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Mental Illness on the Federal Policy Agenda. Presentation to NAMI North Carolina November 1, 2008 Andrew Sperling Director of Legislative Advocacy NAMI National andrew@nami.org. Review of 2008 – BIG VICTORIES FOR NAMI!!!. Insurance Parity Moratoria on Medicaid regulations
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Mental Illness on the Federal Policy Agenda Presentation to NAMI North Carolina November 1, 2008 Andrew Sperling Director of Legislative Advocacy NAMI National andrew@nami.org
Review of 2008 – BIG VICTORIES FOR NAMI!!! • Insurance Parity • Moratoria on Medicaid regulations • Parity in Medicare outpatient cost sharing • Affordable Housing Trust Fund and Section 811 legislation
Parity in Group Health Plans • P.L. 110-343, signed on October 3 • Attached to the financial market rescue and tax extenders legislation • Becomes effective in new group health plan years starting after October 3, 2009 • Requires equity in coverage with respect to: • Durational treatment limits (caps on inpatient days and outpatient visits) • Financial limitations (higher cost sharing, deductibles, out-of-pocket limits)
Parity in Group Health Plans • Includes both mental health and substance abuse “as defined by the plan” “in accordance with applicable federal and state law” • No preemption of state mandates or parity laws above the new federal standard • Small employers exemption for firms with 50 or fewer workers • Cost increase exemption available, unlikely to be used • Senator Baucus played a critical role in the final process
Medicaid Regulation Moratoria • Moratoria on 6 separate regulations runs through April 1, 2009 • Imposed by Congress on President Bush as part of the FY 2008 emergency supplemental funding bill (P.L. 110-252) passed in June • Targeted Case Management (TCM) regulations – become effective March 3, 2008, could go back into effect • Rehabilitation services – NPRM was published in August 2007, without authorization from Congress, unlikely to come back
Medicare Parity • Enacted as part of the Medicare Improvements for Patients and Providers Act (P.L. 110-275) passed over the President’s veto on July 15 • Implements parity in cost sharing for outpatient mental health services under Part B, gradually moving the current discriminatory 50% requirement down to 20% between 2010 and 2014
Improvements to Medicare Drug Benefit in MIPPA • Statutory authority under the Part D drug benefit for CMS to ensure broad coverage on prescription drug plan formularies for antipsychotics, antidepressants and anticonvulsants. • Coverage for benzodiazepines (a critical tool in treatment for acute mania in bipolar disorder and severe anxiety disorders), • Changes to eligibility for the Part D Low-Income Subsidy (LIS) program (also known as “Extra Help”) – Increase the amount of allowable resources, elimination of barriers to enrollment and the current late enrollment penalty and new exemptions for in-kind support and maintenance (lowering premiums and cost sharing and limiting the “doughnut hole” coverage gap).
Affordable Housing Trust Fund • Part of P.L. 110-289, the Housing and Economic Recovery Act of 2008 • Funded through a set aside from Fannie Mae and Freddie Mac, equal to 4.2 basis points for each dollar of unpaid principal balance of new business • Starting in 2012, the Trust Fund gets 65% of these funds • 100% of funds got to the states by formula based on: • State’s shortage of rental units affordable ELI, • State’s shortage of rental units available to VLI, and • Ratio of ELI & VLI households living in substandard housing or paying >50% of monthly income for rent
Affordable Housing Trust Fund • $3 million minimum state allocation • State allocation plan required • No state matching funds • Income targeting – At least 75% of funds most be for rental housing development to ELI households, no funds for households above 50% of AMI • Operating subsidy is allowed • Trust fund dollars are “federal financial assistance” for purposes of federal civil rights laws
HUD Section 811 Legislation • HR 5772/S 3593 - Sponsored by Representatives Chris Murphy (CT) & Judy Biggert (IL) and Senator Bob Menendez (NJ) • Passed the House on September 17, 2008 • Priority for NAMI, TAC and CCD Housing Task Force • Raise Section 811 program profile in Congress • Streamline development process • End HUD mis-managed Mainstream voucher program • Leverage other financing to produce more 811 units • Authorize new PRAC-only demonstration for new rental housing development (North Carolina model)
Medicare Part D in 2009 • 2009 drug plan options currently available • “Open Enrollment” begins on November 15 and runs through December 31 • 1.3 million dual eligibles and LIS will be randomly “reassigned” new prescription drug plans to keep zero premium in 2009 – blue letter • 447,000 full benefit dual eligibles are losing “deemed” status for 2009 – grey letter • Change in cost sharing – Still deemed status for low-income subsidy, can challenge higher cost sharing – orange letter • “Choosers” – Higher premium required in 2009, can switch to a zero premium plan – tan letter • 11 PDPs in North Carolina in 2009 are “below benchmark” and available for dual eligibles at a zero premium
Outlook for 2009 • New Administration and New Congress • Economy will dominate attention at the new White House and the new Congress • FY 2009 discretionary funding bills unfinished, current “continuing resolution” runs through March 6, 2009 • Medicaid regulation moratoria expires on April 1, 2009 • Comprehensive health care reform legislation in a “post parity” world