Table of Contents. Title II Grant Reform and Restructuring Title IV Interagency Serious Mental Health Coordinating Committee

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1 Side by Side Cmparisn f and Table f Cntents Mental Health Refrm Act f 2015 Helping Families in Mental Health Crisis Act Title I Assistant Secretary fr Mental Health and Substance Use Disrders Title I Assistant Secretary fr Mental Health and Substance Use Disrders Title II Grants Title II Grant Refrm and Restructuring Title III Integratin Title III Interagency Serius Mental Illness Crdinating Cmmittee Title IV Interagency Serius Mental Health Crdinating Cmmittee Title IV HIPAA and FERPA Caregivers Title V HIPAA Title V Medicare and Medicaid Refrms Title VI Medicare and Medicaid Refrms Title VI Research by NIMH Title VII Research by NIMH Title VII Behaviral Health Infrmatin Technlgy Title VIII SAMHSA Reauthrizatin and Refrms Title VIII SAMHSA Reauthrizatin and Refrms Title IX Mental Health Parity Title IX Reprting Assistant Secretary fr Mental Health and Substance Use Disrders Title I Assistant Secretary fr Mental Health and Substance Use Disrders Title 1 Assistant Secretary fr Mental Health and Substance Use Disrders s Creates a new ffice f Assistant Secretary fr Mental Health and Substance Use Disrders wh reprts directly t the Creates a new ffice f Assistant Secretary fr Mental Health and Substance Use Disrders pp Secretary f HHS and must be appinted by the President w/ advice and cnsent frm the Senate 101 pp Assistant Secretary must be either a psychiatrist, anther type f physician, r a PhD psychlgist Assistant Secretary must be either a psychiatrist, anther type f physician, a PhD psychlgist, r have a dctral degree in scial Transfers all duties that previusly belnged t the Administratr f SAMHSA t the Assistant Secretary wrk Wide range f duties including crdinatin, administratin, and Oversees the Administratr f SAMHSA versight f prgrams, grants, and the Natinal Mental Health Wide range f duties including crdinatin, administratin, and versight f prgrams, grants, and the Natinal Mental Health Plicy Labratry, reprting requirements, versight f data etc. Plicy Labratry, reprting requirements, versight f data etc. 1

2 Grants [including AOT grants] Title II Grants Title II Grant Refrm and Restructuring 201 pp Establishes a Natinal Mental Health Plicy Labratry w/in the ffice f the Assistant Secretary. Directr f NMHPL will identify and crdinate trends and plicy changes; cllect data frm grantees evaluate & disseminate EBPs and service delivery mdels; and set standards fr grants/grantees 201 pp Establishes a Natinal Mental Health Plicy Labratry w/in the ffice f the Assistant Secretary. Directr f NMHPL will identify and crdinate trends and plicy changes; cllect data frm grantees evaluate & disseminate EBPs and service delivery mdels; and set standards fr grants/grantees s pp [includes AOT] 206 (Blck Grant Funding) pp Staff at NMHPL shuld include physicians with a backgrund in psychiatry; dctral degrees in scial wrk r psychlgy; prfessinals with experience in research and methdlgy; and experts in substance use disrders Every 2 years the Directr f NMHPL must reprt t the Assistant Secretary data n the effectiveness f grant prgrams Establishes a system f innvatin grants fr prmising practices that culd benefit frm further research & testing Establishes a system f demnstratin grants t be awarded t expand r replicate EBPs that fcus screening, early diagnsis and interventin, and treatment f serius mental illness Establishes a series f grants that wuld prvide fr earlychildhd interventin prgrams that are based n prmising EBPs Extends system f AOT grants fr peple with SMI by changing the language in the existing regulatin frm 4 years t 6 years (thrugh 2020) and apprpriates mre funding fr this perid Renews blck grant funding and increases the amunt that wuld be prvided t states (frm $450,000,000 t $483,000,000) Creates a 5% set aside fr translating EBPs like the RAISE study int systems f care Requires a data cllectin system that wuld require cmprehensive reprting f suicide, incarceratin, emergency hspitalizatins, criminalizatin, hmelessness, emplyment, medicatin nnadherence, s pp (Blck Grant Funding) pp [includes AOT] 20% f the staff at NMHPL shuld have an M.D. r D.O and have graduated frm an accredited psychiatric residency prgram; 20% f the staff shuld have a PhD in psychlgy and understand bilgical, psychscial, and pharmaclgy; 20% f the staff shuld have clinical research experience; 20% f the staff shuld have expertise in research design and methdlgies; at least 20% r 2 (whichever is greater) must be appinted by Cngress Must reprt t Cngress 1 year after enactment and every 2 years thereafter effectiveness f grant prgrams Establishes a system f innvatin grants fr prmising practices that culd benefit frm further research & testing Establishes a system f demnstratin grants t be awarded t expand r replicate EBPs that fcus screening, early diagnsis and interventin, and treatment f serius mental illness Establishes a series f grants that wuld prvide fr earlychildhd interventin prgrams that are based n prmising EBPs Extends system f AOT grants fr peple with SMI by changing the language in the existing regulatin frm 4 years t 6 years (thrugh 2020) and apprpriates mre funding fr this perid Renews blck grant funding and increases the amunt that wuld be prvided t states (frm $450,000,000 t $483,000,000) Creates a 5% set aside fr translating EBPs like the RAISE r the Nrth American Prdme studies int systems f care Requires a data cllectin system that wuld require cmprehensive reprting f suicide, incarceratin, emergency hspitalizatins, criminalizatin, hmelessness, emplyment, medicatin nnadherence, 2

3 pp educatin & vcatin system drput rates etc. Permits Assistant Secretary t give states a 2 % increase in blck grant funding fr state utcme measures Creates a system f telehealth child psychiatry access grants that wuld prmte cnsultatin b/t pediatric primary care prviders and psychiatrists Prvides liability prtectins fr health care prviders wh vlunteer at cmmunity health centers and cmmunity mental health centers Creates a minrity fellwship prgram designed t increase prviders knwledge abut serving ethnic minrities and prviding culturally cmpetent care Amends the Natinal Health Service Crps t encurage mental health prfessinals t practice in underserved areas Reauthrizes Mental and Behaviral Health Educatin Training Grant t supprt recruitment f educatin and clinical experience f students in the mental health field Creates a natinal suicide lifeline preventin prgram (als requires cnsultatin with secretary f Veterans Affairs s veterans calling have access t a specialized veterans suicide htline) pp educatin & vcatin system drput rates etc. Permits Assistant Secretary t give states a 2 % increase in blck grant funding t states that have AOT laws Prvides grants fr training primary care physicians n identifying and treating mental illness, particularly when mental health services are nt therwise available r accessible. Prvides payment fr tele mental health cnsultatins prvided by psychiatrists r psychlgists t primary care physicians in areas in which mental health services are nt easily available r accessible. Prvides liability prtectins fr health care prviders wh vlunteer at cmmunity health centers and cmmunity mental health centers Creates a minrity fellwship prgram designed t increase prviders knwledge abut serving ethnic minrities and prviding culturally cmpetent care Amends the Natinal Health Service Crps t encurage mental health prfessinals t practice in underserved areas Includes crisis interventin grants fr plice fficers and first respnders Authrizes grants t help imprve child recvery frm trauma Authrizes grants t reduce the stigma f serius mental illness Reauthrizes the Garrett Lee Smith Act Authrizes grants t institutins f higher educatin t enhance services fr students with mental health r substance use disrders and t develp best practices fr the delivery f these services Creates a natinal suicide lifeline preventin prgram (als requires cnsultatin with secretary f Veterans Affairs s veterans calling have access t a specialized veterans suicide htline) 3

4 Integratin Title III Integratin N equivalent title Lcatin Actin N/A N/A 301 pp Creates a grant prgram t enhance integratin between primary and behaviral health care Interagency Serius Mental Health Crdinating Cmmittee Title IV Interagency Serius Mental Health Crdinating Cmmittee Title III Interagency Serius Mental Health Crdinating Cmmittee 401 pp Establishes a cmmittee t assist Assistant Secretary that willamng ther things develp a strategic plan fr cnducting and supprting prgrams t peple with SMI and present the strategic plan t Cngress 301 pp Establishes a cmmittee t assist Assistant Secretary that willamng ther things develp a strategic plan fr cnducting and supprting prgrams t peple with SMI and present the strategic plan t Cngress Membership shall include N mre than 9 federal reps including: Assistant Secretary fr Mental Health and SUD; Attrney General (r designee); Directr f CDC (r designee); Directr f NIH (r designee); Interagency Cuncil n Hmelessness; and representatives appinted by the Assistant Secretary frm several ther agencies 14 nn federal public members shall be drawn frm a range f perspectives including individuals in recvery, family members, expert practitiners; peer specialists; legal experts and crrectins fficers 4 members which will be appinted by majrity and minrity leaders f Huse/Senate Membership shall include Federal reps including: Assistant Secretary fr Mental Health and SUD; Attrney General (r designee); Directr f CDC (r designee); Directr f NIH (r designee); Interagency Cuncil n Hmelessness; and representatives appinted by the Assistant Secretary frm several ther agencies 14 nn federal public members (r 1/3) shall be drawn frm a range f perspectives including individuals in recvery, family members, expert practitiners; peer specialists; legal experts and crrectins fficers 4 members which will be appinted by majrity and minrity leaders f Huse/Senate) 4

5 HIPAA & FERPA Title V HIPAA Title IV HIPAA and FERPA Caregivers Findings nte: Lack f understanding by health prfessinals has been a barrier t family members assisting with treatment. Als ntes, PAD shuld be encuraged In applying HIPAA t help health prfessinals t determine best interests f the persn Secretary f HHS must cnsider: 1) timely interventin fr treatment; 2) safe and stable husing; 3) increased daily living skills that allw peple t live in the cmmunity and 4) capacity f caregivers t supprt persn living in cmmunity Secretary f HHS must develp mdel training materials and prgrams n HIPAA fr: 1) health care prviders; 2) lawyers; and 3) peple receiving mental health care & their families Cntents f this training must address guidance issued by HHS n HIPAA Privacy Rule and Sharing Infrmatin Related t Mental Health prduced in Feb. f Amends 42 USC Part 2 (substance use cnfidentiality) t permit 401 Pages N/A Creates an ptin fr physicians r licensed mental health care prviders t share limited health care infrmatin with a caregiver if certain cnditins are met: Disclsure is limited t diagnsis, treatment plan, appintment scheduling, medicatins & medicatin instructins [EXCEPTION: Psychtherapy Ntes] Disclsure Is necessary health, safety, welfare f the persn r the general public Disclsure f infrmatin will be helpful in the treatment f a c ccurring medical cnditin Disclsure is necessary fr the cntinuity f treatment f the medical cnditin r mental illness Absence f inf wuld cntribute t the wrsening f the medical cnditin r mental illness Persn has diminished capacity t understand r fllw treatment plan r wuld becme gravely disable if inf nt disclsed Caregiver defined as: 1) an immediate family member; 2) persnal representative within the laws f the state; 3) can shw lngstanding invlvement and respnsibility fr the healthcare f the persn with SMI; 4) but EXCLUDES a persn with a histry f abuse Individual w/ SMI defined as: a persn ver the age f 18 wh has been evaluated, treated, r diagnsed with an emtinal r mental health cnditin that meets the diagnstic criteria f the DSM and results in a functinal impairment r that substantially interferes w/ ne r mre majr life activities. N equivalent prvisin 5

6 a streamlined cnsent prcess fr the interchange f electrnic health infrmatin between ACOs, health care exchanges, health hmes, and ther integrated care settings. Includes a nndiscriminatin prvisin N/A N equivalent prvisin Sec. 402 Pages (FERPA Authrizes disclsure f a student s educatin recrd (which includes health recrds) t a caregiver withut cnsent f the student t a caregiver if a health prfessinal believes such disclsure is necessary t prtect the health, safety, r welfare f an individual with a serius mental illness. Medicare and Medicaid Refrm Title VI Medicare and Medicaid Refrms Title V Medicare and Medicaid Refrms Authrizes same day billing fr mental health and physical health treatment in Medicaid. (Current law prhibits same day Authrizes same day billing fr mental health and physical health treatment in Medicaid. (Current law prhibits same day billing) billing) Permits Medicaid payments t acute psychiatric treatment pp Permits Medicaid payments t acute psychiatric treatment facilities, including state hspitals, where the average stay is less than 20 days fr individuals with mental illness between ages 21 pp facilities, including state hspitals, where the average stay is less than 30 days fr individuals with mental illness between ages 21 and 65. and 65. Permits Medicaid payments fr psychiatric residential facilities Includes a n increased spending clause n p. 91 that indicates fr individuals between ages 21 and 65. these prvisins wuld be allwed nly if it des nt result in increased spending There is a n increased spending clause n p. 127 that indicates these prvisins wuld be allwed nly if it des nt result in Mdifies Medicare discharge planning requirements t assure increased spending. smth transitin t a pst hspital setting. Cdifies psychiatric medicatins as a prtected class f medicatins in Medicare Part D and Medicaid. Eliminates the 190 day limit n hspital stays under Medicare Mdifies Medicare discharge planning requirements t assure smth transitin t a pst hspital setting Research by NIMH Title VII Research by NIMH Title VI Research by NIMH 701 pp Increases funding fr the Brain Initiative Research at NIMH 601 pp Increases funding fr the Brain Initiative Research at NIMH 6

7 Behaviral Health Infrmatin Technlgy N Equivalent Title Title VII Behaviral Health Infrmatin Technlgy N/A N/A Lcatin Actin pp Expand eligibility fr payments in Medicaid and Medicare t imprve the utilizatin f HIT systems in mental health and substance use treatment SAMHSA Reauthrizatin and Refrm Title VIII SAMHSA Reauthrizatin and Refrms Title VIII SAMHSA Reauthrizatin and Refrms At least ½ f the Peer Review grup shall have a medical degree a dctral degree in psychlgy r an advanced degree in nursing r scial wrk and must specialize in mental health pp. 162 psychlgy and clinical experience pp At least ½ f the members f advisry cuncil must have a medical degree, dctral degree in psychlgy r an advanced degree in nursing r scial wrk with a specialty in mental health. Must include ne member frm NIMH and related federal agency Reauthrizes grants fr Jail Diversin Prgrams Reauthrizes Prjects fr Assistance in Transitin frm Hmelessness Reauthrizes Cmprehensive Cmmunity Mental Health Services fr Children with SED Reauthrizes Pririty Mental Health Needs f Reginal and Natinal Significance N equivalent prvisin PAIMI Title VIII, s pp At least ½ f the members f the peer review grup shall have a medical degree r a crrespnding dctral degree in 60 days befre awarding a grant, cntract r cperative agreement, the Assistant Secretary must ntify Huse Cmmittee n Energy and Cmmerce and the HELP Cmmittee f the Senate At least ½ f the members f advisry cuncil must be mental health care prviders with experience in research and treatment. Must include ne member frm NIMH and related federal agency. Appinted members may nt have been a grant recipient r be related t a grant recipient Grants must be based n scientific cntrls and standards Prhibits PAIMI agencies frm cunseling individuals wh lack insight int their cnditin n refusing medical treatment r acting against the wishes f their caregiver. Prhibits PAIMI prgrams receiving federal funding frm lbbying. PAIMI activities shall be exclusively fcused n safeguarding the rights f individuals with mental illness t be free frm abuse and neglect. PAIMI s yearly reprts must be made publicly available.

8 Mental Health Parity Title IX Mental Health Parity Title IX Reprting pp pp Requires the Assistant Secretary t reprt t Cngress hw well cvered grup health plans, including Medicaid are cmplying with MHPAEA. Reprt shuld include infrmatin n hw NQTLs cmply with the law, hw well federal agencies have cmplied with the law, and hw prper enfrcement frm agencies at the federal and state level can ensure cmpliance. Includes a sectin n disclsure requirements and infrmatin n hw t strengthen mental health parity cmpliance PAIMI must include in this reprt accunting infrmatin n the surces f funding (state/federal/private) and hw such funding was spent. Requires the Assistant Secretary fr mental health establish a grievance prcedure fr affected individuals abut the types f claims adjudicated (see ntes). Requires PAIMI t ensure that individuals with serius mental illness have access t EBP treatment prgrams. Requires the Assistant Secretary t reprt t Cngress hw well cvered grup health plans, including Medicaid are cmplying with MHPAEA. Reprt shuld include infrmatin n hw NQTLs cmply with the law, hw well federal agencies have cmplied with the law, and hw prper enfrcement frm agencies at the federal and state level can ensure cmpliance. 8