VMHE NEWS - Virginians for Mental Health Equity Newsletter
Published as a service to mental health and substance abuse consumers, family members and professionals

January 16, 2005

Virginians for Mental Health Equity is a coalition of the major mental health and substance abuse professional and consumer organizations. It is dedicated to improving access to mental health and substance abuse treatment in the private and public sector, with a focus on insurance coverage, but an interest in many other issues.

During sessions of the Virginia General Assembly, VMHE publishes this newsletter on a weekly basis to inform advocates about pending legislation as it moves forward. Our intent is to allow advocates to make their voices heard to public policymakers as they deliberate issues that affect the lives of consumers with mental illness and substance use disorders, and professionals who work to provide care for them. It is distributed by e-mail only.

For more information on any of the bills listed here, or on the General Assembly, please look on the Internet at legis.state.va.us. To subscribe to this newsletter, go to http://www.macbur.com/global/links.php. This also is the webpage to access if you would like to discontinue receiving this newsletter. Please feel free to pass along this issue to others who share your interest in mental health and substance use disorder issues. And, we invite your comments. Please contact Leslie Herdegen at LHerdegen@macbur.com or call 804-649-1053.

CONTENTS

1. Contacting Your Legislators
2. The 2005 Virginia General Assembly
3. Mental Health Insurance Issues
4. Mental Health Issues
5. Minors' Mental Health Issues
6. Substance Use Disorder Measures
7. Miscellaneous Mental Health and Substance Use Disorder Bills

1. CONTACTING YOUR LEGISLATORS

Every Virginian is represented by one member of the Virginia House of Delegates and one member of the Virginia Senate. You can find out who represents you by calling your local voter registration office. You also can find it on the Internet at http://www.macbur.com/global/links.php. This website will give you the names, addresses, and phone numbers of your Senator and Delegate, and you can send an e-mail to them through this webpage. Be sure to get the names of your representatives in the Virginia House of Delegates and the Virginia Senate - not your Congressional representatives.

When the General Assembly is in session, legislators spend much of each day in meetings. If you want to make your opinion known, you may not have a chance to speak directly with your Senator and Delegate, but you have several other options.

If you call, the legislative aide will be happy to discuss the issue with you and pass along your message to the legislator. Be sure to call the legislator's office in Richmond since that is where they can be reached most quickly during the session. You also can send an e-mail or call the constituent opinion line at (800) 889-0229 (outside Richmond) or 698-1990 (Richmond area). Since things happen so quickly during the session, we don't recommend sending snail mail - your letter might get there long after action has been taken.

2. THE 2005 GENERAL ASSEMBLY

This year's legislative session began last Wednesday and will adjourn on Saturday, February 26. In those short 46 days, legislators will consider nearly 3,000 pieces of legislation, and hundreds of amendments to Commonwealth's budget.

New bills can be introduced through this coming Friday, January 21. Therefore, with this issue of NEWS, we don't know all the bills that will be considered. We will tell you about the ones we know at this point, and catch up on the rest in next week's issue.

The deadline for budget amendments also is this week. By next weekend, we expect to know what amendments are being proposed by Senators, and may or may not know about those proposed by Delegates. You certainly can expect more on the budget in next week's issue, too.

The House of Delegates must act on all House bills, and the Senate on all Senate bills no later than February 8. Thus, if you have a concern about a bill - or would like to voice support for a bill -- don't waste any time doing it. Pick up the phone or power up your computer today and let your legislator know your opinion.

3. MENTAL HEALTH INSURANCE ISSUES

Last year's readers will remember that parents of young people asked Del. Lee Ware (R-Powhatan) to introduce a bill to add anorexia and bulimia to the parity law that requires coverage for biologically based mental illnesses on the same terms and conditions as any other illness. He did so, and in accordance with law, the bill was referred to the Special Advisory Commission on Mandated Health Insurance Benefits for consideration over the summer and fall.

Despite exceptional testimony by experts from the National Institute of Mental Health and VCU-MCV's Department of Psychiatry, parents and young people with these illnesses, and Miss Virginia, the Commission declined to recommend this change to the 2005 General Assembly. Their discussion indicated that they remained unconvinced that the illness is biologically based or that treatment is cost effective.

Following that hearing, the Virginia Association of Health Plans offered a compromise proposal to include anorexia and bulimia. This proposal would have added these diseases, but also would have added a 1% cap. In other words, if the claims for biologically based illnesses in any one employer group exceeded 1% of premiums, the employer would have the option to drop parity coverage. So, in a group with ten or twelve employees that pays annual premiums of $50,000 or so, if claims for biologically based mental illnesses exceeded $500 in any one year, the employer could have eliminated parity coverage from the health care plan.

Neither the parents nor VMHE believed this was a good or fair compromise for people with mental illnesses. As a result, the anorexia and bulimia bill will not be reintroduced this year.

If you have a special interest in insurance coverage for anorexia and bulimia, please contact Leslie Herdegen at LHerdegen@macbur.com to join the discussions on this issue for the future.

Virginia's Medicaid program has one of the lowest eligibility thresholds of any state in the nation. To be eligible, families must have incomes at 80% of the federal poverty level or lower. As a result, there are many individuals and families who do not qualify for Medicaid, but also are not able to afford to purchase health insurance.

The Virginia Association of Community Services Boards, the community mental health agencies in Virginia, report that under the current standards, about half of their consumers are eligible for Medicaid. If this threshold were raised to 100% of poverty, 85% of their consumers would be eligible.

When services are covered by Medicaid, the federal government pays for about half of the cost. When they are not covered by Medicaid, Virginia must shoulder the entire bill. As a result, if more people had Medicaid coverage, the Commonwealth may actually save money.

SB-702 introduced by Sen. Roscoe Reynolds (D-Martinsville) proposes increasing Medicaid eligibility to 100% of poverty. This bill was considered briefly in the Senate Education and Health Committee this past week. Knowing that any decision on the measure would have an impact on the state's budget, the Committee re-referred it to the Senate Finance Committee where it will be considered next.

HB1492 was introduced by Del. Phil Hamilton (R-Newport News) to make changes to the requirements for Medical Savings Accounts designed to make them more accessible to Virginians. Medical Savings Accounts allow covered individuals to purchase a high deductible health plan and make tax-deductible contributions into a health savings account, generally up to the amount of the health plan's deductible, and to make tax-free withdrawals from the health savings account to pay for qualified medical expenses. This bill was referred to the Senate Committee on Commerce and Labor.

HB-2143 introduced by Del. John Joannou would require health care plans to notify enrollees 60 days prior to the renewal date of a plan of premium increases in excess of 35%. This would allow the enrollee time to shop for other health care coverage. This bill also is in the Senate Commerce and Labor Committee.

Sen. Yvonne Miller's (D-Norfolk) SB-742 generated a lot of discussion in the Senate Education and Health Committee last week. This bill would require the Department of Medical Assistance Services to identify the employer of applicants for Medicaid or FAMIS, the children's health care plan, and to report employers who employ 25 or more public health program beneficiaries to the Governor and General Assembly. It is designed to allow the Commonwealth to determine whether there are a few big employers who do not offer health care coverage to their employees. While the Senators believed some changes may need to be made in the bill, there seemed to be substantial interest in having this information.

SB-1106 introduced by Sen. Dick Saslaw (D-Springfield) will be of greatest interest to providers who bill insurance companies. It proposes requiring carriers to use independent, binding external mechanisms to resolve billing and claims disputes, prohibits explanations of benefits that suggest that amounts paid by the carrier should be considered appropriate and full compensation for the services provided, and redefines what constitutes a retroactive denial of a previously paid claim. This bill, too, is in the Senate Commerce and Labor Committee.

4. MENTAL HEALTH ISSUES

In an attempt to provide a forum to address issues surrounding temporary detention orders for people with mental illness who are a danger to themselves or others, Del. Phil Hamilton has proposed creation of the Interagency Civil Admissions Advisory Council. To be comprised of representatives of various state and private agencies, this Council would be charged with studying issues related to the provisions of Virginia law regarding the emergency custody, temporary detention, admission, and involuntary inpatient and outpatient treatment of persons with mental illness, to propose recommendations and provide advice addressing those issues, and to improve the coordination and effectiveness of the implementation of those recommendations. This bill is in the House General Laws Committee.

At the request of judges in Prince William County, Del. Michele McQuigg (R-Prince William) introduced HB2110 to place in the law a standard of "clear and convincing evidence" during an involuntary commitment hearing for persons with mental illness. This is the highest existing standard in current civil law. Current law requires the judge to make specific findings before issuing an order for involuntary commitment, but does not set forth a standard of proof for the judge to apply when considering the evidence.

HB-2436 introduced by Del. Charles Carrico (R-Independence) would allow a prisoner with mental illness who has been involuntarily hospitalized to stay in the hospital if the prisoner is capable of and consents to voluntary admission, and is determined to be in need of continued hospitalization by a licensed physician, psychiatrist, or clinical psychologist. This bill will be considered by the House Health, Welfare and Institutions Committee.

SB-714 introduced by Sen. John Edwards (D-Roanoke) would allow the defendant in a criminal matter to be hospitalized if so seriously mentally ill as to be unable to care for himself. Under current law the standard is "imminently dangerous to himself or others." This bill is in the Senate Courts Committee.

Sen. Edwards also introduced SB-725 that would establish by January 1, 2006 no less than two and no more than five mental health courts in Virginia for nonviolent offenders with serious mental illnesses. The Senate Courts of Justice Committee will consider this bill, too.

Sen. Bill Mims (R-Loudoun County) introduced SB-889 to make the Department of Mental Health, Mental Retardation and Substance Abuse Services the lead agency for suicide prevention across the lifespan in the Commonwealth. This responsibility includes coordination of prevention activities of the agencies of the Commonwealth to develop and implement a comprehensive suicide prevention plan addressing public awareness, the promotion of health development, early identification, intervention and treatment, support to survivors, and surveillance. The Department of Health would continue to be responsible for youth suicide prevention.

5. MINORS' MENTAL HEALTH ISSUES

Several advocacy organizations and newspaper articles have shone the spotlight on the need for increased mental health services for young people in Virginia. Legislation proposed already in the 2005 session reflects the responsive concern of legislators about this important issue.

Del. Lingamfelter (R-Prince William) again has introduced a bill requiring public employees who treat young people for a variety of conditions, including contemplated suicide and drug or alcohol addiction, notify the parents almost immediately. This year, the bill is HB-1662. The House Health, Welfare and Institutions Committee will consider the measure first.

Today, the law allows teens to access those services without parental consent to ensure that they get the care they need and fear of their parents' reaction will not prevent them from accessing the care. While all mental health and substance abuse treatment professionals have a treatment goal of parental and family involvement, they realize that sometimes it takes a while for this to occur and, in a few cases involving special circumstances like abuse, it never is appropriate.

In the past, a large informal coalition of health and mental health professionals, youth advocacy organizations and education advocates have worked together to educate legislators about why HB-1662 would keep young people out of necessary treatment and increase the risk of a bad outcome, and the bill has been defeated.

HB-2148 introduced by Del. Kris. Amundsen (D-Fairfax County) would require the Departments of Education; Health; Health Professions; Juvenile Justice; Medical Assistance Services; Mental Health, Mental Retardation, and Substance Abuse Services; and Social Services to develop a children's mental health treatment strategy. The strategy is to include increased funding for Medicaid and FAMIS; group home licensure requirements; adequate home health and mental health professionals; assurances that parents will not have to relinquish custody to obtain treatment for their children; increased services; and the identification and return home of children placed in foster care to obtain treatment. This measure has been referred to the House Health, Welfare and Institutions Committee for consideration.

The House Courts Committee will consider HB-2245 introduced by Del. Rob Bell (R-Albemarle). This bill would require the Board of Juvenile Justice, after consultation with the Board of Mental Health, Mental Retardation, and Substance Abuse Services and other related agencies, to promulgate regulations for the planning and provision of mental health, substance abuse or other therapeutic treatment services for persons returning to the community following commitment to a juvenile correctional center.

6. SUBSTANCE USE DISORDER MEASURES

Again this year, legislators are expressing their concerns about methadone clinics by introducing legislation.

Del. Terry Kilgore (R-Gate City) introduced HB-1778 to prohibit methadone clinics in counties that do not have zoning ordinances. HB-1778 will be considered by the House Health, Welfare and Institutions Committee.

Sen. William Wampler (R-Bristol) approaches his concerns in another way through SB-753. This measure would require the Department of Mental Health, Mental Retardation and Substance Abuse Services to establish standards to evaluate the need and appropriateness for the issuance of new licenses to methadone clinics. It also would create a moratorium on new clinics until the standards are in place. SB-753 passed the Senate Education and Health Committee unanimously and is on the Senate floor for consideration.

Sen. Yvonne Miller (D-Norfolk) again has introduced her bill proposing a Constitutional amendment to restore voting and other civil rights to nonviolent offenders. This measure has been important to the substance abuse advocacy community because addiction sometimes results in criminal convictions that, absent the addiction, would never have happened. Following recovery, advocates submit that rights should be restored. This bill will be considered in the Senate Committee on Privileges and Elections.

7. MISCELLANEOUS MENTAL HEALTH AND SUBSTANCE USE DISORDER BILLS

HB-1517 introduced by Del. Gary Reese (R-Fairfax County) would a court to require a person who is accused of family violence to enter, along with the victim who agrees to such a course of action, an education or treatment program focused upon anger management and designed to retrain the parties on how to disagree effectively and peacefully, if such a program is available. The court, when such a program is not available, may require education or treatment services such as, in the opinion of the court, may be best suited to the needs of the accused. This bill is in the House Courts Committee.

HB-2503 introduced by Del. Jim Shuler (D-Blacksburg) adds marriage and family therapists to certain Code sections that list other mental health professionals. These sections involve privileged communications in civil actions, evaluation of juvenile competency, compensation for expert testimony, and services falling outside of the definition of employment for purposes of unemployment compensation. This measure likely will be considered in the House Health, Welfare and Institutions Committee, although it has not yet been referred there.

Stay tuned for next week's issue that will include all the bills we expect to be introduced, and hopefully some information on budget proposals to benefit services to people with mental illnesses and substance use disorders.