Lobbyist: Behavioral health set to advance on Capitol Hill

New faces and new mental health bills make for serious opportunities to advance behavioral healthcare in Congress, says Mike Bromberg, chairman of The Capitol Health Group, who spoke to the professionals in attendance at the recent National Association of Psychiatric Health Systems (NAPHS) meeting.  The Capitol Health Group is a government affairs consultancy that focuses on healthcare legislation, policy and regulation. 

After welcoming behavioral health professionals to “the land of 12% approval,” Bromberg, who serves as a NAPHS lobbyist and consultant, shared his perspective on the numerous bills about mental health issues currently on Capitol Hill. Bromberg says what’s more interesting than the bills themselves, is finding out who the bills’ sponsors are. Since some of the congressmen who advocated strongly for mental health issues have retired, their places have been filled by others. These new faces, he reminded NAPHS attendees, are “an opportunity list for you.”  

Some of the bills – and faces – he touched on include:

• Senator Mark Begich (D-AK) is sponsoring S. 153: Mental Health First Aid Act of 2013which would amend section 520J of the Public Health Service Act and authorize grants for mental health first aid training programs. The training programs implemented would be designed to train individuals in:

1.      Safe de-escalation of crisis situations.

2.      Recognition of the signs and symptoms of mental illness, including such common psychiatric conditions as schizophrenia, bipolar disorder, major clinical depression, and anxiety disorders.

3.      Timely referral to mental health services in the early stages of developing mental disorders in order to maximize the effectiveness of mental health services and avoid more costly subsequent behavioral health care.

• Mental Health in Schools Act of 2013 sponsored by Sen. Al Franken (D-MN).  This bill would amend the Public Health Service Act to revise and extend projects relating to children and violence to provide access to school-based comprehensive mental health programs. The three main purposes of the act, according to the bill, are to:

1.      Revise, increase funding for, and expand the scope of the Safe Schools-Healthy Students program in order to provide access to more comprehensive school-based mental health services and supports;

2.      Provide for comprehensive staff development for school and community service personnel working in the school; and

    3.     Provide for comprehensive training for children with mental health disorders, for parents, siblings, and other family members of such children, and for concerned members of the community.

• Justice and Mental Health Collaboration Act of 2013(Mental health courts), sponsored by Rep. Rich Nugent (R-Fla.) and Sen. Franken. “These may become extremely important when it comes to the gun violence issue and how you define mental illness, and working at responsibility to do something about it,” Bromberg commented.

This bill serves to reauthorize and improve the Mentally Ill Offender Treatment and Crime Reduction Act of 2004. It will add the following terms to the Section 2991 of the Omnibus Crime Control and Safe Streets Act of 1968: Peer-to-peer programs, qualified veterans, and veterans treatment court program.

The bill will also enables the Attorney General to award grants to establish or expand veterans treatment court programs; peer-to-peer programs for qualified veterans; practices that identify and provide treatment, rehabilitation, legal, transitional, and other appropriate services to qualified veterans who have been incarcerated; and training programs to teach criminal justice, law enforcement, corrections, mental health, and substance abuse personnel how to identify and appropriately respond to incidents involving qualified veterans.

• Excellence in Mental Health Act , sponsored by Sen. Debbie Stabenow (D-MI). Bromberg said that Stabenow “is on the Finance Committee and in a perfect position to help.” This bill would expand access to community mental health centers and improves the quality of mental health care.  It would also amend Section 1913 of the Public Health Service Act in numerous ways, including replacing ‘community mental health centers’ with ‘federally qualified community behavioral health centers’ and adding criteria for the creation of Federally Qualified Community Behavioral Health Centers.

Bromberg also spoke of S. 480: NICS Reporting Improvement Act of 2013, which is sponsored by a bipartisan group of four senators – Republicans Jeff Flake (AZ) and Lindsey Graham (SC) and Democrats Mark Begich (AK) and Mark Pryor (AR).

The bill, which is about gun violence, addresses questions such as:

o   If there’s a registry of some sort, does that breach HIPAA?

o   Who’s going to run the registry?

o   Would the use of a registry be an invasion of privacy?

o   The proposal would also update the definition of mental illness in the National Instant Criminal Background Check System, or NICS, the federal database that gun dealers access to test whether prospective buyers are legally barred from owning firearms. Currently, the law bans gun ownership to anyone who is "mentally defective." The new definition calls for individuals to be added to the database if they are found by an adjudicating body, such as a federal court, to be: 

• an imminent danger to themselves or others;

• found guilty but mentally ill in a criminal case;

• was not guilty in a criminal case by reason of insanity or mental disease or defect;

• was incompetent to stand trial in a criminal case;

• was not guilty only by reason of lack of mental responsibility under the Uniform Code of Military Justice;

• required involuntary inpatient treatment by a psychiatric hospital;

• required involuntary outpatient treatment by a psychiatric hospital based on a finding that the person is an imminent danger to himself or to others; and

• required involuntary commitment to a psychiatric hospital for any reason including drug use.

“If there’s going to be a gun bill, it’s more likely that instead of banning semi-automatic weapons or ammunition amounts and cartridges, it will focus on things like background checks, and how mental health is treated in a background check,” says Bromberg.

Medicare and Medicaid

On the topic of achieving a so-called “grand bargain,” Bromberg says the key part is tax reform. “Democrats want to protect Medicare supposedly, but my guess is that if they can get a deal they’ll cut it. Republicans want to cut it $800 billion.  On Medicaid, Democrats want to cut nothing, while Republicans want to cut down on things like provider taxes in the states,” he explained.

Because Democrats want to protect entitlements, they have taken off the table last year’s proposal to raise the Medicare qualifications age from 65 to 67, according to Bromberg. One reason, he said, is because, under ObamaCare, people aged 65 and 66 would get subsidies to go to the exchange and those might cost more than caring for them on Medicare.

When healthcare reform was first negotiated, “Hospitals were basically promised 94% coverage in return for $155 billion in cuts and a few other things.  It’s not going to be anywhere near that,” said Bromberg, noting that only half of state governors have come out in favor of the Medicaid expansion at this point. And, some governors are not going to want to do it. “Rick Scott in Florida did a big flip and suddenly came out for it and shocked everyone. Then, his party rejected it, so Florida is nowhere,” Bromberg explained. In other states, such as Arizona and Texas, it is unknown what will happen, he said.

Without all states participating in the Medicaid expansion, that 94% coverage rate cannot be realized, he said.