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Legislative Update
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The Rollout Continues on Health Reform

By James K. Finley
Director of Public Policy

Congress is expected to spend much of April positioning itself for the upcoming elections with votes on controversial healthcare bills that have no chance at final passage. 

First up is House consideration of legislation to repeal a Medicare cost-control board known as IPAB (Independent Payment Advisory Board) that was created under the Patient Protection and Affordable Care Act (PPACA). Many GOP leaders have severely criticized the IPAB board that would set Medicare provider rates under certain circumstances. The legislation is highly partisan and not expected to clear the Senate or receive President Obama’s signature. 

House Republicans are also promoting a budget resolution that would cap Medicare spending and cut federal Medicaid spending by $810 billion over 10 years. The spending blueprint is expected to be a focus of partisan debate for a number of weeks. 

While Congress works to chip away at the PPACA, federal agencies are pressing ahead with efforts to implement it. The Department of Health and Human Services (DHHS) recently issued regulations to implement PPACA rules for new, state health-insurance exchanges. 
The final rules on state health exchanges and a DHHS fact sheet outline how the new insurance marketplaces would function. The exchanges are key for mental health counselors because they provide the major avenue for uninsured people to receive insurance with behavioral health benefits at parity levels. 

The new rules grant states some flexibility in establishing standards for their insurance marketplaces, including which entities may run the exchanges and which insurance companies may participate. The exchanges will launch on Jan. 1, 2014, but one year prior, HHS will certify which exchanges are expected to be able to meet federal performance expectations. If a state has not made significant progress towards those benchmarks by next year, the federal government will intervene to do the job for it. 

Some states have halted development of their exchanges in anticipation of an adverse Supreme Court ruling on the PPACA, and they are expected to encounter extreme difficulty in establishing their own exchanges if the law is upheld later this year. 

The DHHS Centers for Medicare & Medicaid Services (CMS) has also announced a major demonstration for Medicaid emergency psychiatric services authorized under the PPACA. CMS announced awards for a $75 million, three-year demonstration project to examine the impact of covering mental health treatment in psychiatric hospitals with more than 17 beds. The study involves 11 states and the District of Columbia and will examine the exclusion from coverage for “institutions for mental diseases” (IMDs) under Medicaid and Medicare for individuals aged 21 to 64. Created and funded under the PPACA, the demonstration is designed to examine the quality of care patients receive at psychiatric facilities, the effect on emergency room utilization, and the overall cost-effectiveness of such care. 

Professions Seek Increased VA Hiring

AMHCA and its coalition partners representing mental health counselors and marriage and family therapists expect the mental health needs of returning veterans will receive increased congressional attention this year. AMHCA is working in coalition to increase outreach to the House and Senate committees on veterans affairs, seeking their support for hiring more clinical mental health counselors and marriage and family therapists in the Department of Veterans Affairs. 

The agency is experiencing an ongoing shortage of VA behavioral health personnel. AMHCA and its coalition partners hope to link up the current professional shortages with the concerns of our professions. 

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