Bazelon Center Mental Health Policy Reporter

Welcome to the Bazelon Center Mental Health Policy Reporter. Available exclusively online and to our email subscribers, the Reporter supplements the Bazelon Center's Action Alerts by providing a periodic bulletin on significant policy developments that affect people with mental illnesses.

Volume VII, No. 3, April 10, 2008

Help May Be on the Way

In this issue

• Medicaid Option Could Expand Access to Home and Community Services
• Lawmakers Would Delay Medicaid and SCHIP Restrictions

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• Briefing Will Promote School-Based Mental Health Programs

The Centers for Medicare and Medicaid Services (CMS) has proposed regulations that merit the attention of mental health advocates. The new rule will give states an option to use Medicaid funds for home- and community-based services to elderly recipients and people with disabilities without having to obtain a federal waiver showing that the cost would be no greater than institutional care. However, the rule also places new limits that may reduce access to these services. The deadline to comment is June 3, 2008.

On the legislative front, bipartisan bills in both houses of Congress would delay controversial Medicaid regulations until April 2009, for action by a new Administration. The seven rules at issue will otherwise drastically reduce access to rehabilitative and other services of great importance to adults and children with mental disabilities. The Senate version would also put a one-year hold on a harmful policy directive that would limit efforts by some states to expand SCHIP health coverage to uninsured children. An outpouring of constituent support is needed.

On May 8th a congressional briefing will focus on the value of effective school-based mental health programs in reauthorization of the Substance Abuse and Mental Health Services Administration (SAMHSA). An impressive turnout will have a positive impact, so please ask your lawmakers and their key staffers to attend.

Medicaid Option Could Increase Access to Home and Community Services

A proposed regulation released by the Centers for Medicare and Medicaid Services (CMS) would implement Section 6086 of the Deficit Reduction Act of 2005 (P.L. 109-171), providing “expanded access to home- and community-based services for the elderly and disabled.''

Section 6086 of the DRA added a new Medicaid section 1915(i) giving states a new option to use Medicaid funds for home- and community-based services to the elderly and people with disabilities without having to obtain a waiver from the federal government. Previously, states had to apply for a waiver and demonstrate cost-neutrality before they could include this option in their Medicaid plans.

The cost-neutrality requirement has been problematic for states, which have found it nearly impossible to secure waivers to serve people between the ages of 22 and 64 who have mental illnesses because of another Medicaid rule that prohibits federal financial participation for services provided in “Institutions for Mental Diseases” (IMDs). With IMD expenditures disallowed, states could not show that community care would be budget-neutral.

The new option has great potential to expand the range of Medicaid services available to adults and children with serious mental disorders. However, income limits are tighter and states are allowed to limit access under this rule to specific geographic areas and to cap eligibility based on the creation of a limited number of slots. As a result, the population that could benefit does not include all individuals who may be eligible for Medicaid in a particular state.

The rule was published in the Federal Register on April 4, 2008 (73 Vol No.66, 18676 18700,42 CFR Parts 431, 440 and 441). The Bazelon Center will submit comments and will post them in advance for use as a model. Stay tuned to this website.

To learn more about what states are doing, see our report on Medicaid policy choices.

Public Comments Encouraged

Comments to CMS on the proposed rules are due by 5 pm on June 3, 2008. Comments can be submitted in one of four ways, but not by fax. The filecode for comments on this rule is CMS-2249-P. For details, see how to submit comments to CMS.

Lawmakers Would Delay Medicaid and SCHIP Restrictions

Bipartisan legislation to delay several controversial Medicaid regulations was introduced on April 3 by Senators John Rockefeller (D-WV), Olympia Snowe (R-ME) and Edward Kennedy (D-MA). The Economic Recovery in Health Care Act (S. 2819) parallels H.R. 5613, The Protecting Medicaid Safety Net Act, introduced in the House in mid-March by House Energy and Commerce Committee Chairman John Dingell (D-MI) and Representative Timothy Murphy (R-PA) (see the Bazelon Center’s March 20 Action Alert.

Both bills would delay until April 2009 seven Medicaid regulations that will otherwise drastically limit critical services and supports for people with disabilities by reducing access to rehabilitative services, case management, school-based transportation and outreach services, graduate medical education payments and hospital clinic services.

On April 9th, the Health Subcommittee of the House Energy and Commerce Committee approved an amended version of H.R. 5613 by voice vote. The full committee is expected to review the bipartisan compromise legislation next week with the hope of swift House passage. In addition to requiring a one-year moratorium on the seven Medicaid regulations, it sets limits on actions by the Department of Health and Human Services (HHS), requires HHS to submit to Congress a report that identifies the prevalence of fraud and abuse in the areas the rules seek to remedy, explains how the rules will address those issues and cites the legal authority for the rules. HHS would also be required to have an independent contractor assess the rules’ impact state-by-state. The bill would authorize $25 million annually to HHS for combating Medicaid fraud and abuse by states

The Senate bill also provides $12 billion in state fiscal relief and delays a harmful August 2007 CMS policy directive that would affect state’s setting of eligibility criteria for the State Children’s Health Insurance Program (SCHIP). Among problematic requirements to address “crowd out” (when one form of insurance is substituted for another), the SCHIP directive would prohibit states from providing health coverage to uninsured children in families earning more than 250% of the federal poverty level unless a state can prove it has enrolled 95% of children whose family income is at or below 200% of the poverty level. The directive will likely reduce state efforts to expand health coverage to uninsured children. It was released by CMS without any opportunity for public comment.

The legislation has been referred to the Senate Finance Committee. For more information on the legislation, see Senator Rockefeller’s press statement and a summary of the Senate bill (both PDF files).

What You Can Do

Contact your Senators and urge them to co-sponsor S. 2819, The Economic Recovery in Health Care Act of 2008.

Contact your Representative and urge him or her to co-sponsor H.R. 5613, The Protecting Medicaid Safety Net Act. Thanks to action by advocates like you, responding to alerts like ours, the House bill has 150 bipartisan sponsors to date!

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Briefing Will Promote School-Based Mental Health Programs

On Thursday, May 8th, the House Mental Health Caucus is sponsoring a Congressional Briefing to focus on the value of school-based mental health programs as key components of a Substance Abuse and Mental Health Services Administration (SAMHSA) reauthorization package.

The briefing honors National Children’s Mental Health Awareness Day with presentations by people who run effective school-based mental health programs in close collaboration with the community mental health system. Lawmakers will also hear from a youth on how these programs produce positive outcomes for children and adolescents with mental health treatment needs.

Action Needed

Please ask your House and Senate representatives and their staff to attend this important breakfast briefing on children’s mental health. In the next week, they will receive a “Dear Colleague” letter about the briefing from Mental Health Caucus members. Your calls, emails and contacts with congressional offices can help produce a strong turnout at the briefing. Here is the vital information:

• Date and Time: Thursday, May 8th from 9:00 – 10:00 a.m.
• Location: Rayburn House Office Building, Room B339

All House and Senate offices can be reached through the Capitol switchboard at 202-224-3121. For email, visit www.congress.org, enter your zip code, then click on the link to your legislator and go to his or her website to use the official contact form. Be sure to give your zip code in your email to show that you are a constituent.

Please call or email your Senators and Representative today!

Thanks for all you do on behalf of children and families.

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