HELPING FAMILIES IN MENTAL HEALTH CRISIS ACT 2015
On June 4, 2015, Rep. Tim Murphy (R. PA) and Rep. Eddie Bernice Johnson (D. TX) introduced the Helping Families in Mental Health Crisis Act of 2015 (“HFMHCA”, HR 2646) which updates the 2013 version which did not pass (HR3717). Following is a summary of the provisions related to serious mental illness.
SAMHSA Replaced by an Assistant Secretary of Mental Health and Substance Use Disorders
The Helping Families in Mental Health Crisis Act replaces SAMHSA and it’s administrator with Assistant Secretary for Mental Health and Substance Abuse Treatment who must be a licensed Psychiatrist or Clinical Psychologist. This raises the profile of mental health in the government org chart and ensures that the lead policy official for mental health policy knows something about mental illness. The Assistant Secretary will administer responsibilities formerly administered by SAMHSA.
The Helping Families in Mental Health Crisis Act requires the Asst. Sec to focus on improving the most important metrics like rates of suicide and attempts, emergency psychiatric hospitalizations, emergency room boarding; arrests, incarcerations, victimization, and homelessness. The bill dramatically tightens the definition of evidence to be used in determining the efficacy of programs. It establishes a coordinating committee to advise the secretary that includes significant representation from criminal justice.
Mental Illness Policy Org strongly supports the elimination of SAMHSA and replacing it with an assistant secretary who is required to rely on independent evidence when deciding what to fund and is required to prioritize services that improve meaningful metrics like reducing homelessness, arrest, violence, incarceration, hospitalization and suicide.
Mental Health Block Grant Applicants Required to Address Serious Mental Illness
The Helping Families in Mental Health Crisis Act requires states applying for block grants to “include a separate description of case management services and provide for activities leading to reduction of rates of suicides, suicide attempts, substance abuse, emergency hospitalizations, incarceration, crimes, arrest, victimization, homelessness, joblessness, medication” and other important outcomes.
Assisted Outpatient Treatment Programs Receive Modest Funding
The Helping Families in Mental Health Crisis Act of 2015 ups the amount provided to states for AOT by $15 million to $20 million annually and extends the grants through 2018. (20% to existing programs and 80% to new programs.) Further, states with an AOT law on their books will receive a 2 percent increase in their block grant funding. (Roughly $10 million annually split between them)
Mental Illness Policy Org believes the amount allocated to Assisted Outpatient Treatment should be increased, in light of the extensive independent evidence that it reduces homelessness, arrest, violence, incarceration, hospitalization and suicide in people with serious mental illness.
HIPAA/FERPA Regulations Slightly Modified to Allow Helpful Disclosures to Caregivers
The Helping Families in Mental Health Crisis Act makes it clear that providers may receive information from caregivers. It defines “caregivers” as “an immediate family member; someone who assumes primary responsibility for providing a basic need of such individual; a personal representative; someone who can establish a longstanding involvement and is responsible with the individual.” That is an important change supported by Mental Illness Policy Org.
The Helping Families in Mental Health Crisis Act allows an entity normally required to maintain patient confidentiality to share some limited information with “caregivers”. HIPPA disclosure is limited to information about the diagnoses, treatment plans, appointment scheduling, medications, and medication related instructions, but does not include any personal psychotherapy notes. The Helping Families in Mental Health Crisis Act does not put a limit on which FERPA-protected information may be disclosed. It establishes numerous complex requirements to be met before the information can be disclosed and therefore might not have as much impact as it should.
The Helping Families in Mental Health Crisis Act also provides that HIPAA protected information may be disclosed if the patient is over 18 and has “serious mental Illness” (Serious mental illness means diagnosed by a doctor that results in functional impairment of the individual that “substantially interferes with or limits one or more major life activities of the individual.”) HIPAA protected information for people without serious mental illness may not be disclosed. FERPA protected information can be disclosed without those limitations.
Disclosure of information can only be made if all the following conditions are met for HIPAA protected information or the first condition only is met for FERPA protected information.
Mental Illness Policy Org believes all information, including case notes, should be allowed to be disclosed if they are needed to protect the health safety and welfare of the patient, caregiver or others. Additional criteria, or limiting what information can be disclosed, makes it more difficult to protect health safety and welfare.
IMD Exclusion Slightly Ameliorated to End Discrimination Against Seriously Mentally Ill who Need Hospital Care
The Helping Families in Mental Health Crisis Act allows states to get Medicaid reimbursement for care of adults in IMDs where the facility-wide average length of stay is less than 30 days. It also provides language preventing residential facilities from being declared IMDs. These provisions only take place if the Congressional Budget Office (CBO) gives a good score.
Mental Illness Policy Org believes the IMD Exclusion should be eliminated as it is federally sanctioned discrimination against people with serious mental illness that prevents them from gaining access to hospital care when needed. The provisions in HR 2646 take a small step in that direction.
PROTECTION AND ADVOCAY (P&A, PAIMI, Disability Rights) Returned to Original Mission of Protecting Mentally Ill from Abuse and Neglect
The Helping Families in Mental Health Crisis Act returns PAIMI to it’s original mission of protecting patients against “abuse and neglect.” Outside the legislation “abuse” and “neglect” are defined.
(5) The term “neglect” means a negligent act or omission by any individual responsible for providing services in a facility rendering care or treatment which caused or may have caused injury or death to a  individual with mental illness or which placed a  individual with mental illness at risk of injury or death, and includes an act or omission such as the failure to establish or carry out an appropriate individual program plan or treatment plan for a  individual with mental illness, the failure to provide adequate nutrition, clothing, or health care to a  individual with mental illness, or the failure to provide a safe environment for a  individual with mental illness, including the failure to maintain adequate numbers of appropriately trained staff.
The Helping Families in Mental Health Crisis Act requires those who get PAIMI contracts to agree to refrain from “lobbying or retaining a lobbyist for the purpose of influencing a Federal, State, or local governmental entity or officer; and “counseling an individual with a serious mental illness who lacks insight into their condition on refusing medical treatment or acting against the wishes of such individual’s caregiver.” Importantly, it also adds a grievance process so state mental health directors, family members and consumers who feel PAIMIs are violating their mission and impeding care can be reported to a third party for investigation.
Mental Illness Policy Org is in strong support of the PAIMI provisions.
Eliminates Discrimination in Medicare Against Mentally Ill who Need Long-term Care
The Helping Families in Mental Health Crisis Act eliminates the 190 day lifetime cap on inpatient psychiatric hospitalization in Medicare if CMS gives it a good score. Mental Illness Policy Org believes the lifetime cap should be eliminated. HR 2646 takes a step in that direction.
Requires Medicaid to Allow Two Services Within Same Day
The Helping Families in Mental Health Crisis Act allows payment for two services received in a single day.
Bans Medicaid Programs from Discriminating Against Medications Used to Treat Serious Mental Illness
The Helping Families in Mental Health Crisis Act protects the most seriously ill. For “major depression, bipolar (manic-depressive) disorder, panic disorder, obsessive-compulsive disorder, schizophrenia, and schizoaffective disorder, a State shall not exclude from coverage or otherwise restrict access to such drugs other than pursuant to a prior authorization program” The bill also requires managed care organizations to cover all mental illness medications.
Strengthens Hospital Discharge Procedures
The Helping Families in Mental Health Crisis Act attempts to make the crack smaller, by requiring (medicare reimbursed?) hospitals to prepare discharge plans and facilitate connection with outpatient treatment for patients they are discharging.
This is an important provisions.
National Institute Of Mental Health
The Helping Families in Mental Health Crisis Act provides $40 million annually for four years specifically for NIMH to start studying violence to self and others plus the Brain Initiative.
Mental Illness Policy Org is strongly in support of this funding for an issue that has been historically swept under the rug and caused neeedless incarceration of the seriously ill.
Increases Minority Mental Health Workforce
Creates Suicide Prevention Technical Assistance Center to Focus on those at High Risk for Suicide.
The Helping Families in Mental Health Crisis Act will provide grants for “prevention of suicide among all ages, particularly among groups that are at high risk for suicide.”
Mental Illness Policy Org believes suicide prevention funds should be directed at those most likely to commit suicide. Those include first degree relatives of those who completed suicide, persons with mental illness, people who previously attempted suicide and the elderly.
Establishes Interagency Serious Mental illness Coordinating Agency
The Helping Families in Mental Health Crisis Act establishes this committee to refocus efforts on the most seriously ill. In addition to those responsible for mental health policy, the Attorney General is on it. Other mandatory members include a judge, a law enforcement officer, and a corrections officials. By giving criminal justice a seat at the mental health table, it is hoped that fewer policies detrimental to the most seriously ill will be incorporated into policies.
Reports on Best Practices to Train and Certify Peer Support Specialists
The Helping Families in Mental Health Crisis Act requires the Assistant Secretary to prepare a biennial report on best practices for “training and certifying peer support and establishing and operating programs using peer-support”. It defines a peer support specialist as someone who has “been an active participant in mental health or substance use treatment for at least the preceding 2 years” and “uses his or her recovery from mental illness or substance abuse plus skills learned in formal training, …to work …with individuals with a serious mental illness or a substance use disorder, in consultation with and under the supervision of a licensed mental health or substance use treatment professional.” Members of the peer community are objecting to government setting standards for peer support, preferring to receive the funds without limitation.
Mental Illness Policy Org believes that before credentialing peer support, government should conduct an independent study to see if peer support is better than non peer support at improving meaningful metrics like reducing homelessness, arrest, violence, incarceration, hospitalization, suicide and other outcomes. If it is, then a credentialing mechanism like the one in HR 2646 makes sense.
Mental Illness Policy Org.
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