Active LegislationApr 13 TestimonyForensic CoalitionAwards
 us capitol_Washington DCThe following is a list of current legislation that may impact Mental and Behavioral Health. Your voice matters! Contact your legislators to let them know what is important to you and how they should be voting/acting on your behalf. Click here to find your legislators!

Senate Bill 1218 (PN 1745) would amend the Mental Health and Intellectual Disability Act of 1966 mandating the Department of Human Services to develop standardized mental health crisis intervention and emergency services training for county mental health and intellectual disability administrators and designated representatives. Representatives are individuals whose duties include intake, screening, assessment, review, assistance or referral for voluntary and involuntary crisis and emergency services. The Senate Public Health and Welfare Committee has considered the bill twice and it is now in Appropriations. During the initial consideration by the committee, Chairman Pat Vance (R-31) stated that DHS in conjunction with the county administrators would create the standards.

Senate Bill 1279 (PN 1859) would suspend Medical Assistance benefits rather than terminate them for enrolled individuals who become incarcerated. Senator Vance (R-31) and Kitchen (D-3) introduced the bill on June 2, which was referred to the Public Health and Welfare Committee.

House Bill 2028 (PN 3608) would establish the Psychiatric Oversight Act to address psychiatric supervision requirements in outpatient psychiatric clinics. Representative Pickett (R-110) introduced the legislation in an effort to meet growing demand and to take into account all prescribing professionals. The bill does not reflect the draft outpatient regulations under final review in the Department of Human Services.

Senate Bill 1326 (PN 1948) would provide five additional points in grading Civil Service examinations to individuals who voluntarily disclose and provide documentation of having a disability as defined in the Pennsylvania Human Relations Act. The bill was referred to State Government Committee on June 20.

House Bill 2173 (PN 3566) was introduced by Representative Murt (R-152) in an effort to strengthen enforcement of the Mental Health Parity and Addictions Equity Act of 2008 passed by Congress. The bill is now in the Insurance Committee.your voice matters

House Bill 2211 (PN 3606), introduced by Representatives Baker (R-68) and Fabrizio (R-2) on June 22, would extend annual assessment in the Human Services Code and place the eHealth Partnership Program under the Department of Human Services. The annual assessments for nursing home, Philadelphia hospitals and Intermediate Care Facilities all expire June 30, 2016. The Pennsylvania eHealth Partnership is a current initiative intended to enable the secure exchange of electronic health information. The bill in in the Health Committee.

CONGRESSIONAL MENTAL HEALTH REFORM MOVES IN HOUSE ~ During the course of the past year, the House Energy and Commerce Committee has heavily debated the Helping Families in Mental Health Crisis Act (HR 2646). The committee dramatically changed the original proposal introduced by Representative Tim Murphy (R-PA). Some notable changes include creating an incentive rather than a mandate Assisted Outpatient Treatment and removal of changes regarding sharing of patient information. The current bill looks similar to the S. 2680, Mental Health Reform Act of 2016, in the Senate.

CONGRESSIONAL BILL TO EXPAND CHILD WELFARE SCOPE TO INCLUDE NEW SERVICES ~ This month the House passed H.R. 5456, Family First Prevention Services Act of 2016. The bill would expand funding for earlier intervention and family services to keep children safely supported at home with their family. Federal child welfare funding under Title IV E and B of the Social Security Act could pay for mental health, substance abuse, parenting programs and prevention services. The Senate has a comparable bill championed by Finance Chairman Hatch (R-UT) and Ron Wyden (D-OR)

parity_alongroadaheadTestimony before the PA House Human Services Committee on April 13, 2016 by Carol Caruso, Executive Director, NAMI Montco: “Representative DiGirolamo, Representative Murt, Committee members, Representative Kennedy, members of the Insurance Commission, guests: Thank you for this opportunity to address you this morning on the very critical issue of parity for mental health and substance use coverage. I am Carol Caruso, Executive Director of NAMI PA Montgomery County. NAMI is the National Alliance on Mental Illness, the nation’s largest grassroots mental health advocacy organization dedicated to building better lives for those affected by mental illness. We do this by providing support, education and advocacy services to all in need at no cost. Although I represent a local NAMI affiliate, I have also served for six (6) years on our state Board (five as president) and a total of nine (9) years on our national Board of Directors. I have been a NAMI member since 1990, and, with other NAMI and peer advocates, went through most of the twenty (20) year fight to make mental health parity the law. I am here with friends and colleagues not only from NAMI but also other mental health advocacy groups. I thank them for their support and collaboration on many initiatives, including this one. Although I have had several family members with mental health challenges, my direct experience as a caretaker of such an individual was with a foster son. That experience was not successful and he unfortunately is serving a life sentence at a Pennsylvania state correctional facility. This unsuccessful experience only further committed me to helping those who fell through the cracks in the mental health and substance use systems. In addition to advocacy I also spent many years working in the mental health field, as a case manager, residential program director and day program staff. From these experiences I worked with many individuals and families with private insurance who soon ran out of mental health and substance use coverage from their insurance carriers. Many paid for services out of pocket, draining financial resources while not only not achieving successful treatment outcomes but also needing to look elsewhere, and often to Medical Assistance, for continued and on-going treatment coverage. This of course drains our state match, and puts people on “the Welfare roles,” not a way to promote recovery nor the hope of a return to or the fulfillment of living a productive life. Yet in order to treat their illness, to stay out of the hospital, or out of jail or off the streets, continued treatment is absolutely necessary, and limits of numbers of sessions or to medication formularies just don’t work. We have a federal law to prevent this. However it is not enforced, and more often than not individuals either do not know that they can challenge service limitations or the provider makes it so difficult to file a grievance that they give up, walk away, and either pay out of pocket or leave treatment until a crisis hits, and possibly a hospitalization, or an arrest, making it much more costly overall. We know that there is a high coincidence of mental illness along with substance use. In order for treatment to be successful, integrated care is a must. However, this is not always the case. As Representative Kennedy so correctly states, the stigma associated with mental illness and substance use is nothing more than discrimination. We find this discrimination in our communities, in our places of employment, within our system of care and even within ourselves. Is it any wonder that despite the 2008 parity law, our insurance providers continue to offer limited mental health and substance use coverage? This and the possibility that many subscribers are not aware of parity, nor if they do, do they know how to file a grievance about it or to whom to file such a grievance? Is their insurance provider, who will ultimately reject further coverage, the absolute end to which they can have this addressed? We need to do a much better job at educating not only about mental illness and substance use disorders as legitimate disorders that are treatable, but we also need to educate on the law and on treatment parity. Some examples of calls from our NAMI members into our office on parity: A gentleman, I will call him Bill, retired from a fortune 500 company. Both he and his wife required mental health treatment for depression while he was working as well as in retirement. They were covered by the same insurance provider both while working as well as in retirement. They were denied adequate on-going coverage and had to pay out of pocket. This became very expensive, for office visits as well as for medications, and one of them, usually Bill, has to stop treatment for a while to save on costs. Bill did not know that he could challenge this, and when told, felt it would do no good and would mean endless appeals. Becoming discouraged, he gave up on the thought of challenging his coverage. Another member, I will call him Art, wanted residential treatment for his sons’ substance use disorder. There was also a strong mental health component. Upon recommendation of his sons’ therapist, Art placed his son in a facility out of state. The facility offered step-down programs and employment as part of the course of treatment. Of course this was a very expensive program, not at all covered by insurance. Figuring his son would never go to college (how sad is that—giving up on someone’s future) the son’s college fund was spent on treatment. Unfortunately this scenario is fairly common—sometimes there are good results however more often the results are not successful and precious time and resources have gone by the wayside. And these are just two examples. We know that more than 10 million Americans live with co-occurring substance use disorders and mental health conditions, and proportionately we have Pennsylvanians living with these conditions. It is imperative for these individuals that they have access to quality, integrated care that treats both conditions. Mental health parity should help ensure that insurance coverage is adequate for both conditions. Last year, NAMI published a report titled The Long Road Ahead. Over 2,700 consumers participated in a survey to assess their experience with insurance coverage for mental health and substance use disorders. The following was found:

  • Consumers and families had a great deal of trouble finding mental health providers in their health plan networks.
  • Denials for mental health care were far higher than for other types of medical care.
  • Health plan coverage of psychiatric medications was inadequate.
  • Even when covered, out of pocket costs for medications posed barriers to care.
  • Out of pocket costs were more onerous for mental health care than comparable medical specialty care.
  • When selecting plans available through the health insurance marketplaces, consumers did not have enough information to make informed decisions.

We also know that here in Pennsylvania, there has been difficulty getting mental health parity enforced. The system is complicated. People find the system of appealing insurance denials and filing complaints cumbersome and often do not get a good response. Some recommendations would be:

  • State agencies coordinate and focus on mental health and substance use parity enforcement.
  • Develop a system that is navigable for people who are filing complaints, specifying where to go, how to file, and how soon they will get a response. We need state and federal officials to be responsive to complaints and bring about resolutions.
  • We need more transparency and access to information for insurance consumers.
  • The end goal is that we get people the mental health and substance use care they need, so they can recover.

We have these opportunities here in Pennsylvania and we are hoping that we can achieve parity of mental health and substance use disorders to the full extent of the law. Evidence for the need for both is seen in next year’s mental health budget, which provides funding for opioid treatment. Thank you for listening and for your efforts moving forward.”

steppingup-bannerThe Forensic Coalition meets quarterly at the Norristown Library. For more information or for the next scheduled meeting date, contact either Kathie Mitchell (610-270-3685) or Carol Caruso at the NAMI PA Montgomery County Office (215-361-7784). “Stepping Up!,” the national initiative to decrease the number of persons with mental illness in our jails, is gaining momentum here in Montgomery County. Started at the federal level by the Council of State Governments and the National Association of Counties, this initiative is an effort to help counties plan for more jail diversion programs and services as alternatives for individuals diagnosed with a mental health condition who come into contact with the legal system. In January 2013, Senators Al Francken (D-MN) and Mike Johanns (R-NE) and Representatives Richard Nugent (R-FL) and Bobby Scott (D-VA) introduced S. 162/ H.R. 401, the Justice and Mental Health Collaboration Act of 2013 (JMHCA). The legislation was overwhelmingly approved by the Senate Judiciary Committee last June and has 64 cosponsors in Congress. If passed, this legislation will bring funds into county systems to help implement this initiative. Here in Montgomery County, Kathie Mitchell, Director of Community Advocates of Montgomery County, and Carol Caruso, Executive Director of NAMI (National Alliance on Mental Illness) PA Montgomery County, have taken it on themselves to promote this effort and gain community support and interest in it. The Montgomery County Forensic Coalition was born and steps were taken to spread the word and get all stakeholders on board to be a part of this. After addressing this need with our county Office of Behavioral Health, Kathie and Carol were advised to join forces with the Forensic task Force which has been meeting monthly at MCES since 1992. The premise seemed to make sense—the mission of the Task Force was similar to that of the Coalition and many of the needed participants were already attending that meeting every month. So an introduction was made, and both parties agreed to work together on this issue. It was also agreed to change the name officially to The Forensic Coalition and to change the location of the meetings from MCES to the Norristown Library. In order to address this issue, the Task Force looked at The Mapping of the county forensic system (which tracked the steps taken from when a person with mental illness first comes into contact with the criminal justice system to incarceration, to re-entry into the community) that was completed in 2008. Since that time, some new services have been implemented (the Behavioral Health Court, the ACCESS Adult Crisis hotline and Team) so it was decided that a good first step would be to look at re-doing the mapping to better track current services and see what gaps need to be filled.

2015 Advocacy
Congressional Awards – May and June 2015
congressional award pres1_2015 congressional award pres2_2015On May 26th and June 1, Board President Neen Davis and Executive Director Carol Caruso were invited to take part in presentations of the Patient Access Champion Awards by the Alliance for Patient Access to representatives Patrick Meehan (L) and Joseph Pitts (R). Also pictured are Robert Blancato from the National Association of Nutrition and Aging Services Program and Barbara Roney and Miriam Myers from the Pennsylvania State Grange.