Representative Tonko Statement on H.R. 2646
While I appreciate Chairman Murphy’s dedicated passion and continued efforts to improve care for persons struggling with mental illness, I do not support this bill as currently written.
I am supportive of many of the goals articulated by Chairman Murphy’s legislation, including increased funding for mental health research, new disclosure requirements for MHPAEA investigations, and extension of incentives for behavioral health information technology. In addition, although I am still reviewing the details, I appreciate his inclusion of a new grant program to focus on early childhood mental health intervention and treatment in schools.
However, in order to fund these new programs, the legislation would make drastic cuts to many current, effective SAMHSA programs, including over $100 million in cuts to critical substance abuse treatment and prevention programs at a time when we are facing a nationwide opioid overdose epidemic, and a 43 percent cut to the Minority Fellowship Program, which helps to increase the representation of minorities in the behavioral health workforce. I am always willing to examine ways we can find smart savings by eliminating specific outdated or ineffective programs, but I do not support the indiscriminate approach that this legislation takes.
In addition, I am perplexed by the provisions surrounding the Medicaid IMD exclusion and the Medicare mental health 190-day inpatient limit. Language in this bill implies that these policies cannot go into effect unless CMS certifies that they will not result in any net spending. Both of these policies have been evaluated numerous times by budget analysts and would clearly imply billions of dollars in increased federal spending. Because of the ‘no-increased spending’ clause, it is unclear how these policies would ever be implemented under this legislation.
I agree with Chairman Murphy that it is time to reexamine the Medicaid IMD exclusion and the Medicare 190-day inpatient limit, but changes to these policies won’t actually occur until we admit that they cost money and work to make the necessary investment. I plan to introduce legislation tackling both of these issues soon.
I continue to have concerns with of a number of privacy and civil liberties provisions in the bill. This legislation continues to coerce states into adopting more permissive forced treatment laws by linking those provisions to mental health block grant funding. In addition, the HIPAA provisions contained in H.R. 2646 still strike the wrong balance and could deter individuals from voluntarily seeking needed care. Finally, while I have announced my intention to work with Chairman Murphy on issues surrounding 42 CFR Part 2, I do not support the specific language on this provision included in his legislation because it amends the ‘non-applicability’ portion of the statute and could be misinterpreted as too broad.
I hope to continue to work with Chairman Murphy to address some of the concerns I have outlined with this current legislation so that we can pass real and meaningful reform in order to best help countless individuals and families in need.