National Alliance on Mental Illness
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(800) 950-NAMI; firstname.lastname@example.org
For Immediate Release, 4 Jan 00
Contact: Chris Marshall
January 4, 2000
Health Care Financing Administration
Department of Health and Human Services
P.O. Box 8018
Baltimore, MD 21244-8010
STATE CHILDREN'S HEALTH INSURANCE PROGRAM
NAMI - the National Alliance for the Mentally Ill - is pleased to offer these comments on the November 8, 1999 proposed rule for the SCHIP program. NAMI is a nationwide grassroots organization with 210,000 members - consumers and families directly impacted by severe mental illness.
The recent White House Conference on Mental Illness and the Surgeon General's report both pointed to the prevalence of treatable disorders among children and adolescents, and at the same time noted the low percentage of those in need who actually access services at all. Tragic events in the national news over the past year have focused public attention on the issue of mental illnesses in adolescents. The popular press has taken up the challenge to research the questions and to inform the public.
As the Nation's Voice on Mental Illness, NAMI is centrally concerned about these issues. The enactment of SCHIP offered opportunity for expanded teatment resources for these children and adolescents. For this opportunity to be realized several decision points must be addressed. We point these out in this commentary.
Children with serious or severe mental illnesses, which NAMI affirms as brain disorders , are reasonably covered for treatment and services when Medicaid eligible, because of Medicaid's EPSDT provisions. NAMI urges that in those states which opt to develop their SCHIP programs outside of Medicaid, the additional children brought into health coverage have the same level of treatment and service as Medicaid provides for serious or severe mental illness.
Unfortunately, the new Title XXI of the Social Security Act as promulgated in Public Law 105-33 was not enacted in a way that requires this kind of parity. NAMI recognizes that HCFA, in writing a proposed regulation implementing the legislation, can not go beyond the clear limits of the statutory text.
The law mentions mental health services to such children only three times.
1) In Subpart D, sec. 457-402 "Child health assistance and other definitions," the text states that for the purposes of this subpart, "child health assistance" means "payment for part or all of the cost of health benefits coverage provided to targeted low-income children, for:"
inpatient mental health services defined at (a)(9) as "including services furnished in a State-operated mental hospital and including residential or other 24-hour therapeutically planned structured services."
outpatient mental health services defined at (a)(10) as "including services furnished in a State-operated mental hospital and including community-based services."
Both (a)(9) and (10) specifically exclude substance abuse treatment services, but these are separately listed at (a)(17) and (18). The construction in a definitions section means only that payment may be made for these services. It does not mean payment shall be made for these services.
2) Section 457-430, "Benchmark-equivalent health benefits coverage" divides services into (b) required and (c) additional. Coverage "must" be included for required services which are limited to: hospital, physicians', lab, well-child including immunizations, and emergency services [from 457.410 (b)(3)] Coverage "may" be included for additional services specified in sec. 457-402. The only adumbration of a requirement for coverage of mental health services is found at (c)(2):
"If (emphasis added) the benchmark coverage package used by the State for purposes of comparison in establishing the aggreagate actuarial value of the benchmark-equivalent coverage package includes coverage for … mental health …the actuarial value of the coverage must be at least 75 percent of the value of the coverage for such a category or service in the benchmark plan used for comparison by the State."
3) But this requirement is substantially qualified at (c)(3):
"If (emphasis added) the benchmark coverage package does not cover one of the … services in paragraph (c)(2) of this section, then the benchmark-equivalent coverage package may, but is not required to (emphasis added), include coverage for that category of service.)
Congressional intent appears to have been that coverage for targeted low-income children in the SCHIP program should not be more generous than the specified benchmark plans, unless a State opts to have it so. This stance is usual in legislation authorizing programs of federal assistance.
NAMI hopes that in those twenty-eight states that have enacted mental illness parity statutes, State decision-makers will conform their SCHIP program to the intent of their state's parity legislation--rather than to the minimum requirement of the 75 percent actuarial equivalence to the benchmark average. The needs of so many children, eligible for SCHIP as part of the targeted population, will be far better served. State and local resources will certainly be conserved over the long run as well, across several public sector areas besides just health: education, public safety, corrections.
NAMI urges that states which have not yet enacted parity statutes also include a full range of mental illness services in their SCHIP plans when they opt to develop these outside of Medicaid. The resource conservation point applies equally to these states.
NAMI is particularly concerned about states that began their SCHIP programs as the Medicaid-extension option but, upon renewal, are reported to be switching to designs outside of Medicaid-thus losing for children with serious or severe mental illness the EPSTD safety net which so far exceeds the 75 percent actuarial equivalent test.
Protection from Disenrollment
Automatic Disqualification For Inpatient Status
The SCHIP law and proposed regulation permit an eligible child to be treated in a state psychiatric facility or a private one following eligibility determination. What happens during a course of medically necessary inpatient services when redetermination occurs? Automatic disqualification, and its dire consequences for the child under treatment and its family, are wholly unacceptable..
Home and Community-based Services, Nursing Care Services
Substance Abuse Treatment Services
Emergency and Post-stabilization Services
Children With Special Needs
Cost-sharing for Children with Chronic Conditions
NAMI thanks the Health Care Financing Administration for the opportunity to comment on the proposed regulations. Should there be any occasion to discuss them, please contact Robert Bohlman at NAMI at (703) 516-7997. E-mail: Bobb@NAMI.org
i designated "serious emotional disturbance" in the authorizing legislation for HHS' Substance Abuse and Mental Health Services Administration, P.L. 102-321.