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Lobbyists for a day

July 8, 2010
by Dennis Grantham, Senior Editor
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National Council members, advocates lobby Congress on funding questions

Fresh from a day of policy briefings, some 500 behavioral health advocates joined National Council leaders on Capitol Hill on June 30 to press Congress on four key issues: extension of enhanced FMAP funding, funding equality for behavioral health information technology, federal status for behavioral health clinics, and increased federal grants for mental health and substance use treatment.

According to Linda Rosenberg, CEO of the National Council, advocates were “looking for leadership, not politics” as they tried to bolster the courage of legislators worried about rising federal deficits and determined opposition in upcoming mid-term elections. Two of the advocates’ goals involved Medicaid, which she says provides 70 percent of the nation’s funding for services to individuals with serious mental illness.

At the top of the list was the continued fight for a “desperately” needed continuation of “enhanced” Federal Medical Assistance Percentage (FMAP) funding for state Medicaid programs. This enhancement began with an $87 billion allocation in the ARRA stimulus bill that boosted the federal share of state Medicaid funding from a normal range of 50 to 76 percent up to 56.2 to 80 percent in the period from October 2008 to December 2010. Rosenberg says that, despite the fact that the reasons for the original FMAP enhancement—recession, high unemployment and falling state revenues—persist, Congress balked at a $25.5 billion FMAP extension this spring and hasn’t yet mustered support for a scaled-down, $15 billion measure.

“There are people who believe that [FMAP] is dead, but I am hoping that now that Congress has finished passing the financial [regulation] bill, the dip in the stock market combined with bad jobs reports will offer Congress some cover to do the FMAP extension,” Rosenberg says. “If jobs don’t pick up, state revenues don’t pick up, and the states are in such desperate shape. We can’t allow people with serious mental illness to get the short end of the stick. They’ve got no other resources, no other choice. We’ve got to keep the heat on.”

Rosenberg joined advocates in hailing Rep. Doris Matsui (D-CA) and Rep. Eliot Engel (D-NY) for introducing a new bill, The Community Mental Health and Addiction Safety Net Equity Act of 2010 (HR 5636), that would permanently strengthen the Medicaid safety net for behavioral health consumers. She explained that the bill resurrects the concept of Federally Qualified Behavioral Health Centers (FQBHCs) that passed the House version of health reform last fall, but was lost with approval of the Senate version in March.

“What that does is help to protect [consumers] from the kind of cuts that are now devastating states. It would create equality in safety net services for those with serious mental illness and substance use disorders,” she says, noting that “although hospitals and health centers already get cost-based reimbursement, behavioral health organizations do not.” The bill would make such reimbursements available to the FQBHCs while creating national standards and reporting that she says will improve care and provide more consistent and stable services. With three House co-sponsors, Rosenberg says that the National Council is seeking a Senate sponsor to introduce a companion bill.

Hill Day advocates clearly boosted support for another House bill, The Health Information Technology Extension for Behavioral Health Services Act of 2010 (HR 5040), as 18 co-sponsors were added in recent days to the 29 that already signed on with Reps. Patrick Kennedy (D-RI) and Tim Murphy (D-PA), who introduced the bill. This measure would extend the electronic health record funding incentives provided in ARRA’s HITECH Act to licensed providers of mental health and substance use treatment and inpatient psychiatric and substance use treatment facilities.

Though ongoing work is needed, Rosenberg asserts, “We have an opportunity to move this bill. Right now, the only objection that Congress has to anything is money. So, the only real question is: If this were to pass, is there enough money in the HITECH ACT to compensate behavioral health organizations the way they do with the others? We think so.” She adds that “there’s no doubt that people know [EHRs] will save money in the long run and in the short run. Transparent medical records cut down on fraud and abuse and certainly save lives and money in terms of medical errors. There’s also the parity argument—the idea that behavioral health must not be treated differently than other health issues.”

Advocates also argued for increased block grant funding for mental health and substance use treatment, and expressed continued support for housing and homeless programs. Says Rosenberg, “These funds become more vital than ever with the kind of cuts that are happening in the states and if, God forbid, FMAP is not extended.”

Additional information as well as the National Council’s Hill Day policy presentations are available at: http://www.thenationalcouncil.org/cs/hill_day/2010_review.