Mental Health America Reacts to Senate HELP Legislation

By:  Paul Gionfriddo, MHA president and CEO

The Senate Health, Education, Labor, and Pensions (HELP) Committee released a draft of mental health reform legislation this week and invited comments from advocates.  The committee plans to take it up on March 16.

The draft does not follow the structure of either S. 1945 or H.R. 2646, but takes an entirely different approach.  For example, it does not include a new Assistant Secretary, relying instead on the current Assistant Secretary for Planning and Evaluation to play that role.  It does not include the same new demonstration and innovation grant programs that were in the earlier proposal.  It also does not include provisions related to AOT or ACT.  It does include sections clarifying HIPAA and promoting Parity Law enforcement.

Largely because of jurisdictional issues it also does not include Medicare and Medicaid provisions, such as revisions to the IMD statute or same-day billing restrictions. 

We thank the HELP Committee for this thoughtful draft.

In general, MHA appreciates that it pushes us forward in many areas of importance, including prevention, early identification and intervention, integration, and recovery. It does much to modernize the SAMHSA statute, and provisions such as parity enforcement and workforce planning will help millions of Americans get access to the behavioral health care that they need.

We have also offered ten recommendations to the Committee to make the proposal stronger.

The recommendations are in the following areas:

• Translating findings to Medicaid

• Pay-Fors in the Bill

• Resilience Outcomes for Population Health

• Screening and Early Intervention

• Integration with Schools

• Supporting the Peer Workforce

• Ending Incarceration of Individuals with Serious Mental Illness

• Supporting Integration By Harmonizing Privacy Laws

• Primary Care and Behavioral Health

• Defunding Existing Programs

While we have addressed them all in detail in our communication to the Committee, let me review several of the most substantive ones here.

• We presented several recommendations for translating the findings from the programs funded by the bill into the Medicaid program.

• We recommended replacing the current statute governing 42 CFR Pt. 2, which makes it harder for individuals to get behavioral health providers to release health records to other providers, and using the $75 million that this will save to offer $15 million in funding for the following five programs:

o   Peer Support Specialist Grants
o   Promoting Innovation Grants
o   Educational Integration Incentive Grants
o   Integration Incentive Grants
o   Community Mental Health Services Block Grant

• We recommended that all funds saved through enactment of early intervention strategies and through an end to incarceration of nonviolent offenders with mental illness be redirected to support programs included in the new law.

• We recommended that the legislation result in the identification of short-term outcomes that could be used in value-based payment and population health models to predict long-term outcomes.  This would create financial incentives for providers to get involved in resilience and prevention for their patient population.

• Because the U.S. Preventive Services Task Force has recommended mental health screening for everyone over the age of eleven, including pregnant and post-partum women, we recommended adding a requirement that all entities receiving block grant dollars offer screening and early intervention to the individuals they serve – and that a significant percentage of dollars be directed to people under the age of eighteen, as is included in the House bill.

• We recommended a few modest statutory changes – which could have a profound positive effect on the lives of our children – to promote integration of educational, special educational, and behavioral health services for children.

• We recommended a more comprehensive approach to promoting the work of peers and the development of the peer workforce.

• We recommended that the legislation include the language in the House bill for the Interagency Coordinating Council to create a plan to end incarceration of individuals with serious mental illness or serious emotional disturbance for non-violent offenses within 10 years.

• We recommended an idea promoted by Senator Franken to improve pre-service training for all provider types in behavioral health.

• We expressed concerned about Sec. 409, which repeals a number of existing programs.  We have not had time to review all of these in detail, but hope that these are simply programs that are no longer funded and not programs that are being defunded. 

Our bottom line is this.  The proposal is another good start, and further evidence of a bipartisan commitment to mental health reform during this session of Congress.  That’s great, and we’re grateful.  But there is still much work to be done.  Members of the House and Senate need to work together to make this happen.  And we’re not from the government, and are here to help!