Mental Health Policy Reporter

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

Newsbyte

• 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 on April 4th 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 our 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 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!

Newsbyte

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.