June 20, 2016
Washington, DC – On June 15, the House Energy and Commerce Committee passed the “Helping Families in Mental Health Crisis Act.” This bipartisan legislation begins to tackle a number of the major gaps in the nation’s mental health delivery system.
We support the Congress as it works to advance those policies which can effectively build capacity and strengthen the quality of services offered by the nation’s behavioral health system, including to ensure access to appropriate services for vulnerable individuals with severe mental illness at the point of crisis and when they transition back into their community. Going forward, we are hopeful that Congressional leaders will build on the foundation laid by the House Energy and Commerce Committee as well as the complementary work undertaken by the Senate Finance and Health, Education, Labor and Pension committees.
Medicaid is the largest payor of behavioral health services. States have major integration and delivery system transformations underway, many of which have as a goal improving access to high quality services for individuals with mental health and substance use conditions. In order to maximize the federal funds helping to support these transformations, there must be a clear expectation that federal-level mental health agencies and the officials that lead them strategically coordinate and communicate with the Centers for Medicare and Medicaid Services and state Medicaid agencies.
NAMD also applauds the House Energy and Commerce Committee for acknowledging the flaws with – and supports Congressional efforts to more broadly reform — the existing federal law which bars federal contributions to the cost of medically necessary inpatient care for certain Medicaid-eligible individuals who receive services in Institutions for Mental Disease (IMD). The so-called Medicaid IMD exclusion undermines access to appropriate services for individuals in crisis and vulnerable populations with mental illness and substance use disorders. While Medicaid beneficiaries can receive physical health services in a wide range of inpatient facilities, individuals with behavioral health conditions frequently cannot access specialized inpatient behavioral health services, even when they may be most appropriate to meet their needs. It also unnecessarily complicates the care experience for such individuals. In addition to the personal cost, the exclusion drives up otherwise avoidable system costs that are ultimately born by taxpayers, such as inappropriate use of expensive emergency room services, and other perverse incentives.
Still, the Committee-passed bill must be viewed as a first step in breaking down this discriminatory and outdated policy which conflicts with the federal requirements for parity between mental health and addiction recovery services. Without further changes to the Medicaid IMD exclusion, beyond what the House Committee already approved, state Medicaid programs will be limited in their ability to provide services in the most appropriate and cost-effective setting for individuals with severe mental illness and substance use disorder.
We believe legislative work on behavioral health policies should also address the ongoing barrier presented by federal policies governing the confidentiality of drug and alcohol treatment and prevention records. Without further changes to the restrictions found at 42 CFR Part 2, beyond what federal regulators have already proposed, state Medicaid programs will be limited in their ability to coordinate care for beneficiaries and address major safety concerns, such as drug-drug interactions or risk of overdose. Specifically, individuals receiving treatment by a provider or in a program subject to the Part 2 rules could be more vulnerable by reason of the non-availability of their patient record than an individual with a SUD who does not seek treatment.
We also look forward to continuing to work with Congress to improve the broader set of Medicaid Mental Health provisions included in the proposal. As always, these must be grounded in evidence and support states in shoring up the integrity of their programs.
The National Association of Medicaid Directors (NAMD) is a bipartisan, nonprofit, professional organization representing leaders of state Medicaid agencies across the country. NAMD members drive major innovations in health care while overseeing Medicaid, one of the nation’s most vital health care safety net programs, which covers more than 72 million Americans. NAMD serves as the voice for state Medicaid directors in national policy discussions, supports state-driven policies and practices that strengthen the efficiency and effectiveness of Medicaid and actively monitors emerging issues in Medicaid and health care policy. Learn more at www.medicaiddirectors.org and follow NAMD on Twitter @statemedicaid.