HR 2369

HR 2369 IH

To improve mental and substance use health care.

May 12, 2009

Mr. KENNEDY (for himself and Mrs. BONO MACK) introduced the following bill; which was referred to the Committee on Energy and Commerce

To improve mental and substance use health care.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS; FINDINGS.

(a) Short Title- This Act may be cited as the ‘Improving the Quality of Mental and Substance Use Health Care Act of 2009’.

(b) Table of Contents- The table of contents of this Act is as follows:

Sec. 1. Short title; table of contents; findings.

Sec. 2. Evidence-based mental and substance use health care.

Sec. 3. Improved coordination of care.

Sec. 4. Information technology for mental health and substance use health care providers.

Sec. 5. Council on the Mental Health and Substance Use Health Care Workforce.

Sec. 6. Funding of research through national centers of excellence.

Sec. 7. Patient-centered care.

Sec. 8. Uniform methodologies for reimbursing behavioral health claims.

Sec. 9. Study on use of public mental health and addiction services by individuals with private health coverage.

Sec. 10. High-quality mental health and substance use health care Medicaid demonstration project.

Sec. 11. Medicaid requirement for State repeal of laws denying health benefits coverage based on intoxication.

(c) Findings- The Congress finds the following:

(1) In its study, ‘Improving the Quality of Health Care for Mental and Substance-Use Conditions’, the Institute of Medicine found that each year, more than 33,000,000 Americans use health care services for their mental problems and illnesses, and for conditions resulting from their use of alcohol, inappropriate use of prescription medications, or, less often, illegal drugs. In the United States, mental and substance use illnesses (which often occur together) are the leading cause of death and disability for women, the highest for men ages 15 to 44, and the second highest for all men.

(2) Effective treatments for these medical illnesses exist, but multiple barriers prevent many from receiving them. The consequences of these barriers are serious for these individuals and their families, for their employers and the workforce, for the Nation’s economy, and for the Nation’s education, welfare, and justice systems. The Institute of Medicine further found that a comprehensive approach is needed to remedy this issue that addresses the distinguishing characteristics of mental and substance use health care in the United States.

(3) The Institute of Medicine recommended a multifaceted and comprehensive strategy to improve the quality of mental and substance use health care in the United States and thereby ensure that--

(A) individual patient preferences, needs, and values prevail in the face of residual stigma, discrimination, and coercion into treatment;

(B) the necessary infrastructure exists to produce scientific evidence more quickly and promote its application in patient care;

(C) multiple providers’ care of the same patient is coordinated;

(D) emerging information technology related to health care benefits people with mental or substance use problems and illnesses;

(E) the health care workforce has the education, training, and capacity to deliver high-quality care for mental and substance use conditions; and

(F) government programs, employers, and other group purchasers of health care for mental and substance use conditions use their dollars in ways that support the delivery of high-quality care.

(4) To implement this strategy, the Institute of Medicine noted that action is needed from many health care leaders, including the Congress.

SEC. 2. EVIDENCE-BASED MENTAL AND SUBSTANCE USE HEALTH CARE.

(a) Commission for Evidence-Based Mental and Substance Use Health Care-

(1) ESTABLISHMENT- The Secretary of Health and Human Services (in this Act referred to as the ‘Secretary’) shall establish a Commission for Evidence-Based Mental and Substance Use Health Care (in this section referred to as the ‘Commission’) to strengthen, coordinate, and consolidate the synthesis and dissemination of evidence on effective mental and substance use treatments and services.

(2) DUTIES- For the purposes described in paragraph (1), the Commission shall, on an ongoing basis--

(A) identify, describe, and categorize the available evidence-based preventive, diagnostic, and therapeutic interventions (including screening, diagnostic, and symptom-monitoring tools), including interventions for various age and ethnic groups;

(B) recommend procedure and payment codes and definitions for such evidence-based interventions and tools for their use in administrative datasets under part C of title XI of the Social Security Act and recommend standards for health data collection relating to such interventions;

(C) identify on an annual basis priority areas for research on--

(i) the development of new evidence-based preventive, diagnostic, and therapeutic interventions;

(ii) comparative effectiveness and cost effectiveness of existing interventions and new evidence-based interventions; and

(iii) how best to translate new evidence-based findings into practice in community-based clinical settings;

(D) recommend to the Director of the National Institute of Mental Health, the Director of the National Institute on Drug Abuse, the Director of the National Institute on Alcohol Abuse and Alcoholism, and other Federal officials methods to coordinate the conduct or support of research described in subparagraph (C);

(E) collect, synthesize, and disseminate information on research concerning evidence-based strategies for promoting the use of evidence-based preventive, diagnostic, and therapeutic interventions;

(F) provide guidance on effective mental and substance use interventions to Federal agencies that provide or support such interventions, including the Centers for Medicare & Medicaid Services, the Substance Abuse and Mental Health Services Administration, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the Department of Defense, the Department of Veterans Affairs, the Indian Health Service, and the Bureau of Prisons; and

(G) periodically assess the progress of agencies described in subparagraph (F) in implementing such interventions.

(3) CONSULTATION- In carrying out this section, the Commission shall--

(A) seek consultation from leading public and private State and national authorities, and consolidate evidence, opinions, and findings of these authorities as they see fit; and

(B) ensure that interested parties have opportunities to provide input before the Commission makes recommendations or decisions.

(4) MEMBERSHIP- The Commission shall be composed of not fewer than 15 and not more than 20 members, who shall be appointed by the President from among experts in evidence-based mental and substance use health care. Such members shall include--

(A) researchers;

(B) practitioners from various specialties, professions, and practice settings;

(C) mental health and substance abuse health care consumers; and

(D) health care payers.

(5) TERMS-

(A) IN GENERAL- Each member of the Commission shall be appointed for a term of 4 years, except as provided in subparagraphs (B) and (C).

(B) TERMS OF INITIAL APPOINTEES- As designated by the President at the time of appointment, of the members of the Commission first appointed, 1/4 shall each be appointed for terms of 1, 2, and 3 years and the remainder shall be appointed for a term of 4 years.

(C) VACANCIES- Any member appointed to fill a vacancy occurring before the expiration of the term for which the member’s predecessor was appointed shall be appointed only for the remainder of that term. A member may serve after the expiration of that member’s term until a successor has taken office.

(b) CMS Annual Report- The Administrator of the Centers for Medicare & Medicaid Services shall report annually to the Congress on the extent to which the Medicaid program under title XIX of the Social Security Act provides coverage of evidence-based interventions identified by the Commission, including--

(1) a list of those interventions not so covered and the reasons why they are not covered;

(2) a justification for each evidence-based intervention that is not so covered; and

(3) a list of evidence-based interventions that can be covered only with statutory change.

(c) Construction Regarding Application- Nothing in this section shall be construed as requiring, as a condition of payment under the Medicaid program under title XIX of the Social Security Act, that an intervention must be an evidence-based practice.

(d) Prompt Development and Implementation of Claims Processing and Data Codes- The Secretary, acting through the Administrator of the Centers for Medicare & Medicaid Services, shall establish, or enter into an agreement with, one or more entities for the purpose of developing, as soon as practicable after the date of the enactment of this Act, codes that should be applied to claims processing and health data collection activities as recommended by the Commission pursuant to subsection (a)(2)(B).

(e) Definition- In this section, the term ‘intervention’ means a preventive, diagnostic, or therapeutic action with respect to a mental health or substance use disease process.

SEC. 3. IMPROVED COORDINATION OF CARE.