment) pilots for an additional 2 more years (originally included a 2% financial incentive for states and localities to adopt or expand the program
- No significant change to Protection and Advocacy groups (originally removed most of their capability to advance people’s rights and to require states to serve people with disabilities in the most integrated setting)
- Requires greater education about the latitude providers and others have in sharing ‘patient information’ (originally included broader exclusions to disclose)
- Installs a Secretary for Mental Health and Substance Use within HHS who has be a doctor or psychologist who would oversee but not replace the SAMHSA administrator (originally would have transferred all powers to the Assistant Secretary).
The bill is expected to get to the House floor this fall and then negotiations would begin to reconcile differences with a Senate bill.
This version of the proposal is a decidedly mixed one but is a lot better than where we started several years ago.
House Panel Advances Long-Delayed Mental Health Bill
By Peter Sullivan – The Hill June 15, 2016
A House committee on Wednesday advanced a controversial mental health reform bill, 53-0, that Republicans have cast as their response to mass shootings.
The original version of the legislation, from Rep. Tim Murphy (R-Pa.), was introduced in 2013 following the mass shooting in Newtown, Conn., but it has been delayed for years because lawmakers on both sides of the aisle have opposed it.
In recent months, Energy and Commerce Committee Chairman Fred Upton (R-Mich.) worked to change the bill significantly to smooth over areas of objection, particularly from Democrats. The changes led many of the more sweeping provisions to be scaled back.
“Today, this Committee takes a monumental step by advancing a bill that makes real reforms and offers evidence-based treatment for families in mental health crisis,” Murphy said. “Today we are taking a stand. We affirm that mental illness is not a crime. Mental illness is not a moral defect, it is not a choice, and it is not a joke. Mental illness is just that: an illness.”
The bill still faces a long path to becoming law, but both parties agree there needs to be action on mental health. Murphy said he spoke to Speaker Paul Ryan (R-Wis.), who has pointed to the bill as the party’s response to gun violence, about it on Tuesday.
Murphy is hoping to get a vote in the full House before the August recess, though Upton said at the markup that the bill is likely to reach the floor in the fall.
Democrats called it a good first step but noted that more funding is needed to truly address the problem.
“Congress has got to be willing to put its money where its mouth is,” said Rep. Diana DeGette (D-Colo.).
Several of the most sweeping and controversial changes had to be rolled back in order to smooth the way for the committee vote.
In particular, a provision to allow Medicaid to pay for more care at mental health facilities, which was projected to cost tens of billions of dollars, was scaled back to codify a new regulation covering stays only if they are less than 15 days long.
Changes in the Health Insurance Portability and Accountability Act (HIPAA), meant to allow information about a mentally ill person to be shared with caregivers, were taken out, with the bill instead directing the Department of Health and Human Services (HHS) to issue a regulation to clarify the privacy rules.
The bill would create a new assistant secretary role in the HHS to oversee mental health and substance abuse programs. The official is intended to be a doctor, which Murphy touts as a way to bring needed oversight to government mental health programs that he says are often ineffective in their current form.
The bill also includes measures such as grants for innovative programs that are intended to make initiatives more effective.
It also authorizes grants for areas such as preventing suicide and early intervention for children with mental illnesses. Funding for the range of grants will depend on the appropriations process. Murphy says he has talked to appropriators and is hopeful for funding beginning in 2018.
The Senate also has a mental health bill, from Sens. Chris Murphy (D-Conn.) and Bill Cassidy (R-La.), which has generally been narrower and less controversial than the House bill.
The House bill’s most recent changes have made it more like the Senate bill.
The Senate bill has been facing a tight floor schedule and Democratic opposition to gun-related measures in a broader mental health bill from Sen. John Cornyn (R-Texas), which he is seeking to combine with the Murphy-Cassidy bill.
Some in the Senate have floated the idea of adding mental health provisions to the conference committee working on opioid legislation as a way to push the measures forward.
In the House, Rep. Joe Kennedy III (D-Mass.) pushed for stronger provisions on mental health parity, making insurers cover mental health as well as they cover physical health. While the provisions were not included, Upton promised a hearing on the subject in the fall.
Democrats also countered the Republican messaging that the House bill is a response to mass shootings.
Rep. Tony Cárdenas (D-Calif.) offered an amendment to lift a ban on federal research on gun violence, a longtime Democratic goal, but it failed on a party line vote of 23-29.
More broadly, Rep. Frank Pallone (D-N.J.), the committee’s top Democrat, said gun control, not just mental health reform, is needed.
“We're not going to begin to stop the violence until this Congress finally decides to address gun safety legislation,” Pallone said.
Meanwhile, Chris Murphy took over the Senate floor Wednesday, refusing to allow the chamber to go into other business until his colleagues did something about gun control.
“I'm prepared to stand on this floor and talk about the need for this body to come together on keeping terrorists away from getting guns ... for, frankly, as long as I can, because I know that we can come together on this issue,” said Murphy.