News & Notes

NAMI analyzes state legislation enacted in 2015: The National Alliance on Mental Illness (NAMI) has released its third annual survey of new state laws related to behavioral health services and systems. In a 70-page report, State Mental Health Legislation: Trends, Themes and Effective Practices (www.nami.org/statereport), NAMI includes both good and bad news. The bad news is that the number of states reporting a decrease in funding was higher than the number where funding grew. Only 23 states increased mental health spending in 2015, compared with 36 in 2013 and 29 in 2014. The good news is that 35 states adopted measures that NAMI considers innovative or exceptional and has marked with a gold star in its report, encouraging other states to adopt similar legislation. Minnesota, New York, and Virginia stand out as leaders. For example, Minnesota passed a law allowing peer specialists to serve as case manager associates and directing the Commissioner of Human Services to develop recommendations for utilizing peer specialists in the mental health system. A 2015 bill allows New Yorkers to direct a portion of their tax return to an antistigma public awareness campaign. A Virginia law allocates $104 million to implement the Governor’s Access Plan, which provides services for uninsured adults with mental illness under a section 1115 Medicaid demonstration waiver. Across all states, five bills stood out, according to NAMI. An Arizona bill has created a trust fund for rental assistance to people with serious mental illness. Minnesota legislation supplements federal dollars to support evidence-based programs for first-episode psychosis. In Utah, legislation requires the state’s departments of corrections and mental health to collaborate on providing treatment to inmates and developing alternatives to incarceration. A Virginia law designed to address “boarding” of psychiatric patients requires all public and private facilities to report daily on the availability of inpatient and crisis stabilization beds. New Washington State legislation defines telemedicine as a reimbursable service for purposes of diagnosis, consultation, or treatment. The NAMI site also summarizes new investments in mental illness research and services included in the $1.1 trillion 2016 federal budget that was passed by Congress in late December (www.nami.org/About-NAMI/NAMI-News/$400-Million-Boost-In-Budget-for-Mental-Health#sthash.nmGFiJwh.dpuf).

Client handout on self-management: Resources for Integrated Care has developed a customizable handout for behavioral health care providers that is designed to support conversations on the self-management of chronic conditions by patients who have serious mental illness. “What to Expect When You’re Self-Managing” includes information on the purpose of self-management, what clients should expect from their care team, what clients may ask for from natural supports (family and friends), and resources available to support self-management. It encourages clients to learn as much as they can about their conditions, to set long- and short-term goals, and to collaborate with the care team to reach these goals. Providers can list contact information for key members of the care team and for local groups that provide opportunities for volunteering or becoming more active in the community. Resources for Integrated Care is a collaboration between the Centers for Medicare and Medicaid Services, the Lewin Group, and the Institute for Healthcare Improvement. The handout can be downloaded at www.resourcesforintegratedcare.com/What_To_Expect_When_You_Are_Self-Managing.

Technical assistance brief describes opportunities to improve care for “dual-eligibles”: In January 2015, a Medicare payment policy for chronic care management (CCM) became effective for physicians who provide care to persons enrolled in both Medicare and Medicaid (“dual-eligibles”), many of whom have serious mental illnesses. Previously, Medicare’s physician fee schedule limited reimbursement primarily to face-to-face visits. The new policy allows qualified physicians to receive monthly payments for CCM services, including non–face-to-face management and coordination, furnished for at least 20 minutes per month to individuals with two or more chronic conditions. According to a technical assistance brief recently released by the Integrated Care Resource Center, the new policy provides states and their contracting plans with opportunities to align Medicare and Medicaid coverage of CCM for this group, avoiding duplicative Medicare and Medicaid payments and facilitating a more seamless approach to providing services. The four-page brief, Medicare Chronic Care Management Services Payment: Implications for States Serving Dually Eligible Individuals, is available on the Integrated Care Resource Center site (www.integratedcareresourcecenter.net/PDFs/ICRC_Medicare_Chronic_Care_Mgt_Pmt.pdf).

Kaiser Foundation calculates penalties for remaining uninsured in 2016: The individual mandate of the Affordable Care Act (ACA) requires most people to have health insurance or pay a tax penalty, which is phased in between 2014 and 2016. For uninsured persons eligible for ACA marketplace plans, the average penalty for remaining without coverage in 2016 will be $969 per household—47% higher than the estimated 2015 average of $661, according to a new analysis from the Kaiser Family Foundation. Uninsured persons who qualify for premium subsidies for marketplace plans face an average penalty of $738 per household if they remain uninsured in 2016, and those not eligible for subsidies—who typically have higher incomes—face an estimated average penalty of $1,450. The penalty for 2016 is calculated as the greater of two amounts: either $695 per adult plus $347.50 per child, up to a maximum of $2,085 for a family, or 2.5% of family income in excess of the 2015 income tax filing thresholds. The penalty is capped at an amount equal to the national average premium for a bronze plan—the minimum coverage under the law. According to the Kaiser analysis, nearly half (48%) of the 7 million uninsured people eligible for marketplace subsidies could buy a bronze plan for either a zero premium contribution or for less than the penalty they will owe for remaining uninsured. The five-page brief, The Cost of the Individual Mandate Penalty for the Remaining Uninsured, is available on the Kaiser Foundation Web site (kff.org/health-reform/issue-brief/the-cost-of-the-individual-mandate-penalty-for-the-remaining-uninsured).

Commonwealth Fund brief details improvements in 2016 marketplace plans: Before the third ACA open enrollment season began late last year, the U.S. Department of Health and Human Services (HHS) was able to shift its focus from the initial challenges presented by the ACA’s complex rollout to other areas of concern, such as the qualified health plans offered in insurance marketplaces. A new issue brief from the Commonwealth Fund outlines areas in which important changes have been made in plan coverage. One area is prescription drug rules. The ACA requires qualified plans to cover prescription drugs without discriminating on the basis of health condition, among other factors. In 2015, advocacy groups argued that several plans discriminated against people with HIV/AIDS by placing all HIV drugs, even generics, in high-cost tiers, outside basic formularies. For 2016, HHS modified the rules so that consumers can more quickly obtain drugs that are not on a plan’s formulary through a standard “exceptions process.” The plan must make a coverage decision within 72 hours, and consumers may request an independent review of any denials, which also must occur within 72 hours. The HHS guidance thus signaled to state regulators and health plans that a review of cost sharing is part of the discrimination standard test. Other changes in 2016 give consumers more information on their plan’s provider network, require coverage of habilitative services on par with rehabilitative services, include a per-person cap within the maximum family out-of-pocket cost limit, and enable consumers to more easily compare out-of-pocket costs under different plans. The seven-page brief, Increased Transparency and Consumer Protections for 2016 Marketplace Plans, is available on the Commonwealth Fund’s Web site (www.commonwealthfund.org/publications/issue-briefs/2015/dec/increased-transparency-consumer-protections?omnicid=EALERT955048).

SAMHSA TIP provides guidance on services for homeless persons: The Substance Abuse and Mental Health Services Administration (SAMHSA) has developed Treatment Improvement Protocol (TIP) 55 to equip service providers and program administrators with guidelines to support the care of persons who are homeless or at risk of homelessness and who need or are currently receiving substance abuse or mental health treatment. The three-part TIP includes chapters for providers offering practical information on the types of problems and issues faced by homeless persons and assessment and treatment planning; chapters for administrators on collaboration with other agencies to provide comprehensive services, training and staff needs, and resources for implementation of best practices; and chapters presenting and analyzing research findings. The 235-page TIP, Behavioral Health Services for People Who Are Homeless, is available on the SAMHSA Web site (store.samhsa.gov/product/TIP-55-Behavioral-Health-Services-for-People-Who-Are-Homeless/All-New-Products/SMA15-4734).

Report outlines trauma-informed diversion strategies for the juvenile justice system: Over three-quarters of youths who become involved in the juvenile justice system have experienced traumatic victimization, according to a new report jointly released by the National Center for Mental Health and Juvenile Justice at Policy Research Associates, Inc., and the Technical Assistance Collaborative (TAC). Given the complexity of their needs and the documented inadequacies of care within the juvenile justice system, there is a growing consensus that whenever safe and feasible, youths with behavioral health conditions should be diverted as early as possible to community-based services and that diversion approaches and service systems should be able to recognize and respond to trauma-related disorders. The 58-page report draws on the experiences of states participating in an initiative funded by SAMHSA and the MacArthur Foundation: the 2014–15 Policy Academy–Action Network Initiative. The initiative sought to disseminate models and strategies specifically targeting the implementation of probation-intake diversion strategies. Four states were competitively selected to participate in the initiative—Georgia, Indiana, Massachusetts, and Tennessee. In addition to a detailed description of trauma-informed diversion strategies and services, the report includes case studies describing how the four states mobilized local communities, developed policies and procedures for engaging youths and their families, and established interagency collaborations. Strengthening Our Future: Key Elements to Developing a Trauma-Informed Juvenile Justice Diversion Program for Youth With Behavioral Health Conditions, is available on the TAC Web site (www.tacinc.org/knowledge-resources/news/strengthening-our-future-%E2%80%94-a-new-report-on-trauma-informed-diversion-for-youth-with-behavioral-health-conditions).

AHRQ review rates effectiveness of depression treatments: In any given year, nearly 7% of the U.S. adult population experiences an episode of major depressive disorder that warrants treatment, according to a review of the effectiveness of depression treatments conducted by the Agency for Healthcare Research and Quality (AHRQ). Forty-four research trials met inclusion criteria for the review, which compared second-generation antidepressants; psychological, complementary, and alternative medicine; and exercise treatment options as first-step interventions for adult outpatients with acute-phase major depressive disorder and as second-step interventions for those who do not achieve remission after initial treatment with antidepressants. The strength of evidence was rated as moderate for only one outcome of one first-step comparison: results indicated that second-generation antidepressants and CBT were similarly effective for symptomatic relief. For second-step interventions, available data suggest that switching to another second-generation antidepressant, switching to CBT, and augmenting with a particular medication or CBT are all reasonable options. The 274-page review, Nonpharmacological Versus Pharmacological Treatments for Adult Patients With Major Depressive Disorder, is available on the AHRQ Web site (effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=2152).