THE WHITE HOUSE
Office of the Press Secretary
PRESS BRIEFING
ON 6/7/99 MENTAL HEALTH CONFERENCE
BY
CHRIS JENNINGS, DEPUTY ASSISTANT TO THE PRESIDENT
FOR HEALTH POLICY
The Briefing Room
1:57 P.M. EDT
MR. TOIV: Now we're going to do our second briefing. (Laughter.) Remember, that first one's embargoed until 10:06 a.m. Saturday, and our second briefing that Chris is going to do now is embargoed until 7:00 p.m. Sunday evening.
MR. JENNINGS: Thank you, Barry.
MR. TOIV: You can start. (Laughter.)
Q Tell us your name again? (Laughter.)
MR. JENNINGS: On Monday, there will be an all-day conference -- again, it's the first-ever White House Mental Health Conference in which all four principals -- the President, the Vice President, the First Lady and Mrs. Gore -- will be involved with and actively participating in.
It is a conference that has attracted almost unprecedented interest from around the country. We, in fact, have had so much interest that we now are downlinking well over 1,000 conferences across the country into the Washington-based Mental Health Conference. We expect actually quite -- much more than 1,000. That will occur concurrent with the plenary session that the President and all the other three principals will be involved with, as well as Mike Wallace, who, many of you know, has his own personal experience with mental illness, and who will be engaging in a very, very informative plenary session.
In addition, throughout this process we've involved a multi-agency review process. We actually are going to have nine department and agency heads, including five Secretaries, who will be involved with this conference, and throughout a series of announcements that I'm going to go over, at least briefly, in a moment.
There are going to be at least 22 members of Congress involved, on a bipartisan basis, and I think in addition to all the downlinks, we're going to have one major downlink to Atlanta where Surgeon General Satcher will be participating at the plenary session with the President within that presentation.
In the morning, there's going to be over 14 -- I think there's going to be 14 breakout sessions on a range of different issues in which experts, members of Congress and others will be leading those conferences. Subsequent to the breakouts will be the plenary session, and then later in the afternoon there will be a town hall type meeting in which the Vice President and Mrs. Gore will be leading conversations. Some of that will be carried to these downlink conferences, but definitely the plenary session is going to be to well over 1,000 across the country.
Now, I thought I would just -- and, by the way, the agencies that are involved in this process are the Department of Health and Human Services as the lead agency. Not so surprisingly, but interestingly enough, we have the Department of Defense, Department of Veterans Affairs, HUD, OPM, DOJ, the Social Security Administration, the Federal Communications Commission, the Department of Agriculture, the Department of Labor and, obviously, the Office of Personnel Management. All of their agency heads are going to be actively involved within the conference.
Now, in terms of the specific announcements, one that has gotten a little bit of coverage -- and we're going to fill in a little more of the details. The President will be announcing that he has asked and OPM will be sending an official notification letter to all 285 participating health plans in the Federal Employees Health Benefit Program that, as a condition of participation and as a desired outcome as an employer, that FEHBP will be offering both mental health and chemical and substance abuse parity.
What that means in terms of specifics, it means that parity means for copayments, for deductibles, for day limits, for any type of capped benefits, you have to provide the same service and same coverage for mental health and substance abuse coverage as you do for all other benefits that are provided.
The notification will go out the day of the conference, which is Monday; and then subsequent to that, they will involve immediate discussions with each of the 285 plans and contracting, and OPM expects the parity provision to be in place by 2001, January 2001, fully implemented at that point in time.
This is a major step, we believe, but it's what we think is a leadership step as a model employer. We've been actually heartened to note that the American Association of Health Plans, who represents many of the managed care industry, thinks and has stated publicly that it is not at all unusual for employers, such as FEHBP, to say what I want to have in a benefit package and then ask to include that.
This is exactly what OPM is doing through this call letter. We hope it will serve as an incentive for other employers to be model employers around this country, to do similar things. We think not only will it show a commitment in this area, and improve access to quality health care, but it also will illustrate that appropriately managed mental health and substance abuse programs can be done very cost-effectively.
In addition, the Department of Labor will be launching a new outreach campaign to inform Americans about their rights under the current Mental Health Parity Act of 1996. They are pushing in this year's budget for additional funding and enforcement in that area of $2.5 million. And they will be announcing a toll-free number for Americans to find out more information about their rights -- that toll-free number is 1-800-789-2647. Again, that's 789-2647. The President will be making that announcement.
He will also be announcing that -- a number of clarifications for Medicaid policy across the country. As many of you know, Medicaid is a major provider of mental health services in this nation. We are going to be encouraging states to make the most effective services available. We will be sending out a letter to advise all state Medicaid directors that Medicaid will reimburse for services provided in a program called Assertive Community Treatment.
These Assertive Community Treatment programs, or ACT programs, provide for a range of services that are covered today under Medicaid, but many times states do not integrate all these services, and don't have an effective and a quality of medical outcomes coverage policy. The ACT program covers 24-hour case management. It covers hospital discharge planning. It integrates mental health with substance abuse services. You may know that many people with mental illness frequently also have concurrent problems with substance abuse, as well. And when that occurs, you want to coordinate services appropriately.
And lastly -- not that this is an all-inclusive list, but it would provide for reimbursement for medication management which, for those of you who have followed this closely, is a major issue for people with mental illness, as well as elderly, in general. But when you have multiple medications for multiple diagnoses, this can be quite a challenge.
Secondly, we are going to be clarifying that Medicaid recipients should have access to medications approved by FDA for treatment of serious mental illness. That means that if a doctor prescribes a drug as medically necessary and makes that notation, that Medicaid, under current statute, is required to cover that medication. And in some cases, there have been some indications that there may be some formularies set up in some states that do not provide for immediate or adequate access to those medications.
And, lastly, we're going to be notifying states that they should be educating Medicaid providers and their beneficiaries about their ability to enter into advanced planning directives. This is an important issue for people who have occasional bouts of mental illness. In many cases, for example, in bipolar disease, sometimes called manic-depressives, people will have episodic experiences with mental illness.
If you can give treatment guidance and what kind of guidance you should be taking, what kinds of medications you've taken in the past, this could make a very significant difference, in terms of successful outgrowths.
Now, I'm not going to go through all these announcements, because it's on your paper, but I want to -- I think that those two issues, in particular, are very, very important, as well as -- there's a new SSDI demonstration program that really helps link into this whole issue of employment and taking away barriers to employment for people with mental health illness and disorders.
SSDI was going to launch a new five-year, $10 million demonstration to provide treatment for SSDI beneficiaries with affective disorders. In many ways, we think this serves as a very, very important complement to the Jeffords-Kennedy-Roth-Moynihan workers' incentives legislation that I'm going to talk to you in a moment about.
Lastly, beyond all the initiatives that we have, we are going to continue to encourage Congress to pass a host of legislation. We're going to challenge them again, both the President and the rest of the administration, to pass important legislation that the President has advocated for consistently.
One, of course, is this year's budget, where he's had the largest single increase in the mental health grant program, $70 million -- SAMSA program. Secondly, he will once again challenge, as well as all our administration, challenge the Congress to pass the workers' incentives legislation. He will also be urging the Congress to pass the patients' bill of rights. Many of you may know that the provisions of access to specialists and continuity of care can be very, very important to people with mental illness who have insurance.
And, lastly, to pass a strong privacy protections legislation this year, before August, and also legislation to eliminate genetic discrimination, both in the work force and in health insurance -- very, very critically important areas for people who have family and genetic predispositions to mental illness, and also are concerned about employers and insurers having access to any of their records in mental health care.
So I'm going to stop with that, in terms of the substantive briefing. I'd be happy to answer any questions on the Mental Health Conference.
Q Do you have any predictions about whether the premiums will increase to any extent once full parity goes into place?
MR. JENNINGS: Yes, well, we don't until we open up negotiations specifically and see how they bid the premiums subsequent to that. I have been in conversation with OPM, they are projecting that it should be actually quite low-cost. They are currently spending about 2 percent of health care costs, of their health care programs, on mental health care services. They would say at most, it would increase by another 2 percent; the premiums would be, in their mind, very small, and actually the evidence bears that out in other programs.
In effectively managed programs, we've seen very, very little increase in health care on the managed care side, which the majority of the 285 programs providing services to federal employees are currently utilizing managed care-type techniques. There's been a lot of experience in Ohio and elsewhere with the FEHBP equivalent in Ohio that, when provision is of mental health parity protections are provided, that you see very small increases in premiums.
And I think if you talk to advocates in the business community, people in the business community like Mary Jane England and others from the Washington Business Group on Health, that they would indicate that effectively managed it should be a very low-cost, very cost-effective service.
As it relates to substance abuse, all estimates that I've seen on substance abuse are the very, very modest price increases -- I mean like tenths of a percent. But I don't want to give you numbers until OPM has engaged in all these negotiations.
Q When you say it might increase by 2 percent, do you mean the total premium might increase by 2 percent, or the mental health share of the premium might increase by 2 percent?
MR. JENNINGS: I mean that total expenditures associated to mental health, so I think it would be consistent with -- if those numbers are correct, then the premium would increase by no more than 2 percent.
Q So that means spending for mental health care could double. Is that the idea? You say you already spend 2 percent on mental health.
MR. JENNINGS: Well, it would be that -- the numbers that I think they were looking at were about, in terms of premiums, per se -- hold on one second, I think I might be able to give you something, just bear with me. Sorry, why don't I get that to you. I wouldn't want to give specific numbers until they actually get the estimates backspaced on their negotiations.
But what they have told me, based on their preliminary information, is they expect very, very low impact in terms of beneficiary contributions. And I mean like less than $1.30 a month or something. But, on the record, I would just say that I would get all those numbers confirmed with OPM, and at the end of this -- sometime this afternoon we will give you the contact people within each of the agencies to provide that information directly.
Q For this conference, is it mostly new initiatives or the expansion and improvement of existing programs that have been ongoing in the administration?
MR. JENNINGS: Well, actually if you look at the list, this is a combination of both. There are many, many new initiatives that are underway that are being announced. Actually, there are more new initiatives currently than announcements for Congress to call and pass this legislation.
I would say that the dollar amounts the President has dedicated this year's budget, you may know that as the President and others have made clear, because of the appropriation allocations that the Republicans have provided to the appropriator -- the Republican leadership has provided to the appropriators, that those constraints are quite severe, particularly in the Labor/HHS legislation.
So we're going to be pushing very, very hard to get those numbers included.
Q On the homeless front, is it dealing with the expansion and already existing programs, mostly that's out of HUD, that's basically what's --
MR. JENNINGS: Yes, there are a lot of creative programs going on at HUD. But also, you know, in that paper, I think -- and if it's not, we'll give you some backup, more detail -- the Department of Veterans Affairs has also done a lot of work in this area and homeless, and they are instituting programs and actually dedicating some dollars for that purpose. So I wouldn't say it's just HUD.
Q There are two mental health parity bills pending in Congress right now. The one in the Senate is a little more strict, confined to just serious mental disorders, or what are called serious mental disorders. The one in the House is much broader and more permissive. And the FEHB proposal here seems to be on the side of the House bill, a little bit more permissive.
Does the administration have a preference between these two bills? Are you going to endorse one of these two?
MR. JENNINGS: Well, what I would say about the legislation, on Monday we are announcing the OPM initiative, which is specially is the federal government as an employer showing other employers that one, we think that we can and should do this and do it cost effectively.
As for the legislation pending, what I think you'll hear from the President and Mrs. Gore and others is that we feel that Congress should move quickly to hold hearings on that legislation, to determine the feasibility, advisability of moving quickly on this legislation.
Our belief is that if you get good information around that legislation, you will see, just as we expect to see at OPM, that these things can be done cost effectively. But we're not going to be making announcements specifically on particular pieces of legislation, other than to say that we think Congress should move with all deliberate speed to hold hearings on these issues.
Q You said at least 22 members of Congress will be participating in your conference.
MR. JENNINGS: Yes.
Q Who will be participating?
MR. JENNINGS: I have a list, actually, and I think it's a growing list. But if you want me to go through it afterwards, I will tell you that for example -- and I know Senator Specter and Senator Chafee and Senator Wellstone and -- I'm trying to find my little list here -- we have a list, and it's very impressive.
You might note that we have a very impressive cadre of members of Congress who have had backgrounds in this area. We have Congressman Strickland from Ohio, a psychologist; we have Congressman McDermott, we have other -- we have physicians, we have nurses, social workers and others who have been very much involved with this, and you'll -- they have really been very active and wanting to participate in a very, very positive way, and we really appreciate their role in this conference. And you'll note their participation on those breakouts on Monday morning.
Oh, by the way, those breakout sessions are open to the press, as well. And Mrs. Gore made a decision very early on that she wants to amplify all these issues as much as she possibly can.
Q What do you truly expect from Monday, after you have this conference? What concrete results could we see?
MR. JENNINGS: Well, one, I think that Mrs. Gore's first goal -- as is the President's, of course -- is to start to break down some of the mythologies of mental illness in this country. I think to talk about it, to understand what the experience has been in terms of treatment and costs associated with treatment, to talk about how that impacts in our daily lives, particularly in the absence of treatment.
But I think -- and I'll tell you, we had -- Sara Bianchi is here, with the Vice President's Office -- we've had multiple meetings with Mrs. Gore on this front, and the President feels very similarly -- this is not a one-stop shop issue; this is something that's going to continue on. The ad campaign's going to be later this fall, in which she's going to highlight it. I believe that each one of these initiatives will continue on and be serving as foundations and the building blocks for future initiatives. And if anyone knows Mrs. Gore, this is not a one-day issue for her. She continues to push this agenda, she has for years and years, and I don't anticipate that changing into the future and I know the President feels the same way.
Q I was talking to somebody in the insurance industry, and they're under the impression that there would be a requirement that this is a managed care benefit -- I mean, that it would have to be done through managed care. Is that just --
MR. JENNINGS: No. I think that you'll find that a lot of health insurers will choose to managed care, and you'll find that -- and provide coordinated care for this benefit. And they do that not just because it's more cost-effective, but they do that because the medical outcomes associated with such management has proven to be quite successful.
We've noted that many, many plans around the country who have instituted similar parity provisions usually go in that direction, and when they do so, they tend to be well-received both by the business -- by the insurer and, most importantly, by the patient community.
There are some examples of which that's not the case, certainly, but for the most part, the advocates are quite clear that this has been a very positive development.
I would like to say one more thing about the continuation issue, which is Surgeon General Satcher has a deep personal commitment to the mental health issue, both mental health issues in general and suicide in particular. The first-ever Surgeons General report on mental health is going to be released later this year, I think near December or so. And his active participation in Atlanta and throughout the year has been greatly appreciated by the entire administration, and I think you'll find him to be a great resource in this area, as well.
Q Could this be a building block for federal legislation on mental health parity?
MR. JENNINGS: Well, I mean, it's possible. I think that what we need to see is the degree to which the act by the President, by the Office of Personnel Management -- spurs on other employers to move quickly in this area. Legislation is one way to do it. And we're going to be making a determination as to whether that's the best way to do it, and that's why we're hoping that Congress moves quickly to hold hearings on these bills.
Q Will the President follow up this FEHB initiative with direct calls on the private insurance community to follow suit and offer similar levels of parity?
MR. JENNINGS: I think that he certainly will encourage employers to provide mental health parity and substance abuse parity. You know, General McCaffrey has been very, very strong in his advocacy for the coverage of substance abuse, as well as mental health parity. And in the end we think that that's a long-range benefit that can't even be scored, it's so important. And I think that, yes, we're going to encourage employers to move in that direction.
But I think what you generally have to do if you move in more of a requirement age, you have to talk about health benefits, per se. Our preference is, always, for employers to work with the advocacy community, the health plan and insurer community, to develop the best health benefits package for their employees. And most employers are very, very much cognizant of helping out the employees. And I think once they find the information about, that this conference is going to present, they're going to be much more likely to move in that area.
Q What's the resistance? Why doesn't this happen? Why has it taken so long to even have people look at this parity?
MR. JENNINGS: Well, I believe that -- and I know, more importantly, Mrs. Gore believes, that there is a fundamental discrimination, and fear, about mental health in this country. The fear leads to discrimination, and discrimination leads to policy decisions about coverage.
And I think the best way to address fear and discrimination is to provide honest, direct information about these issues. And that's why the -- Mrs. Gore from day one wanted to start with the educational process and talk about breaking down the myths. And that's what you'll start hearing from her, both on Saturday and Monday.
Q And can you talk to that and can you talk about the composition of the conference? Someone talked about it as there really are a lot of industry people, that it would or wouldn't be preaching to the choir. Tell us about how you decided on the composition of who's coming.
MR. JENNINGS: Well, I'll tell you what, it was a very broad spectrum of people. We have business, we have health plans, we have providers, we have advocates, we have elected officials. I don't know anyone we don't have, actually, at this conference.
Mrs. Gore wanted to make certain that it was a very, very widely based, well-sampled population of people who know something about this issue. And I think that what you'll see, both in terms of the conference and through all the satellite feed and the subsequent actions, that through information comes change. And that's her commitment, and that's her -- I mean, her undying commitment to move this issue is to educate the public and providers and insurers and businesses as to why past practices have been discriminatory and should be redressed.
Q To what extent -- that will be in the breakout session?
MR. JENNINGS: Oh, there's 14 topics. And, in fact, rather than going through each one of them, I do have some paper which will list both the topics and the participants within those breakouts. And within those there will be either subsequent paper or not -- we will give you the contacts for the departments who are involved in the policy announcements or initiatives through those breakout sessions.
Q That will be available today?
MR. JENNINGS: Today. Today. We can pass out the breakout information, can't we? Yes.
Q Will we be free to circulate amongst them, at the conference? Free?
MR. JENNINGS: Are they going to allow people to go back and forth to -- or once you're there, you're there? I think it's once you're there, you're there.
I think the preference, obviously, in these breakout sessions is, once people go -- (laughter) -- you pick one, you move on -- you stay, if you can. I'm not sure there will be people at the guards' desks, though.
Q When will the transcript be available for the radio address tomorrow?
MR. TOIV: This afternoon, after it's recorded and transcribed.
Q All of these million dollar -- initiatives. Has the money already been budgeted for them?
MR. JENNINGS: All the money that is associated specifically in these initiatives, except for the budget call that we've asked for, for the SAMSA dollars, are within currently available money that has been reprogrammed and dedicated for this purpose.
Q What about the ad campaign, though?
MR. JENNINGS: The ad campaign is a privately-funded ad campaign.
Q -- the research?
MR. JENNINGS: The research is -- yes, very interesting. There are a host of research announcements -- NIMH is going to be announcing immediately on Monday that there will be a $7.3 million study. They believe this is a landmark study to determine the nature of mental illness and treatment nationwide and to use that information to help guide future treatment strategies and policy.
Steve Hyman will be there and participating and the First Lady is going to be in his conference. She's very much interested in the research component in this area and will be participating in this announcement.
In addition, NIMH will announce that later this fall we're going to be investing a total of $61 million to build on effective treatment research that NIMH has historically dedicated resources to. They're thrilled about both these areas; Steve will talk about it in much greater detail, and again we will give you contact people today to talk to.
And, by the way, I'm going to try to give you all weekend numbers, so if you're deciding to write later in the weekend you can bother people, too. I hope they forgive me for that.
Q On substance abuse, I hope this isn't too esoteric, but there are also bills in Congress on substance abuse parity. One has been introduced and one is coming.
MR. JENNINGS: I think you would find a similar answer. My answer would be parity with my mental health answer.
Q In the FEHB initiative, does that cover pharmacologic treatment for substance abuse -- i.e., methadone -- you know, the drugs people use to cure substance abuse?
MR. JENNINGS: Yes. We would not make a disparity between -- if drugs are covered in other areas, we would not discriminate against in any way about coverage decisions for substance abuse.
Now, if there are some plans in this country who don't provide prescription drug coverage, they're not required to cover prescription drugs. But if they do provide prescription drug coverage, then that's one treatment modality for substance abuse, and that would, indeed, be covered.
THE PRESS: Thank you.
END 1:26 P.M. EDT