Chuck Ingoglia on Proposed Cuts to Federal Behavioral Health Spending

by Rebecca Farley on February 18, 2011

Welcome to our webchat with guest blogger Chuck Ingoglia, Vice President for Public Policy at the National Council! On Feb. 18, 2011, Chuck took readers’ questions about the federal budget for behavioral health programs.

Although this event has now concluded, the questions and answers will remain on the blog for you to reference at any time. To view updates on this issue that have occurred since the time of this webchat, please click “Federal Budget” on the Browse All Topics page.

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{ 40 comments… read them below or add one }

Mary Meacham February 12, 2011 at 6:10 pm

What are the prospects for reduced enforcement or elimination of the upgraded compliance program requirements for Medicaid providers in the health care reform legislation? And/Or, what are the prospects for the proposed budget cuts shrinking the resources for compliance audits and providers’ risks of penalties ? Of interest are the greater compliance program requirements, the self reporting of non compliance and the whistle blower provisions described by Adam Falk in his webinar sponsored by the National Council in October 2010.

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Chuck Ingoglia February 18, 2011 at 12:02 pm

Mary – I do not think that this will be the case, in fact the Presidents 2012 Budget requests additional funding for Fraud and Abuse. Here are the details:

“Health Care Fraud and Abuse Control (+$269.6 million)
CMS is requesting $580.6 million in discretionary HCFAC funding in FY 2012, an increase of $269.6 million above the FY 2010 enacted level. This additional funding will allow CMS and its law enforcement partners to invest in activities that will reduce fraud in Medicare, Medicaid, and CHIP. This includes investments in state-of-the-art analytic technology to detect and prevent improper payments; measures to reduce the improper payment error rate by 50 percent, including focused pre-payment review, aggressive representation at cases before administrative law judges, staffing to implement corrective actions, and establishing a CMS overpayment vulnerabilities task force; expansions of existing Strike Forces, used to identify and prosecute fraudulent providers, from seven cities to up to 20 cities; enhancements of Medicaid audits; increased provider and supplier site visits; increased fraud hot lines and beneficiary outreach; and implementation of a robust package of program integrity legislative proposals.”

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Karen Rose March 2, 2011 at 9:07 pm

I am very sad to read about the gargantuan “Fraud and Abuse” investigation budget. The therapists where I work spend far too much time obsessing about the quality of their progress note and whether or not the correct words are used, and quality of care suffers. Now there will be even more pressure, and my company will continue talking only about audits and paybacks, not clinical issues. Our caseloads continue to soar, but the amount of services we can provide decline. Clients are bewildered about all of it, and we must pretend all is well, even when therapists are laid off due to lack of funds and their caseloads must be re-distributed. I do thank the people who run this site, however, for providing a place to speak about all of it!

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Christina VanRegenmorter February 15, 2011 at 12:11 pm

What are the implications of these cuts to already funded grant programs? If we were awarded a 5-year grant, are we at risk of losing the 4 other years of funding if the funding program for that grant is zeroed out in the budget?

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Chuck Ingoglia February 18, 2011 at 12:02 pm

Christina – Multi-year grant awards are subject to the availability of funds. In other words, if a program were to lose its appropriation, or if that appropriation were reduced, there is a very possibility that grants could be reduced or canceled. The current debate in Congress on the 2011 Continuing Resolution (CR) does not detail where cuts to SAMHSA would come from.

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Fred Chanteau February 15, 2011 at 1:09 pm

Many states use federal block grants to supoort MH services. In Maryland ,a major allocation has been made for crisis response services. What if any cuts can we expect and how are the feds trying to redirect this money? Thanks.

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Chuck Ingoglia February 18, 2011 at 12:02 pm

Fred – There are two appropriation/budget processes happening simultaneously. We are currently in Federal Fiscal Year 2011 and the House of Representatives is debating a bill known as a Continuing Resolution that would fund the government until the end of September. All we know if that the House is asking for $214 Million in cuts to the SAMHSA budget – there is no description of where that money would come from – e.g., Block Grants of discretionary grants.
The President’s 2012 Budget Request includes small increases for both the MH and SU block grants.

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Terrie L. Ward February 18, 2011 at 9:15 am

Our company provides mental health services in 3 counties, with services anywhere from medication management to In-patient treatment to residential housing. I do not understand where these folks are to go for help if our budget is cut any more? Are not the jails, State Hospitals etc. already over run and also facing budget cuts? Have the people making the decision to cut this budget so deeply ever actually “been” around a mental health facility? Have they actually “seen” what these facilities do? All of our clients “want” help. They not only hope for, but are trying to achieve a level where they can transition back into normal society. Without facilities like ours, that will never happen. And I’m sorry, but who has the right to say they are not worth the budget to help them make a positive difference in their lives? To try to help turn their lives around. I personally don’t consider myself any better, but by the Grace of God, just very lucky. I read an article the other day where President Obama made a comment about how our mental mealth system being broken which results into tragdy’s happening, so this is how you fix it? These people have just as many rights as the people who are lucky enough to not be in the same situation. If you want to “fix” the mental health industry, it seems pretty obvious. Stop cutting the budget to the point where there are no resourses available to begin to fix it. Thank you for listening.

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Chuck Ingoglia February 18, 2011 at 12:03 pm

Terrie – I am a big fan of the adage that “seeing is believing” and would therefore encourage you to invite your member of Congress to visit your location, to meet some of the consumers that you serve and to get a sense of the programs that you offer. Cutting “SAMHSA” involves a faceless federal agency, but cutting services to constituents in your community is something different. We have some resources on our web page to help you with this – especially http://www.thenationalcouncil.org/galleries/policy-file/Template%20Request%20a%20August%20Meeting%20Letter.doc

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Alex Dunn February 18, 2011 at 11:33 am

I have a question about programs that are going to maintain steady funding in the next year. If the funding level is not going to increase, does that mean that funds will just go to sustaining current grantees and that no new grants in that program will be awarded ?

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Chuck Ingoglia February 18, 2011 at 12:04 pm

Alex – When programs are level funded it usually means that current grants will continue. Since grants are for a defined period of time, there are always some that come to an end on their own. So even in a level funding environment, there is the possibility that funds become available as the result of a grant ending and that new grant announcements (RFAs) could be released.

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Yoshi Pinnaduwa February 18, 2011 at 11:43 am

One of the advocay emails from the APA mentioned a $6 million cut to treatment for mentally ill persons who are incarcerated. Do you have any more information about these cuts and how it will impact services in states and localities?

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Yoshi Pinnaduwa February 18, 2011 at 11:45 am

How will the proposed cuts to SAMHSA be distributed among states and localities?

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Chuck Ingoglia February 18, 2011 at 12:11 pm

Unfortunately, we don’t know at this point how the cuts for Fiscal Year 2011 will be distributed among states, localities, or programs. All we know if that the House is asking for $214 Million in cuts to the SAMHSA budget – there is no description of where that money would come from. If the House approves these cuts, the
Senate would still have to debate them and could modify the bill to mitigate these reductions.

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John North February 18, 2011 at 11:50 am

I have heard that SAMHSA may change the way the Substance Abuse block grant may be used. Michigan currently uses a substantial share for direct treatment services. Will SAMHSA continue to allow this practice?

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Chuck Ingoglia February 18, 2011 at 12:30 pm

John – There are no changes to the Substance Abuse Treatment Block grant included in the President’s 2012 Budget Request. The monies previously included for the Prevention set aside have been transferred to a new prevention grant program that will go to states.

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Kate Smith February 18, 2011 at 12:05 pm

1. In FY 2014, ACA intends to fund substance abuse will support services that have been prior funded through Block Grants. In SAMHSA’s proposed Substance Abuse Block Grant changes, how likely is it that both alcohol abuse and illicit drug abuse can be funded and supported through ACA?
2. 20% of the Substance Abuse Prevention and Treatment Block Grant funds are proposed to be reallocated to the New Substance Abuse – State Prevention Grants. Could this planed change of the Substance Abuse – State Prevention Grants funds include mental health prevention initiatives, and/or co-occurring substance abuse and mental health prevention initiatives?

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Chuck Ingoglia February 18, 2011 at 12:09 pm

Katie – It looks like SAMHSA is proposing the creation of 4 new prevention programs. The monies that have up until now been included in the SAPT Block Grant will continue to be used for SU prevention. Then there is a new MH State Prevention Grant, a new Tribal Prevention Grant that focuses on SU, and a new program called Prevention Prepared Communities.

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Chuck Ingoglia February 18, 2011 at 12:10 pm

Expanded coverage that will occur in 2014 should pay for SU Treatment. I agree that the Prevention dollars through SAMHSA will continue to be very important.

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Clarice McClure February 18, 2011 at 12:10 pm

We have a Case Management Program that is funded by Medicaid billing. Is it possible that if funding goes to Managed Care Medicaid we will not be funded? Managed Care, at this point, will not fund case management services. Will the carve out remain so that our Case Management Program can be paid by some form of Medicaid?

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Chuck Ingoglia February 18, 2011 at 12:16 pm

Clarice – In order to move to managed care, your state will have to file a waiver request with the federal government and then issue an RFP for interested companies to respond to. Both of these documents would include descriptions of the services to be offered – and there may even be a public review/comment period available. Many managed care arrangements pay for case managment.

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Larry Green Jr February 18, 2011 at 12:14 pm

Chuck, with many states rolling back benefits and or trying to reduce overall eligibility for mental health and substance abuse services, has there been any further discussion in Washington about FQBHCs to keep our state systems from being torn completely apart? Thanks…Larry

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Chuck Ingoglia February 18, 2011 at 12:29 pm

Larry – We are currently working to have the “FQBHC” legislation re-introduced in the House and Senate – and for the very reasons that you mention. We know that state budget cuts are causing much pain and suffering and we need to be able to protect the addiction and mental health safety-net.

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Eric Brody February 18, 2011 at 12:19 pm

What if any impact is the budget having on the offering of SAMHSA grant opportunities this year (for projects starting October 1, 2011)? There have been few announcements thus far this year in comparison with prior years.

What impact do you anticipate for next year?

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Chuck Ingoglia February 18, 2011 at 12:24 pm

Eric – The way this is supposed to work is that Congress should pass appropriation bills in October to fund the Federal government for the coming fiscal year. That did not happen and so the government is curently being funded on a continuing resolution – meaning that the government is funded at the same level as the previous fiscal year (2010) and that the government cannot start anything new.

Since grants have a natural lifespan, you expect some churning – grants come to a natural end and then monies are available for new grant opportunities. That is why you may see a few grant announcements coming out, but not too many.

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Yoshi Pinnaduwa February 18, 2011 at 12:21 pm

Sorry, you mayve missed this post since I had two, but an email from the APA mentioned a $6 million cut to treatment for mentally ill persons who are incarcerated. Do you have any more information about these cuts and how it will impact services in states and localities?

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Chuck Ingoglia February 18, 2011 at 12:25 pm

Yoshi – I am not familiar with this cut = please send us the email that you received from the APA and we are happy to investigate – chucki@thenationalcouncil.org

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Alex Dunn February 18, 2011 at 12:27 pm

Along with Eric’s question, do you expect more grants to be released from SAMHSA later this grant season? Do you expect them to be released all at once or will RFAs just continue to come out later into the summer instead of slowing down mid-June? Thanks!

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Chuck Ingoglia February 18, 2011 at 12:30 pm

Alex – It is unclear how the current CR debate will be resolved, what the level of cuts will be for SAMHSA, and how much discretion that will have in implementing these cuts. I could forsee a scenario in which SAMHSA chooses not to release RFAs as opposed to cutting current grantees – but this is all conjecture at this point…

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Laura Osburn February 18, 2011 at 12:30 pm

What might the impact of cuts be on mental health and addiction services for children and families?

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Chuck Ingoglia February 18, 2011 at 12:36 pm

Laura – In the absence of any details from the House leadership regarding the 2011 cuts, it is difficult to know exactly what programs at SAMHSA will endure a cut. There are many programs that provide important services to children and families. I should note that the President’s 2012 Budget proposal it does not look as if any programs serving children and youth are proposed to be cut.

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Paula Kelson February 18, 2011 at 12:34 pm

Who are the primary champions of mental health and substance abuse services in the Senate? Who are the greater detractors?

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Chuck Ingoglia February 18, 2011 at 12:39 pm

Paula – we are lucky to have a few champions in the Senate – including Senators Franken, Durbin, Kerry, Stabenow, Reed, Bingaman, Menendez, Murkowski, Snowe, Collins and others. There are not any great detractors, but the political pressure to cut the deficit and the fact that many of these Senators will be running for re-election in 2012 means that the Senate will accept some level of cuts proposed by the House.

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Kate Smith February 18, 2011 at 12:41 pm

In your opinion, is there Congressional support for the SAPT Block Grant change regarding redirection of funds for the New Substance Abuse – State Prevention Grants? And does a mixed targeted group in the New Prevention Prepared Communities have bi-partisan support?

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Chuck Ingoglia February 18, 2011 at 12:43 pm

Kate – Since the budget was just released this week and most folks are paying attention to the House and the 2011 process, I would suggest that it is too early to tell about level of support is for these proposals.

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Chuck Ingoglia February 18, 2011 at 12:55 pm

Thank you for visiting the Natonal Council’s blog today. We will continue to monitor questions and to provide answers.

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Blossom Fonoimoana February 18, 2011 at 12:59 pm

Chuck and respondents,
I totally am informed by the comments and questions the respondents have sent and been answered. Many of these questions were ones I also had regarding getting more info about changes. I will keep you as a resource should I have more questions in the future.
with pleasure,
Dr. Blossom Fonoimoana

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Cindy Fagan February 18, 2011 at 2:07 pm

I wasn’t able to join the web chat, but agree with Dr. Fonoimoana that the questions and replies are very informative. I look forward to hearing more- particularly about the reintroducation of the FQBHC concept. thanks, Chuck et al…

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Rebecca Farley February 22, 2011 at 9:23 am

Thank you to all of our readers who attended Friday’s webchat. The House on Feb. 19 voted to approve a 2011 continuing budget resolution (CR) that included over $200 million in cuts to SAMHSA. The CR has now moved to the Senate, where debate over the proposed cuts is sure to be intense.

There is still time to reach out to your legislators about the importance of fully funding the behavioral health safety net. Please visit http://capwiz.com/thenationalcouncil/home/ today to write an email to your Members of Congress opposing these cuts to SAMHSA and other important programs.

- Rebecca Farley, Policy Associate, National Council

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Ophelia April 25, 2013 at 2:07 pm

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