Presentation to NAMI North Carolina

1
Mental Illness on the Federal Policy Agenda

• Presentation to NAMI North Carolina
• November 1, 2008
• Andrew Sperling
• Director of Legislative Advocacy
• NAMI National
• andrew_at_nami.org

2
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

3
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)

4
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

5
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

6
Medicare Parity

• Enacted as part of the Medicare Improvements for
  Patients and Providers Act (P.L. 110-275) passed
  over the Presidents 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

7
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).

8
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
• States shortage of rental units affordable ELI,
• States shortage of rental units available to
  VLI, and
• Ratio of ELI VLI households living in
  substandard housing or paying gt50 of monthly
  income for rent

9
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

10
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)

11
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

12
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