YAPRS Note: Here’s some early press reports about yesterday’s US House Energy and Commerce Committee’s review of Rep. Tim Murphy’s “Helping Families in Mental Health Crisis” bill, HR.2646.
Here are a few observations from the reporters’ accounts:
· Rep. Murphy has just introduced an amendment to his bill with several changes…it’s too early to offer a full analysis and it’s not clear which of the following accounts include the impact of the new proposals. One change is that federal mental health block grants would be linked to a requirement that states have an ‘active outreach and engagement program’ that may rather than must include AOT. HR.2646 had previously appeared to require the inclusion of AOT to get SAMHSA block grant dollars.
· The ranking Democrat Ranker Rep. Pallone came out strongly against the bill;
· Reps. Pallone and Schakowsky opposed changes to SAMHSA, especially cuts to its SU treatment programs
· CBO has estimated total costs of the new proposals could amount to $46-66 billion over the next ten years. More narrowly, lifting the IMD exclusion (allowing Medicaid to pay for inpatient care at state and private hospitals) and permitting same day payments for primary and mental health care at a mental health or Federally Qualified Health Center would cost $40-60 billion from 2016-2025, if taken together. See next posting with more details about the CBO’s scoring.
· TAC’s John Snook says AOT is not controversial and is supported by DOJ and SAMHSA. He says that AOT is not aimed at violent individuals, although many public statements by supporters have suggested otherwise.
· HIPAA: The bill asserts that mental health professionals are legally permitted now to share critical diagnostic and treatment information with the parents or caregivers of patients experiencing serious mental health conditions. Congressional members have proposed an education campaign to let providers know they have somewhat broader authority to do so then most believe. In addition, Congressman Murphy proposes the use of a special HIPAA exception for families he says will be rarely used.
Stay tuned for info on new information and developments.
Congress Clashes Over Mental Health Laws: ‘The Body Count Is Always Climbing’
Chance Seales, Media General National Correspondent November 3, 2015, 8:29 pm
WASHINGTON (MEDIA GENERAL) – Mental health is shaping up to be a top bipartisan issue in 2016 on Capitol Hill.
But crafting a bill suitable to both parties could be tough, as members of Congress proved Tuesday by unleashing pointed criticisms of a leading reform proposal in the House.
Rep. Tim Murphy’s (R-Pa.) bill, the Helping Families in Mental Health Crisis Act, took center stage in a health subcommittee and quickly faced scorching critiques by Democratic opponents.
Rep. Murphy, who is also a clinical psychologist, opened by recalling a summer of deadly American tragedies spurred by mental illness and the all-too-familiar subsequent ceremony of lowering the congressional flag and observing a moment of silence.
“The body count is always climbing,” Murphy reminded colleagues, imploring them to be bold. “We need action, not silence.”
He faced anything but silence from the opposing party as left-leaning members ticked off a checklist of flaws they see in the bill.
The subcommittee’s top Democrat, Rep. Frank Pallone (D-N.J.) argued that Murphy’s proposal “will do more harm than good,” by degrading patient privacy and shifting “funding away from substance abuse treatment” provided by the Substance Abuse and Mental Health Services Administration (SAMHSA).
Murphy has already gathered 158 cosponsors for his ‘Helping Families,’ which he says will deliver resources for Americans in desperate need of mental health treatment, clear HIPAA red tape for their families, institute a mental health office in the Department of Health and Human Services and free up federal dollars for additional mental health research and assistance.
In committee, Murphy denounced the “bigoted belief” that mentally ill people are incapable of becoming more than their illness.
A group of six GOP congresswomen joined Rep. Renee Ellmers (R-N.C.) in a letter voicing their support for Murphy’s bill, writing, “This has a disproportionate impact on women, since women make up a sizable majority of those who rearrange their lives to care for children, parents, spouses, other family members and friends with mental illness.”
Mothers Urge Action
Mothers also showed up, in person, to display their support.
Advocates, many of them mothers of children battling mental illness, wore neon pink stickers urging members to pass Helping Families.
Tanya Shuy of Maryland was one of them. She lost her 26-year-old daughter Caitlyn to suicide in early September. Less than two months later, she is determined to see a change in the system she says sent her daughter to the grave.
“The biggest problem was HIPAA,” Shuy said soft but assuredly. Despite her daughter receiving inpatient treatment for suicidal ideation, the mother explains, “No doctors would speak to me. The hospital won’t speak to me…I don’t have a doctor who’s told me, ‘This is what your daughter had.’”
That’s why she supports Murphy’s bill.
The current version of the Helping Families in Mental Health Crisis Act aims to clarify that mental health professionals are legally permitted to share critical diagnostic and treatment information with the parents or caregivers of patients experiencing serious mental illness.
Treatment or Prison Time
Supporters of Murphy’s bill like Rep. Susan Brooks (R-Ind.) also touted the benefits of routing patients to professionals rather than prisons.
Brooks, a former criminal defense attorney, echoed the sentiments of many members on both sides of the aisle. “Our jails and prisons have become the mental health hospitals and mental health facilities that used to be in place many years ago,” she said.
She concluded that the cycle only worsens over time, because, “it’s a downward spiral once they go into the criminal justice system.”
The left side of the aisle roundly praised Murphy’s steadfastness, but took issue with three major elements of his bill: erosion of patient privacy, lack of investment, and certain court-mandated treatment programs.
For instance, Rep. Pallone used his time to predict that, “the proposed changes to HIPAA would weaken the privacy rights of individuals with diagnosed mental illness in a manner that would be unheard of if it were suggest for patients with physical illness.”
Rep. Jan Schakowsky (D-Ill.) called mental health “a critical and emotional issue.” She even revealed personal ties to the issue, saying, “In my own immediate family we have struggled to find appropriate care for a loved one.” But that personal tie, Schakowsky says, is what keeps her from supporting the current version of Murphy’s bill, concluding that it doesn’t sufficiently invest in the nation’s mental health safety net.
“We simply cannot claim to be helping to solve this serious problem,” Schakowsky told attendees, since it cuts funding to SAMHSA’s substance abuse program. She then turned to her colleague from Pennsylvania, addressing him directly: “I plead with you, Mr. Murphy, we can do this. We can do this together.”
The final major sticking point is the assisted outpatient treatment (AOT) section, which would allow judges to order and enforce outpatient treatment programs rather than commit individuals to jail or inpatient facilities. Advocates say AOT ensures mental health problems are treated by professionals, not prison systems. On the other hand, opponents see it as a slippery slope of government overreach.
Wednesday will bring a first vote for Murphy’s mental health bill by the full health subcommittee. To become law, it would also require approval by the Energy Committee, House of Representatives, Senate and President Obama.
Similar mental health measures are percolating in the Senate, awaiting committee hearings. It’s unclear which proposal will prevail as the 114 Congress’ final mental health reform package, but a handful of options are currently moving to the fore.
GOP Changes Mental Health Bill, Seeking Dem Support
By Peter Sullivan The Hill November 3, 2015
Rep. Tim Murphy (R-Pa.) on Tuesday introduced an updated version of his sweeping mental health reform legislation that seeks to allay some of Democrats’ concerns.
The move comes the day before the bill is marked up in the House Energy and Commerce health subcommittee. The measure, billed as the Republican response to the mass shooting in Newtown, Conn., when it was first introduced in 2013, has been controversial and delayed for years, but is now moving forward.
The bill has some bipartisan support — 43 of its 154 cosponsors are Democrats — but Democrats on the Energy and Commerce committee have raised objections to several core parts.
The new bill was only shared with committee Democrats on Tuesday morning, and ranking member Rep. Frank Pallone (D-N.J.) said he still has to review the changes, but cannot support the bill in the form it had been in previously.
One of the most controversial parts of the bill incentivizes states to adopt what is known as Assisted Outpatient Treatment (AOT), where judges can mandate treatment for patients with serious mental illness.
Committee Democrats had warned that the bill as written would have rescinded federal funding from states that do not have AOT laws. The updated version of the bill seeks to clarify that funds will not be rescinded, only that states that have the laws in place will be rewarded with a 2-percent increase in funding.
Democrats still object to that incentive. “The use of the court system and law enforcement to force individuals into care is a dramatic departure from how individuals, particularly those who pose no imminent threat to themselves or others, obtain health care services in this country,” wrote 19 committee Democrats in a letter earlier this month.
Another controversial area of Murphy’s bill is its changes to a health privacy law known as the Health Insurance Portability and Accountability Act, or HIPAA. The changes are aimed at allowing caregivers and family members to have more information about a mentally ill person’s care.
Murphy added in language from a bill from Democratic Rep. Doris Matsui (Calif.) that would provide training for doctors and patients about what the privacy law allows. But the bill still makes changes to the underlying law that some Democrats object to, warning that they think the loss of privacy protection would deter mentally ill people from seeking care.
There have also been questions about how to pay for Murphy’s bill, and the updated version makes some changes that could help it cost less.
The Congressional Budget Office estimated Tuesday that the previous version of the bill would cost $3 billion over ten years. If certain provisions freeing up Medicaid to spend more on mental healthcare were included, though, the cost would spike to between $46 and $66 billion over ten years.
In the new version, provisions that would have eliminated a lifetime limit on Medicare’s coverage of care at psychiatric hospitals has been removed. An expansion of grants for community mental health centers has also been removed.
The repeal of a ban on Medicaid paying for care at certain mental health facilities has also been pared back.
Murphy on Tuesday thanked Democrats on the committee for recent conversations with him, saying “I know we can come to a solution to this.”
Congress Wrestles With Court-Ordered Mental Health Treatment
By Shannon Muchmore Modern Healthcare November 2, 2015
One of the provisions that is keeping a House mental health reform bill from relatively easy passage involves assisted outpatient treatment. Some experts say it has been unfairly labeled as questionable since widespread evidence has shown success.
A few organizations, however, and about 20 Democrats in the House Energy & Commerce Committee, say assisted outpatient treatment, or AOT, is not proven to be helpful and the law as currently written would punish the five states that don’t have AOT laws on the books.
AOT is court-ordered outpatient treatment for people with severe mental illness and a history of not following treatment.
The bill’s sponsor, Rep. Tim Murphy (R-Pa.), has said he will revise the wording to ensure that states are not required to have AOT, but are rewarded for it. The bill is scheduled for markup this week.
His office said the bill would give block grants to all states and an additional 2% bonus to states with AOT laws. A Congressional Research Service report found that the law could be interpreted in such a way that states without those laws would have funding restrictions.
A companion bill in the Senate does not include language regarding AOT. It is scheduled for markup sometime early next year.
John Snook, executive director of the Treatment Advocacy Center, said AOT treatment is necessary. Studies from the past several years show there are people who need more than voluntary treatment to remain in their communities.
The practice is supported by the U.S. Justice Department, Substance Abuse and Mental Health Services Administration, American Psychiatric Association and National Alliance on Mental Illness, he said.
“It’s not a controversial program anymore,” he said, except on Capitol Hill.
Snook said he understands the concerns that the bill will spur belief that people who are mentally ill are also violent, but the program isn’t for violent individuals. It is for people who are caught up in jail or are homeless.
It can help prevent the illnesses that cause everyday stigma, he said.
“What (people are) going to see is the guy on the street who’s talking to himself,” he said.
A lack of providers to treat mental illness is a concern with AOT, but the House bill has measures to help increase the number of beds and other treatment options. Helping people who frequently cycle in and out of various mental health services can actually free up providers for others in need, Snook said.
Raymond Bridge, public policy director for the National Coalition for Mental Health Recovery, said the bill doesn’t do enough to increase the number of providers, social workers and case managers available.
More finances should be directed toward housing, crisis prevention and community mental health services, he said.
“Let’s learn how to really engage people on their own terms,” he said.
The letter from some House Democrats says they support a state’s right to have AOT but do not think funding should be used to incentivize it. They say people who are not a harm to themselves or others should not be forced into treatment and worry it will be disproportionately used on minority populations.
A study of New York’s AOT law in 2009 by researchers with the Duke University Medical School found no racial bias.
Rep.: Mental Health Reform Designed To Stop ‘Revolving Door’
By Kimberly Atkins Boston Herald November 03, 2015
WASHINGTON – As a House committee is set to take up a sweeping mental health reform bill today, the measure’s chief architect is defending provisions that have drawn criticisms from Democrats including U.S. Rep. Joseph Kennedy III.
U.S. Rep. Tim Murphy (R-Pa.) said his bill, the Helping Families in Mental Health Crisis Act, is designed to overhaul the inefficient federal government bureaucracy that currently costs taxpayers billions of dollars, but fails to delivery crucial health care access to those who need it most.
“It’s also motivated by the tragedies happening around the country,” Murphy told the Herald Monday, referring to recent mass shootings by individuals with mental health issues as well as the burgeoning opioid abuse epidemic affecting communities across the country. “We know we have to do it. I’d be a shame if we walk away.”
Though there is bipartisan support for overhauling the nation’s mental health system to increase access to services and treatment, some lawmakers including Kennedy have expressed concerns about some provisions in the House bill.
Kennedy told the Herald Sunday that his concerns center around provisions that would create an exception to federal privacy laws to allow health care providers to disclose information about individuals with serious mental illness over the patient’s objection and strip funding from states that do not have assisted outpatient treatment (AOT) laws, which allow courts to order outpatient treatment.
While Kennedy and 18 other lawmakers wrote a letter to the chairman of the House Energy and Commerce Committee saying those provisions “would restrict patients’ civil rights” Murphy, who is also psychologist, disagreed.
“The point is to ensure people are getting care,” said Murphy, who added that the AOT programs are designed to stop the “revolving door” of individuals with mental health repeatedly getting arrested and jailed by giving judges the power to order treatment in limited circumstances.
As for the privacy law exception, Murphy said it is meant to ensure doctors can enlist the help of family members to care for those with several mental illness.
The use of the exception “would be rare, but it’s significant,” Murphy said, citing the example of Virginia State Senator Creigh Deeds, whose son stabbed him and left him critically wounded before taking his own life in 2013. Deeds testified at a congressional hearing in June that federal privacy laws “prevented me from accessing the information I needed to keep him safe and help him towards recovery.”
Murphy said that he is willing to work with those with concerns about the bill at its markup to come up with a compromise in order to advance the measure, but added that some provisions, including the privacy law exception, already represents a compromise.
“(Some) say it’s too narrow, other people say it is too broad,” Murphy said.