U.S. Treasury Secretary Timothy Geithner (Bloomberg News/Landov)

Political observers in Washington this week felt a sense of déjà vu in the wake of comments by House Speaker John Boehner (R-OH) about the national debt. One year ago, in May of 2011, Congress was hotly debating whether to raise the debt ceiling, with Republicans insisting that any increase to the national debt be fully paid for with spending cuts, while Democrats sought an approach that mixed cuts with revenue increases. The parties eventually agreed on a compromise (the Budget Control Act), which raised the debt ceiling limit but also laid out a schedule of spending caps for the next 10 years and set in motion a special committee process whose failure ultimately triggered $1.2 billion in automatic spending cuts to begin in 2013.

Fast forward one year, to Treasury Secretary Timothy Geithner’s recent announcement that the U.S. will once again reach its borrowing limit near the end of 2012 – and Speaker Boehner’s response on Tuesday that any increase in the debt ceiling must be fully matched with “real spending cuts and reforms.” Democrats, in turn, instantly revived last year’s critiques that the fiscal hawks in Boehner’s caucus were holding the global economy hostage to their cost-cutting agenda.

The newest round of congressional sparring over the debt limit sheds light on what is likely to be a particularly complicated season for national fiscal policy. The end of 2012 marks not only the point at which the U.S. will once again reach its borrowing limit, but also the expiration of the Bush tax cuts and the launch of the automatic spending cuts outlined under the Budget Control Act. And the political pressures of the upcoming elections will only make resolving this trio of fiscal issues more difficult. Many experts say a comprehensive deal is unlikely until after the November elections. Nonetheless, Boehner announced on Tuesday that the House would vote before the elections on legislation to extend the Bush tax cuts and put in place a process for expedited passage of a broader tax overhaul in 2013.

Some lawmakers have said they expect Congress to pass a short-term fix that would give them several months or even a year to strike a long-term deal on deficit reduction, the Bush tax cuts, national tax policy more broadly, and the U.S. debt limit. As Sen. Lamar Alexander (R-TN) noted, “my guess is an extension is almost inevitable.” Yet, the extra breathing room may not help lawmakers reach a compromise if the next Congress remains as ideologically polarized as the current one. In fact, the convergence of these three fiscal issues – which has come about precisely because Congress repeatedly failed to find common ground on longer-term fixes for any of them – highlights the pitfalls of relying on legislative patches and extension bills to solve problems of major national importance.

The National Council will continue to keep you informed about the latest updates on the federal budget, spending cuts, and the debt limit. Please visit our blog to see our past coverage about the threats to healthcare and social services spending in the ongoing debates over the nation’s fiscal course.

The Supreme Court this year held hearings on one of the most historic cases in decades: a challenge by 26 states to the constitutionality of the Affordable Care Act. The Court’s decision will have ramifications far beyond President Obama’s signature healthcare achievement. And with a ruling widely expected to be issued during the last week in June, there’s no better time to visit Washington, DC to get briefed on what it means for the U.S. health system.

At the National Council’s 8^th Annual Public Policy Institute and Hill Day, we’ll be bringing you up-to-the-minute news about the ACA case. Patricia A. Millett of the prestigious DC law firm Akin Gump will present a breakout workshop on June 25 entitled “Supreme Court: Implications of the Affordable Care Act Decision.” The session will cover the four major issues at stake in the case against the ACA, the possible decisions the Court might make on each, and the impact of those decisions on both the ACA and the nation’s healthcare system.

Patricia Millett heads Akin Gump’s Supreme Court practice and co-heads the firm’s national appellate practice. She has argued a total of 31 cases before the U.S. Supreme Court (the most of any woman in history) and approximately 35 in the courts of appeals. She has briefed scores of cases in the Supreme Court and appellate courts across the nation.

Join us at Hill Day to get expert insights from Ms. Millet on the ACA ruling! Click to register and book your hotel room.

You can also read our prior blog coverage on the ACA case by clicking here.

On Wednesday, May 9, 2012, the Department of Health and Human Services (HHS) released proposed language for implementing the Medicaid primary care rate increase under Section 1902(a)(13) of the Affordable Care Act (ACA). The purpose of the provision is to encourage physicians to participate in Medicaid, and thereby promote access to primary care services for current and new Medicaid beneficiaries to be served via coverage expansion in 2014. The proposed rule is intended to provide states with appropriate direction for implementing this provision within both managed care and fee-for-service delivery systems.

This fact sheet prepared by the Center for Health Care Strategies (CHCS) provides an initial overview of HHS’ planned regulatory approach and briefly outlines next steps for states. It was developed through Leveraging the Medicaid Primary Care Rate Increase, a national initiative made possible by The Commonwealth Fund, with additional support from the New York State Health Foundation. Look for further analyses and tools from CHCS in the future to help states and other Medicaid stakeholders prepare for the rate increase

Read the Fact Sheet.

Infosys Public Services surveyed health plans and provider organizations about their thoughts on key imperatives for health reform readiness in 2012. The results are displayed in this infographic (click to enlarge) – or, in this pdf summary.

As states continue to grapple with the effects of the recession, many have been forced to cut services. This documentary from Milestone in Pittsburgh, Pennsylvania, details the impact of transit cuts on people with disabilities. It shares the story of a group of individuals with mental illnesses and/or intellectual/developmental disabilities, and their fight to preserve their independent way of life.

The Honorable Gordon H. Smith

Have you ever felt that political polarization in Congress makes it hard to get your message through? If you have, you’re not alone.

This year at the National Council’s Public Policy Institute and Hill Day, we are pleased to welcome the Honorable Gordon H. Smith as one of our keynote speakers. Senator Smith will tackle the question of how to work across party lines to raise the profile of mental health and addiction issues in Congress.

Senator Smith, a Republican from Oregon, served in the U.S. Senate from 1997-2009. During his time in office, he continually demonstrated his commitment to protecting our nation’s health care safety net by working with his Republican and Democratic colleagues to save and improve the Medicaid and SCHIP programs. He was also instrumental in enacting the 2008 Paul Wellstone-Pete Domenici Mental Health Parity and Addictions Equity Act, which prohibits the discriminatory treatment of mental health and addictions benefits in health insurance plans.

Senator Smith’s personal leadership was also critical in securing the passage of the Garrett Lee Smith Memorial Act, which is named in memory of his son.  Throughout his tenure in the Senate, he was a constant and vocal advocate for helping states and communities develop the infrastructure needed to help prevent suicide. Senator Smith is President of the National Association of Broadcasters.

Working together, advocates can raise Congress’ awareness of our nation’s mental health and addiction treatment needs. And together, we can win bipartisan support for policies that support a strong behavioral health safety net.

Don’t miss this opportunity to hear Senator Smith’s insights on charting a path forward! Click to register for Hill Day and book your hotel room.

House Speaker John Boehner (R-OH) and Senate Majority Leader Harry Reid (D-NV)

Today, the House approved legislation that would cut $315 billion from social programs in 2013. The legislation is House Republicans’ response to the $72 billion in cuts that are slated to go into effect in January 2013 under the terms of the Budget Control Act of 2011. That law tasked a special committee with reducing the deficit by $1.2 trillion – and upon its failure, triggered automatic cuts of the same amount spread out over the next ten years, split evenly between domestic and defense programs.

However, the GOP plan goes well beyond the cuts required by the BCA. It restores the $72 billion that would be cut in 2013 and then identifies $315 in new cuts elsewhere in the budget. A primary target for these new cuts is the Supplemental Nutrition Assistance Program (also known as food stamps), which would see a $38.5 billion reduction from tightening eligibility rules and returning benefits to pre-2009 levels. The bill also repeals the Social Services Block Grant, which is used to fund a wide variety of social support and human services programs around the country, including some programs that provide mental health services. Additional savings would come from requiring federal workers to pay more for their defined benefit pensions and capping damages and limiting attorney fees in medical malpractice lawsuits.

The bill also repeals portions of the Affordable Care Act, including the Prevention and Public Health Fund, federal funding for the development of State Health Insurance Exchanges, and the Maintenance of Effort provisions that prevent states from restricting Medicaid eligibility below 2010 levels.

Democrats have stated that they would also like to see the automatic cuts repealed – yet, they favor what they call a “balanced approach” that combines spending cuts with revenue-generating provisions such as raising taxes on high-income earners or closing corporate tax loopholes. The House Republican plan is essentially dead on arrival in the Senate. Yet, by staking out a position now that achieves far more in savings than what is necessary to replace the 2013 automatic cuts, this bill stakes out fiscal conservatives’ ground for the eventual negotiations that will occur with Senate Democrats.

Assistant Secretary Phyllis Borzi, Head of EBSA

The Department of Labor’s Employee Benefits Security Administration (EBSA) has posted a set of frequently asked questions and answers on implementation of the Mental Health Parity and Addiction Equity Act of 2008.

The FAQs address a variety of topics, including:

• It is permissible for a health plan to define mental health coverage as consisting solely of inpatient care benefits?
• Does my health plan violate MHPAEA because it uses a separate managed behavioral health organization to provide utilization review and other services with respect to mental health and/or substance abuse benefits (sometimes called a carve-out arrangement)?
• How does MHPAEA interact with State mandates?

The FAQs clarify that if a plan covers mental health or substance use disorder benefits in one of the six coverage classifications under MHPAEA, the plan must provide coverage in all of the classifications in which medical/surgical benefits are available. A plan that provides medical/surgical benefits on an outpatient basis may not limit mental health or substance use disorder benefits to inpatient care only.

Other questions dealt with who oversees implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA); how the law interacts with state mandates; which plans are exempt from MHPAEA; and what DOL, the Treasury Department, and the Department of Health and Human Services are doing to promote compliance with the law.

This week, the Centers for Medicare and Medicaid Services announced the first 26 Health Care Innovation grants that have been awarded, including  to two National Council member organizations, Kitsap Mental Health Services in Kitsap County, Washington and the Center for Health Care Services in San Antonio, Texas.

Made possible by the Affordable Care Act, the awards will support 26 innovative projects nationwide that will save money, deliver high quality medical care and enhance the health care workforce. The preliminary awardees expect to reduce health spending by $254 million over the next 3 years. The new projects include collaborations of leading hospitals, doctors, nurses, pharmacists, technology innovators, community-based organizations, and patients’ advocacy groups, among others, located in urban and rural areas that will begin work this year to address health care issues in local communities.  This initiative allows applicants to come up with their best ideas to test how we can quickly and efficiently improve the quality and affordability of health care.

A number of the innovation projects focus on primary and behavioral health care integration; in this first announcement, these projects include:

• Kitsap Mental Health Services: Kitsap Mental Health Services of Kitsap County, Washington (a National Council member organization), is receiving an award to integrate care for one thousand severely mentally ill or severely emotionally disturbed adults and children, many of them Medicare, Medicaid, and/or CHIP beneficiaries, with at least one co-morbidity.
• Center for Health Care Services: The Center for Health Care Services in San Antonio, Texas (a National Council member organization), is receiving an award to integrate behavioral care and health care for a group approximately 260 homeless adults in San Antonio with severe mental illness or co-occurring mental illness and substance abuse disorders, at risk for chronic physical diseases.
• Courage Center: The Courage Center is a program in Minneapolis-St. Paul serving adults with disabilities and complex medical conditions. The grant will enable Courage Center to save money and improve the quality of care by creating a patient-centered medical home focused on highest-cost Medicaid patients.

Preliminary awardees were chosen for their innovative solutions to the health care challenges facing their communities and for their focus on creating a well-trained health care workforce that is equipped to meet the need for new jobs in the 21st century health system. The Bureau of Labor Statistics projects the health care and social assistance sector will gain the most jobs between now and 2020.

The first batch of awards total $122.6 million. The Center for Medicare and Medicaid Innovation within the Centers for Medicare & Medicaid Services at HHS administers the awards through cooperative agreements over 3 years. More information about the first 26 sites is available online.  The next batch of preliminary awardees will be announced in early June 2012.

HHS Secretary Kathleen Sebelius

The Department of Health and Human Services has released a proposed rule outlining the approach it intends to take in implementing a temporary Medicaid physician payment increase for primary care services.

The pay bump was enacted as part of the Affordable Care Act and is aimed at increasing Medicaid beneficiaries’ access to primary care services by addressing the low rates paid to physicians under the program. For 2013 and 2014, Medicaid payment rates for primary care services furnished by primary care physicians will be raised to equal Medicare payments for those services. The law defines “primary care physicians” as physicians with a primary specialty of family medicine, internal medicine, or pediatrics.

The new proposed rule offers additional guidance on this definition. It would allow all subspecialists within the three specialty designations – including pediatric subspecialists – to be eligible for the increased payments for primary care services. Increased payments are not available to physicians practicing within Federally Qualified Health Centers or Rural Health Clinics. The proposed rule also provides details on how the payment increase will be applied to physicians working in a managed care arrangement.

States will be responsible for implementing the payment increase within the outlines of the HHS guidance. HHS is accepting public comments on the proposed rule for 30 days. The full text of the proposed rule is available here.