Expands Medicaid funding for stays in private or state mental health and for addiction treatment facilities: loosens the “IMD exclusion” to allow states with 1115 Waivers to authorize Medicaid managed care (only) funds to pay for hospital stays in state or private psychiatric and addiction treatment facilities for up to 15 days per stay. States will have to apply to use this option and CMS will have to approve on a state-by-state basis. The bill originally authorized all Medicaid to pay for unlimited stays in those facilities, provided they didn’t show an average of 30-day stays.
HIPAA privacy protections: essentially makes no changes in the current statute. It allocates $10 million through 2022 to educate health care providers and families about the level of flexibility to disclose patient information within the current law. It does direct the federal Health and Human Services Agency in conjunction with the Office of Civil Rights to consider new regulations next year.
Court mandated outpatient treatment (termed AOT): allocates funding to pay for a provision that was approved last year by Congress to establish AOT pilots. It increases the amount and the years of those pilots. The original bill penalized states that didn’t use or expand AOT programs by reducing their federal block grant totals by 2%.
Protection and Advocacy Agencies: no essential changes here; the bill does repeat previously stated prohibitions against P&A groups to use their federal funds to lobby and establishes a grievance procedure for complaints. The original bill would have all but gutted these programs.
Federal Agency Changes: creates an assistant secretary for Mental Health and Substance Use Disorders within the Health and Human Services Department to oversee and coordinate federal behavioral health policy. It is “preferred” but not required that the assistant secretary be a psychiatrist, osteopath, or psychologist. This position will oversee SAMHSA and the Center for Mental Health Services (CMHS) activities, establish priorities, performance metrics, and standards for grant programs.
SAMHSA Block Grants: re-authorizes all existing programs and includes an emphasis that these existing and new programs should address the needs of those with the most advanced conditions.
Assertive Community Treatment: provides $5 million a year for 2018–2022 ($25 million total) to expand Assertive Community Treatment teams.
Peer Services Study and Education: the Comptroller General will study peer support in 10 states to identify possible ‘best-practices.’ It also authorizes grants to colleges of $10 million a year for 5 years ($50 million) to increase the behavioral health paraprofessional workforce, including peers.
Psychologist Education: there is $12 million a year for five years ($60 million) to train psychologists to work with those with more advanced conditions.
Crisis Intervention Training for Police: authorizes $9 million for 2018–2020 ($27 million) for CIT Training.
Same Day Treatment: allows Medicaid to reimburse for physical health and mental health services received within the same day.
Suicide Prevention: there is an adult suicide prevention allocation of $30 million a year ($150 million total) and another grant of $9 million a year for 2017–2021 ($45 million total) for suicide prevention for any age group. There is also $35 million a year ($175 million) allocated to youth suicide. Rep. Murphy disclosed yesterday about his own father’s suicide attempt.
Interdepartmental Serious Mental Illness Coordinating Committee: establishes a high-level cross-government committee to issue a report and recommendations to improve care.
Innovation Grants: provides two separate grants of $7 million each over three years ($21 million total); one for evaluating promising models that enhance prevention, diagnosis, treatment and recovery or to integrate health and mental health; and one to scale up evidence-based programs.
Bed Registry or Community Crisis Response Plan: allocates $5 million a year ($25 million total) for 2018–2022 for grants communities can apply for to create a crisis response plan (agreements between providers and criminal justice, etc.) or to create a registry of existing empty beds.
Parity: The bill calls for a GAO study on parity compliance.