A Closer Look at Mental Health Reform Legislation

With half of Americans with mental health conditions going without essential services and supports—and others getting only minimal care—reform of our nation’s mental health system is a priority issue for NAMI.

Fortunately, Congress is listening.

There is unprecedented agreement in the U.S. House and Senate on the need for mental health reform. This has resulted in the introduction of several bills, each of which NAMI supports. All the bills have positive provisions that will help move mental health reform forward.

In the House

NAMI did it. Our combined grassroots power sent a message, and Congress acted.

The House voted overwhelmingly (422-2) to pass H.R. 2646, the Helping Families in Mental Health Crisis Act of 2016 on July 6, 2016. 

“What has made this work are…the thousands and thousands and thousands of letters and phone calls to members of Congress saying that we’ve got to do something about mental health.” Representative Tim Murphy (R-PA) 

H.R. 2646:

Strengthens community crisis response systems, so people experiencing a psychiatric crisis can get help sooner, before their condition worsens.

  • Provides specialized training to law enforcement, corrections officers and first responders in responding to people with mental illness, grants to enhance crisis response services and grants to develop psychiatric inpatient and residential bed tracking. Also creates grants to support ACT programs.

Supports the mental health workforce, so more trained professionals are available to help.

  • Includes pediatric mental health professionals in the National Health Service Corps loan repayment program, creates a Minority Fellowship Program and affords liability protections for volunteer health professionals. Also provides grants for pediatric tele-mental health consultations and for peer professional workforce training, including peer support specialists and recovery coaches.

Combats suicide in our schools and communities, so more lives are saved.

  • Extends the Garrett Lee Smith Memorial Act suicide prevention services to all ages, supports early intervention and prevention strategies to combat youth suicide, promotes awareness of mental health and substance use disorders and services on college campuses and puts the National Suicide Prevention Lifeline into federal statute.

Promotes early intervention, so people get the right mental health care at the right time to promote healthy lives.

  • Continues the 5% set-aside for evidence-based programs that address early serious mental illness, such as First Episode Psychosis (FEP) and provides grants for infant and early childhood mental health promotion, intervention and treatment programs.

Helps support integration of health and mental health care, so people get care that treats the whole person, not just one condition.

  • Permits Medicaid billing of health, mental health and substance use services provided the same day in the same facility (known as same-day billing).

Helps support evidence-based and promising practices, so people get effective mental health and substance use services and supports.

  • Provides grants to evaluate promising models and for expanding evidence-based programs for prevention, diagnosis, treatment and recovery services.

Clarifies health privacy laws, so mental health professionals, families and individuals know their rights.

  • Adds a training program on appropriate information-sharing under HIPAA for health care providers, legal professionals and for individuals and families.

Increases reporting on mental health parity, to move toward holding health plans accountable for covering mental health and substance use conditions fairly. 

  • Requires federal agencies to collaborate to improve compliance with the mental health parity law, to report on federal parity investigations and to create a plan to improve federal parity enforcement.  Requires a Government Accountability Office (GAO) study on mental health insurance parity.

The bill includes the following bipartisan provisions on complex issues:

  • Requires that the Secretary of Health and Human Services create an independent grievance procedure for complaints against PAIMIs (there is already a grievance process, but it is not necessarily independent) and prohibits use of federal funds to lobby (current law). Previous bill restrictions on the scope of PAIMI work have been removed.
  • Extends existing AOT grant program, but eliminates the previous 2% mental health block grant increase to incentivize AOT laws.
  • Replaces previous language on HIPAA with a “Sense of Congress” that outlines need for clarity regarding HIPAA, but does not change the law. Requires the U.S. Department of Health and Human Services (HHS) to issue final regulations within 1 year to clarify circumstances in which a health care provider may share protected health information.
  • Permits states to provide payments to Medicaid managed care organizations (MCOs) for adults ages 22-64 who are in psychiatric hospitals and acute behavioral health residential facilities (known as IMDs) for short-term stays of no more than 15 days per month. This puts into statute what is already in the recently released Medicaid managed care rule.
  • Creates a new Assistant Secretary for Mental Health and Substance Use that will elevate the position of SAMHSA in the Administration. The new Assistant Secretary will be required to be a mental health professional, rather than permitting a lawyer or other professional to lead the agency. The bill also permits the appointment of a Deputy Assistant Secretary (which may be the current Administrator). SAMHSA representatives have indicated that they are comfortable with this provision.

In the Senate

The Mental Health Reform Act of 2016 (S. 2680) has a strong chance of getting a vote, but the window of time to get a bill passed is brief. Senator Lamar Alexander (R-Tenn) hinted that the Senate will probably take up mental health reform in September and we need to ensure that happens through our advocacy.

Learn more about what S. 2680 does and ask your Senator to bring this bill to the Senate Floor.

The Senate is pursuing a three-pronged strategy regarding mental health reform:

  1. Improve mental health care through provisions in S. 2680.
     
  2. Address potential criminal justice reforms, including mental health diversion and reentry, if S. 2002 (sponsored by Sen. Cornyn (R-Tex.) is included as an amendment to S. 2680.
     
  3. Address potential changes to Medicaid and/or Medicare financing if the Senate Finance Committee sponsors an amendment to S. 2680. Getting an amendment to address financing may be challenging, but important proposals include:

NAMI’s Efforts to Pass Mental Health Reform

NAMI is working in coalition with leading organizations and a diverse array of advocates in a united push for a Senate vote on S. 2680. NAMI considers the passage of H.R. 2646 a major success.

What has NAMI done in the recent past regarding this effort?

NAMI wrote a letter in support of the Helping Families in Mental Health Crisis Act of 2015 to Representatives Murphy and Johnson and has written a blog on June 17, 2015 about the importance of H.R. 2646.

NAMI wrote a letter in support of the Senate H.E.L.P Committee’s effort to bring forward bipartisan mental health reform legislation on March 15, 2016.

Mary Giliberti, NAMI CEO, wrote a blog on HuffPost on May 20, 2016 about the significance of S. 2680 and the need for action now.

In addition, NAMI is aiming social media and in-person efforts at rallying NAMI grassroots supporters and mental health advocates to call for full passage of #MentalHealthReform.