State and Federal Updates

In this post, surprisingly NO budget updates, but a little on Medicaid and federal and state behavioral health legislation.

Medicaid Expansion Being Debated Today

This morning, the House Appropriations Subcommittee on Budget Transparency and Reform heard testimony on HB 3376 by Rep. Sylvester Turner, which would expand Medicaid to all individuals eligible under the ACA.  As previously mentioned, it is estimated that 90% of individuals currently receiving public mental health and substance abuse services would be eligible for Medicaid under such an expansion.

Dozens of advocates were out in full force to express their support for this important legislation.  NAMI Policy Director Greg Hansch and Hogg Foundation for Mental Health Fellow Peter McGraw gave testimony about the positive impact Medicaid expansion would have on people with mental illness.  The hearing recessed for House proceedings but will resume after the House adjourns for the day.

Other legislation the subcommittee will consider include HB 3791, Rep. Zerwas’ “Texas solution” Medicaid expansion bill, and HB 3339 by Rep. Martinez-Fisher, which would allow the use of Rainy Day Funds to restore the $5.4 billion cut from public schools last session.

Comprehensive Federal Behavioral Health Legislation Moving Forward

Last week I shared a little about S. 689, the Mental Health Awareness and Improvement Act, which is being sponsored by Health, Education, Labor and Pensions (HELP) Committee Chairman Tom Harkins. The bipartisan bill was introduced after the HELP Committee’s January hearing to assess the state of the country’s mental health system. The bill was voted unanimously out of the HELP Committee last Wednesday and is now awaiting action by the full Senate.

The bill takes a number of positive steps to promote prevention and early intervention and improve the delivery of mental health and substance abuse services. From the Section-by-Section analysis (with a few minor revisions), key provisions of the bill include:

• Encouraging the development of school-wide prevention programs, such as positive behavioral interventions and supports.

• Encouraging states to provide technical assistance to school districts and school personnel on the implementation of school-based mental health programs.

• Reauthorizing the Youth Suicide Early Intervention and Prevention Strategies grants to states and tribes.

• Reauthorizing the Mental Health and Substance Use Disorder Services on Campuses grant program and updates the use of funds to allow for the education of students, families, faculty, and staff to increase awareness and training to respond effectively to students with mental health and substance use disorders, to provide outreach to administer voluntary screenings and assessments to students, and to enhance networks with health care providers who treat mental health and substance use disorders. Incorporates consideration of the needs of veterans enrolled as students on campus.

• Reauthorizing grants to states, political subdivisions of states, Indian tribes, tribal organizations, and nonprofit private entities to train teachers, appropriate school personnel, emergency services personnel, and others, as appropriate, to recognize the signs and symptoms of mental illness, to become familiar with resources in the community for individuals with mental illnesses, and for the purpose of the safe de-escalation of crisis situations involving individuals with mental illness.

• Reauthorizing the National Child Traumatic Stress Initiative.

• Requiring a Government Accountability Office (GAO) report on the federal requirements affecting access to mental health and substance use disorder treatment related to integration with primary care, administrative and regulatory issues, quality measurement and accountability, and data sharing.

• Directing the Substance Abuse and Mental Health Services Administration to advance the education and awareness of providers, patients, and other stakeholders regarding FDA-approved products to treat opioid use disorders; calls for a report on such activities, including the role of adherence in the treatment of opioid use disorders, and recommendations on priorities and strategies to address co-occurring substance use disorders and mental illness.

• Requiring a GAO report on the utilization of mental health services for children, including information about how children access care and referrals; the tools and assessments available for children; and the usage of psychotropic medications.

• Encouraging the Secretary of HHS to disseminate information and provide technical assistance on evidence-based practices for mental health and substance use disorders in older adults.

• Requiring a GAO study on the status of implementation of recommendations developed after the Virginia Tech tragedy, as well as identification of any barriers to implementation and identification of additional actions the Federal government can take to support states and local communities to ensure the Federal government and laws are not obstacles at the community level.

We will continue to monitor and share updates on this bill as it makes its way through the legislative process.

Behavioral Health Legislation

Many pieces of legislation MHA is tracking continue to be on the move. In the last week, the following bills have passed out of committee or their respective chambers:

VOTED OUT OF COMMITTEE

HB 592
Relating to the definition of serious mental illness for purposes of certain group health benefit plans. 

HB 1947
Relating to the criteria for commitment of a person with mental illness.

HB 1952
Relating to professional development training for certain public school personnel regarding student disciplinary procedures.

HB 2392
Relating to the mental health program for veterans.

HB 2812
Relating to an annual report by the reentry and integration division and the parole division of the Texas Department of Criminal Justice.

SB 34
Relating to the administration of psychoactive medications to persons receiving services in certain facilities.

SB 861
Relating to requiring certain notices to be posted on the premises of certain alcoholic beverage retailers. 

SB 913
Relating to the reexamination of an applicant for a professional counselor license. 

SB 914
Relating to a behavior improvement plan adopted for certain students with an individualized education program.

SB 1356
Relating to requiring trauma-informed care training for certain staff of county and state juvenile facilities.

VOTED OUT OF CHAMBER

HB 232
Relating to allowing certain minors convicted of certain alcohol offenses to perform community service instead of attending an alcohol awareness program.

HB 807
Relating to the practice of psychology; authorizing a fee.

HB 1738
Relating to a standard form of notification for the detention of a person with mental illness.

SB 718
Relating to voluntary and involuntary mental health services.

SB 831
Relating to a list of mental health, substance abuse, and suicide prevention programs that may be selected for implementation by public schools.

SB 898
Relating to the mental health program for veterans.

SB 1057
Relating to information about private health care insurance coverage and the health insurance exchange for individuals applying for certain Department of State Health Services health or mental health benefits, services, and assistance.

SB 1114
Relating to the prosecution of certain misdemeanor offenses committed by children and to school district law enforcement.

SB 1178
Relating to training for public school educators in identifying mental health and suicide risks among students.

SB 1352
Relating to inclusion of mental health concerns in existing state and local coordinated school health efforts.

For a more in-depth view of behavioral health legislation and MHA’s position on these bills, check out our bill tracker here.

More next week!

More on the Budget and Bill Updates

In this post, get an update on the state budget, some federal mental health news, and more bills!

State Budget

Last Thursday, the Texas House had a marathon debate on CSSB 1. The $193.8 billion bill passed the House 135 to 12. House members adopted dozens of amendments, including the following mental-health related amendments:

Amendment 41 by Zerwas, which would require DSHS and other state agencies to review and revise contracts with LMHAs to ensure compliance with federal requirements and to coordinate with private hospitals to improve access to services and funding under the 1115 Waiver;

Amendment 44 by Naishtat, which would provide $5 million over the biennium for technical assistance and grants to school districts that implement best practice-based positive youth development, mental health promotion, and substance abuse prevention and intervention programs;

Amendment 48 by Menendez, which would designate $37 million of mental health funds to expand or improve community mental health services and ensure funding equity among LMHAs;

Amendment 49 by Menendez, which would designate $57.2 million of mental health funds to eliminating the children and adult waiting lists and allocate any unused funds to LMHAs that are below per capita funding levels;

Amendment 57 by Naishtat, which would require HHSC to hire one FTE to maintain an interagency consortium to oversee the Texas Integrated Funding Initiative; and

Amendment 66 by Naishtat, which would allocate $150,000 to HHSC to facilitate cross-agency services to improve service delivery to, and outcomes for, children and their families.

In addition, an amendment by Rep. Lon Burnam and Rep. John Zerwas that would have set the parameters for Medicaid expansion in Texas initially passed by a vote of 86 to 57. A few hours later, however, Rep. Geannie Morrison made a motion to reconsider the vote, which passed by a margin of 93 to 54. Rep. Burnam subsequently withdrew the amendment.

Of course, this doesn’t mean the end of expansion discussions. The Senate already included a similar rider in its version of the budget, and there is buzz around the Capitol that the House Appropriations Committee will be considering Rep. Zerwas’ “Texas solution” Medicaid expansion bill next week. So it aint over til it’s over…

Mental Health Moving Forward at the Federal Level

There are also some positive mental health developments going on at the federal level. President Obama is set to release his budget today, and reports indicate that he is asking for at least $235 million more for mental health services, including many of the projects he recommended in the aftermath of the Newtown tragedy. These include funding to train educators and other individuals on how to recognize the signs of mental illness, as well as funding to expand the mental health workforce.

Meanwhile, the Senate Health, Education, Labor, and Pensions Committee currently is marking up the Mental Health Awareness and Improvement Act, a bill to reauthorize and improve programs related to mental health and substance use
disorders. While the text of the legislation is not yet available online, it likely is a combination of already filed legislation, including some of the President’s mental health recommendations. It is being sponsored by Chairman Tom Harkin, and is co-sponsored by 5 Republicans, including Ranking Sen. Lamar Alexander, and 4 Democrats on the committee. I’ll share more on this next week as additional information becomes available.

Behavioral Health Legislation

Many pieces of mental health and substance abuse legislation have been on the move. The following bills have been voted out of committee or their respective chamber:

VOTED OUT OF COMMITTEE

HB 459
Relating to the creation of a navigator program as described by the Patient Protection and Affordable Care Act.

HB 517
Relating to the eligibility of inmates convicted of certain intoxication offenses for release on parole or mandatory supervision.

HB 1191
Relating to certain information about housing for persons with mental illness provided through the Texas Information and Referral Network Internet site.

HB 1561
Relating to access to a deceased person’s mental health information.

HB 1739
Relating to the administration of psychoactive medications to persons receiving services in certain facilities.

HB 2240
Relating to a study on homeless youth.

SB 11
Relating to the drug testing of certain persons seeking financial assistance benefits.

SB 263
Relating to the designation of certain synthetic cannabinoids as controlled substances and controlled substance analogues under the Texas Controlled Substances Act.

SB 264
Relating to the addition of a synthetic hallucinogenic substance to Penalty Group 2 of the Texas Controlled Substances Act.

SB 418
Relating to a notification requirement if a public school campus or open-enrollment charter school does not have a nurse assigned to the campus during all instructional hours.

SB 646
Relating to court-ordered outpatient mental health services.

SB 898
Relating to the mental health program for veterans.

VOTED OUT OF CHAMBER

HB 243
Relating to the authority of a community center that provides mental health or mental retardation services to sell certain real property of the center.

HB 808
Relating to the authority of a psychologist to delegate the provision of certain care to a person under the psychologist’s supervision, including a person training to become a psychologist.

HB 838
Relating to the monitoring of certain medications provided to foster children.

SB 1115
Relating to reporting, standards, restrictions, and requirements regarding public school disciplinary actions.

You can find out more about these bills using MHA’s bill tracker here.

Hasta next week!

The Budget, Parity and Bills

In this post, more about the budget, a little news on parity, and bill updates, including exciting news about school behavioral health legislation.

Budget Amendments

As I mentioned last week, the full House is scheduled to take up and consider CSSB 1, the budget bill, this Thursday. House members pre-filed a total of 267 budget amendments, which will make for a loooong day for members. Several behavioral-health related amendments have been pre-filed, including:

An amendment by Alonzo, which would require the collection of behavioral health outcomes data for indigent & Medicaid-eligible LGBT youth;

An amendment by Bohac, which would designate 5% of children’s mental health funding to mental health promotion, literacy and personal safety activities. This is a recommendation from the School Behavioral Health Initiative;

An amendment by Burnam to require expansion of Medicaid to all populations eligible under the Affordable Care Act;

An amendment by Sarah Davis to fund best practice-based school behavioral health programming; and

An amendment by Naishtat to fund an institution of higher education to provide technical assistance to communities across the state in implementing evidence-based and promising practices to serve children with Serious Emotional Disturbance.

All 267 amendments can be found here.

Getting Serious on Parity

As many of you know, the Paul Wellstone and Pete Dominici Mental Health Parity and Addiction Equity Act (MHPAEA) passed in 2008. However, to this date, the Obama Administration has not issued final rules for the law, which leaves in limbo some of the treatment and coverage requirements of the law. There has been speculation that some insurance companies have been skirting provisions of the law, and now, finally, the first class-action lawsuit citing MHPAEA violations has been filed. The lawsuit, which was filed in New York, accuses United-Health, UHC Insurance, United Healthcare of New York, and United Behavioral Health of violating the law by, among other things, limiting psychotherapy visits and denying long-term treatment. In the absence of final rules, there may be more lawsuits filed that seek to clarify these provisions.

If you are someone you know feels your insurance company is denying you needed mental health or substance abuse services in violation of MHPAE, please visit the national Mental Health America Parity Center to share your story. The Obama Administration needs to hurry up and issue those almost 5 year-late rules, or they may end up writing themselves through lawsuits!

Bill Updates

We’ve had some major movement on a number of mental health and substance abuse bills, but before I cover the full list, I want to hone in on specific school behavioral health legislation that passed Senate Education last week.

For those who recall, I mentioned in an earlier post that Sen. Dan Patrick, Chair of the Senate Education Committee, has previously expressed support for behavioral health initiatives and that I hoped we would see that reflected in the legislation that passes his committee. Well, last Thursday that hope came true!

The Senate Education Committee heard 3 pieces of school behavioral health legislation that MHA is supporting:

SB 831
Relating to a list of mental health, substance abuse, and suicide prevention programs that may be selected for implementation by public schools;

SB 1178
Relating to training for public school educators in identifying mental health and suicide risks among students; and

SB 1352
Relating to inclusion of mental health concerns in existing state and local coordinated school health efforts.

Particularly on SB 1178, the committee heard very moving testimony from a number of family members who have lost loved ones to suicide, including Linda de Sosa, a School Behavioral Health Initiative participant. After the testimony, two witnesses who initially were opposed to the bill withdrew their opposition.

All three bills sailed out of the committee unanimously, and the bills were referred to the Local and Uncontested Calendar. If they remain on that calendar, they will pass the Senate without debate.

Thanks to everyone who testified in favor of, or registered support for, these important bills.  We’ve got to start investing in prevention and early intervention if we are truly going to improve outcomes for children and adults down the line!

Other behavioral health legislation on the move include the following bills that have been voted out of committee:

HB 915
Relating to the administration and monitoring of certain medications provided to foster children.

HB 978
Relating to the transportation of certain patients to a mental health facility.

HB 1738
Relating to a standard form of notification for the detention of a person with mental illness.

SB 11
Relating to the administration and operation of the Temporary Assistance for Needy Families (TANF) program.

SB 1115
Relating to reporting, standards, and restrictions regarding public school disciplinary actions.

In addition, the following bills have been voted out of their respective chambers:

HB 144
Relating to a mental examination of a child subject to the juvenile justice system.

SB 36
Relating to the detention and transportation of a person with a mental illness.

SB 58
Relating to the integration of behavioral health and physical health services into the Medicaid managed care program.

SB 152
Relating to the protection and care of persons who are elderly or disabled or who are children.

SB 250
Relating to the requirements of using certain technology to conduct certain mental health hearings or proceedings.

SB 256
Relating to tracking career information for graduates of Texas medical schools and persons completing medical residency programs in Texas.

SB 401
Relating to a notification requirement if a school counselor is not assigned to a public school campus.

SB 462
Relating to specialty court programs in this state.

SB 715
Relating to use of consistent terminology to refer to school counselors in the Education Code.

SB 944
Relating to criminal history record checks for certain employees of facilities licensed by the Department of State Health Services.

SB 1185
Relating to the creation of a mental health jail diversion pilot program.

To see MHA’s full bill tracker for summaries and positions, click here.

That’s all I’ve got for now!  Toodles!