Mental Illness on the Federal Policy Agenda Presentation to NAMI North Carolina November 1, 2008 Andrew Sperling Director of Legislative Advocacy NAMI National

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 , 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 ) 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 ) 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 , 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 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 drug plan options currently available “Open Enrollment” begins on November 15 and runs through December 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