A quarterly legislative update from the Treatment Advocacy Center
Summer 2022

   
 
This Summer 2022 issue of SMI Advocate covers legislative news from April 5 to June 29. We are celebrating the enactment of eight bills that will reduce treatment barriers for people with severe mental illness (SMI) in five states and have many updates to share. 

Four states made significant changes to their civil commitment laws. The Louisiana State Legislature enacted a bill establishing a psychiatric deterioration standard for inpatient civil commitment to make treatment possible sooner. The Maine Legislature authorized funds to remove a legal and cost barrier to outpatient civil commitment. Legislatures in Arizona and Colorado also enacted laws changing civil commitment processes.

Our advocacy work to eliminate the shortage of psychiatric beds and demand an end to the discriminatory institutions for mental diseases (IMD) exclusion continues to make progress. The Colorado General Assembly passed legislation making substantial investments in both civil and forensic psychiatric beds, taking an innovative approach that can serve as a model for other states confronting the bed shortage. While applying for an IMD SMI waiver is an administrative process, legislatures can pass bills to require agencies to apply for waivers. The Missouri General Assembly included language in their state budget requiring its Medicaid department to apply for an IMD exclusion waiver.

While most state legislative sessions have adjourned, six states remain in session, including Ohio and California. A bill that would establish a psychiatric deterioration standard in Ohio's civil commitment law was reported out of committee and will likely be considered by the Ohio House of Representatives this fall. The California State Legislature is prioritizing addressing untreated mental illness and homelessness this session and considering a number of bills in the area of civil commitment. These include Gov. Gavin Newsom's CARE Court proposal as well as a bill to expand the definition of "gravely disabled" in the Lanterman-Petris-Short (LPS) Act.

This spring, Treatment Advocacy Center continued to advance federal legislation and initiatives to reduce barriers to treatment for SMI. We have worked with congressional staff on bills to fund assisted outpatient treatment (AOT) programs, repeal the discriminatory IMD exclusion, reform and decriminalize the nation's crisis response system and increase research and knowledge of SMI. 

The deadline for states to launch the federally-mandated 988 crisis hotline for mental health emergencies is just two weeks away. Treatment Advocacy Center partnered with NAMI and Cicatelli Associates Inc. to host an online training, "Crisis Conversations Problem Solving Convening," to help prepare advocates working to ensure the SMI community is included in planning and implementation. 

We could not do this work without you, our partners on the ground advocating every day to fix our broken mental health system. Thank you for taking the time to join us in our advocacy campaigns. This quarter, we ran state campaigns on key legislation in California and Louisiana, and you sent a total of 326 messages to your lawmakers. Visit our Action Center for a list of active campaign and contact your lawmakers today! 

We hope you find this summer issue of SMI Advocate informative. If you missed the previous issue, check out our Spring 2022 edition. We had a busy and successful winter and early spring, when seven states enacted bills making substantive improvements to civil commitment processes! 

If you have feedback on this publication or would like to share information about a bill in your state, we would love to hear from you! Contact Legislative Advocacy Manager Clara Keane at [email protected].

State Updates 

Key Civil Commitment Bills Enacted 

Arizona - SB 1114 makes several changes to Arizona's civil commitment laws including adding a severe mental disorder that "significantly impairs judgement, reason, behavior or capacity to recognize reality" as a new criterion to meet the definition of "persistent or acute disability," and addressing issues of case records and confidentiality.
Colorado - HB22-1256 makes a number of changes to the state's civil commitment law, particularly regarding emergency holds. Among the substantive improvements are supporting patient rights by ensuring that family members are contacted or that the patient is counseled on contacting family members, expanding the list of professionals that can place a mental health hold, and requiring care coordination and continuation at the time of discharge.
Louisiana - HB 335, effective Aug. 1, Louisiana joins nearly half of all states in including psychiatric deterioration in their criteria for inpatient commitment. Previously, individuals could only be involuntarily hospitalized if they were a danger to self or others, or gravely disabled and unable to meet their basic physical needs. The new law adds "significant risk of psychiatric deterioration" to the definition of "gravely disabled" and defines "psychiatric deterioration" as "a decline in mental functioning, which diminishes the person's capacity to reason or exercise judgment." This expanded definition means those with SMI will have access to treatment earlier in the course of a crisis. We would like to thank Janet Hays with Healing Minds NOLA and the bill sponsor Rep. Royce DuPlessis for their tireless advocacy to advance this critical bill.
Maine - LD 1994 removes a unique barrier to accessing progressive treatment program (PTP), Maine's court-ordered outpatient treatment. In Maine, private hospitals, intensive case managers, ACT teams, or county sheriffs must pay the legal fees to initiate a PTP petition for an individual being discharged by a private hospital. This new law creates a non-lapsing fund to reimburse legal fees to initiate PTP petitions.

Additionally, three bills that we reported in the previous issue of SMI Advocate as having passed state legislatures have since been signed by their respective governors and enacted - including Alabama HB 70, Georgia HB 1013, and Virginia HB 663. 

Treatment Beds & IMD Waiver Bills Enacted

Colorado (3) - The Colorado General Assembly has worked to address the critical bed shortage this session. Rep. Judy Amabile has championed the issue, both to address the backlog of forensic beds and to ensure civil beds are available for those who need them. DJ Jaffe Advocate Sabah Muhammad testified to the members of the House Public & Behavioral Health & Human Services Committee in March in support of HB22-1303. In her testimony, Muhammad noted that Colorado's 10 state hospital beds per 100,000 people fails to meet the minimum standard (Treatment Advocacy Center research indicates that 40-60 beds per 100,000 population is the optimal number for access to treatment, and 30 beds per 100,000 population is the absolute minimum). Effective May 18, the new law authorizes funds to create, develop or contract to add at least 125 additional civil psychiatric beds across the stateas well as 16 new forensic beds at the Fort Logan state hospital. In addition to state funds, the bill uses federal funds authorized in the American Rescue Plan Act (ARPA). Another bill (HB22-1386) authorizes funds to contract for additional beds for competency services and to conduct a feasibility study of renovating a facility in Adams County to provide inpatient beds for competency services. HB22-1281 established a community behavioral health-care continuum gap grant program. Funds can either create or redesign mental health inpatient beds.
Missouri - The Missouri General Assembly included a provision to require MO HealthNet (Missouri's Medicaid program) to apply for the federal institutions for mental disease (IMD) exclusion waiver within the Department of Social Services appropriations bill (HB 3011). Treatment Advocacy Center has seen this approach successfully result in acquiring a waiver in other states. For example, Utah passed a bill in 2020 that resulted in an IMD waiver for SMI, and the Washington legislature in 2019 used a similar approach to Missouri, including the mandate for a waiver within its state budget bill. Treatment Advocacy Center looks forward to supporting this application.

Key Civil Commitment Bills Moving through the Legislative Process

California (2) - Governor Gavin Newsom announced CARE Court, a proposal to establish a new form or court-ordered outpatient treatment, in March. This initiative is part of Gov. Newsom's ongoing efforts to address untreated mental illness and homelessness across California. Hearings are underway now in both chambers (SB 1338/AB 2830) to determine what CARE Courts should be and how they will interact with Laura's Law programs, LPS conservatorship procedures and other forms of treatment in California. Treatment Advocacy Center is also tracking a number of other bills that have been introduced as a result of the California State Legislature's efforts to reform the LPS Act, California's statute governing civil commitment and conservatorship for grave disability. Of particular importance is SB 1416, Sen. Susan Eggman's bill to modernize the definition of "gravely disabled" within LPS. The bill would expand the definition to better meet the needs of those with (SMI). While the expanded definition originally proposed has already been weakened through legislative amendments, the current language is still an improvement to existing law. Under the expanded definition, a person's inability to provide for their medical care is added to the list of personal basic needs (currently limited to food, clothing, and shelter) that an individual must be found unable to provide for in order to meet the definition of "gravely disabled." The bill passed the Senate and Assembly Health Committee and is currently under consideration by the Assembly Judiciary Committee.
Ohio - HB 439 would establish a psychiatric deterioration standard by expanding the definition of dangerousness to include "mental deterioration." The bill would enable law enforcement and other designated professionals to intervene in instances in which a person has a history of untreated mental illness, is too ill to appreciate their need for treatment and without treatment is likely to suffer mental deterioration and, as a result, become a danger to self or others. The bill was reported out of the House Civil Justice Committee on June 1, and the next step is a House floor vote. The Ohio General Assembly is currently on summer recess but will return this fall. The legislative session is year-round. Treatment Advocacy Center is part of a coalition mobilizing support for this important bill. Our partners include our board member Judge Elinore Stormer, NAMI Ohio, the Ohio Judicial Conference, the Ohio Psychiatric Physicians Association and the Ohio Psychological Association.

Federal Updates 

As Congress emphasizes addressing the broken mental health system, Treatment Advocacy Center is more committed than ever to ensuring the needs of people with SMI and their families are not ignored. 

With Congress currently making decisions on which programs to reauthorize, Treatment Advocacy Center is pleased to have overwhelmingly positive outcomes to share about the Assisted Outpatient Treatment Program, which was established in 2014. We also had the opportunity to engage with congressional staff to share how the program can be further improved. 

Discussions are underway in Congress to finally repeal the discriminatory institutions for mental disease (IMD) exclusion. Congressional offices have reached out to Treatment Advocacy Center as a leader on this issue, and two IMD repeal bills were introduced this Congress. Some momentum has also built to repeal Medicare's 190-day lifetime coverage limit for psychiatric inpatient care, another discriminatory policy that disproportionately impacts those with SMI. Integration of services is critical for the estimated four million low-income Americans who have a serious mental illness and are eligible for both the Medicare and Medicaid programs. We support another bill that would require states to develop a strategy to integrate and coordinate Medicaid and Medicare coverage for full-benefit dual eligible individuals.

Many states are scrambling to launch their 988 call system by July 16, as required by federal law. Treatment Advocacy Center has engaged with coalitions of mental health and substance use organizations to help provide guidance for state implementors and to support efforts in Congress to offer assistance to states. During "Crisis Conversations: A Problem-Solving Convening," an online event hosted in partnership with NAMI and CAI, Executive Director Lisa Dailey shared ways to advocate for SMI issues connected with the hotline's rollout. DJ Jaffe Advocate Sabah Muhammad discussed how to elevate the voices of individuals and families with lived experience as families of color affected by SMI to identify the critical gaps and barriers in the current system of care. Dailey has been a leader in the CEO Alliance for Mental Health's efforts to ensure a full continuum of mental health and substance use care is established that successfully serves those with SMI. Rep. Tony Cardenas' bill will be a critical piece in this work. President Joe Biden signed the Bipartisan Safer Communities Act into law on June 25, investing hundreds of millions of dollars to expand and improve mental health services, including funds dedicated to the 988 rollout. 

Treatment Advocacy Center continues to demand clinical research for SMI as well as better prevalence data and a fuller understanding of the impact SMI has across society. We have had the opportunity to work with congressional staff on two important bills in these areas. Treatment Advocacy Center's recommendations were incorporated into a bill seeking to estimate the costs of SMI across systems of society. We also reccomended that another bill to study the neurological impacts associated with COVID-19 infection retain language specific to psychiatric illnesses that was included in a previous version. 

Find details of ten federal bills we support below. 

Reauthorizing the Assisted Outpatient Treatment Program 

Mental Health Reform Reauthorization Act of 2022 (S 4170) - Treatment Advocacy Center sent a letter in response to Sens. Bill Cassidy (R-La.) and Chris Murphy's (D-Conn.) request for information last fall concerning the reauthorization of certain programs funded under the Mental Health Reform Act of 2016. We shared the undeniable successful outcomes of the Assisted Outpatient Treatment Program and made three recommendations on how it could be improved. We are thrilled that S 4170 not only reauthorizes the important program but also includes language incorporating several of our recommendations. The following three key improvements are included: (1) increasing the pool of grantees by making existing programs eligible; (2) clarifying that AOT is in a civil (as opposed to criminal) court by adding "civil" to the definition; and (3) requiring more robust data collection and reporting by requiring the Substance Abuse and Mental Health Services Administration (SAMHSA) to report on how AOT impacts participants' rates of psychiatric hospitalization and arrest (in addition to homelessness and incarceration currently required) and to study the impact of variations in program design among grantees. Among many other provisions in the bill is a section to end harmful opt outs from federal mental health and addiction parity requirements for nonfederal government health care plans. Sens. Cassidy and Murphy introduced S 4170 on May 10.
Restoring Hope for Mental Health and Well-Being Act of 2022 (HR 7666) -  While not identical to S 4170, this bill also reauthorizes the Assisted Outpatient Treatment Program with our recommended improvements and removes the harmful opt outs from federal mental health and addiction parity requirements for nonfederal government health care plans. Treatment Advocacy Center signed onto a Kennedy Forum letter that outlines this issue. Rep. Frank Pallone (D-N.J.) introduced HR 7666 on May 6, and it passed the House on June 22 with a vote of 402-20!

Addressing Discriminatory Medicaid & Medicare Policies 

Michelle Alyssa Go Act (HR 7803) - This bill would repeal the discriminatory IMD exclusion and require IMD's to meet nationally recognized, evidence-based standards. Rep. Carolyn Maloney (D-N.Y.) introduced HR 7803 on May 17. Treatment Advocacy Center staff joined Rep. Maloney in the press conference rolling out this important bill. "This discriminatory federal law denies coverage to people with severe mental illness while allowing federal Medicaid dollars to be spent on the treatment of other health conditions," said Executive Director Lisa Dailey in Maloney's press release. The bill has four cosponsors.
Increasing Behavioral Health Treatment Act (HR 2611) - This bill would repeal the discriminatory IMD exclusion. Rep. Grace Napolitano (D-Calif.) introduced HR 2611 in April 2021, and the bill has 14 cosponsors.
Medicare Mental Health Inpatient Equity Act of 2021 (HR 5674/S 3061) - This legislation would repeal Medicare's discriminatory 190-day lifetime coverage limit for psychiatric inpatient care. Sen. Susan Collins (R-ME) introduced S 3061 in Oct. 2021, and the bill has two cosponsors. Rep. Paul D. Tonko (D-N.Y.) introduced HR 5674 in Oct. 2021, and The bill has three bipartisan cosponsors.
Advancing Integration in Medicare and Medicaid Act (S 4264) - This bill would require states to develop a strategy to integrate and coordinate Medicaid and Medicare coverage for full-benefit dual eligible individuals. In an endorsement letter to the bill's sponsors Sens. Tim Scott (R-S.C.), Robert Casey (D-Pa.) and Bill Cassidy (R-La.), Treatment Advocacy Center outlined the importance of S 4264 to the SMI community. Over four million low-income Americans who are eligible for both the Medicare and Medicaid programs are estimated to have a serious mental illness, which is most likely a schizophrenia diagnosis. Integration between care providers could improve patient outcomes, especially considering 44.1% of persons with SMI also have other physical health challenges.

Funding Mental Health & 988 Crisis Line Implementation

Bipartisan Safer Communities Act (S 2938) - President Joe Biden signed S 2938 into law on June 25. The legislation authorized hundreds of millions of dollars to expand and improve mental health services, including $250 million for the Community Mental Health Services Block Grant program and $150 million towards 988 implementation. The bill also expands the Medicaid Certified Community Behavioral Health Center (CCBHC) program and requires the Centers for Medicare and Medicaid Services to issue guidance to states on covering telehealth through Medicaid.
9-8-8 Implementation Act of 2022 (HR 7116) - The bill includes provisions that would fund the launch, infrastructure, and modernization of the new hotline. It would also exclude crisis centers from the IMD payment prohibition. The Behavioral Health Crisis Services Expansion Act (HR 5611/S 1902), which included critical elements to the success of 988 is included in this larger bill. Rep. Tony Cardenas' (D-Calif.) introduced HR 7116 on March 17, and the bill has 45 cosponsors.

Advancing SMI Research 

Cost of Mental Illness Act of 2022 (HR 7483) -  This bill would direct the Department of Health and Human Services to study the direct and indirect costs of serious mental illness. The study would include estimating costs to public and private inpatient psychiatric hospitals, hospital emergency departments, skilled nursing facilities, family members and caregivers, and state, local and federal penal systems, among other entities. The bill includes a separate section requiring a national surveillance study of individuals with schizophrenia. Introduced by Rep. Guy Reschenthaler (R-Pa.) on April 7, HR 7483 has four bipartisan cosponsors.
Brycen Gray and Ben Price COVID-19 Neurological Impact Act (HR 7180/S 4014): This legislation would direct the National Science Foundation to award grants to support research on the disruption of regular cognitive processes associated with COVID-19 infection. Introduced by Rep. Anthony Gonzalez (R-Ohio) on March 21, HR 8180 was reported favorably by the Committee on Science, Space, and Technology on June 15. The bill has nine bipartisan cosponsors. Introduced by Sen. Tammy Duckworth (D-Ill.) on April 6, S 4014 has two bipartisan cosponsors.

Treatment Advocacy Center
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(703) 294-6001
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  Questions or comments? Contact:
Clara Keane, Legislative Advocacy Manager
[email protected]

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