House Energy & Commerce Committee Issues Report on Helping Families In Mental Health Crisis Act
Excerpts of the report follow:
Purpose and Summary
H.R. 2646, the "Helping Families in Mental Health Crisis Act of 2016," was introduced on
Background and Need for Legislation
Hearings
The Subcommittee on Health held a hearing on H.R. 2646 on
Representative (RI), Founder,
Committee Consideration
On
Committee Votes
Clause 3(b) of rule XIII of the Rules of the
Committee Oversight Findings
Pursuant to clause 3(c)(1) of rule XIII of the Rules of the
Statement of General Performance Goals and Objectives
The legislation aims to improve and increase access to evidence based treatment and services for individuals with mentally illness and SMI and provide greater oversight of the Federal mental health system, specifically focusing on the
In compliance with clause 3(c)(2) of rule XIII of the Rules of the
Earmark, Limited Tax Benefits, and Limited Tariff Benefits
In compliance with clause 9(e), 9(f), and 9(g) of rule XXI of the Rules of the
Committee Cost Estimate
The Committee adopts as its own the cost estimate prepared by the Director of the
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
U.S.
Re Helping Families in Mental Health Crisis Act of 2015
Hon.
Chairman,
Dear Mr. Chairman: The
CBO estimates that enacting H.R. 2646 would reduce net direct spending in the
Implementing the legislation also would affect spending subject to appropriation mostly because it would reauthorize and make changes to several grant programs administered by the
CBO estimates that enacting the legislation would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2027.
PROVIDING SERVICES TO CHILDREN IN INSTITUTIONS OF MENTAL DISEASE
Section 206 of the bill would allow federal reimbursement for certain medical services (such as screening, diagnostic, and treatment services) for children and young adults receiving inpatient care in institutions of mental disease (IMDs), beginning in 2019. Under current law, federal reimbursement is limited to inpatient psychiatric services for these individuals. Based on an analysis of administrative data from the
ELECTRONIC VISIT VERIFICATION SYSTEMS
Section 207 of the bill would require state
Based on information from states and other stakeholders, CBO estimates that EVV programs would reduce spending for personal care services and home health services by less than 1 percent, on average, over the 2017-2026 period. Because of the flexibility that H.R. 2646 would provide to states to establish such programs, CBO expects that some states would generate significantly higher savings than the average and others would generate little to no savings. CBO does not expect that any states would have their federal payments reduced as a result of the provision.
Under current law, about two thirds of spending for personal care services and less than a third of spending for home health services are estimated to be subject to EVV over the next ten years because of programs initiated voluntarily by some states. After adjusting for EVV programs that will be in place under current law, CBO estimates that enacting section 207 would reduce direct spending by
OTHER PROVISIONS
Section 201 of H.R. 2646 would allow states to continue to provide separate
LONG-TERM BUDGETARY EFFECTS
CBO estimates that enacting the legislation would not increase net direct spending or on-budget deficits in any of the four consecutive 10-year periods beginning in 2027.
INTERGOVERNMENTAL AND PRIVATE-SECTOR MANDATES
H.R. 2646 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act. CBO estimates that provisions in the bill that would decrease federal spending in
Sincerely,
Director.
Enclosure.
CBO ESTIMATE OF THE DIRECT SPENDING EFFECTS FOR H.R. 2646, THE HELPING FAMILIES IN MENTAL HEALTH CRISIS ACT OF 2016, AS ORDERED REPORTED BY THE COMMITTEE ON ENERGY AND COMMERCE ON
To view the table, click this link: https://www.congress.gov/congressional-report/114th-congress/house-report/667/1.
Source:
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal mandates prepared by the Director of the
Duplication of Federal Programs
No provision of H.R. 2646 establishes or reauthorizes a program of the Federal Government known to be duplicative of another Federal program, a program that was included in any report from the
Disclosure of Directed Rule Makings
The Committee estimates that enacting H.R. 2646 specifically directs to be completed 1 rule making within the meaning of 5 U.S.C. 551.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b) of the Federal Advisory Committee Act were created by this legislation.
Applicability to Legislative Branch
The Committee finds that the legislation does not relate to the terms and conditions of employment or access to public services or accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act.
Section-by-Section Analysis of the Legislation
TITLE I--ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE USE
Section 101. Assistant Secretary for Mental Health and Substance Use
This section would create an Assistant Secretary for Mental Health and Substance Use (ASMHSU). The Assistant Secretary would replace the Administrator of SAMSHA. The Assistant Secretary would be appointed by the President and confirmed by the
Section 102. Improving Oversight of Mental Health and Substance Use Programs
This section directs the Assistant Secretary for Planning and Evaluation (ASPE) to improve oversight of mental health and substance use programs. The ASPE will collect and organize relevant data, evaluate programs across Federal departments and agencies, and consult with other relevant agencies. The ASPE shall make recommendations on the evaluation of relevant programs across the department.
Section 103.
This section creates
Section 104. Peer Support Specialists Programs
This section directs the Comptroller General of
Section 105. Prohibition against Using Federal Funds by Systems Accepting Federal Funds to Protect and Advocate the Rights of Individuals with Mental Illness
This section reiterates current appropriations law and restates the prohibition on Protection and Advocacy organizations against using Federal funds for lobbying.
Section 106. Increased Reporting for Protection and Advocacy Organizations
This section leverages existing reporting that the state- based Protection and Advocacy organizations currently submit to SAMSHA. This section requires Protection and Advocacy organizations to make their yearly Program Performance Request publicly available. In releasing these reports, Protection and Advocacy organizations should ensure the protection of personally identifiable information from public disclosure. This section also requires Protection and Advocacy organizations to provide a more detailed and disaggregated accounting for how each system spends funds and what the source of those funds are. The Committee intends this to build upon the existing data and reporting requirements of current law and not require new data collection or additional reporting.
Section 107. Grievance Procedures
This section directs the Secretary of HHS to establish a grievance procedure within SAMSHA for the state based Protection and Advocacy organizations. The Committee believes that the use of this grievance procedure should come after the exhaustion of the internal grievance procedure established by existing law. The Committee intends the Secretary to ensure compliance with the requirements of the Protection and Advocacy for Individuals with Mental Illness (PAIMI) Act through this grievance procedure.
Section 108.
This section authorizes the already existing
Section 109. Strategic Plan
This section directs the ASMHSU to develop and carry out a strategic plan that is to be updated every five years. The plan should among other initiatives include and help identify strategic priorities, goals and measurable objectives for SAMSHA activities, identify ways to improve services for individuals with SMI and serious emotional disturbance (SED), and ensure programs provide access to evidence based care.
Section 11. Authorities of
This section ensures that the
Section 111. Advisory Councils
This section adds the Director of the
Section 112. Peer Review
This section requires not less than half of all members of peer review groups related to mental health treatment at SAMSHA to be licensed and experienced professionals with relevant medical, doctoral or advanced degrees in the prevention, diagnosis, or treatment of, or recovery from mental and substance use disorders.
TITLE II--MEDICAID AND MENTAL HEALTH COVERAGE
Section 201. Rule of Construction Related to Medicaid Coverage of
This section clarifies that nothing in the
Section 202. Optional Limited Coverage of Inpatient Services Furnished in Institutions for Mental Diseases
This section codifies the provision in the recently- finalized
Section 203. Study and Report Related to Medicaid Managed Care Regulation
This section directs the Secretary acting through the Administrator of the
Section 204. Guidance on Opportunities for Innovation
This section directs the Administrator of the
Section 205. Study and Report on
This section directs the Secretary, acting through the Administrator of the
Section 206. Providing Full-Range of EPSDT Services to Children in
While
Section 207. Electronic Visit Verification System Required for Personal Care Services and Home Health Care Services Under Medicaid
TITLE III--INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS COORDINATING COMMITTEE
Section 301. Interdepartmental Serious Mental Illness Coordinating Committee
This section establishes a committee known as the Interdepartmental Serious Mental Illness Coordinating Committee (SMICC). The committee shall report on a summary of advances in serious mental illness SMI and serious emotional disturbance (SED) research, evaluate Federal programs related to SMI and SED, a plan to improve outcomes for those with SMI and SED, and specific recommendations on action relevant agencies can take. The SMICC shall terminate six years after the date it is established.
TITLE IV--COMPASSIONATE COMMUNICATION ON HIPAA
Section 401. Sense of
This section states that it is the Sense of
Section 402. Confidentiality of Records
This section directs the Secretary to convene stakeholders one year after the regulations updating part 2 of title 42, Code of Federal Regulations are finalized. Stakeholders will determine the effect of the regulation on patient care, health outcomes, and patient privacy.
Section 403. Clarification of Circumstances Under Which Disclosure of Protected Health Information is Permitted
This section directs the Secretary to promulgate rulemaking to clarify circumstances under which disclosure of protected health information is permitted for a patient with mental illness. The Secretary already has the authority to undertake a rule making here, so this does not represent any sort of expansion of Secretary's authority.
Section 404. Development and Dissemination of Model Training Programs
This section would require the Secretary to develop and disseminate model program and materials for training health care providers, lawyers, patients and their families regarding the circumstances under which patient with mental illness' protected health information can be disclosed without patient consent.
TITLE V--INCREASING ACCESS TO TREATMENT FOR SERIOUS MENTAL ILLNESS
Section 501.
This section directs the ASMHSU to award grants to establish assertive community treatment programs for individuals with SMI. This section has an authorization of
Section 502. Strengthening Community Crisis Response Systems
This section directs the Secretary of
Section 503. Increased and Extended Funding for Assisted Outpatient Grant Program Individuals with Serious Mental Illness
This section extends the authorization of the existing assisted outpatient treatment grant program to 2020. The authorization would be increased to
Section 504. Liability for
This section extends liability protections for health professional volunteers at community health centers. This section has no authorization of appropriations.
TITLE VI--SUPPORTING INNOVATIVE AND EVIDENCE-BASED PROGRAMS
SUBTITLE A--ENCOURAGING THE ADVANCEMENT, INCORPORATION AND DEVELOPMENT OF EVIDENCE-BASED PRACTICES
Section 601. Encouraging Innovation and Evidence Based Programs
This section promotes innovation in awarding grants in the mental health space with a focus on advancing evidence-based models. The grants will go towards evaluating models that show promise, integrating care, and expanding and scaling up successful programs.
Section 602. Promoting Access to Information on Evidence-Based Programs and Practices
This section directs the Assistant Secretary to improve access to reliable and valid information on evidence-based programs and practices through the
Section 603. Sense of
This sense of
SUBTITLE B--SUPPORTING THE STATE RESPONSE TO MENTAL HEALTH NEEDS
Section 611. Community Mental Health Services
This section directs states receiving the mental health block grant to submit a plan to SAMSHA on a variety of measures and activities. States will outline their goals and objectives for the period of the plan and identify targets and milestones to be met.
Additional provisions include empowering SAMSHA to hold states that are found materially incompliant on their maintenance of effort within their block grant program accountable.
SUBTITLE C--STRENGTHENING MENTAL HEALTH CARE FOR CHILDREN AND ADOLESCENTS
Section 621. Telehealth Child Psychiatry Access Grants
This section awards grants to support the development of statewide child psychiatry access programs and the improvement of already existing statewide programs. This section has an authorization of
Section 622. Infant and Early Childhood Mental Health Promotion, Intervention and Treatment
This section provides grants to programs for infants and children at significant risk of developing, exhibiting early signs of, or having been diagnosed with mental disorders including SED. This section has an authorization of
Section 623. National Child Traumatic Stress Network
This section reauthorizes the National Child Traumatic Stress Network at its last appropriated level of
TITLE VII--GRANT PROGRAMS AND PROGRAM REAUTHORIZATIONS
SUBTITLE A--GARRETT LEE SMITH MEMORIAL ACT REAUTHORIZATION
Section 701, 702, and 703.
This section reauthorizes the
SUBTITLE B--OTHER PROVISIONS
Section 711. National Suicide Prevention Lifeline Program
This section authorizes the National Suicide Prevention Lifeline at its last appropriated level of
Section 712. Workforce Development Studies and Reports
This section directs the ASMHSU to report on national and state level workforce projections, the workforce capacity and other relevant information.
Section 713. Minority Fellowship Program
This section authorizes the Minority Fellowship Program at
Section 714. Center and Program Repeals
The repeals in this section are for programs that have expired authorizations and have never been appropriated.
Section 715. National Violent Death Reporting System
This section encourages the
Section 716. Sense of
This Sense of
Section 717. Peer Professional Workforce Development Grant Program
This section authorizes the Secretary to award grants to develop and sustain behavioral health paraprofessional training and education programs at
Section 718.
This section clarifies that child and adolescent psychiatrists can participate in the
Section 719. Adult Suicide Prevention
This section authorizes grants for adult suicide prevention at
Section 720. Crisis Intervention Grants for Police and First Responders
This section authorizes crisis intervention training grants for police officers and first responders at
Section 721. Demonstration Grant Program to Train Health Service Psychologists in
This section authorizes a grant program to increase the psychologist work force at
Section 722. Investment in Tomorrow's Pediatric Health Care Workforce
This section reauthorizes Section 774(f) of the Public Health Service Act which provides for a pediatric specialty loan repayment program. The authorization is for
Section 723. Cut-Go Compliance
This section brings this bill into cut-go compliance.
TITLE VIII--MENTAL HEALTH PARITY
Section 801. Enhanced Compliance with Mental Health and Substance Use Disorder Coverage Requirements
This section aims to improve mental health payment parity through better compliance guidance and disclosure support. Among other items, the section develops inter-agency agreements for information sharing and creates new standards for updating program compliance documents. Agency officials must hold stakeholder meetings with plan issuers to improve public- private coordination and take into consideration public feedback.
Section 802. Action Plan for Enhanced Enforcement of Mental Health and Substance Use Disorder Coverage
Under this section, federal agency officials must hold a public stakeholders meeting with state governments and nationwide stakeholders, including third-party groups and patient advocates, to produce an action plan for improving mental health parity and addiction equity requirements.
Section 803. Report on Investigations Regarding Parity in Mental Health and Substance Use Disorder Benefits
One year following enactment, and annually for five years, an inter-agency analysis on any serious violations of mental health parity compliance standards would be published, summarizing the results of all closed federal investigations finalized in the 12 months preceding the report.
Section 804. GAO Study on Parity in Mental Health and Substance Use Disorder Benefits
Within three years, the Comptroller General of
Section 805. Information and Awareness on Eating Disorders
In an effort to improve education and awareness of eating disorders, this section updates and modernizes public outreach efforts through the
Section 806. Education and Training on Eating Disorders
Similar to the provision on eating disorder awareness, this section provides support to educate and train health professionals and school personnel in effective strategies to identify individuals with eating disorders and facilitate early intervention programs. Further, this section helps with early intervention and prevention efforts for avoiding eating disorders.
Section 807. GAO Study on Preventing Discriminatory Coverage Limitations for Individuals with Serious Mental Illness and Substance Use Disorders
Two years after the bill takes effect, the Comptroller General of
Section 808. Clarification of Existing Parity Rules
This section clarifies that plan issuers offering coverage for eating disorder benefits must do so in alignment with current mental health parity standards.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of the
The full text of the report is found at: https://www.congress.gov/congressional-report/114th-congress/house-report/667/1.
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