NYAPRS Note: Yesterday, the US House of Representatives gave almost full approval to HR.2646, federal mental health legislation that was originally proposed by Rep. Tim Murphy (R-Pittsburgh). The bill has been extremely controversial, taking 3 years of negotiation to get to the version that was approved yesterday. The bill was originally presented as a violence prevention measure following the Newtown tragedies but that linkage was essentially dropped, with Democrats continuing efforts to pass separate gun control legislation.
There are winners and losers on all sides depending on the issues, with full attention now turning to influencing how the Senate will approach negotiations with the House to get a bill through the full Congress this session.
Here’s our assessment:
Expands Medicaid funding for stays in private or state mental health and for addiction treatment facilities: the bill loosens the “IMD exclusion” to allow states with 1115 Waivers to authorize Medicaid managed care (only) funds to pay for hospital stays in state or private psychiatric and addiction treatment facilities for up to 15 days per stay. States will have to apply to use this option and CMS will have to approve on a state by state basis. The bill originally authorized all Medicaid to pay for unlimited stays in those facilities, provided they didn’t show an average of 30 day stays.
HIPAA privacy protections: the bill essentially makes no changes in the current statute. It allocates $10 million through 2022 to educate health care providers and families about the level of flexibility to disclose patient information within the current law. It does direct the federal Health and Human Services Agency in conjunction with the Office of Civil Rights to consider new regulations next year. The original bill would have opened up
Court mandated outpatient treatment (termed AOT): The bill allocates funding to pay for a provision that was approved last year by Congress to establish AOT pilots. It increases the amount and the years of those pilots. The original bill penalized states that didn’t use or expand AOT programs by reducing their federal block grant totals by 2%.
Protection and Advocacy Agencies: no essential changes here; the bill does repeat previously stated prohibitions against P&A groups to use their federal funds to lobby and establishes a grievance procedure for complaints. The original bill would have all but gutted these programs.
Federal Agency Changes: The bill creates an Assistant Secretary for Mental Health and Substance Use Disorders higher up within the Health and Human Services Agency to oversee and coordinate federal behavioral health policy. It is “preferred” but not required that the Ass’t Secretary be a psychiatrist, osteopath or psychologist. This position will oversee SAMHSA and the Center for Mental Health Services (CMHS) activities, establish priorities, performance metrics and standards for grant programs.
SAMHSA Block Grants: the bill re-authorizes all existing programs and includes an emphasis that these existing and new programs should address the needs of those with the most advanced conditions.
Assertive Community Treatment: The bill provides $5 million a year for 2018-2022 ($25 million total) to expand Assertive Community Treatment teams.
Peer Services Study and Education: The Comptroller General will study peer support in 10 states to identify possible ‘best-practices.’ It also authorizes grants to colleges of $10 million a year for 5 years ($50 million) to increase the behavioral health paraprofessional workforce, including peers.
Psychologist Education: There is $12 million a year for five years ($60 million) to train psychologists to work with those with more advanced conditions.
Crisis Intervention Training for Police: The bill authorizes $9 million for 2018-2020 ($27 million) for CIT Training.
Same Day Treatment: The bill allows Medicaid to reimburse for physical health and mental health services received within same day.
Suicide Prevention: there is an adult suicide prevention allocation of $30 million a year ($150 million total) and another grant of $9 million a year for 2017-2021 ($45 million total) for suicide prevention for any age group. There is also $35 million a year ($175 million) allocated to youth suicide. Rep. Murphy disclosed yesterday about his own father’s suicide attempt.
Interdepartmental Serious Mental Illness Coordinating Committee: Establishes a high-level cross-government committee to issue a report and recommendations to improve care.
Innovation Grants: The bill provides 2 separate grants of $7 million each over three years ($21 million total), one for evaluating promising models that enhance prevention, diagnosis, treatment and recovery or to integrate health and mental health and one to scale up evidence based programs.
Bed Registry or Community Crisis Response Plan: The bill allocates $5 million a year ($25 million total) for 2018-2022 for grants communities can apply for to create a Crisis Response Plan (agreements between providers and criminal justice, etc.) or to create a registry of existing empty beds.
Parity: The bill calls for a GAO study on parity compliance.
Democrats continued to insist that much more money is needed: Rep. Frank Pallone (D-N.J.), the ranking member on the Energy and Commerce Committee said “…I want to be very clear on this point — if we are truly serious about fixing our broken mental health system, we have to expand access and make sustained investments.” Rep. Jim McDermott (D-Wash.) said that the newly approved bill is a "hollow promise without any money in it.” And NYC First Lady Chirlane McCray said that “to truly help people and fix our broken mental health system, Congress must provide new resources. Only with serious investment can we address the decades of neglect that have left so many families in pain and distress."
Imagine if the funds that are being approved for more hospital stays and beds and for outpatient commitment programs and new additional funding were spent instead on outreach, engagement, activation, diversion, housing, employment, rehabilitation and peer support services (vs studies or training).
According to Politico, “the White House, which has been engaged in its own mental health push focused on reducing stigma around mental illness and expanding access to insurance through the 2010 Affordable Care Act, was noncommittal on the bill.
“We welcome bipartisan efforts to make progress toward ensuring that Americans can get the treatment they need,” said Katie Hill, a spokeswoman.”
All eyes and voices turn now to the Senate where Senators Chris Murphy and Bill Cassidy have a bill that will provide the framework for what changes they will suggest be made to the House measure. Senator Murphy comes from Connecticut, one of the few states that don’t have an outpatient commitment law (a practice the Senator once labeled ‘draconian’). Chairman Lamar Alexander said yesterday that he’d like the Senate to take up that measure in September.
Stay tuned for some recommendations about what to ask of Senate negotiators over the next few months!
House Passes Mental Health Bill
By Peter Sullivan The Hill July 6, 2016
The House on Wednesday overwhelmingly passed a long-delayed mental health bill that Republicans have cast as their response to recent mass shootings.
The measure from Rep. Tim Murphy (R-Pa.), which passed 422-2, had been stalled and mired in controversy for years, but lawmakers in recent months dropped or scaled back many of the most contentious, sweeping measures.
That process has led to a bill that is much more modest than the original plan but that advocates are still praising as a good first step. Democrats stressed that more funding is still needed.
The bill aims to improve the oversight and effectiveness of federal mental health programs and authorizes a range of grants for treatment.
Mental health reform has been a rare area where both parties are looking to enact legislation, but a parallel effort in the Senate has been stalled over gun politics, and it is unclear whether a bill can be signed into law this year.
“Our mental health system in this country is a failure, and this is one of those times when we’re not gathered for a moment of silence, but a time of action,” Murphy said Wednesday.
“We’re here, finally, to speak up for the last, the lost, the least and the lonely. That is those that suffer from mental illness.”
Advocates have in particular pointed to a lack of providers and beds at treatment hospitals for mental illness.
The vote comes in a week when Republicans are responding to a Democratic push to pass gun control legislation. Republicans say mental health reform is a way to prevent mass shootings by mentally ill people.
Democrats warn against stigmatizing mental illness and argue that gun laws are needed, but say they support mental health reform for its own sake. Both parties were able to put aside gun politics to pass the bill.
The measure would create a new assistant secretary role in the Department of Health and Human Services (HHS) to oversee mental health and substance abuse programs. The role is intended for a doctor, which Murphy touts as a way to improve the oversight of federal mental health programs that he views as currently ineffective.
The bill 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, but Murphy noted that he has talked to appropriators and is hopeful that funding can begin in 2018.
Several of the most ambitious 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, drew objections from some Republicans. It 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, meant to allow information about a mentally ill person to be shared with caregivers, were taken out after objections from Democrats and some Republicans. The bill instead directed HHS to issue a regulation to clarify the privacy rules.
Ron Honberg, senior policy adviser for the National Alliance on Mental Illness, said his organization knew that some provisions would have to be scaled back for the sake of compromise.
“There’s still a lot of really good stuff in this bill,” Honberg said, pointing to early identification and prevention efforts in young people, improved coordination of services and simply changing the conversation.
“All of the focus on this bill has helped shape the conversation,” he added. “A lot of the issues being talked about today weren’t being talked about two or three years ago.”
The Senate has a parallel, bipartisan bill from Sens.Chris Murphy(D-Conn.) and Bill Cassidy (R-La.).
The changes to the House bill have made it similar to the Senate bill, which had always been narrower and less controversial.
However, the Senate bill hasfaced an obstaclein gun politics. Sen.John Cornyn(R-Texas) wants to combine the measure with his mental health bill, which includes provisions that Democrats denounce as making it easier for mentally ill people to get guns.
There has been no resolution yet on that front, and the measure also faces a tight time window on the Senate floor.
U.S. House Passes Murphy's Mental Health Reform Bill
By Tracie Mauriello / Pittsburgh Post-Gazette Washington Bureau July 7, 2016
WASHINGTON – The source of U.S. Rep. Tim Murphy’s passion for his life’s work and for mental health reform became clear Wednesday, when he spoke publicly for the first time about his father’s suicide attempt years ago.
Mr. Murphy, who worked for 30 years as a psychologist, choked up during a floor speech just before the House overwhelmingly passed the reform bill that has been the focus of his work in Congress for nearly four years.
“I was in college at the time when I heard a soft voice in my house just saying, ‘Help,’” the Upper St. Clair Republican said, visibly near tears. “It was my father. I went into the bathroom where he was and he had cut the arteries in his arms and he was bleeding out.”
The young Mr. Murphy called an ambulance and his father recovered. The memory still motivates the congressman’s work, although he hadn’t shared it publicly.
“It’s decades later and he is long gone, but it’s in a soft voice that millions of Americans are also calling out for help,” Mr. Murphy said on the House floor.
The Families in Mental Health Crisis Act aims to improve access to treatment before the mentally ill wind up in crisis.
The legislation is Mr. Murphy’s answer to the problem of gun violence caused by mentally ill people in crisis. It still must pass the Senate, which has its own version. Differences would have to be worked out in a conference committee.
Mr. Murphy’s bill was one of the few things lawmakers could agree on during a day of particularly contentious debate over gun control….
Mr. Murphy’s bill, however, sailed easily through the House on a 422-2 vote with lawmakers on both sides of the aisle praising him for his work on it.
House members previously had been divided mostly along party lines, with objections centering on a provision to change federal privacy laws so that caregivers can access treatment plans of patients with severe mental illnesses that impair their ability to make sound decisions about their own care.
Democrats were concerned that the measure would dissuade mentally ill people from seeking treatment.
To appease them, Mr. Murphy changed his bill. Instead of requiring a change in federal statute, it now requires the Department of Health and Human Services to change its rules on access to patient information. HHS is empowered to make such changes after holding hearings and considering public input.
The bill also would create a new position for an HHS assistant secretary who would coordinate mental-health and substance-abuse programs across the government.
The bill also would expand access to in-patient psychiatric care for Medicaid patients, and would tie grants for mental health programs to measurable outcomes.
Mr. Murphy called his bill “wide-ranging and impactful.”
But many Democrats said it isn’t enough, and several called for increased funding for mental health services.
U.S. Rep. Joe Kennedy, D-Mass., called it an incremental step forward.
“We cannot accept this bill as a full, comprehensive fix to a fully broken system. If we do, patients suffering from mental illness will continue to fall through the same gaps that exist today.
“Unless we increase Medicaid reimbursement rates, providers will still be able to turn away our most vulnerable patient population,” Mr. Kennedy said. “Unless we inspire and encourage a new generation to pursue careers as psychologists, psychologists and social workers there will still be a shortage of professionals to care for patients. And unless we can guarantee parity [between coverage for mental and physical care], insurance companies will continue to construct barriers to care, leaving patients without access to the mental health system no matter how strong that system may be.”
In an interview, Mr. Murphy said he hadn’t talked about his father’s suicide attempt in years, and only decided to talk about it Wednesday a few moments before his speech when he jotted down a few notes about it in the margins of his prepared remarks.
“I heard hundreds of people’s stories through the course of this, and I really wanted to focus on them and what their needs were. I didn’t want anybody to think I was doing this for myself,” he said later Wednesday. “But today I wanted people to know ‘I’ve been there, too. I know what the pain is like for families.”