December 30, 2013
By Kris Carlson and Matthew Caspari*
On December 12, Representative Tim Murphy (R-PA) introduced the "Helping Families in Mental Health Crisis Act of 2013." The 135-page bill is the result of the year-long investigation by the House Energy and Commerce Oversight subcommittee of the nation's mental health system following the Newtown, CT, tragedy.
Within its 11 Titles, the bill covers a wide range of topics. The following is a brief summary of some of the proposed changes with legal significance.
Title I would create an Assistant Secretary for Mental Health and Substance Use Disorders with authority over the Substance Abuse and Mental Health Services Administration (SAMHSA) to oversee and coordinate programs. Title 1 would also authorize grants to encourage states to adopt "assisted outpatient treatment programs," increase primary care physician training in behavioral health and substance abuse screenings, and increase use of telehealth technology.
Title II would establish grants to ten states for five-year demonstration programs to improve the provision of behavioral health services provided by federally qualified community behavioral health clinics in the state. As a condition of the grant, the states would be required to follow a prospective payment system for community behavioral health clinics.
Title III would amend the Health Insurance Portability and Accountability Act (HIPAA) to require a covered entity to treat an immediate family member or caregiver as a personal representative under 45 CFR 164.502(g), thus permitting disclosure without a signed release, if the disclosure is necessary to protect the health, safety, or welfare of the individual with mental illness or another individual. Title III makes similar changes to the Family Educational Rights and Privacy Act.
Title IV would establish U.S. Department of Justice-related grants that support training in existing community-oriented policing and fire/emergency response programs that improves the recognition and emergency response to behavioral emergencies in the community by first responders. Title IV would also make multiple amendments to Omnibus Crime Control and Safe Streets Act of 1968 by providing grants to states to encourage the creation of Veteran's Treatment Courts.
Title V would permit federal government reimbursement under Medicaid for same-day qualifying services and for acute psychiatric services provided in an "institution for mental disease" for individuals 21 years of age or older and under 65 years of age as long as the hospital or unit where treated has an average facility-wide length of stay (annually) of less than 30 days.
Title VI would establish funding in the amount of $40 million for each of the fiscal years 2015 through 2019 for the purpose of research into determinants of violence related to mental illness, and to support brain research through the Brain Research through Advancing Innovative Neurotechnologies Initiative.
Title VII would reform the administration of block grants by requiring states to report to the National Mental Health Policy Laboratory data on state mental health services relating to mortality, emergency room visits, and medication adherence. As a condition of the grant, the states would be required to have law which allows the state courts to order an individual to undergo mental health treatment.
Title VII would create a national awareness campaign directed at secondary and postsecondary students designed to reduce the stigma associated with serious mental illness; educate the students about assisting an individual that demonstrates signs of serious mental illness; and educate the students about the importance of seeking treatment from a licensed mental health caregiver.
Title IX would extend eligibility for Medicare and Medicaid health information technology assistance to clinical psychologists and psychiatric hospitals (both public and private).
Title X would seek to extend liability protections to volunteers that assist at accredited federal and community mental health centers. Volunteers would be deemed employees of the Public Health Service. Professional Volunteer status would be obtained by application from a sponsoring health care professional.
Title XI would establish a Center for Mental Health Services and directs the Assistant Secretary for Mental Health and Substance Use Disorders to award a grant for the operation and maintenance of a suicide prevention resource center. Collection of behavioral health statistics would be transferred from the Center for Behavioral Health Statistics and Quality to the National Mental Health Policy Laboratory. Additionally, SAMHSA is prohibited from awarding any grants to a program that does not utilize evidence-based practices. There will be no new SAMHSA programs without explicit statutory authorization, and any existing program without such explicit authorization will be terminated.
The Behavioral Health Task Force will be closely monitoring this legislation as it moves through Congress and will be making appropriate reports to its membership.
*We would like to Military/Veterans Work Group Co-Chairs thank Kris Carlson (Polsinelli PC, Phoenix, AZ), and Matthew Caspari (DC Department of Behavioral Health, Washington, DC), for providing this email alert.
The Behavioral Health Task Force is supported by the following work groups: Military/Veterans; Payers; Providers/Clinicians; Risk Management; Rural; and State/Government.