Thursday, April 7, 2016

Final rule strengthens access to mental health and substance use disorder benefits for low-income Americans

CMS finalizes mental health and substance use disorder parity rule for Medicaid and CHIP

In conjunction with the President’s visit to the National Rx Drug Abuse and Heroin Summit, the Centers for Medicare & Medicaid Services (CMS) today finalized a rule to strengthen access to mental health and substance use services for people with Medicaid or Children’s Health Insurance Program (CHIP) coverage, aligning with protections already required of private health plans. The Mental Health Parity and Addiction Equity Act of 2008 generally requires that health insurance plans treat mental health and substance use disorder benefits on equal footing as medical and surgical benefits.

“The Affordable Care Act provided one of the largest expansions of mental health and substance use disorder coverage in a generation,” HHS Secretary Sylvia M. Burwell said. “Today’s rule eliminates a barrier to coverage for the millions of Americans who for too long faced a system that treated behavioral health as an unequal priority. It represents a critical step in our effort to ensure that everyone has access to the care they need.

“This rule will also increase access to evidence-based treatment to help more people get the help they need for their recovery and is critical in our comprehensive approach to addressing the serious opioid epidemic facing our nation.”

“The need to strengthen access to mental health and substance use disorder services is clear,” said Vikki Wachino, Deputy Administrator of CMS and Director of the Center for Medicaid and CHIP Services. “This final rule will help states strengthen care delivery and support low-income individuals in accessing the services and treatment they need to be healthy.”

The protections set forth in this final rule will benefit the over 23 million people enrolled in Medicaid managed care organizations (MCOs), Medicaid alternative benefit plans (ABPs), and CHIP. Currently, states have flexibility to provide services through a managed care delivery mechanism using entities other than Medicaid managed care organizations, such as prepaid inpatient health plans or prepaid ambulatory health plans. The final rule maintains state flexibility in this area while guaranteeing that Medicaid enrollees are able to access these important mental health and substance use services in the same manner as medical benefits.

Under the final rule, plans must disclose information on mental health and substance use disorder benefits upon request, including the criteria for determinations of medical necessity. The final rule also requires the state to disclose the reason for any denial of reimbursement or payment for services with respect to mental health and substance use disorder benefits.

This is one of our latest efforts to increase access to and improve mental health services and care for low income individuals, especially in light of the opioid abuse epidemic, which constitute significant health risks and cost drivers in the Medicaid program. We introduced several initiatives to assist states with behavioral health system transformation to better meet the needs of beneficiaries with substance use disorders:
  • In 2014, CMS launched the Innovation Accelerator Program, a new strategic and technical support platform designed to improve delivery systems for beneficiaries that are high need and high cost. Our first effort in this area was to provide states with expert resources, coaching opportunities and individualized technical assistance to accelerate policy, program and payment reforms appropriate for a robust substance use disorder delivery system.
  • In July 2015, CMS issued guidance to states on a new section 1115 demonstration opportunity to develop a full continuum of care for beneficiaries with a substance use disorder, including coverage for short-term residential treatment services not otherwise covered by Medicaid.
  • In response to the growing prescription opioid abuse epidemic, CMS recently released information on effective safeguards and options to help address over-prescribing of opioid pain medications.
  • CMS disseminated important information regarding screening and early intervention services for children and youth who have or may have a mental illness or substance use disorder, including best practice information for the delivery of medication-assisted treatment as well as services and supports that can address first psychiatric episodes to reduce the likelihood of ongoing hospitalizations, involvement with police and courts, and increase the chances of keeping families intact. 

The final rule is currently on display at and will be published in the Federal Register on March 30, 2016.

For more information, go to

Wednesday, February 17, 2016

HB 18 Narrowly passes the Committee, heads to the House floor

A message from our Executive Director 

HB 18 Medicaid Preferred Drug List Amendments (PDL) Update: 

On 02/17/2016, Rep. Ward offered a substitute bill which would remove long acting injectables from consideration on the PDL, meaning, there will be open access to those meds while the rest of the mental health meds will be subject to the PDL and Prior-Authorization process.

The bill passed out of Health and Human Services Committee by a hair. Votes were 5 and 5 until Rep. Chavez-Houck ran into committee to tip the scales. Votes ended in favor 6 to 5 with 1 absent.

I assure you, this is not over. There is a long way for this bill to travel. It now goes to the House Floor. I encourage you all to email and call your representative, encouraging them to VOTE NO on HB18. Should the bill make it's way out of the house, it will go to the Senate Health and Human Services Committee before it can move to the Senate Floor.

Thank you all for following this bill and for talking to your representatives! It is so important that you stay involved and continue to education our legislators. Find out your legislator here 

You who are living with a mental illness, you are my heroes! You who are fighting for your loved one's wellness, you too are my heroes! We are not weak, we are not victims, we are strong, we are fighters, we fight everyday for our well being and will fight anyone or anything standing in our way.

Jamie Justice 

Tuesday, February 9, 2016

HB 18 was held in Committee

House Bill 18 was held in Committee

The House Health and Human Services Committee  listened to people who came to speak in favor of the bill. We are grateful to our Executive Director, Jamie Justice, who is advocating diligently on behalf of NAMI’s community and making sure our voices are being heard. After much deliberation, the Committee decided to hold the bill in the committee until the Commission on Criminal and Juvenile Justice Committee (CCJJ) takes a position on the bill. CCJJ has major concerns about the bill given that there is evidence in other states where this kind of legislation negatively impacts those with serious mental illness and drives up incarceration rates. Results that work directly against CCJJ’s efforts to redirect those who are nonviolent offenders with mental illness away from jails and prison and into treatment.

We also want to thank those who took time off work and away from their families to testify against the bill! There is so much power in telling your stories and educating our law makers about what it’s really like for individuals and families, not what those in power believe are happening.‪#‎mentalhealthUT‬

Defeating this bill will not happen without all of your continued support, efforts, emails, phone calls, and presence! The Health and Human Services Committee will likely hear this bill again this week.
It is not over yet, but yesterday’s outcome was a success! 

We will keep you post it.
You can access the committees’ audio link for today at this link

Monday, February 8, 2016

NAMI Utah Call to Social Media Action - 02.08.2016

NAMI Utah Call to Social Media Action - 02.08.2016

Fiscal Note       2016-2017 FY Utah Budget   NAMI Utah Position on PDL   Open Access

House Bill 18, sponsored by Representative Raymond Ward, would remove the Medicaid Preferred Drug List (PDL) exemption for psychotropic drug classes, placing the most vulnerable among us at risk for possible negative repercussions, including the state’s homeless population.

H.B. 18 Medicaid Preferred Drug List will be heard in the House Health and Human Services Committee today, Monday, Feb. 8, between 3:40 and 6:00 p.m.

To help shine a light on this bill, we encourage you to share the following suggested posts and hashtags in advance of today’s meeting.


#BlockUTHB18 #utleg #mentalhealthmatters #utpol #mentalhealthUT

Suggested Tweets/Instagram Copy

I trust my #UTdoctor, not #UTLeg, to make the best medical decisions for #mentalhealthUT. #BlockUTHB18 #mentalhealthmatters #UTpol 

Don’t limit my ability as a #UTdoctor to prescribe the most effective drugs to my patients. ‪#‎mentalhealthmatters ‪#‎utpol ‪#‎mentalhealthUT ‪#‎BlockUTHB18 #UTLeg

Facebook Posts

H.B. 18 Medicaid Preferred Drug List will be heard in the House Health and Human Services Committee today, Monday, Feb. 8, between 3:40 and 6:00 p.m. Let’s fill the room. ‪#‎mentalhealthmatters ‪#‎utpol ‪#‎mentalhealthUT ‪#‎BlockUTHB18 #UTLeg #mentalhealthmatters

HB18 seeks to restrict access to what a team of fewer than 25 committee members determines to be "too expensive." ‪#‎utleg please listen to the experts on this one.

‪#‎utpol ‪#‎mentalhealthUT ‪#‎BlockUTHB18 #UTLeg #mentalhealthmatters

So many bills fly unnoticed through the Utah Legislature during its warp-speed 45-day session. H.B. 18 has been defeated multiple times, yet still comes up each session. Reach out to your legislator and let them know you do not support trying to save a few dollars on the backs of Utah's most fragile population. They'll only listen if we speak up! ‪#‎utpol ‪#‎mentalhealthUT ‪#‎BlockUTHB18 #UTLeg #mentalhealthmatters