President signs landmark mental health reform

December 21, 2016 ABILITY

As part of the 21st Century Cures Act, mental health reform has become law with the president’s signature in December 2016. It’s the most significant mental health reform in more than 50 years and is part of a $6.3-billion package that addresses other high-priority medical issues and the cancer “moonshot” campaign to find cancer cures.

What is mental health reform?

The legislation was first envisioned by Representative Tim Murphy, a practicing psychologist, who began his crusade to reform the mental health system in 2013. Even with strong bipartisan support, the bill has taken four years and a winding path to become law. At the end, it received strong support from both the House and Senate and was rolled up into the larger Act at the end of the year. That bill passed with strong support from both sides of the aisle.

Mental health reform includes new roles

As always, funding will determine the longer-term fate for parts of the legislation. The future is hazy for much of healthcare under a new administration. But as written, the new law addresses the following:

  • New leadership. The law creates an Assistant Secretary position overseeing the Substance Abuse and Mental Health Services Administration (SAMSHA) at the U.S. Department of Health and Human Services (HHS). Murphy and others have strongly criticized SAMSHA for a non-scientific approach and lack of attention to severe mental illness since it was created in 1963. At one time, there was just one clinician on staff for the agency of more than 600 people. A chief medical officer position – obviously a clinical role – will also be created.
  • Mental health parity. HHS is tasked with developing a plan to ensure mental health parity is enforced. A presidential commission released a report in the fall of 2016 addressed this issue and noted that further work is needed. (Read more here.)
  • Integration of physical and behavioral health. More support is becoming available for the treatment of the whole person in their psychosocial context.

Integrating behavioral health care with primary care is gaining recognition for its effectiveness and is supported by Medicare codes that become effective in 2017. Apart from mental health reform legislation, four new codes allow reimbursement for care coordination and inter-specialty psychiatric consultation for providers in a primary care setting.

  • Criminal justice system. The goal is to move care for the mentally ill out of the justice system and back into healthcare. This will include special training for law enforcement in dealing with people having psychiatric emergencies, as well as creating federal mental health courts and improved mental health screening for those in the criminal justice system.
  • Opioid addiction. The law allocates $500 million to fight the opioid crisis. (Additional funding was passed earlier in the year.) The White House is pushing that money to states to monitor prescribing, train clinicians and treat patients. It will be prioritized over other substance use treatment and is intended to especially help in rural areas. Nearly 80 Americans die daily from opioid overdoses.

Additional funds allocated

Other mental health reform programs and grants address:

  • Children’s mental health services
  • Assisted Outpatient Treatment and Assertive Community Treatment for community care of the most vulnerable and sick
  • Suicide prevention programs

Information sharing still in question

One change mental health advocates hoped to make that was not included in the final bill was a tweaking of HIPAA regulations that would have allowed medical professionals to share more information with family caregivers. While providers already have some latitude in this area, many are afraid to use it for fear of violating regulations. The Act instructs HHS to clarify what’s appropriate for both family caregivers to know and healthcare providers to share.

Healthcare is gearing up for major change once again, but some things never change. A smooth administrative workflow is always important to a successful medical practice and ABILITY can help. Browse our Resource Center for more.

 

 

 

 

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