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!

A Little News Here and There

In this post, an update on the budget, a look at how Harris County squares up health-wise, and the status of a few bills.

On the Budget

Last Wednesday, the Texas Senate passed CSSB 1, the budget bill, on a vote of 29-2. The only “no” votes were newly elected Senator Sylvia Garcia and Senator Wendy Davis, largely due to the fact that the Senate version restored only $1.4 billion of the $5.4 billion cut from public schools last session. On Thursday, the House Appropriations Committee substituted the bill with its own version and voted it out unanimously.

There are not significant funding differences for mental health and substance abuse services between the two bills, but one issue of note is that the House version added $2.5 billion for public education–over $1 billion more than did the Senate.

The full House is scheduled to take up CSSB 1 next Thursday, April 4th. A great thing about the House (at least to an advocate like me) is that all 150 members have an equal opportunity to put their imprint on the budget by offering amendments on the Floor. Expect anywhere from 200-300 amendments to be filed by this Thursday’s deadline, including a couple recommended by MHA. 🙂

State of Health in Harris County

In the recently released 2013 County Health Rankings and Road Map, a joint project of the Robert Woods Johnson Foundation and University of Wisconsin Population Health Institute, Harris County ranked 70th among 232 counties. This is down from a rank of 53 last year. Williamson County was ranked first, and Polk County was ranked last. The rankings take a variety of health factors into consideration, including poor health and mental health days, excessive drinking, physical activity, and the rate of uninsured. For a complete look at the rankings, click here.

Bills on the Move

Many pieces of legislation that MHA is tracking are on the move.  You can view an update on them all by checking MHA’s bill chart.  Bills that recently have been voted out of committee include:

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

HB 591
Relating to the health professions resource center.

HB 1872
Relating to federal firearm reporting for a person who voluntarily identifies as a person with mental illness.

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

In particular, I want to call attention to HB 1872, which would require the Department of Public Safety (DPS) to include in the information it reports to the Federal Background Check System a person who voluntarily identifies himself or herself to DPS or local law enforcement as a person with mental illness who should be precluded from purchasing a gun.

MHA and several other advocacy organizations oppose this legislation because it unfairly and discriminatorily singles out people with mental illness.  While there may indeed be people with mental illness who would voluntarily place themselves on this list, there are likely just as many people without mental illness who would do the same.  In my view, this legislation unnecessarily stigmatizes an entire group of people. Thankfully, the good folks at MHA Texas are working on a floor amendment that would strike the reference to mental illness in the bill.  If it comes up for a vote on the Floor, look for an advocacy alert on that amendment, and please be sure to contact your representative and show them your support!

“A pen rather than a lance has been my weapon of offence and defence; with its point I should prick the civic conscience and bring into a neglected field men and women who should act as champions for those afflicted thousands least able to fight for themselves.”

–Clifford Beers: mental health consumer,Yale graduate, and founder of the National Committee for Mental Hygiene, predecessor of Mental Health America

Write ya next week!

All About the Budget…and a Little More

In this issue, get more detailed information on the mental health and substance abuse services funded by the House and Senate budget bills, information on how sequestration will affect behavioral health, and as always, a bill update.

Senate Budget On Its Way to the Floor

Last Wednesday, the Senate Finance Committee voted out its budget bill, CSSB 1, which includes over $200 million more for behavioral health services.  Since I’ve previously outlined the approved Senate mental health and substance abuse initiatives, I won’t repeat all of that information. However, there are a few budget riders–“footnotes” that designate funding for certain purposes–worth mentioning:

  • Requirement that DSHS withhold 10% of appropriated funds to each Local Mental Health Authority (LMHA) for ongoing community and crisis mental health services and distribute the funds based upon a performance-based incentive plan
  • Requirement that DSHS develop a 10-year plan for the provision of psychiatric services at state hospitals (with the inclusion of public input)
  • Designation of children’s mental health prevention and early intervention funds for  evidence-based curricula that train school personnel and community members about the signs and risks of mental health issues
  • $8 million of appropriated funds designated for the veterans mental health program
  • $8 million of appropriated crisis funds designated for outpatient competency restoration programs

House Makes Amends

As I mentioned in my last post, also on Wednesday, the House Appropriations Committee approved over $200 million more for mental health and substance abuse services as well. This was a reversal from earlier Article II Subcommittee decisions that amounted to just $33 million more for behavioral health. The House budget bill, which will be substituted in place of the Senate bill when it makes its way over to the House, funds the following services:

Mental Health

  • $54.2 million to eliminate the ~6,500 person waiting list for mental health services
  • $24.8 million to expand housing support options for people with mental illness
  • $32.5 million to expand the YES waiver
  • $25 million for Haven for Hope-like community parterships
  • $25 million to expand crisis services
  • $20 million to expand community mental health services for children and adults
  • $17 million to increase service package offerings for underserved children and adults
  • $6 million to expand NorthSTAR services
  • $4 million for veterans mental health
  • $2.4 million for 6 long-term treatment beds (up to 90 days) at the Harris County Psychiatric Center

Substance Abuse

  • $6 million to increase substance abuse provider rates by 3.9%
  • $5 million for substance abuse services for individuals referred by DFPS
  • $4.9 million to eliminate the 946-person substance abuse service waiting list
  • $1.1 million to expand the Oxford House model across Texas

Additionally, Representatives Sylvester Turner and Ruth Jones McClendon submitted a rider to the budget that would ensure that increased mental health funding would address inequities among LMHAs. If maintained in the final version of the bill, this would mean that Harris County MHMRA, which has one of the lowest per capita funding rates among the LMHAs, would receive a disproportionate amount of the additional monies. The House Appropriations Committee also adopted the performance-based incentive plan rider adopted by Senate Finance.

Regarding funding for behavioral health services, so far, so good! If you didn’t get a chance to respond to the MHA alert sent out yesterday, how about take a moment to call your favorite members of House Appropriations and Senate Finance to thank them for their good work?

Federal Behavioral Health Funding Cut

While the budget is looking good at the state level, things are shaky at the federal level. As a result of sequestration–the automatic federal budget cuts that are kicking in due to lack of Congressional action on deficit reduction–the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) is set to lose $168 million, or about 5%, of its total funding by September 30th of this year. This will include across-the-board cuts to all programs, including the mental health block grant (funded at a level of $460 million) and the substance abuse block grant (funded at a level of $1.8 billion). As a result, funding will be reduced accordingly at the state level.

According to DSHS, funding for substance abuse services will need to be reduced by $6.7 million and funding for mental health services by $1.7 million. DSHS has asked stakeholders to complete a survey to give input on how DSHS should implement these cuts.

Obviously, substance abuse programs will take a bigger hit, so it’s important to try and minimize the impact to the most important programs. For whatever my 2 cents is worth, I probably would recommend that funding for children’s substance abuse prevention, intervention and treatment services remain unharmed. If the adults take cuts, it may be better to target those to prevention and intervention, rather than treatment, since we still have a substance abuse treatment waiting list (at least in the current fiscal year). Again, that’s just what I think.  If the substance abuse community has any thoughts, please share!

That being said, please take a moment to complete this survey. It is due this Friday, March 22nd.

Behavioral Health Legislation

As you know, MHA is tracking over 200 mental health- and substance abuse-related bills. You can view them all here. Many of the bills have been progressing quickly through the process.The following legislation has been voted out of committee:

HB 908
Relating to the assessment of an elderly or disabled person’s psychological status for purposes of an emergency order authorizing protective services.

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

SB 58
Relating to integrating behavioral health and physical health services provided under the Medicaid program using managed care organizations.

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

SB 256
Relating to tracking career information for graduates of Texas medical schools.

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

In addition, the Senate already has voted a few bills out of its chamber, which are now awaiting action in the House. These include:

SB 50
Relating to the Children’s Policy Council, including the composition of the council.

SB 109
Relating to a housing plan developed and certain housing information collected and reported by the Texas Department of Housing and Community Affairs.

SB 126
Relating to the creation of a mental health and substance abuse public reporting system.

SB 426
Relating to a home visiting program for at-risk families.

Again, check out summaries of these bills, MHA’s positions, and more by viewing our bill tracker.

Catcha next week!

State and Local Updates: Part 2

Well, I don’t have any more local updates (at least that I can share…yet!), but I’ve got some more budget news and the much-awaited bill tracker!

Behavioral Health and the Budget

I’ve already laid out the Senate mental health and substance abuse budget recommendations for the Department of State Health Services (DSHS), but below you can find out about the House recommendations, as well as a few other behavioral health-related budget items of interest. These include:

House Appropriations Committee Mental Health Recommendations (DSHS)

  • $20 million to reduce (not eliminate) the statewide waiting list for adult mental health services
  • $2 million for beds to prevent the relinquishment of parental custody to DFPS

House Appropriations Committee Substance Abuse Recommendations (DSHS)

  • $4.9 million to eliminate the 948-person statewide waiting list for substance abuse services
  • $5 million for substance abuse services for individuals referred by DFPS
  • $1.1 million for expansion of the Oxford House model across Texas

Other House Appropriations Committee Behavioral Health-Related Recommendations

  • $39 million for restoration of most of the funding cuts to the Prevention and Early Intervention Service programs (Services to At-Risk Youth, Community Youth Development, Texas families, and other prevention programs)
  • $545,761 to restore funding for the statewide coordination of the Community Resource Coordinating Groups and a statewide data reporting tool
  • $6 million to expand the Texas Corrctional Office on Offenders with Medical and Mental Impairments (TCOOMMI) caseload of adults with serious mental illness
  • $15.2 million for the hiring of mental health professionals in each juvenile probation facility

Other Senate Finance Committee Behavioral Health-Related Recommendations

  • $10.4 million to partially restore funding cuts to Communities in Schools
  • $850,000 for behavioral health personnel to assist soldiers and airmen through the Family Support Services Group (Adjutant General’s Department)
  • $6 million to expand the TCOOMMI caseload of adults with serious mental illness
  • $15.2 million for the hiring of mental health professionals in each juvenile probation facility

While the House still needs to come a long way in increasing funding for mental health and substance abuse community services, it is good to know that these issues are still being addressed in other areas of the budget!

Bills, Bills Coming Out of My Ears!

Well, a few folks have been asking for the updated bill chart, and you can find it here in all of its glory! March 8th was the bill filing deadline, and almost 2,600 bills–or about 44% of total bills–were filed last week! That made for a long weekend and is at least partially responsible for the delay in getting this out for public consumption. But, I’m sure you’ll all forgive me!

MHA is now tracking over 200 bills and will update them weekly. Please note that we will only be tracking the major actions of bills, e.g. when they are voted out of committee and voted out of a chamber. We will not include when a bill is set for hearing or when it’s set to be heard on the floor.  However, on some legislation MHA is supporting, you will see Action Alerts when a bill is set for Floor debate. All of that being said, let’s check out some of the major mental health and substance abuse bills filed last week:

HB 2625 by Coleman, which expands the Priority Population served by LMHAs to include single episode or recurrent major depression, post-traumatic stress disorder, paranoid disorder, pervasive developmental disorder, obsessive compulsive disorder, panic disorder, dysthymia, attention deficit disorder, or tic disorder/tourette’s syndrome;

HB 2881 by Toth, which creates the Task Force to Reduce the Habitual Incidents of Driving While Intoxicated to study and make recommendations regarding best practices to reduce habitual incidents of driving while intoxicated, as well as fatalities related to driving while intoxicated;

HB 2887 by Davis, which requires DSHS to make Haven for Hope-like grants to local entities to coordinate services for homeless individuals, people with mental illness, and people with substance use disorders.

HB 3003 by Allen, which requires school districts to establish a program to help students transition back into school after being placed in a DAEP, JAEP, TJJD or juvenile probation facility, residential treatment center or public or private placement for 30 or more instructional days;

HB 3326 by Coleman, which requires a private group health plan, including those for small employers, to provide health insurance coverage for the diagnosis and treatment of mental disorders as defined by the DSM;

HB 3632 by Canales, which requires certain minors convicted of alcohol- or drug-related offenses to take an alcohol awareness program or a drug, alcohol, and substance abuse education program as a condition of community supervision;

HB 3635 by McClendon, which requires school districts to employ a licensed psychologist or licensed professional counselor on each campus in the school district and allows school districts to receive state aid in an amount necessary to carry out these requirements;

HB 3684 by Naishtat, which updates the current Texas Integrated Funding Initiative Consortium statute by giving the consortium responsibility to oversee a state system of care for minors receiving inpatient mental health services, or who are at risk of being placed in a more restrictive environment to receive mental health services;

HB 3692 by Branch, which changes the Primary Care Residency Program to the Graduate Medical Education Program and expands it to include psychiatry and surgery

SB 1114 by Whitmire, which allows a county, municipality or justice or municipal court to employ case managers to provide intervention services to youths at-risk of juvenile justice involvement; prohibits peace officers from issuing citations to students who commit offenses; establishes progressive sanctions for a student before a school district may file a complaint against the student in criminal court;

SB 1178 by Deuell, which requires that school districts train teachers, principals, counselors and all other appropriate school district personnel in how to recognize and appropriately respond to students exhibiting signs of mental illness or of being at risk of suicide

SB 1185 by Huffman, which Requires DSHS to establish and operate a mental health jail diversion pilot program in Harris County for between 500 and 600 individuals using the Critical Time Intervention model;

SB 1291 by Ellis, which makes the possession of a trace amount of a controlled substance a Class C Misdemeanor;

SB 1356 by Van de Putte, which requires juvenile probation officers, detention officers, and court-supervised community-based program staff to receive training in trauma-informed care; and

SB 1477 by Deuell, which requires HHSC to negotiate with the United States Secretary of Health and Human Services for flexibility in the Texas Medicaid program and in obtaining a block grant to cover the Medicaid expansion population under the ACA through premium assistance for the purchase of private health insurance coverage.

In addition, the following bills have been voted out of committee:

HB 144
HB 243
HB 424
HB 473
HB 617
HB 807
HB 808
HB 838
HB 908
SB 715

Remember, you can track all these bills, read their text and find out MHA’s position on them by using our trusty bill chart!

Until I post again…

State and Local Updates: Part 1

In Part 1 of this post, learn about state discussions on Medicaid, local goings on with the Felony Mental Health Court, and what happens When a Mind Changes.

Medicaid Matters

It is clear to any Capitol observer that Medicaid is on the forefront of the minds of Texas legislators, both Republicans and Democrats. To make sure it stays there, approximately 2,000 people gathered at the Capitol last Tuesday to show support for Medicaid expansion as laid out under the Affordable Care Act (ACA). For a summary of the rally, check out the post by Peter McGraw of the Hogg Foundation for Mental Health.

On Friday, the House Appropriations Committee heard testimony from experts and elected officials on Medicaid expansion. Health and Human Services Commissioner Kyle Janek made a presentation outlining what the expansion would look like in Texas.  Along with other provisions of the ACA, the Medicaid expansion would cut the current uninsured rate in half. In addition to the Legislative Budget Board’s earlier estimate that $50 million of state general revenue could draw down $4 billion of federal money in the next biennium, former chief revenue estimator Billy Hamilton stated that the expansion could free up an additional $1.2 billion of general revenue next biennium. Our very own Judge Ed Emmett also testified, sharing that Medicaid expansion has the potential to bring $975 million a year to Harris County. He reminded legislators that “poor people are going to continue to get sick and they’re going to continue to get care,” but the main issue is going to be who pays for it.  Currently, local taxpayers are largely footing that bill. He also urged them to recognize the immediate pay off of Medicaid expansion, while also cautioning “that it’s not just about dollars, it’s also about human potential.”  Well said, Judge!

Medicaid expansion holds significant potential for people with mental health and substance use disorders. The PCG Report estimated that 90% of current non-Medicaid eligible individuals receiving publicly funded mental health and substance abuse services would qualify if eligibility was expanded.

There’s no doubt that legislators will continue to weigh all options related to this matter, including a “Texas solution” that grants flexibility in the use of Medicaid dollars, potentially steering people into private health plans.  We’ll continue to monitor this throughout this session and beyond!

Felony Mental Health Court: A Year Later

Last week, the Harris County Felony Mental Health Court held a stakeholders meeting to give updates on the court since it started operating over a year ago.  Obviously, the court has seen a few major changes over the past few months, including two new judges.  Judges David Mendoza and Brock Thomas will run two dockets for individuals with mental illness and individuals with co-occurring mental health and substance use disorders, respectively.

Since its inception, the Court has received 159 referrals, with 64 current clients.  Over the past six years, these clients have cumulatively spent over 15,000 days in jail, incurring a cost of close to $900,000 in jail time alone. No doubt, the mental health court has the potential to help these folks maintain their treatment and break the cycle of incarceration.

Dr. Clete Snell of the University of Houston conducted a comprehensive review of the Court and had several recommendations for implementation, including:

  • Reviewing the original planning document for the court, which consisted of recommendations from criminal justice and mental health stakeholders. MHA played an integral role in the planning of the mental health court and hopes that some early recommendations, such as accepting certain violent offenders, will be considered;
  • Establishing a committee to identify additional funding for intensive treatment services. The lack of community mental health services has hampered the Court’s ability to provide alternatives to incarceration;
  • Implementing specific phases to mark participants’ progress. The report notes that phases can serve as a “powerful motivator” for participants; and
  • Individualizing sanctions for court infractions, while using jail as a penalty as a last resort.

Over all, the Court’s first year of operation was considered a great success.  The mental health community should continue to support the court and advocate for expansion opportunities whenever and wherever they arise.

When a Mind Changes

I am so very proud of a new MHA publication, “When a Mind Changes: Personal Stories About Mental Illness and Its Effect on Individuals, Families and Communities.” This booklet, which includes forewords by Harris County Judge Ed Emmett and Houston Mayor Annise Parker, tells real stories about real people in the Greater Houston area.

The stories of mental illness are as varied as we are. Take Elizabeth McIngvale, a young girl ravaged by a severe case of Obsessive Compulsive Disorder before she even turned 13. Or Dr. James McSwain, Principal of Lamar High School, who actually allowed his son to remain in the Harris County Jail so he could receive needed mental health treatment. Or Brenda Bouie, who lived in Hermann Park for 17 years, largely due to her battle with Schizophrenia.  Their words are powerful; their courage is inestimable. You’ll recognize fears, hopes, and dreams that you or someone you know may be dealing with right now.

I encourage you to get to know the people and the issues in this booklet. We hope it will promote a better understanding of mental illness and the need for services among the general public and, in particular, our elected officials.

If you would like hard copies of this booklet, please contact Traci Patterson at tpatterson@mhahouston.org.

That’s all for today. Stay tuned for more budget updates and bills tomorrow!

Even Bigger Budget News, a Local Jail Update, and More Bills

In this post, learn about preliminary Senate Finance Article II Workgroup decisions on mental health and substance abuse funding, news about privatization plans for the Harris County Jail, and more behavioral health legislation.

Andreas Loves the Article II Workgroup

Budget proceedings as they relate to mental health and substance abuse just keep getting better and better, at least in the Senate. Last week the Article II Workgroup met to determine preliminary funding levels for health and human services. There are three different decisions the workgroup can make:

PRIORITY 1–items that the workgroup gives its highest priority and recommendation for funding
PRIORITY 2–important items the workgroup would like to fund, if funding is available
PENDED–items on which the workgroup took no action (this does not mean action will not be taken at a later date)

The workgroup’s decisions related to the current Department of State Health Services mental health and substance abuse Exceptional Items are as follows (and thanks to a Senate staffer and Lee Johnson with the Texas Council for filling in details!):

DSHS Exceptional Item # 6–$80 million to eliminate statewide waiting lists
a. Children with Special Health Care Needs (802 additional clients served per year) $23,600,000 PRIORITY 2
b. MH Adults (6,242 additional clients served per year) $54,100,000 PRIORITY 1
c. MH Children (286 additional clients served per year) $3,100,000 PRIORITY 1

DSHS Exceptional Item #7–$33,550,084 to improve substance abuse services
a. Capacity Expansion (948 additional clients served per year) $4,941,828 PENDED
b. Substance Abuse Provider Rate (12% increase) $18,471,549 PRIORITY 1
c. Set aside slots for people referred by DFPS (6,000 over the biennium) $10,136,707 PRIORITY 1

DSHS Exceptional Item #8–$28,037,202 for supportive housing services for people with mental illness and substance use disorders
a. Oxford House (supportive housing for people in substance abuse recovery) $ 1,140,000 PRIORITY 1
b. Relinquishment Slots for DFPS (10 beds per year) $ 2,056,262 PRIORITY 1
c. Rental Assistance (people with mental illness who are homeless or at-risk for homelessness and new Medicaid 1915i state plan option)–$24,840,940 PRIORITY 1

In addition, the $115.5 million plan that DSHS unveiled last week also was made a Priority 1 item. So all in all, the Article II Workgroup prioritized almost $30 million for substance abuse related services, and about $200 million for mental health services!

The total Article II Workgroup Priority 1 ask was $2.5 billion, the lion’s share of which was related to Medicaid. Senate Committee Finance Chairman Tommy Williams asked the workgroup to pare down its ask to $1.7 billion, but specifically asked Workgroup Chairwoman Jane Nelson to do everything possible to protect the $200 million identified for mental health! I am hoping the Workgroup also will preserve the current substance abuse Priority 1 items, as well as add the $5 million substance abuse capacity expansion item to that list. 

The full Finance Committee is expected to meet this Friday to consider the Workgroup’s final health and human services recommendations, so stay tuned for more on this!

County Poised to Say “No” to Privatization

This morning, Harris County Commissioners Court will meet to approve a number of different projects recommended by the Purchasing Office. Privatization of the Harris County Jail will not be among them.

In April 2011, Commissioners Court voted to accept bids to privatize the jail. This caused concern among a number of advocates, including this blogger, particularly due to the potential disruption of health and mental health services to inmates. On any given day, the Harris County Jail houses almost as many people with mental illness as the entire state hospital system, so privatizing these services would have affected more people with mental illness than the recently scrapped proposal to privatize a state hospital.

According to the Houston Chronicle, out of the four bids that were submitted, the bid from the Corrections Corporation of America (CCA) was the only proposal that was seriously considered. While CCA estimated cost savings of between $8 and $11 million, there was uncertainty about whether the savings actually would be realized.  Additional concerns included the impact of privatization on security, re-entry programs and inmate treatment.

So, we can put the nail in the coffin on this one for now. Kudos to the County for making what appears to be the right decision, particularly for the 2,100 or so inmates with mental illness who are housed in the jail each day!

Behavioral Health Legislation

OK, so back to the Legislature.  As of yesterday, over 2,700 bills have been filed by House and Senate members. The filing deadline is next Friday, March 8th, and if previous sessions are any guide, we’ll probably see another two or three thousand bills filed between now and then! I’ll save my “sigh” for when I’m sifting through a thousand bills next weekend. Anyhoo, mental health and substance abuse bills of interest include:

HB 1541 by Turner, which requires the Texas Department of Criminal Justice, along with the Texas Juvenile Justice Department and Department of Public Safety, to conduct a comparative study on the supervision, incarceration and treatment practices of TDCJ and TJJD on recidivism and rehabilitation rates of young offenders;

HB 1698 by Farrar, which adds school social workers to the Education Code and details their responsibilities, including assessment and counseling of students and their families, providing crisis prevention and intervention services, and coordinating community resources to meet the needs of students and their families; and

HB 1745 by Naishtat, which requires hospitals and emergency rooms to report to the Department of State Health Services regarding suicide attempts

For a more in-depth look at mental health and substance abuse legislation and to see MHA Houston’s position on these bills, click here.

Hasta next week!

Big Budget News, School Behavioral Health and Bills

In this post, learn about the Department of State Health Services’ big budget recommendation for mental health, information about school behavioral health initiatives, and an updated list of behavioral health legislation.

Biggest Possible Mental Health Increase…EVER?

Yesterday, DSHS Commissioner David Lakey unveiled a comprehensive mental health services plan to the Senate Finance Article II Workgroup. According to my friend and colleague Danette Castle of the Texas Council of Community Centers, the $115.5 million plan includes the following components:

    • Public Awareness Campaign:  $4 million
      To address stigma and increase public awareness of mental health, mental illness & how to access help.
    • Prevention & Early Identification:  $2 million
      To increase availability of school-based training for teachers and other school staff (through 20 Educational Service Centers)
    • Crisis Services:  $30 million
      Includes 15 grants (would require 25% local match) for crisis stabilization and other crisis services to divert hospitalization.
    • Mental Health Treatment:  $52.5 million
      To address increased demand as a result of public awareness campaign and increased crisis services.  $20 million of this amount for mental health adults & children services, $32.5 million to expand YES Waiver services.
    • Collaborative Projects:  $10 million
      Provide grants to leverage public and private resources to address mental illness, substance use disorders and contributing factors.  5 grants at $2 million each – Haven for Hope in San Antonio used as example.
    • Funds for Underserved:  $17 million
      To address people receiving fewer services than they need in lieu of creating waiting list.

I should note that these funds are ABOVE and BEYOND what DSHS already has outlined in its $100 million plus mental health and substance abuse Exceptional Items requests (more on these below). 

Needless to say, this plan is HUGE for advocates!  I’ve been around for less than 40 years, but I think it’s safe to say that the passage of this plan would represent the single largest increase for mental health EVER. It’s going to take a full court press to pass this, but I know advocates are up to the challenge!

And don’t fret, my substance abuse friends–the Senate Article II Workgroup already has declared the substance abuse exceptional item a priority! 🙂

Looks like It’s shaping up to be a pretty good legislative session for behavioral health!

House Appropriations Article II Subcommittee

Although it’s tough to beat that first bit of news, the House Appropriations Article II Subcommittee also met last Wednesday to take testimony on funding for the Department of Health Services. I was there to deliver testimony, along with fellow Houston consumers and advocates from St. Joseph’s House. Thanks so much for making the trek, gang!

Mental health and substance use disorders were a significant focus of the hearing. Commissioner Lakey laid out Exceptional Item 6 ($57.2 million–eliminating the statewide mental health service waiting list), Exceptional Item 7 ($33.6 million–eliminating the statewide substance abuse waiting list and increasing provider reimbursement), and Exceptional Item 8 ($23.2 million–increasing housing and support options for people with mental health and substance use disorders). He noted that substance use disorders are among the largest cost drivers in the criminal justice and child welfare systems and also discussed the successful outcomes of the Oxford House model. When pressed by Subcommittee Chairman John Zerwas about whether there was a need for a significant increase in funding for mental health services due to the large number of 1115 waiver projects that address mental health, Commissioner Lakey was adamant that the 6,000+ people waiting for mental health services across the state need services now, not later. Amen to that!

A Plan for Improving School Behavioral Health

MHA’s School Behavioral Health Initiative, which convened school district personnel, behavioral health providers, child-serving and education-related agencies, and parents, recently issued its full report containing recommendations to improve the prevention, identification and treatment of behavioral health issues among students. The report includes 37 recommendations aimed at the Texas Legislature, state agencies, Commissioners Court, school districts and community agencies.  MHA already has been working at the state legislative level to promote legislation that furthers the implementation of these recommendations.  Among them are SB 460 by Deuell, which would require mental health training in educator preparation programs.  I will keep you abreast of additional legislation and budget riders that are filed!

Federal School Behavioral Health Legislation

On a related note, U.S. Senator Al Franken and U.S. Representative Grace Napolitano have filed S. 195 and H.R. 628, the Mental Health in Schools Act. The Mental Health in Schools Act would provide grants to partnerships between school districts and community organizations to implement programs that promote behavioral health, reduce the likelihood of students developing mental health and substance use disorders, and provide early identification of mental health and substance use disorders.  It also calls for the appropriate training of school personnel, as well as parents and other family members.

Please urge Senators John Cornyn and Ted Cruz, as well as your U.S. Representative, to support this legislation. You can do so easily by clicking here!

Behavioral Health Legislation

While almost 2,200 bills have been filed, MHA is now tracking over 100 mental health and substance abuse related bills! Gotta be honest–I’m really hoping we don’t reach 200! Mental health and substance abuse bills of interest include:

HB 1191 by Burkett, which requires the Texas Department of Housing and Community Affairs to make information about public and private housing options for people with mental illness available through the Texas Information and Referral Network website;

HB 1266 by Guillen, which establishes the 18-member Adult and Juvenile Administrative Segregation Task Force to review and make recommendations regarding administrative segregation and seclusion policies in Texas juvenile and adult correctional facilities;

HB 1396 by Susan King, which requires the Department of Family and Protective Services to annually report information regarding the number of children who are born addicted to alcohol or controlled substances; and (just for fun)

SB 612 by Lucio, which requires that candidates for elected office submit to a drug screen. 🙂

For a more complete list of filed behavioral health legislation and to see MHA Houston’s position on these bills, click here.

As always, stay tuned for more up-to-date mental health and substance abuse legislative news!

Another Week in the Lege

In this post, more information about upcoming budget hearings and the House Supplemental Appropriations bill, Mental Health Day at the Capitol, as well as plenty of new mental health and substance abuse legislation.

Budget Business

Yesterday the House Appropriations Committee voted out a $4.8 billion Supplemental Appropriations bill to cover the budget shortfall in the current biennium, largely due to the unpaid Medicaid tab left from last session. Somewhat surprisingly–at least to Chairman Jim Pitts–the bill was voted out of committee 25-0.

As previously mentioned, the House Appropriations Article II Subcommittee will be hearing public testimony regarding the Department of State Health Services, which oversees funding for public mental health and substance abuse services, tomorrow, February 13th. The hearing will be held at 7:30 am in Room 120 of the John H. Reagan Building, located at 105 West 15th Street in Austin, TX. Yea to leaving home at 4:30 am! Sigh. Good thing I already have my testimony drafted, which you can access here.

The Senate Article II workgroup, chaired by Sen. Jane Nelson, with Senate Members Bob Deuell, Joan Huffman, Dan Patrick and Judith Zaffirini, will be meeting the following day to begin making its funding recommendations for health and human services items.

Mental Health Day at the Capitol

Mental Health Day at the Capitol will be held on February 28th! A bus will leave Houston at 6:00 am from the NAMI of Greater Houston office. If you want to reserve your seat, you can do so by contacting Natalie Cloyd at ncloyd@namimetrohouston.org or 713-970-4419.

Whether you are driving or riding the bus, the day requires a $10 registration fee, which includes the cost of lunch. You will need to complete a registration form and return it, along with your $10 fee, to the Texas Federation of Psychiatry. Please note that MHA will be covering the registration cost for all participating MHA Members, as well as for consumers. 

If you have any questions, contact me directly at ausanga@mhahouston.org. Hope that many of you will participate in this exciting day!

Behavioral Health Legislation

We’re now passed the 2,000 filed bill mark–woo hoo!  There were a number of mental health and substance abuse bills filed in the past week, including:

HB 933 by Sylvester Turner, which allows the expunction of a juvenile record after the juvenile’s 17th birthday if the juvenile completed a deferred prosecution program and had no other referrals resulting in adjudication or deferred adjudication. This will be of benefit to youths participating in the Harris County District Attorney Office’s Juvenile Non-Petition Deferred Prosecution Program;

HB 1023 by Burkett, which creates a task force to investigate the mental health workforce shortage in the state and to make recommendations to alleviate the identified shortages;

HB 1070 by Allen, which allows the expunction of arrest records for offenses related to the possession of alcohol or controlled substances under certain circumstances; and

SB 460 by Deuell, which requires that, in educator preparation programs, teachers receive training in the detection and education of students with mental or emotional issues. This bill is the result of a recommendation from MHA’s School Behavioral Health Initiative.

For a more in-depth look at filed behavioral health legislation and to see MHA’s position on these bills, click here.

Hero? Moi?

Finally, I surprisingly was named Children at-Risk’s February Hero of the Month.  It is an honor to receive this recognition, particularly from an organization that has done so much to advance the cause of children both locally and across the state!

That’s all I’ve got for now.  Until next time…