Abstract
As the country continues to grapple with this unprecedented COVID‐19 pandemic, mental health field leaders are responding to what the most recent $2 trillion stimulus aid package passed by the Senate and House and signed by President Trump means for mental health and substance use providers.
Bottom Line…
The economic aid stimulus package offers a number of resources for community mental health and addiction treatment providers during this pandemic crisis, including small loan assistance.
As the country continues to grapple with this unprecedented COVID‐19 pandemic, mental health field leaders are responding to what the most recent $2 trillion stimulus aid package passed by the Senate and House and signed by President Trump means for mental health and substance use providers.
The congressional stimulus legislation, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), includes new funding for providers to address the COVID‐19 impact.
The Substance Abuse and Mental Health Services Administration (SAMHSA) received $425 million in emergency allocations. That funding includes $250 million that the National Council for Behavioral Health requested for Certified Community Behavioral Health Clinics (CCBHCs).
Other funding support includes:
$50 million for suicide prevention programs, including $10 million for the National Suicide Prevention Lifeline;
$100 million for mental health and substance use disorder emergency grants;
$350 billion for small business guaranteed paycheck protection loans between Feb. 15 and June 30, 2020, not exceeding $10 million, provided to self‐employed individuals, independent contractors, sole proprietors, nonprofit organizations, veterans organizations or tribal business concerns, presumed to be impacted by the COVID‐19 pandemic; and
The CARES Act provisions also include a repeal of the Medicare requirement that only allows a health care professional to see a patient via telemedicine if they have previously seen that patient within the past three years.
Available resources
A tele‐town hall meeting hosted by the National Council for Behavioral Health March 31 provided an opportunity for providers to at least receive some specific answers to the hundreds of questions they submitted.
Regarding the more than $400 million received by SAMHSA, over the next several days, the organization will be trying to parcel out how that funding will be distributed to community behavioral health organizations, Chuck Ingoglia, president and CEO of the National Council, told participants.
The National Council has offered input on how the funds should be distributed. One of the recommendations to SAMHSA regarding the $250 million for mental health and addiction treatment organizations would be to make the funding eligibility as broad as possible, said Ingoglia. The council would like to see some of that funding available to those organizations that exceed 500 employees who may not be eligible for the available small loans, he said.
The National Council has cited “huge opportunities” in the stimulus aid package to support small businesses. The CARES Act includes the Small Business Administration's Economic Injury Disaster Loan, an emergency grant award of up to $10,000. Private, nonprofit organizations are eligible to apply, Reyna Taylor, vice president of policy and advocacy for the National Council and tele‐town hall co‐presenter, told attendees.
If their applications are accepted, monies would be available within three days, said Taylor, adding that the loan advance does not need to be repaid. The $10,000 loan is considered an advance on a larger loan. Organizations could apply for additional funding. “It's like saying, ‘Let's get you to continue going where you are now and then process your loan as it comes through,’” Taylor said.
The CARES Act also implements a $349 billion Payroll Protection Program, designed to provide a direct incentive for small businesses to keep their workers on payroll by providing businesses with less than 500 employees with a loan up to $10 million for payroll and certain other expenses. The Paycheck Protection Program would allow businesses to not have to lay off employees and continue to pay rent, said Taylor.
Medicaid flexibility
The federal government, meanwhile, is making it clear that states have a lot of flexibility in their Medicaid programs in how they design telehealth provisions, noted Ingoglia. That can be done through new waivers to provide other kinds of support to organizations, he said.
Some states have gone on to pledge to keep community behavioral health organizations whole and are paying them a comparable amount to what they have billed historically, said Ingoglia. The National Council sent out a letter last week to state associations representing mental health authorities as well as organizations representing substance abuse and Medicaid to take similar kinds of actions, he said. “The federal government will support your state in being flexible during this time,” said Ingoglia.
In preparation for the fourth stimulus package, the National Council will be asking members to participate in a survey on how the pandemic has affected their clinical and financial operations, said Ingoglia.
NASMHPD weighs in
“The stimulus package has been most effective for the general population,” Brian Hepburn, M.D., executive director of the National Association for State Mental Health Program Directors (NASMHPD), told MHW. “They get the message that the government cares about what happens in their homes and in their community.”
The specific funding provided for CCBHCs, for example, should help stabilize these programs, he said. Designated funding for the National Suicide Prevention Lifeline is also critical. “The use of the hotline has spiked during this disaster,” Hepburn said. “Building additional capacity is very important.”
“One of the biggest questions we're dealing with is retention funding, which is important for mental health and substance use providers,” said Hepburn. Everything is happening so quickly, and providers are being negatively impacted in terms of their funding, he said. “They're moving from a brick‐and‐mortar service to telehealth, which is good for individuals receiving services but has had a very dramatic impact for community providers who are [experiencing] decreasing revenue,” Hepburn stated.
The Centers for Medicare & Medicaid Services is making key waivers and amendments to give states flexibility to address the COVID‐19 pandemic. The NASMHPD supports Sections 1115 and 1135 in order for states to receive appropriate funding useful to community providers, said Hepburn. “The waivers are used by states in order to safeguard providers at risk during this difficult situation,” he said. “It's retention funding — necessary additional funding — to retain providers.”
Hepburn added, “We don't want to lose providers, which would decrease access to services.”
Screening and testing
Hepburn noted that keeping people in the community and away from emergency rooms is important. “We need to protect individuals when they are receiving services,” he said. “We need to protect our staff. If we depend on the ER for screening and testing, that's pushing people in the ER rather than keeping them out.”
While most behavioral health community‐based services are being conducted via telehealth, some people will need to receive necessary care in residential programs, Hepburn said. “We need to make sure access is available in community residential programs for people who need it,” he said. Good access to screening and testing is essential, said Hepburn.
“The more we can have it so that our community residential programs are independent of the ER process but are able to provide safely for individuals and staff, it would be more effective not only for our community but also for the overall health care community,” he stated. “We want to make sure behavioral health providers have adequate access to protective equipment like masks and we're trying to make sure residential behavioral health programs have access to testing.
“From a public health standpoint, we're trying to do our best in working together. We'll come out of this. We'll be OK.”
Resources and tools for addressing COVID‐19 are available on the National Council for Behavioral Health's website at https://www.thenationalcouncil.org/covid19.
Economic relief stimulus package extends, expands CCBHCs
The coronavirus stimulus package signed by President Trump last month extends and expands the Certified Community Behavioral Health Clinics (CCBHCs). According to the CARES Act, the current demonstration of CCBHCs will extend from May 22, 2020 through Nov. 30, 2020.
The eight‐state demonstration will expand to include two additional states within six months. The National Council for Behavioral Health expects that the two‐state selection might be announced even sooner.
“We expect the announcement of the next two states by SAMHSA [the Substance Abuse and Mental Health Services Administration] could move faster,” said Rebecca Farley David, senior advisor for public policy for the National Council for Behavioral Health, during a teleconference March 31 (see story, beginning on page 1). Farley David, who served as moderator, is also hopeful a CCBHC expansion could occur beyond November.
The National Council will continue its advocacy on expanding the CCBHC demonstration program, she said. “We do see a lot of bipartisan support,” Farley David said to attendees.
The two states will be selected based on the applications previously submitted to SAMHSA — essentially, allowing the two states that would have been next in line to participate with submission of any additional application materials, the National Council stated in an update on the stimulus package.
An enhanced federal match rate is available for the first eight quarters of the demonstration for new states, and for the eight quarters beginning Jan. 1, 2020, for the current eight demonstration states: Nevada, New York, New Jersey, Pennsylvania, Minnesota, Missouri, Oklahoma and Oregon, according to the National Council.