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Legislative
and
Advocacy
Update
October 2019
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The Federation is involved at the national level in monitoring
legislation, advocacy and funding opportunities and identifying resources that could aid your work as the voice for families.
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The Federation actively represents you as part of the
Mental Health Liaison Group
(MHLG)
.
The MHLG is a forum for collaboration among the leading national mental health and addiction-focused organizations. Together, we provide policymakers with information and support in advancing our shared policy priorities. The MHLG hosts congressional staff briefings to share information on trends and best practices in the field, provides annual recommendations on mental health and addiction funding in the federal appropriations bills, writes letters to Congress outlining our position on important legislation or offering suggestions for improving proposed policies and more. The current statement issues for MHLG are found
here
.
MHLG letter to HELP Committee on school safety and mental health recommendations
Chairman of the HELP Committee, Sentator Lamar Alexander asked for recommendations. The letter to the Chariman will be in next month's newsletter.
The Mental Health Professionals Workforce Shortage Loan Repayment Act
The Mental Health Liaison Group wrote to the Honorable Kamala Harris and the Honorable Cory Gardner to support this vital step in addressing our nation’s dire shortage of mental health professionals and reducing the unmet mental health treatment gap for Americans across the lifespan.
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UNDERSTAND Act (S. 1323)
The Federation joined other national advocacy organizations to support the UNDERSTAND ACT. The UNDERSTAND Act gathers data on social determinants of health by requiring Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) providers to use ICD-10 Z-codes to track trends between social determinants and various health issues. These codes will be used by any provider who is administering care to Medicare and Medicaid beneficiaries. The findings will influence future policy making in regard to health, poverty, quality of life, and health care access in economically disadvantaged communities.
H.R. 4194 – the National Suicide Hotline Designation Act
Along with a coalition of over 40 other behavioral healthcare organizations and nonprofits, the Federation extends its strong support for
H.R. 4194 – The National Suicide Hotline Designation Ac
t
to establish 988 as the three-digit telephone number for a national suicide prevention and mental health crisis hotline. The legislation, introduced by Rep. Chris Stewart (R-UT), has bipartisan support in Congress led by Reps. Seth Moulton (D-MA); Greg Gianforte (R-MT); and Eddie Bernice Johnson (D-TX). Behavioral health leaders from across the nation are urging Congress to pass the bill and ensure this service is universally available and fully funded.
H.R. 4309 - The Barriers to Suicide Act
U.S. Representatives Don Beyer (D-VA) and John Katko (R-NY), the co-chairs of the House Suicide Prevention Task Force, and Grace Napolitano (D-CA), founder and Co-Chair of the Congressional Mental Health Caucus today introduced the Barriers To Suicide Act. The bipartisan legislation would create grants for state and local governments to fund nets and barriers on bridges, which have been shown to reduce suicide.
Resilience Investment, Support, and Expansion (RISE) from Trauma Act (S. 1770, H.R. 3180
)
We joined 28 other national advocates in supporting the
Resilience Investment, Support, and Expansion (RISE) from Trauma Act (S. 1770, H.R. 3180
).
sponsored by Senator Durbin and Representative Davis.
- The RISE Act would direct important resources for communities to implement evidence-based best practices to prevent and mitigate the impact of trauma; incentivize communication and cooperation between government agencies, health care and social service organizations; enhance training to better identify at-risk behaviors among youth; and increase authorized funding for behavioral health graduate school loan repayment programs and recruitment of trauma-related health professions.
- The bill focuses on enhancing training programs and tools for early childhood clinicians, teachers, peer support specialists, and first responders, and on enabling facilities to customize their evidence-based approaches in light of unique, local considerations.
- The RISE Act focuses on coverage for trauma-related care.
- We strongly support the bill’s focus on providing resources to facilitate insurance parity compliance related to youth. The RISE Act would focus important resources on strengthening and ensuring mental health parity for infants and preschool aged children—a significant need considering the increase in neonatal abstinence syndrome among mothers with OUD or SUD.
Sandy Hook Promise
As the House Committee on the Judiciary reviewed proposals to prevent gun violence, including extreme risk protection order (ERPO) legislation, the Federation joined a coalition of mental health and wellness organizations to urge the Committee to oppose any policy that furthers the dangerous conflation of mental health and gun violence or encourages the practice of involuntary commitment. Any attempt to require courts to consider a respondent’s mental health status when deciding whether to restrict gun ownership improperly perpetuates unfounded assumptions that people with mental disabilities are prone to violence. Most ERPO laws that are already in place at the state level permit the court to consider patterns of
behavior
that indicate risk of future violence such as a conviction of a violent misdemeanor, conviction of a domestic violence misdemeanor, and unlawful or reckless use, display, or brandishing of a firearm by the respondent. These behavioral factors are a stronger predictor of future violence than an individual’s mental health status.
Mental Health Parity Compliance Act
The bipartisan Mental Health Parity Compliance Act (H.R. 3165 / S. 1737) enhances transparency and accountability of coverage for Mental Health and Substance Use.The Mental Health Parity Compliance Act would help by ensuring that insurance companies do the work necessary to comply with the law and are accountable and transparent in how they design coverage.
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For More Details about National Issues
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State Actions with Potential National Impact
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DOJ vs Mississippi -
Landmark Mental Health Ruling
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Judge Carlton Reeves
issued his
Memorandum and Order
in the case of the
United States vs. Mississippi
regarding the state's mental health system on September 3.
"
On paper, Mississippi has a mental health system with an array of appropriate community-based services. In practice, however, the mental health system is hospital-centered and has major gaps in its community care. The result is a system that excludes adults with SMI from full integration into the communities in which they live and work, in violation of the Americans with Disabilities Act (ADA)
.
The parties are therefore ordered to submit, within 30 days, three names of potential special masters and a proposal for the special master's role. A hearing will be held this fall."
The U.S. Justice Department argued that Mississippi’s movement toward community services was far too slow, forcing hundreds or thousands of people into avoidable hospital stays. Judge Reeves found that Mississippi is violating the Americans with Disabilities Act, as well as a 1999 U.S. Supreme Court decision that said “unjustified” mental hospital confinement is illegal.
The federal government catalogued a litany of alleged transgressions during the trial
- Mentally ill people held in jails because crisis teams don’t respond
- People forced to live far from their family because services aren’t available in their hometowns
- People who make repeat trips to state mental hospitals because there’s no effective planning for them to transition to community services and the most intensive kinds of services aren’t made available.
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Joy Hogge shares why this ruling could have National Implications
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I am not exactly sure how this ruling will affect Mississippi so it's even harder to conjecture about other states, but these are some things that I have contemplated along the way.
In the midst of all the political chaos we live in every day, I think it is telling that this case began in the Obama administration with Attorney General Eric Holder and then was brought to trial in the Trump administration with Attorney General William Barr - and nothing about its content or allegations changed. Perhaps Olmstead and its mandate for community integration for everyone is one concept profound enough to begin bridging some of the political chasms that we face. I've certainly seen in my own state that understanding the importance of everyone having the support they need to live in the community is not an insight owned by one political party.
Three things struck me as very relevant to the work of family and consumer run organizations as I watched the trial.
- The trial was much more about coordinating support between the community and institutional care than it was about "de-institutionalization." Our organizations and the members within them have a wealth of expertise to help our systems be more responsive in their coordination.
- We also know this concept in our heads and in our hearts - Olmstead is not so much about where a person gets treatment - it's about the right of every individual to be with their family, to live in the community and to do the things that other people do. Providing the right kind of support for people to do that is very different than simply providing similar treatment in a different setting. And it's really about how we perceive people and them still being just people when they have a mental illness.
- It is always tempting to make issues about lack of funding - often because they are. But this trial opened my eyes to the importance of understanding how current money is being spent. The definition of family-driven practice includes family run organizations and families partnering in funding decisions. I am sure that holds true for consumers and consumer run organizations as well. We need to thoughtfully consider how to become meaningfully involved in funding decisions and monitoring how they are implemented.
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Tennessee Request to convert TN Medicaid into a Block Grant Program
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Tennessee was the first state to develop a plan and request a waiver to implement its own Medicaid Plan – TennCare. They have now become the first state to
r
equest that they be allowed to implement Medicaid as a block grant. They are more likely to be approved due to their successful implementation of Tenncare. TN’s Governor Bill Lee said, “It would be very important for the country to see an opportunity to lower the cost of Medicaid services without changing the quality or level of those services to the Medicaid population. For Tennessee to be an example of how we can deliver that would be a very big deal.”
The draft plan is not a pure version of a block grant. It would rely on fixed annual payments, adjusted yearly for inflation. The state would get extra money per person in years in which enrollment grew but would not get less money if enrollment shrank. If the state spent less in a given year than it would have under the traditional Medicaid system, Tennessee would split those savings with the government, according to the draft.
Opponents of the state’s TennCare block grant proposal think it puts coverage and services at risk for vulnerable Tennesseans.
The proposal would give Tennessee new authority to cut services for children, seniors, low-income parents, and people with disabilities. Under the proposal, the state could:
- Eliminate or restrict services like physical therapy, hospice, and medicine without normal federal oversight – and arbitrarily limit who gets them
- Cut back on core health care services like hospital care and emergency services without federal approval or public notice
- Allow Medicaid managed care plans to restrict access to needed care, and
- Exclude coverage of some important prescription drugs
Opponents are also concerned that Tennessee will only keep half of the money saved (with the other half going to the federal government), that means the state plans to cut at least $2 billion out of the $12 billion TennCare program. The block grant proposal would enable the state to divert funds from the health care system and spend the money however it chooses. It’s a transfer from patients and providers to the state and federal governments
.
p
lan
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Title IV-E Prevention Services
Clearinghouse Announces Public Call
for Programs and Services
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The Family First Prevention Services Act (FFPSA) presents an opportunity for states to take a systemic approach (child welfare, Medicaid, children's behavioral health, juvenile justice agencies) in planning for FFPSA so that resources are maximized and coordinated across systems. The
Title IVE-E Prevention Services Clearinghouse
public call to recommend programs and services for systematic review is now open! See below for details.
The Title IV-E Prevention Services Clearinghouse requests recommendations for mental health, substance abuse, in-home parent skill-based, and kinship navigator programs and services to be considered for systematic review.
The TA Network encourages states to consider services and programs that have proven effective in systems of care.
On Demand: Introduction to Title IV-E Prevention Services Clearinghouse Standards and Procedures -
This webinar described the Title IV-E Prevention Services Clearinghouse’s procedures for identifying programs and services and associated research studies for review or re-review; standards for assessing the design, execution, and findings of research studies and for rating programs and services; and definitions of key terms
.
Watch now
The deadline for submissions is Oct. 31, 2019.
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Mass Violence in America: Causes, Impacts and Solutions
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Adapted from The National Council Capital Connector
“What’s happening in our society is not a mental illness, it’s a social illness.
Hate and anger are not mental illnesses.” –
Dr. Joe Parks, Medical Director of the National Council and
Co-Chair of the Medical Director Institute
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HHS Awards $374 Million to Programs Supporting Maternal and Child Health
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September 12 - The U.S. Department of Health and Human Services (HHS) announced approximately $351 million in funding to 56 states, territories, and nonprofit organizations through its Maternal, Infant, and Early Childhood Home Visiting Program and approximately $23 million in funding to three new programs aimed at improving maternal health outcomes.
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Helping Emergency Rooms Prepare for
Kids in Crisis
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At a time when increasing numbers of children are showing up in emergency rooms with mental health issues, less than half of the nation's hospitals have written protocols in place for care coordination and management of kids in crisis – and that number falls to about a third in rural areas, two senior HRSA leaders reported in a recent webcast.
Suicide is now the second leading cause of death among young people, age 10 to 19 years old. And absent immediate intervention, the risk of a suicide attempt or death by self-harm is highest within 30 days of discharge from an emergency department.
Those findings are the impetus behind a new HRSA toolkit to help emergency room staff manage young people in psychiatric distress, said Associate Administrators Dr. Michael Warren and Tom Morris.
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Want to know where to find legislative information nationally and in your state?
This new resource developed by the Federation lists resources nationally and for each state wher you can keep up with the latest.
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Value-based Payments and Behavioral Health: Results of a Nationwide Environmental Scan
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On September 11th the National Council for Behavioral Health conducted a webinar where they presented an overview of the environmental scan on behavioral health provider participation in Medicaid value-based payment models they conducted as well as a panel discussion.
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Understanding Mental Health Parity
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The Mental Health Parity and Addiction Equity Act (MHPAEA) requires health plans to provide equal levels of treatment for mental health conditions and substance use disorders (SUDs) as they do for physical illnesses. Mental health parity has become an increasingly critical challenge for health plans, partly driven by the exploding opioid crisis that is dominating headlines and making SUDs and mental health problems a central issue in the national healthcare debate.
In a recent webinar, Manatt examined mental health parity and its effects on health plans and state regulators from multiple perspectives—regulatory, policy and litigation. The program provides multifaceted insights into a full range of key topics—from defining requirements to developing compliance practices to analyzing the latest lawsuits that are shaping MHPAEA’s implementation. We want to be sure you don’t miss any of this important information. If you or anyone on your team were unable to attend the session or want to view it again, click
here
to view the program free, on demand—and download a free copy of the presentation for your continued reference. During the session, you will:
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The State of America In 2020
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For the 6th year in a row, Mental Health America (MHA) released its annual State of Mental Health Report, which ranks all 50 states and the District of Columbia based on several mental health and access measures.
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California
From the Capital Connector
California Passes Bill Promoting
Mental Health First Aid in Schools
Earlier this month the California Assembly passed
SB 428
, a bill that will require ten percent of staff and teachers in each California school be trained in a program like Youth Mental Health First Aid (YMHFA). The purpose of the bill is to increase school and community-level capacity to tackle California’s growing youth mental health crisis. SB 428 is supported by a broad coalition led by Born This Way Foundation, California Council of Community Behavioral Health Agencies (CBHA), County Behavioral Health Directors Association (CBHDA), and Children Now. The bill now awaits signature from the Governor.
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Colorado
Prop CC is on the November Ballot
What does it do?
Prop CC allows the state to keep revenue that it already collects under existing tax rates. Currently, under certain conditions that policymakers and voters don’t control, some tax revenue is returned to taxpayers.
What is the impact?
If it passes, Prop CC would allow Colorado to invest in three critical areas: K-12 education, higher education and transportation
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Idaho
From the Capital Connector
CMS Rejects Idaho Medicaid Waiver
CMS denied Idaho’s Medicaid waiver application to allow individuals above the federal poverty line to keep their subsidized private insurance through the state’s Affordable Care Act (ACA) exchange, even if they qualified for Medicaid under the expansion set to begin in January 2020. According to CMS, the request did not meet established budget neutrality requirements. Idaho is finalizing a separate Medicaid waiver application to implement work requirements for Medicaid enrollees, requiring 20 hours per week of work or work-related activities to continue Medicaid eligibility and coverage
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Illinois
From the Capital Connector
Illinois to offer Mental Health First Aid to Educators
Illinois’ governor has
signed into law
a bill that requires in-service training on mental health for educators to be evidence-based and to help participants recognize the signs and symptoms of mental illness and substance use disorders. Mental Health First Aid is named as an example of training acceptable under the new law. The National Council thanks the sponsors of the legislation and the advocates in Illinois for recognizing the value of Mental Health First Aid, and for ensuring educators have the tools needed to support school-aged children and youth.
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Iowa
The Iowa Department of Human Services is (again) proposing a status quo budget for FY 2021. That's no new state dollars for the department to use to support the well-being of Iowa children, families and individuals. DHS Officials made budget presentations last month to the Council on Human Services, which acts in a policy making and advocacy capacity for the department. This isn't good news, given the degree of unmet needs in Iowa — and especially with the Governor's office recently touting a $289 million budget surplus for 2019.
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Kansas
A class-action lawsuit intensifies against the Kansas Department for Children and Families.
Advocacy group
Kansas Appleseed
filed a lawsuit in the fall of 2018. Recently, it has amended its lawsuit, saying kids continue to be neglected by the state.
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Montana
Montana recently expanded its patient-centered medical home (PCMH) program to better meet the needs of children enrolled in its Medicaid and Children’s Health Insurance Program. Montana is expanding its PCMH pool of providers, applying measures to track the quality of care, and using team-based, coordinated care to link enrollees and families to support services designed to improve care and control costs.
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New Hampshire
It calls on everyone from behavioral health providers to foster parents to advocacy groups to academia to put forward ideas on how the agency can better achieve goals including reducing the number of families with repeated reports of maltreatment and decreasing the number of children removed from their families.
SDCYF is the state agency tasked with investigating allegations of child abuse is issuing a sweeping request for public input on how it could better do its job.
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New York
From the Capital Connector
New York is
seeking approval
from CMS to authorize federal Medicaid matching funds for certain incarcerated individuals 30 days before their release from state prisons and county jails. If approved, the waiver would provide health coverage for the 207,000 incarcerated individuals released each year who are living with a serious mental illness, substance use disorder, HIV/AIDS or two or more chronic conditions.
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North Carolina
NC House Health committee approved H655, the NC Health Care for Working Families Act
H655 is bipartisan legislation to bring affordable health coverage to half a million low-income people in NC. It is an imperfect bill, but it’s also a pragmatic, bipartisan solution for closing the gap.
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Tennessee
ACEs Before Discipline
This bill requires Local public schools and public charter schools to adopt a trauma-informed discipline policy that takes these things into account before progressive discipline -- a major step towards giving our kids the holistic attention they need.
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Utah
CMS denied Utah’s request for enhanced federal funds to support a change to the state’s Medicaid program that would provide a partial expansion of eligibility. Utah’s request was submitted as part of the 1115 demonstration waiver, would have expanded Medicaid eligibility in a limited capacity.
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Legislation and Advocacy Pages
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- Where to Find Legislative Information Nationally and In Your State
- Learn how to keep up with news and updates
- Finding your legislator, state Medicaid Director and state Mental Health Commissioner
- Tips on committees
- Live streams of the House and Senate
- Information on highlighted National legislation
- Information on highlighted legislation from the states
- State tabs where, for each state, you will find:
- The General Assembly page
- How to find your state legislator
- Link to state legislative advocacy organization
- Links to the live stream sessions from the state
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Alerting us to what is happening on the state level will aid not only those in your state but others nationally as ideas spread. As you become aware of state or national legislative alerts, funding and advocacy opportunities or resources that could be used to build funding requests, please let us know by emailing
mcovington@ffcmh.org
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