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Current Advocacy/Issues


 

One pager – NJAMHAA FY2022 Budget and Policy Priorities

State Issues with Pending Legislation


Workforce
(See pages 3 and 4)

NJAMHAA continues to advocate for several budgetary, policy and legislative changes to support the behavioral health workforce.  These include several recommendations to assist providers in being competitive in the wages they offer, such as funding to cover the costs of minimum wage increases and a formula index that will adjust rates and contracts for inflation, as well as regulatory changes such as allowing Psychiatric Advanced Practice Nurses (APNs) to lead Programs for Assertive Community Treatment (PACT) teams. 

A5836 – Downey, Vainieri Huttle, Benson: NJAMHAA was successful in having this legislation introduced in June 2021 which “establishes annual cost of living adjustments… for programs providing mental health, substance use treatment, or services to persons with developmental disabilities.”  NJAMHAA will secure a Senate sponsor and work to move this legislation to the Governor’s desk.

Fee-for-Service Supplemental Funding (See page 5)

A1361 – Asm. Daniel Benson, Asw. Carol Murphy, Asw. Valerie Vainieri Huttle: Having secured a budget line for fee-for-service (FFS) supplemental funding in the FY2019 budget through the budget resolution process, which was retained in the FY2020 and FY2021 budgets, NJAMHAA continues to advocate for the nominal amount of $500,000 to be increased to $25 million. This funding is intended to cover deficits under FFS until such time as the independent study of rates is concluded and adequate rates are established. NJAMHAA has reached out to several legislators requesting they assist in getting the RFP for the rate study released from Treasury.

Early Intervention Support Services (EISS) Expansion (See page 5)

NJAMHAA achieved success in reaching the years-long goal of having the EISS program expanded to all 21 counties (from the current 11).  The FY2022 budget includes $11 million for this purpose. NJAMHAA continues to advocate for increased funding for the existing EISS programs and recommends that these programs be a core component of the 988 Crisis Response System to be implemented in 2022. 

Testimony to Assembly Health and Senior Services Committee – September 13, 2018

Permanent Telehealth Changes (See page 7)

A4179/A4200 S2559 – Downey, Conaway, Benson, Houghtaling, Karabinchak/Gopal, Gill: NJAMHAA’s advocacy efforts were successful in having the bill amended to ensure that clients may receive telehealth services in their homes or other places of their choosing and retaining audio-only services with parity reimbursement for behavioral health services. The bill was conditionally vetoed by Governor Murphy, has passed the Senate with his recommended changes and awaits a vote in the Assembly. The Governor’s changes limit parity reimbursement to two years and requires a study in the interim before extending the provisions. NJAMHAA does remain concerned about the provision in the bill that repeals two telehealth laws passed in 2020 as they provided the authority to Departments to issue waivers. NJAMHAA has shared these concerns in detail with legislators and the Administration and will continue to work to ensure waivers are not abruptly ended.

Testimony to Assembly Health Committee – June 23, 2020

Testimony to the Senate Health, Human Services and Senior Services Committee – Oct. 27, 2020

Motor Vehicle Registration Fee Exemption

S138/A1444  Sen. James Holzapfel, Sen. Robert Singer/Asw. Betty Lou DeCroce, Asm. Daniel Benson:  These bills are not currently listed as companion bills on the Legislature’s website since the Senate bill already includes the amendment NJAMHAA secured last session that adds non-profit behavioral health providers (and all non-profits) to the list of those organizations that are exempt from motor vehicle registration fees.  Non-profits had been exempt for more than 70 years until the law providing exemptions was reinterpreted under the last Administration.  NJAMHAA is working with the Assembly sponsor to have its bill amended to match the Senate bill, after which we expect it to promptly get a hearing in the Transportation Committee, which is chaired by Assemblyman Benson, who is also a primary sponsor of this bill.

Testimony to Senate Transportation Committee – June 11, 2018

988 Crisis Response System

S3500/A5496 –
 Vitale, Gopal/Benson, Vainieri Huttle, Verrelli, Mukherji: This bill “establishes a Core Behavioral Health Crisis Services Sytem”. Federal law requires all states to implement a 988 crisis hotline in July 2022. This bill goes beyond that to develop a crisis response system. NJAMHAA has been working with other stakeholders and Senator Vitale’s office on proposed amendments to this bill. Due to the July 2022 deadline and need to appropriate funding for implementation, this bill is expected to pass in the lame duck session (November 2021 – January 2022). NJAMHAA will be sharing details and advocacy alerts with members regarding the proposed system leading up to and during that time.

 State Issues in Need of Legislation

NJAMHAA is currently in the midst of having several bills written and introduced to address some of our priority items:

  • A bill to allow Psychiatric Advance Practice Nurses to fill the role of Psychiatrists on Programs for Assertive Community Treatment (PACT) Teams. A Senate sponsor has been secured for this legislation. (See page 4)
  • A bill to establish a formula for automatic upward rate and contract adjustments that is indexed to actual costs.  An Assembly sponsor has been secured for this legislation. (See page 4)
  • NJAMHAA is also working to have a bill introduced to further increase the funding of the School Based Youth Services Program (SBYSP) to expand it to many more schools and provide funding to existing programs. (See page 6)

State Budget

Budget Priorities
  • Close the deficit gap caused by the Division of Mental Health and Addiction Services’ (DMHAS') transition to fee-for-service reimbursement with a $25 million investment (until such time that rates are adjusted to cover the actual costs of care). (See page 5)
  • Increase the School Based Youth Services Program (SBYSP) appropriation for a total $30 million state investment in readily accessible comprehensive services for middle and high school students. (See page 6)
  • Appropriate funds to cover the increased costs under mandated minimum wage requirements as they are implemented, including other salary increases needed to prevent the compression of wage scales. (See pages 3 and 4)

Other Budget Recommendations

  • Appropriate $1.5 million to support the Screening Center early intervention grant program.* (See page 5)
  • Appropriate $10 million as an initial investment into facility resources for behavioral health providers to further develop integrated care. (See page 9)
  • Appropriate $10 million for mental health providers and renew the $6 million appropriation for substance use treatment providers to upgrade, implement and maintain interoperable electronic health records. (See page 8)

*Legislation that NJAMHAA spearheaded to establish a grant program for Screening Centers to expand community outreach through expanded mobile response, satellite offices and other approaches was signed into law in January 2020, but without funding. 

Other State Issues

1115 Waiver Renewal

New Jersey’s proposed 1115 Waiver renewal application was made public in September.   NJAMHAA submitted these comments on the initial draft renewal application.

Department of Human Services Slide Presentation at September MAAC Meeting

CMS will open a public comment period in the summer and then negotiate a final renewal with DMAHS.  The new waiver demonstration period will begin on July 1, 2022.

NJAMHAA will be monitoring this process, continuing to provide input and keeping members informed of their opportunity to do so.

 Federal Issues

With a new Administration, there is a great deal of activity at the federal level that impacts NJAMHAA members and those they serve.  These include budgets, telehealth provisions, COVID relief packages, healthcare changes and more, including new and changing regulations and initiatives.

The list below represents priority legislation that NJAMHAA is monitoring.

Federal Legislation NJAMHAA Supports

       You can check the status of these and any other federal bill by searching at Congress.gov.

Excellence in Mental Health and Addiction Treatment Act. HR4323/S2069: The bill expands the Medicaid certified community behavioral health clinic demonstration program and authorizes funding for additional grants to certified community behavioral health clinics.

Medicaid Reentry Act. HR955/S285: The bill requires states to make Medicaid available for incarcerated individuals no less than 30 days prior to release, ensuring more coordinated behavioral and other health care for people reentering communities, a measure made more critical than ever right now during the pandemic.

Mental Health Access Improvement Act. HR945/S286: The bills would extend Medicare coverage to marriage and family therapists, and mental health counselors and the services they provide, including discharge plans for post-hospital services.

Mainstreaming Addiction Treatment Act. HR1384/S445: This bill removes the requirement that a health care practitioner apply for a separate waiver through the Drug Enforcement Administration (DEA) to dispense certain narcotic drugs (e.g., buprenorphine) for maintenance or detoxification treatment (i.e., substance use disorder treatment). Further, a community health aide or community health practitioner may dispense certain narcotic drugs for maintenance or detoxification treatment without registering with the DEA if the drug is prescribed by a health care practitioner through telemedicine (it preempts state laws related to licensure for this activity). The bill also directs the Substance Abuse and Mental Health Services Administration to conduct a national campaign to educate health care practitioners and encourage them to integrate substance use disorder treatment into their practices.

Mental Health Services for Students Act (HR721/S1841): The bill would provide $200 million in competitive grants for public schools nationwide to partner with local mental health professionals to establish comprehensive mental health services for students. While schools work to navigate this pandemic, they need the resources to create mental health plans to reach their students during this stressful time. The legislative text is nearly identical to the version of the Mental Health Services for Students Act passed unanimously by the U.S. House of Representatives in the 116th Congress. The single change increases funding from $130,000,000 to $200,000,000. The bill has nearly 100 cosponsors.

Suicide Prevention Lifeline Improvement Act. (HR2981/S2425): This bill expands the requirements for the National Suicide Prevention Lifeline Program, requiring the Substance Abuse and Mental Health Services Administration (SAMHSA) to: (1) develop a plan to ensure the provision of high-quality service, (2) strengthen data-sharing agreements to facilitate the transmission of epidemiological data from the program to the Centers for Disease Control and Prevention, and (3) implement a pilot program focused on using other communications platforms (e.g., social media and texting) for suicide prevention. The bill is identical to a version of the measure that was passed unanimously by the U.S. House of Representatives on 9/29/20 in the 116th Congress.

Behavioral Health Crisis Services Expansion Act.HR1319/S1902: This bill empowers communities to establish continuums of care for individuals experiencing mental or behavioral health crises and requires the establishment of standards. It identifies the minimum components of a system as: crisis call center, mobile crisis response teams, crisis receiving and stabilization facilities and behavioral health urgent care facilities. It also makes changes to Medicare, Medicaid, group health plans and other coverage to mandate coverage for crisis response services.

The Virtual Peer Support Act. S157: The bill, being reintroduced in this Congress, is designed to help boost the capacity of peer behavioral health support programs by transitioning them to an online setting. To that end, under the bill, SAMHSA would receive $50 million to make grants to eligible organizations to implement new, virtual peer support programs and to expand existing online services to meet community needs.

Promoting Effective and Empowering Recovery Services in Medicare (PEERS) Act. HR2767/S 2144: This bill specifies that peer support specialists may participate in the provision of behavioral health integration services with the supervision of physicians or other entities under Medicare. The bill defines peer support specialists as individuals who are recovering from mental health or substance-use conditions and have certain national or state credentials, as specified, to provide peer support services.

Ensuring Medicaid Continuity for Children in Foster Care Act. HR5414/S2689): This bill would provide a narrow exemption from the Institutions for Mental Disease (IMD) exclusion to ensure children in foster care receiving care in qualified residential treatment programs can continue to receive care provided in these settings without losing their federal Medicaid coverage.

Medication Access and Training Expansion (MATE) Act. HR2067/S2235: The MATE bill requires healthcare providers, as a condition of receiving or renewing a registration to prescribe potentially addictive drugs, to complete a one-time training on managing patients with substance use disorders. It also includes grants for health professional associations and education programs for integrating substance use disorder training into relevant curricula.

Telehealth Modernization Act. HR1332/S368: This bill modifies requirements relating to coverage of telehealth services under Medicare. Among other things, the bill allows (1) rural health clinics and federally qualified health centers to serve as the distant site (i.e., the location of the health care practitioner); (2) the home of a beneficiary to serve as the originating site (i.e., the location of the beneficiary) for all services (rather than for only certain services); and (3) all types of practitioners to furnish telehealth services, as determined by the Centers for Medicare & Medicaid Services.

CONNECT for Health Act of 2021. HR2903/S1512: This bill expands coverage of telehealth services under Medicare. Among other provisions, the bill: allows the Centers for Medicare & Medicaid Services (CMS) to waive certain restrictions, such as restrictions on the types of technology that may be used; permanently removes geographic restrictions on originating sites (i.e., the locations of the beneficiaries) and allows the home of each beneficiary to serve as the originating site for all services; permanently allows federally qualified health centers and rural health clinics to serve as the distant sites (i.e., the locations of the healthcare practitioners); and allows CMS to generally waive coverage restrictions during any public health emergency.

Permanency for Audio-Only Telehealth Act. HR3447: This would audio-only mental and behavioral health services permanent under Medicare.

Telemental Health Care Access Act. HR4058/S2061:This bill removes the requirement that Medicare beneficiaries must have been seen in person by their providers within the prior six months in order to receive services via telehealth.

Tele-Mental Health Improvement Act. HR2264/S660: The bill requires employer-sponsored healthcare plans to cover tele-behavioral healthcare services at the same pay rate as those services provided in person.

Federal Budget

Congress passed the FY2021 budget late in December, as they previously were operating under a Continuing Resolution (the FY2021 budget year began on October 1st).  The budget bill was tied to the December COVID relief package, highlighted below.  The $1.4 trillion omnibus budget continued what had been passed in September, with the No Surprises Act, designed to prevent patients from receiving surprise medical bills, included.

The $4.25 billion allocated to the Substance Abuse and Mental Health Services Administration (SAMHSA) to provide increased mental health and substance abuse services and support, included:

  • $1.65 billion for the Substance Abuse and Prevention Treatment Block Grant
  • $1.65 billion for the Mental Health Services Block Grant
  • $600 million for Certified Community Behavioral Health Clinics
  • $50 million for suicide prevention programs
  • $50 million for Project AWARE [Advancing Wellness and Resiliency Education] to support school-based mental health for children
  • $240 million for emergency grants to states
  • $10 million for the National Child Traumatic Stress Network

Not less than $125 million of the funds provided to SAMHSA must be allocated to tribes, tribal organizations, urban Indian health organizations and health service providers to tribes across a variety of programs.

You may read a full summary of the Omnibus Budget here.

COVID Relief Packages

March 2020

The largest relief package last year was the  Coronavirus Aid, Relief, and Economic Security (CARES) Act.  This bill established the Paycheck Protection Program and Provider Relief Fund, among many other provisions.  You can read a summary of all of the Act’s provisions here.

December 2020

As noted above, another relief package was attached to the Omnibus Budget passed in December 2020.  Those provisions are included in this summary of the Omnibus Budget. The omnibus budget included supplemental funding for both the Mental Health Block Grant (MHBG) and Substance Abuse Prevention and Treatment Block Grant. The Department of Human Services shared this final, CMS approved list of items to be funded with the omnibus supplemental MHBG funds.

March 2021

The third package that was passed is the American Rescue Plan. This bill:

  • Provided $1,400 stimulus checks to supplement the $600 checks awarded in the last COVID-19 relief package, including, for the first time, payments to adult dependents.
  • Sped up vaccine distribution ($20 billion), opened federal vaccination sites and increase testing capacity across the country ($50 billion).
  • Extended emergency unemployment benefits through September 2021 and included the federal supplement to weekly state unemployment payments at $300.
  • Provide $350 billion to support state, county, and city recovery from massive COVID-related service costs.
  • Require employers to provide up to 14 weeks of paid sick leave for family members to care for relatives with COVID-19, with firms up to 500 employees receiving up to $1,500 per employee to offset these costs.
  • Extend the Child Tax Credit, the Earned Income Tax Credit, and the Premium Tax Credit.
  • Extend enhanced Supplemental Nutritional Assistance Program (SNAP) benefits.
  • Provide $25 billion for rent relief, and a moratorium on evictions and foreclosures through September 2021.
  • Made $4.2 billion available for SAMHSA and Health Resources and Services Administration to expand behavioral health services.


October 2021 Reconciliation Package

As Congress continues to negotiate this package, which is expected to land between $1.5 trillion and $2.5 trillion, NJAMHAA continues to advocate for inclusion of provisions to support behavioral health care. In particular, we wish to see the Excellence in Mental Health and Addiction Treatment Act of 2021 be included. It is anticipated that several other behavioral health supports, including provisions to address the workforce shortage, will be included. NJAMHAA will provide details as soon as they become available.

December 2021 Reconciliation Package

This package, which is currently estimated at $1.75 trillion, has passed the House. The Senate hopes to vote on the bill before their holiday break. NJAMHAA continues to advocate for inclusion of provisions to support behavioral health care. In particular, we wish to see the Excellence in Mental Health and Addiction Treatment Act of 2021 be included in the final version (the House did include the Excellence Act in the bill they passed). Several other behavioral health supports, including provisions to address the workforce shortage, have been included. NJAMHAA will provide details as soon as they become available.

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