6. Financing of Treatment and Services

6.1 Health Care Reform

(6.1.1) NAMI supports health care for all persons with mental illnesses that is affordable, nondiscriminatory, and includes coverage for the most effective and appropriate treatment.

(6.1.2) NAMI supports equal access to affordable health care for every American.

(6.1.3) NAMI supports mandatory coverage and full parity for mental illnesses that is equal in scope and duration to coverage of other illnesses, without lifetime maximum-benefit caps and other limits more restrictive than those required for other illnesses or disorders, and covers all clinically effective treatments appropriate to the needs of individuals with mental illnesses.

(6.1.4) While NAMI supports federally mandated, minimum standards for health insurance coverage, federal standards must not pre-empt state laws that provide higher standards.

(6.1.5) NAMI believes that all insurance plans, whether based on employment in the private sector, employment in the public sector (including federal, state and local governments), available through membership in unions, or individually purchased, must cover mental illnesses and addictive disorders at parity with all other medical disorders. These parity requirements must apply both to quantifiable treatment limitations (for example, premiums, co-pays, deductibles, annual limits, lifetime limits, etc.) and non-quantifiable treatment limitations (for example, medical management standards, utilization review practices, formulary designs for prescription drugs, etc.). NAMI strongly opposes all exceptions to these parity requirements.

(6.1.6) NAMI opposes health care rationing.

(6.1.7) NAMI urges federal and state standards that make any determination of “medical necessity” by a consumer’s primary mental health care provider a presumption rebuttable only on the basis of clear and convincing independent medical evidence.

(6.1.8) NAMI believes that treatment and care for all consumers requires a documented diagnosis, an individual treatment plan with clinical goals and documentation of progress, and that mental health care providers are properly licensed, certified, or recognized by the state and meet national standards for clinical care.

6.2 Public Responsibilities and Resources

(6.2.1) NAMI affirms that a just and humane society, using the instrument of government for policy direction and public resources allocation, must care for its most vulnerable members when they are unable to care for themselves. Essential needs must be addressed irrespective of decisions concerning what level of government should have control, what proportions of the financing each level of government should be responsible for and whether administrative, supervisory or other responsibilities are contracted out privately.

(6.2.2) Persons of all ages who suffer from serious mental illnesses are frequently unable to provide for themselves because of acute or chronic symptoms. The most basic needs are for shelter, food, clothing, medical and social supports, and assistance toward self-sufficiency. All levels of government must address such needs by providing programs for income maintenance, medical treatment and a full range of psychotherapies, rehabilitation, and evidence based treatments for mental illnesses, medical insurance, other health and social services, shelter and housing, education, transportation assistance, legal assistance, advocacy, training, and employment assistance.

(6.2.3) Government at all levels must oversee, assist and encourage the fullest possible integration of public and private resources into an effective and sustainable system of mental health care at all levels.

6.3 Medicare

(6.3.1) Medication prescribed for the treatment of serious mental illnesses must be fully covered under the Medicare prescription program.

(6.3.2) Co-payments imposed on outpatient mental health care and services must be equalized with all other Medicare co-payments.

(6.3.3) There should be no lifetime limit in Medicare on inpatient psychiatric hospitalization. Coverage of inpatient and outpatient mental health treatment and services should be equal to all other inpatient and outpatient treatment and services in Medicare.

(6.3.4) NAMI advocates for coverage of psychiatric rehabilitation, case management, assertive community treatment and other evidence-based mental health services in Medicare. (RH 3-3-2010)

(6.3.5) NAMI supports coverage of partial hospitalization under Medicare but believes that this benefit must be structured to cover services that are rehabilitative and intended to restore functioning or improve functioning to enable recipients to live safely and as independently as possible in the community. (RH 3-3-2010)

(6.3.6) Any risk adjustment payment mechanism under Medicare must include consideration of both severity and chronicity of mental illness.

(6.3.7) Social Security Disability Insurance (SSDI) recipients who seek work should be allowed to continue Medicare insurance coverage and persons who go off Medicare because they have obtained employment should be automatically re-enrolled in Medicare in the event of a subsequent clinical relapse.

(6.3.8) Medicare must include comprehensive patient protections that are the same as any other health care coverage.

6.4 Public Financing

(6.4.1) NAMI recognizes that the cost of not treating serious mental illnesses vastly exceeds the cost of treatment.

(6.4.2) Financing services for persons with serious mental illnesses who are unable to care for themselves is a public responsibility. Governments at all levels have a responsibility to develop an integrated system of care that is funded sufficiently, effectively and efficiently.

(6.4.3) Meaningful accountability for expenditure of funds for programs and services to persons with serious mental illnesses must be ensured and especially stringent whenever there is co-mingling of public and private funding.

(6.4.4) NAMI urges sufficient and sustained funding to avoid waiting lists and "dumping" of persons with serious mental illnesses from publicly funded mental health care for any reason.

(6.4.5) NAMI advocates for sufficient and sustained funding for biomedical and service research related to serious mental illnesses and for treatment and services for individuals with serious mental illnesses. These research funds must be awarded to those proposals most likely to help persons with the most severe disabilities and federal oversight of this research funding must be effectively maintained by appropriate national institutes responsible for health research and development with respect to serious mental illnesses.

(6.4.6) NAMI supports consumer and family education that enables consumers and families to communicate more effectively with providers, better understand serious mental illnesses and develop coping skills. NAMI believes that consumer and family education should be provided without charge as an integral part of community services.

(6.4.7) NAMI supports funding for respite care.

(6.4.8) NAMI will monitor the expenditure of federal mental health care funding at all levels of government in order to assure that these funds are spent to benefit individuals with serious mental illnesses and that non-compliance results in appropriate sanctions

(6.4.9) NAMI opposes restrictions on Medicaid eligibility solely based on residence in so-called “Institutions for Mental Diseases” (IMDs) or otherwise solely on the basis of place of residence or location of services provided rather than need.

(6.4.10) NAMI believes that resources saved as a result of closing public hospitals and other facilities no longer necessary for the treatment of persons with serious mental illnesses, reduced utilization of such hospitals and facilities, or through service improvements and efficiencies should be reallocated supplementally to expand community-based services and supports for persons with serious mental illnesses.

(6.4.11) NAMI supports the integration of mental health, alcohol and substance abuse funds at all levels of government in order to improve the effectiveness of treatment for co-occuring disorders of serious mental illness and substance abuse.

( NAMI urges governments at all levels to assure that basic services provided to persons with developmental disabilities are also provided to persons with mental illnesses; supports the inclusion of mental illnesses in the scope of developmental disabilities planning and funding; and promotes effective collaboration between the Center for Mental Health Services and the Administration on Developmental Disabilities; and between each State Mental Health Planning Council and State Planning Council on Developmental Disabilities.

6.5 Managed Care

(6.5.1) Governments at all levels must continue to have authority over and be accountable for the delivery of treatment and services for persons with serious mental illnesses when contracting out treatment and services to private managed care organizations (MCOs).

(6.5.2) NAMI believes that even when treatment and services are contracted out to MCOs, persons with serious mental illnesses who are employed but cannot obtain employer-provided health care coverage should continue to be eligible for public health care benefits and government at all levels must maintain the availability of a comprehensive community-based system of treatment and services for persons with serious mental illnesses.

(6.5.3) There must be meaningful participation by consumers and families in the design, implementation, monitoring and evaluation of managed care system as well as cultural sensitivity to ethnically diverse populations and communities.

(6.5.4) Whenever government at any level contracts with MCOs or other entities to solely manage or deliver Medicaid-funded services for persons with serious mental illnesses, there must be no resulting division within the overall mental health system that causes persons who are most severely disabled by serious mental illnesses and require the greatest use of more costly treatment and services to be carved out into less funded or less effective public mental health care systems.

(6.5.5) When contracting out to MCOs results in reduced public expenditures, the savings must be reinvested in expanding services to persons with serious mental illnesses.

(6.5.6) MCO administrators and treatment staff must be trained and expected to understand serious mental illnesses, work with persons with serious mental illnesses including awareness of the consumer and family perspective and accept accountability for the quality of services provided.

(6.5.7) All MCO treatment staff must be rigorously and appropriately credentialed by appropriate state agencies.

(6.5.8) MCOs must provide comprehensive community-support services available for persons with serious mental illness regardless of ability to pay and these services must include the availability of the most individually effective medications, talk therapy, inpatient treatment, residential support services, intensive case management, psychosocial rehabilitation, consumer-run services, around-the-clock crisis services seven days a week and outpatient services that are mobile and accessible.

(6.5.9) MCOs must be accountable for appropriate and effective linkages to housing as well as supportive services and employment services.

(6.5.10) MCOs must be required to adhere to appeal and grievance procedures that are user-friendly and timely, given the life-threatening nature of psychotic episodes.

(6.5.11) MCOs must provide sufficient information and government at all levels must report at least annually on the number of persons with serious mental illnesses and other mental illnesses who 1) are identified but fail to present for services; 2) are in jail, prison or juvenile detention; 3) have been placed in a hospital, nursing home, or long term care facility; and 4) have died.

6.6 Fundraising by Non-Profit Agencies

(6.6.1) NAMI strongly encourages non-profit agencies serving persons with mental illness to engage in fundraising in order to diversify the sources of funding, augment services and raise community awareness.

(6.6.2) Governments at any level should not reduce funding to non-profit agencies serving persons with mental illness because the agencies have independently raised funds for services.