Taking action on federal behavioral healthcare legislation

When we returned from this past holiday season, which now seems very long ago, we were quite pleasantly surprised to learn that Senator Lamar Alexander, the Chair of the U.S. Senate Health, Education, Labor, and Pensions Committee (HELP), would like to develop and pass a long-awaited mental health bill this year. This week, we were even more delighted when Representative Gene Green of Texas, the Ranking Member of the Health Subcommittee of the U.S. House Energy and Commerce Committee, and five of his colleagues, introduced the Comprehensive Behavioral Health Reform and Recovery Act of 2016. Considered together, these two developments could not be more consequential for us.

The Comprehensive Behavioral Health Reform and Recovery Act of 2016

First, I would like to provide a brief overview of the bill Representative Green just introduced.

This bill consists of several major components:

Strengthening and investing in SAMHSA programs. The proposed legislation would create a new Assistant Secretary for Mental Health and Substance Use Disorders, but significantly also assign that role to the Administrator of SAMHSA. It would call for a full review of SAMHSA to determine what programs, staffing, and funding will be needed to meet America’s current needs for behavioral health services, and it would authorize a much-needed Center for Behavioral Health Quality and Statistics. It also would create and reauthorize a broad range of grant and technical assistance programs to promote innovation and adoption of evidence-based practices throughout the field. For the states, it would create an acute care bed registry and require a biannual report on state mental health and substance use services.

Interagency serious mental illness coordinating committee. The bill would implement a much-needed interagency serious mental illness coordinating committee that would monitor research and practice developments and make recommendations to the Assistant Secretary. Funding would be authorized to support this function.

HIPAA clarifications. The proposal would require the Health and Human Services (HHS) Secretary to issue a regulation consistent with the 2014 HHS Office of Civil Rights guidance on HIPAA privacy protections, and to provide training and technical assistance on its implementation. Significantly, it also would require the Secretary to issue a regulation modernizing 42 CFR Part 2, which provides special privacy protections for substance use care. Finally, it would authorize pilot grants to improve communication between consumers, family members, and providers.

Improving Medicaid and Medicare mental health services. The resolution would permit same-day billing for behavioral health and primary care services under Medicaid, as well as extend and expand the federally qualified behavioral health clinic and the Medicaid emergency psychiatric demonstration projects. Very importantly, it also would modify IMD exclusions under managed care arrangements for both Medicaid and CHIP so that additional funds would be available for care.

Under Medicaid, EPSDT services for children would be expanded, home and community based service waivers would be extended to psychiatric residential treatment facilities, CMS would have expanded authority to engage in Medicaid innovations around behavioral healthcare, and Medicaid reporting on children’s services would be improved. Importantly, the proposed legislation also would require suspension rather than termination of Medicaid benefits when at-risk youth are detained in correctional facilities.

Under Medicare, the 190 day lifetime limit on inpatient care would be eliminated, new discharge planning requirements would be instituted, and new reporting and review requirements would be developed for drug formulary practices and appeals.

Strengthening the behavioral health workforce and improving access to care. The title on workforce is among the most important sections of the proposed legislation. It would require SAMHSA to develop a national workforce strategy and to implement a broad range of grant programs to develop the workforce. Among others, training would be provided for peer support specialists, primary care physicians, minority clinicians, psychiatrists for Indian health programs, as well as for telepsychiatry and continuing education on serious mental illness.

This title also would extend malpractice liability protections to volunteer providers at FQHCs and FQBHCs. Also included would be grant programs to implement care integration, behavioral health crisis systems, public health approaches to mental health in schools and on college campuses, improved access to care after jail incarceration, and assertive community treatment.

Improving mental health research and coordination. This section would authorize research on the determinants of self- and other-directed violence.

Behavioral health information technology. This title would authorize Medicaid and Medicare grants for behavioral health entities to implement electronic health records.

Making parity work. This section would strengthen parity implementation, reporting, and enforcement.

Substance abuse. This piece of the proposed legislation would improve prevention through better training, new grants to improve practice and better surveillance reporting. To address the prescription opioid and heroin crisis, grant programs would be created for syringe exchange and expansion of naloxone availability. The Controlled Substance Act would be updated to expand up to 100 the number of consumers who can be treated with buprenorphine by a single physician.

This section also would reauthorize a residential treatment program for pregnant and postpartum women, create a pilot program to extend this care to outpatient settings, authorize SAMHSA to target intervention programs to high need areas, and create a demonstration program for improved care to adolescents. Finally, it would authorize a youth recovery initiative as well as grants to expand recovery support services.

Critical next steps

On balance, Representative Green’s proposed legislation is excellent. Thus, two very important next steps come immediately to mind:

1. Strongly encourage your Representative to become a cosponsor of Representative Green’s Comprehensive Behavioral Health Reform and Recovery Act of 2016.
2. Strongly encourage Senator Alexander, the other members of the Senate HELP Committee, and your own senators to adopt the Green bill as the framework for a parallel behavioral health bill in the Senate.

As always, it is urgent that you take these actions as soon as possible.

Thanks in advance for all that you do.