H.R. 2646 Passes Committee: NYAPRS 2^nd Look

Here’s an updated summary (and a few corrections) of key provisions of the amended federal mental health bill that was approved this week by the House’s Energy and Commerce Committee, taken in part from materials provided by the National Council for Behavioral Healthcare and Mental Health America.

NYAPRS was very pleased to work with numerous national groups to see that the most onerous provisions of the original bill were removed and to support several encouraging advances. Great thanks are due to House Democrats and for the tireless work of our colleagues to greatly improve this legislation. We hope and expect that this bill will only get better as it advances through the House and onto the Senate.

• IMD Exclusion – The bill codifies a limit on Medicaid coverage for inpatient mental health care at institutions for mental diseases (IMDs) per the final Medicaid managed care rule. Codifies into law newly adopted federal rules permitting Medicaid to pay for stays of up to 15 days a month in IMDs, a term that includes state and private psychiatric hospitals and SU treatment facilities. The original bill would have funded unlimited stays in facilities that averaged less than 30 days an admission.

• HIPAA – The bill no longer includes language that would loosen Health Information Portability Accountability Act (HIPAA) restrictions, creating instead a program to educate providers about what information can and cannot be shared.

• Protection and Advocacy Systems: The bill no longer prevents P&A attorneys from carrying out their historic responsibilities to represent the rights or preferences of people with disabilities and to sue states and others to advance systemic rights. It does prohibit P&As from using federal funds to lobby and adds some reporting requirements.

• Outpatient Commitment (Assisted Outpatient Treatment) – The amended version no longer includes a provision that would provide those states with existing AOT laws a 2% increase derived from existing block grant dollars. The bill does fund and extend a previously authorized outpatient commitment grant program through 2020.

• Assistant Secretary for Mental Health – The new bill includes the creation of an Assistant Secretary for Mental Health within the Department of Health and Human Services (HHS) that will assume the roles and responsibilities of the SAMHSA Administrator. Preference for hiring an Assistant Secretary will be given to individuals with a doctoral degree in medicine, osteopathic medicine, or psychology with clinical and research experience. The Assistant Secretary will be responsible for improving the standards used to evaluate grants, grantees, and the programs being administered by SAMSHA in consultation the National Mental Health Policy Lab (NMHPL). The Assistant Secretary will have a Deputy Assistant Secretary that will replace the Deputy Administrator of SAMSHA.

• SAMHSA Strategic Plan – The amended bill requires the Substance Abuse and Mental Health Services Administration (SAMHSA) to create a strategic plan in coordination with the National Institutes of Mental Health, the Assistant Secretary of Mental Health, and the HHS Secretary. The bill also calls for an independent evaluation of SAMHSA to determine whether the agency is meeting its indicated mission effectively.

• Interagency Council – The bill creates an Interagency Council that will be tasked with developing a plan to reduce incarceration and homelessness and increase employment for people with mental health conditions

• Parity – The approved legislation no longer requires the Centers for Medicare and Medicaid Services (CMS) to report on federal investigations into compliance with the law. It does requires the Government Accountability Office (GAO) to complete a study detailing federal oversight of group health plans – including Medicaid managed care plans – to ensure those plans are not using discriminatory coverage limitations for persons with mental health and substance use conditions.

• Grant Programs – The approved bill reauthorizes grant programs – including the Garrett Lee Smith program and a program dedicated to early intervention and prevention of youth suicide.

• Other Initiatives – The bill also:
• builds some new connections between the educational and behavioral health systems
• funds new innovation grants and new programs for children
• authorizes $10 million for peer training programs,
• promotes integration of health and behavioral health services,
• promotes greater use of ACT services

The bill will next be considered by the full House after which negotiators will work to reconcile differences between a finalized House bill and the Senate’s Mental Health Reform Act of 2016 (S.2680). Some estimate that this process will go into the fall, possibly after the November elections, if not beyond. In any event, NYAPRS will continue our advocacy efforts here and to keep our readers informed of major developments.