Cynthia Persily, PhD, RN, FAAN
Dr. Persily is the CEO of Highland Hospital in Charleston, WV
There is cause for celebration this week on the federal front as related to mental health and substance use care. On December 7, 2016, the U.S. Senate passed overwhelmingly (94-5) mental health reforms and funding to address the opiate crisis as part of the 21st Century Cures Act. The House passed the Cures Act earlier (392-26), and President Obama will sign the legislation into law.
This is extremely important legislation to address issues that are impacting West Virginians, and those who the Highland Companies serve. We thank our federal delegation for their support of this Act, and their leadership in moving it through the legislative process and getting it to the President’s desk.
What are some of the key components of the legislation? First, the legislation provides $1 billion over 2 years for grants to states to supplement opioid abuse prevention and treatment activities, such as improving prescription drug monitoring programs, implementing prevention activities, training for healthcare providers, and expanding access to opioid treatment programs. Importantly, the legislation ensures accountability without increasing burden on states.
Next, the 21st Century Cures Act requires the CMS Administrator to send a letter to State Medicaid Directors regarding opportunities to design innovative service delivery systems, including systems for providing community-based services, for adults with a serious mental illness or children with a serious emotional disturbance who are receiving medical assistance under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.). West Virginia has already gone through the process of designing these systems, and has applied for the 1115 waiver that this part of the legislation addresses. We hope that this renewed interest in these waivers allows approval of the waiver by CMS and subsequent introduction of these innovative delivery systems in West Virginia.
Finally, while the legislation doesn’t include a full repeal of the Institution for Mental Disease (IMD) exclusion for short-term psychiatric hospital care for Medicaid beneficiaries that impacts Highland Hospital’s ability to provide services to adults with Medicaid significantly, it does direct the Health and Human Services Secretary to conduct a study and report on the provision of care to adults aged 21 to 65 enrolled in Medicaid managed care plans receiving treatment for a mental health disorder in an IMD like Highland Hospital. The report is due within three years and must include information on the number of individuals receiving treatment in IMDs, their lengths of stay, and how Medicaid managed care plans determine when to provide services in an IMD in lieu of other benefits, such as community-based mental health services. While we would have liked to see a full repeal of this exclusion that in our state causes many adults to have to wait for inpatient psychiatric treatment because of the lack of beds when the IMDs like Highland Hospital are excluded, this may be a step in the right direction. We will watch this carefully, and continue to work with our partners on a full repeal.
As always, we will continue to advocate for mental health and substance abuse services, and we will continue to provide the best care possible to our patients and our communities. This legislation promises to make our work just a little bit easier!