Mental Health Legislative Advocacy Priorities
Affordable Care Act (ACA) Implementation and Medicaid Expansion
Now that most of the health care reform, the law of the land, has been upheld by the Supreme Court and validated by the 2012 national election, we are working on a number of levels:
- Joining with advocates around the country to conduct enrollment outreach; Influencing implementation activities by the federal administration and state governments;
- Pushing for federal regulations that broadly define the mental health and substance use disorder benefit to include a comprehensive array of services (usually referred to as the "Essential Health Benefits (EHB)");
- Ensuring effective implementation of a ground-breaking Medicaid expansion in that every state implements some form of Medicaid expansion;
- Ensuring that state Health Insurance Exchanges (HIE) issue benchmark plans that are at parity.
With the federal mental health parity law now fully effective (enacted in 2008), we are working to increase awareness of its requirements (interim rule promulgated in 2010), responding to requests on the impact on state laws, pushing for regulations and a final rule that reflect Congressional intent, and monitoring compliance by health plans. We await the final rule due sometime in 2013.
Incorporating mental health and substance use disorders into federal prevention initiatives is an important priority. We also will be promoting and supporting legislation to encourage prevention and promotion activities in schools, including the Mental Health in Schools Act and the Garrett Lee Smith Memorial Act, which supports suicide prevention programs. We have strongly supported legislation that would protect students from inappropriate seclusion and physical restraint by requiring states to set minimum standards on their use. Although a bill passed the House last Congress, the Senate failed to act.
In addition, we will be working on a project aimed at encouraging states to improve access to preventive and preemptive services for all age groups through their Medicaid programs. We are advocating for increased implementation and funding for "Upstream Services" - which are behavioral health prevention and early intervention services.
We are currently trying to meet the mental health needs of the military community. More than half a million Iraq and Afghanistan war vets have not sought care from the Department of Veterans Affairs (VA), even though 20 percent of vets have PTSD or depression, and another 20 percent report traumatic brain injury (TBI) during deployment. We support efforts to deliver community- based services that include trained and certified peers, service navigation, and community outreach. We support an integrated, holistic model of health, recognizing mental health needs cannot be separated from other critical needs, such as housing and employment, and resource coordination, to avoid duplication and ineffective services.
Mental Health Funding and Appropriations
Funding for mental health programs and services at the Substance Abuse and Mental Health Services Administration (and other federal agencies) are at risk as Congress and the administration look to cut domestic spending. We will continue our advocacy in support of essential funding for these programs-and the implementation of health reform-in the appropriations process and other fiscal negotiations. In addition, we will work to support funding for behavioral health research at the National Institutes of Health.
Health Information Technology
We will push for legislation to extend financial incentives for adopting health information technology including electronic health records to mental health and addiction treatment providers and facilities.
Medicare Part D
We are working to maintain strong coverage of mental health medications and oppose state efforts to limit access to treatments.
MHA is pushing for wide implementation of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. According to the U.S. Surgeon General, while 11 percent of youth have been diagnosed with a mental illness, two-thirds of youth who have a condition are not identified and do not receive mental health services. Prevention and early identification of health conditions, which is a key component of EPSDT, promotes positive health outcomes and can reduce health care costs across an individual's lifespan. Under the EPSDT benefit, eligible individuals must be provided periodic screening (well child exams) as defined by statute. One required element of this screening is a comprehensive health and developmental history including assessment of physical and mental health development.
State Mental Health Budgets
States have cut mental health budgets by nearly $5 billion over the last 3 years -the largest reduction to mental health spending since the de-institutionalization of state hospitals in the 1970s. Individuals receiving treatment through state funded resources are increasingly vulnerable as states cut other important community supports such as education, criminal justice, and housing. We are organizing our affiliates to prevent further cuts to states' mental health budgets, and advocate for increased funding.
Regional Policy Council (RPC)
- Mental Health America's (MHA) Regional Policy Council (RPC) is comprised of nine of MHA's most knowledgeable affiliate public policy or executive directors, representing the 10 Department of Health and Human Services (HHS) regions, working in conjunction with MHA policy staff to create a strong and proactive advocacy network.
- Primary to the work of the RPC are issues related to the implementation of the Affordable Care Act, such as essential benefits, Medicaid expansion, enrollment, and full parity that meets the needs of people with mental health and substance use conditions.
MHA Legislative Priorities
With the increased awareness of mental health issues in the aftermath of the Sandy Hook tragedy and the never-ending fiscal negotiations that threaten to cut discretionary funding to SAMHSA, NIH and other key agency programs such as housing and education, MHA continues to advocate for increased funding for important mental health programs, including preserving Medicaid, and our legislative priorities for the 113th Congress:
- Budget/Appropriations (S.Con.Res. 8/H.Con.Res. 25) - the Senate and House have adopted budgets that will set funding levels for discretionary and mandatory programs. These Budget proposals will shape the Appropriations bills that will ultimately fund critical mental health services and supports;
- Mental Health in Schools Act (S. 195/H.R.628) - Authorize grants to school districts to help them implement effective mental health programs;
- Children's Recovery from Trauma Act (S. 380) - To reauthorize and update the National Child Traumatic Stress Initiative for grants to address the problems of individuals who experience trauma and violence related stress;
- Excellence in Mental Health Act (S. 264) - Establish standards, oversight, and improved reimbursement for Federally Qualified Community Behavioral Health Centers;
- Mental Health First Aid Act (S. 153/H.R. 274) - Provide grants to universities to train staff in Mental Health First Aid;
- Garrett Lee Smith Memorial Act Reauthorization of 2013 (S. 116) - To renew the commitment to critically important youth and college suicide prevention programs, which provide a comprehensive approach to addressing the national problem of youth suicide;
- Justice and Mental Health Collaboration Act of 2013 (MIOTCRA; S. 162/H.R. 401) - Reauthorize and update a 2004 law (PL 108-414) that set up a grant program to support mental-health courts and other collaborative programs between the criminal justice and mental-health systems;
- Mental Health Awareness and Improvement Act of 2013 (S. 689) - To reauthorize and improve programs administered by both the Departments of Education and Health and Human Services related to awareness, prevention, and early identification of mental health conditions, and the promotion of linkages to appropriate services for children and youth;
- Youth PROMISE Act (H.R. 1318) - Amend the Juvenile Justice and Delinquency Prevention Act of 1974 to provide communities support and funding to effectively address youth violence issues and thus preventing mental health conditions from leading to bad outcomes;
- Behavioral Health IT Act (not yet introduced) - Extend federal incentive payments for health information technology to behavioral health facilities and providers that are currently ineligible for this funding; and
- Keeping All Students Safe Act (not yet introduced) - To prevent and reduce physical restraints and seclusion in schools to ensure the safety of all students and staff.
For more bill summaries, please go to http://thomas.loc.gov/home/thomas.php.
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