What Does 2014 Have in Store for Mental Health Funding and Access?

ChuckIngogliaCharles Ingoglia
Senior Vice President, Public Policy, National Council for Behavioral Health

Now that we’re a couple of weeks into January, 2014 is shaping up to be another important year for mental health policy. In today’s CFYM post, Charles Ingoglia, MSW, Senior Vice President, Public Policy, National Council for Behavioral Healthcare shares why he is optimistic about advancement of mental health policy issues in 2014.

Last week, we asked for your input about the most pressing mental health issues for the year ahead. So, there’s certainly plenty to talk about. Share your thoughts on whether or not you are optimistic about mental health advancements or if you think there is still much work to be done by commenting in today’s post.

Like you, I have read many a column at the beginning of the new year filled with predictions about the year ahead in all kinds of human endeavors, from guessing the results of local elections, to the possibilities of local building projects, to the chances of certain celebrities getting married or having children. I am always struck by the authors who begin with the warning that their crystal ball is fuzzy and they are equally as likely to be wrong as to be correct.

It is therefore with a bit of trepidation that I share my musings on what the year ahead may mean in terms of mental health funding and access. And I must confess, at this moment I am feeling confident that for many individuals, families and communities, the chances of accessing mental health services seem brighter.

To what do I owe this optimism? Let’s start with something almost remarkable… state revenue collections are looking brighter, meaning that there is more money available at the state-level to invest in things like mental health treatment and social services. It is true that any new investment will not make up completely for what was lost during the recession, but I will take some investment over cuts any day of the week. As state legislative sessions begin, I have hope that state-level appropriations for mental health services may get a boost.

Secondly, we ended 2014 with several significant movements at the federal level related to mental health services and capacity. The federal government (finally) released final regulations implementing the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA), which establishes standards within private health insurance guaranteeing that mental health and substance use treatment and payment must be comparable to treatment available for any other illness. The final regulations, while very technical in the details, establish a firm foundation of protection for thousands of individuals and families in need of care.

The Affordable Care Act builds on this foundation by extending coverage for mental health and substance use services to all insurance products available through the newly established Marketplaces and applies the MHPAEA standards to these plans as well. The combination of these coverage expansions with parity should guarantee access to needed services for thousands of individuals and families.

As 2013 came to a close, Congress was actively debating Medicare physician payment policy when Senators Debbie Stabenow (D-MI) and Charles Grassley (R-IA) offered an amendment based on the Excellence in Mental Health Act (S. 264) to the Senate Finance Committee version of the Medicare bill that was passed on voice vote. The Excellence in Mental Health Act would establish new standards and enhanced payment for community-based mental health services within Medicaid, support an increased array of services, and increase capacity for the many people who desperately need it. Some have called this the most important public-sector mental health bill since the passage of the Community Mental Health Center Construction Act in 1963, which gave birth to the community mental health movement. We are hopeful that the bill will find final passage in the Senate swiftly in the New Year as well as surviving the final stages of the legislative process to become law.

I look forward to seeing how this all plays out during the coming months and to offering you all year-end reflections to see which of these predictions stand the test of time.

Your Turn

  • What are the most pressing mental health issues for 2014?
  • Are you optimistic that significant policy advancements will be forthcoming this year?
13 comments
Stephen Bonin
Stephen Bonin

This post contains more positive examples than what I have been reading. Unlike the horror experienced by some of my cyberspace colleagues, I, here in a small city south of Dallas, Texas, have experienced and do experience reasonable treatment for crisis and non-crisis.

Debbie
Debbie

Accessing Mental Health Services is a nightmare! Just last night I had to bring my daughter (age 18) to the ER due to her boyfriend assaulting her. While there I informed them that she had said that she wishes to harm herself and she confirmed saying it to the doctors...instead of giving her an evaluation they sent us home with the number to Crisis Intervention to call! When I called I was told it would take 4-5 MONTHS before she could be seen! I was able, on my own, to find her a therapist for tomorrow, but as the group is contracted with my insurance and the actual therapist is still in the process of being credentialed it is going to cost me $70 a visit...Does a person actually have to attempt suicide before agencies in the State of MA will help them. Another problem I have is that my EAP doesn't have anyone who also takes our company insurance, which to me seems rather backwards.....The Mental Health System is BROKEN and after speaking with my insurance company I have no hope that it will be fixed any time soon...

Stephen Bonin
Stephen Bonin

Now this is my kind of posting!

Substantial good news. Plentiful reasons to be hopeful.

In my small city of 26,0000 in Texas, I just paid a visit yesterday to Lakes MHMR, which opened first in the past couple of years for substance abuse treatment and MR treatment.

Now, with state Medicaid funds, they are offering FREE Counseling!

This online community is one more example of positives.

Beyond that, I've been articulating examples in my posts this week.

Thank you! Talk with you next week!

Stephen

Louise Labbe
Louise Labbe

I was reviewing my brother's medications which are paid by Medicare. (Well there is no way he could afford this)

He is receiving one monthly Invega Sustenna injection (Manufacturer: Janssen Pharmaceuticals - A Johnson & Johnson Company) which cost $1,859.53.

This is totally outrageous! How can one injection cost so much??

Is anyone monitoring the outrageous prices that the pharmaceutical companies

are charging? What ingredients can possibly cost so much for one injection??

Lucinda Jewell
Lucinda Jewell

The most pressing concern for mental health care is access to care. Even if insured, many people are priced out because many of the best therapists and psychiatrists operate outside the insurance system. This means clients have to pre-pay their fees and wait for reinsurance reimbursement. Many people cannot afford this. For those practitioners who operate within an insurance system, therapy is limited often to six visits a year. Where available, practitioners are not accepting new clients and many rural areas do not have any or enough practitioners to provide care.

Another issue is the continuing reliance on pharmacology to treat mental health symptoms. Since the advent of drug interventions decades ago, the incidence of severe mental illness has not diminished nor have the suicide rates gone down. This is a case of doing the same thing over and over expecting a different result. Researchers need to ask different questions, to discover and explore alternatives. Looking to harnessing the strengths and resiliencies inherent in many mental health conditions is a first step, like boosting the immune system to fight off disease. Mental health is a whole health issue and requires multiple approaches from nutrition, lifestyle practices and as yet to be discovered medical interventions to become a reality for all.

Stephen Bonin
Stephen Bonin

The information in this article astounds me! I had not been aware.

To have a new law as the optimal since 1963 is significant.

I think the timing of this article is pertinent. Last night President Obama delivered his State of the Union Address. He exuded boldness, unwavering authority, determination that he and Congress will cooperate in the remaining days of his administration. When I asked a friend 14 years my senior what he thought about all the assertions. He quickly brought up the stock market record on his phone, showing me the truth of a significant positive swing upward in the Dow Jones.

So, we need to always be hopeful. This writer is seducated about our issues. He cares, and he is hopeful.

I think we--in our individual comnunities--need to stay positive, educated, and hopeful. We need to communicate effectively to others with kindness. Only in a space of respect and friendship relationship building can hopes for improvement become reality.

Joseph Vegazo
Joseph Vegazo

Hi friends,

I just read that the Centers for Medicare and Medicaid Services (CMS) is considering de-listing antidepressants and antipsychotics from their list of "protected" medications, i.e., those medications that all Medicare Advantage plans with Medicare Part D drug coverage and stand alone Medicare Part D drug plans are REQUIRED to cover! Can you believe this? Besides all the 65 and older people on Medicare that need antidepressants and antipsychotics, how about those of us that are under 65 and are on Medicare because we are on Social Security Disability and we are on S.S.D. because we have major depressive disorder, bipolar disorder or schizophrenia, such as myself??? Are we not going to be able to receive medication for the conditions that are the very reason we are on Medicare in the first place??? CMS is accepting public comments on this proposed change until 5:00pm March 7. To post your comment on-line go to www.regulations.gov and click "How do I submit a comment?" and refer to file code CMS-4159-P. To comment via paper and pen, send comments to Centers for Medicare & Medicaid Services, Dept. of Health & Human Services, Attn: CMS-4159-P, PO Box 8013, Baltimore, MD 21244-8013. I urge everyone to express their concern to CMS. Thank you, God bless you and God bless D.B.S.A.

chicagopaul
chicagopaul

Let's hope the bill with the amendment based on the Excellence in Mental Health Act passes, and let's work strenuously to show our support. This is a viable way to strengthen community-based mental health services, "the front line" in addressing mental health issues in this country.

ktcoll
ktcoll

I think we need to build on the momentum of greater awareness and increased mental health funding on both the state and federal levels. A new $25 million behavioral health center opened yesterday at the Erie County Medical Center in Buffalo, NY. This major project will triple the space of the often overcrowded Comprehensive Psychiatric Emergency Program from 6,500 square feet to 18,000 square feet. New York State provided $15 million through a Healthcare Efficiency and Affordability Law grant, with the hospital funding the rest. Only 60 percent Americans who suffer from mental illness receive treatment, according to a 2011 report by the Substance Abuse and Mental Health Services Administration. Some of this is due to lack of knowledge of available services and overcrowding. This program at ECMC, which will be among the largest in NYS, will serve nearly 25 percent of the hospital's inpatient business and will hopefully help remedy the problem of overcrowding. On the Federal level, the Excellence in Mental Health Act, as noted by Mr. Ingoglia, is one of the most important public sector mental health bills in recent time. It is important that this find final passage in the Senate and become law. As many of us come forward as advocates for better mental health care funding and access, our lawmakers will get a greater sense of what an important priority this is to overall American health care.

careforyourmind
careforyourmind moderator

You raise some very valid points.  Both the Excellence in Mental Health Act and the Behavioral Health Information Technology Act seek to address several of the issues you bring up in your comments.  Let's challenge all our readers to learn more about these Acts in 2014 and take concretet steps to work towards passing this legislation in the current Congress.

kimgallen
kimgallen

In terms of the most pressing mental health issues for 2014 and the ACA extending MH and SA coverage to all insurance coverage available through the newly established Marketplaces, I think there are pressing issues related to access and insurance:

a) The ACA confusion and website navigation difficulties are still a pressing issue. As an insurance agent who wants to help consumers not only enroll in health plans but also educate them on their choices, I feel that many brokers and agents do not clearly grasp the choices in consumer MH care, both within and outside the exchanges. 

b) Another pressing issue is that consumers not only get access to care, they must get improved care. This means that organizations must reevaluate and/or establish systems to measure care in mental health so their outcomes and standards are up to par. Organizations must work on items such as meaningful use, ICD diagnosis codes mandated for billing, the DSM 5 codes for some organizations, and things like the billing changes for Medicaid/Medicare. As a past Administrator of a treatment facility, I have seen how coding issues may result in delayed claims payment. I am aware of how complex the upcoming changes are, and think that it will take time for organizations to train their staff. 

c) Also, MH organizations often lack experts who work in risk management, patient safety, as well as data analysis and trending and may be unsure of what experts to choose for reevaluation and review of new trends and practices. This is a pressing issue. 

d) Finally, to assure a good 2014 Compliance Plan within organizations, there still must be a team-based approach to risk management. The changes are complex, and it will take time and working in teams to grasp how to address these pressing issues.

afish
afish

As an MSW/LICSW, unfortunately I am not optimistic about mental health coverage for patients needing out patient treatment.  As Mr. Ingoglia is certainly aware, the majority of mental health providers are opting out of Medicare, Medicaid and other insurance plans.  This is no secret as one attempts to get outpatient tx and no one can mandate that any mental health provider to accept any of the above insurance plans.  Granted, there will be some mental health providers available, but will they have the much needed experience and knowledge of psychopharmacology as it relates to psych meds along with good clinical interventions.  Further, mental health parity does now allow for insurance companies to include mental health services, but in most instances, patients will have to submit their claims to their insurance companies and pay out of pocket first to their mental health provider.

Obviously the major problem is the reimbursement rate and the huge amount of paperwork involved with Medicare, Medicaid and other insurance plans.

Annabelle Fisher, MSW, LICSW 



Stephen Bonin
Stephen Bonin

Thank you for the link! I will travel there right now to post my comments.