Building a national presence: the National Council's chair lays out some policy areas the association has been following lately.

During the past few years, the National Council for Community Behavioral Healthcare has increased its national presence to position itself to better influence federal policy and legislation. It's an effort for which Elizabeth Earls, chair of the National Council's Board of Directors since July, is proud to be a part.

"It has been a love and real dream that our national organization would be in a better place to help set policy for us nationally," says Earls, who is also president and CEO of the Rhode Island Council of Community Mental Health Organizations, Inc. "I'm struck every month by how different it is from where we were just a few years ago."

One area the National Council is following closely is federal parity legislation, which would affect private insurance plans. Although the lion's share of people served by National Council members rely on public financing to pay for their care, Earls points out that many National Council members also serve a significant number of privately insured clients. And she says that there's more to this legislation than the words written into law. "The legislation itself, the symbolism of it, the fight and the continued push against the stigma are so important and really have always been at the core of my belief of why we need national parity legislation," Earls says.

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Earls has been working closely with fellow Rhode Islander U.S. Rep. Patrick Kennedy to ensure that a parity bill reaches President Bush's desk. Kennedy is a cosponsor of the House version, but the National Council has not endorsed either chamber's bill. "I don't know if there is value in putting up barriers in the beginning by taking a side," Earls says. "I think we need to continue to be at the table with policy makers so that they understand as they make their decisions what the impact will be." She adds, "Some of the other national organizations already have shown greater favor for one version or the other, and that closes down discussion."

Another area on the National Council's radar are the Centers for Medicare and Medicaid Services' (CMS) new rules for case management services under Medicaid, which Earls says are "far more extensive and invasive than states anticipated." The National Council and other organizations are urging Congress and the U.S. Department of Health and Human Services to reconsider the rules or delay their implementation, but "states don't have the luxury of waiting to see if that happens," notes Earls. "The case management rules went into effect March 3. As of April 1, CMS is holding states accountable for them. So state programs are making the changes, and they're cutting back."

Earls hopes something will be done about the case management rules sooner rather than later. "The families our members see have such complicated needs," she explains. "They often are immersed in poverty on top of everything else. And to not have the ability to incorporate case management into the whole treatment modality can really be the maker or breaker of whether families have any success in achieving significant clinical improvements."

The National Council also is following CMS's requirement that prescriptions for Medicaid recipients be written on tamper-resistant pads. The rule's implementation, originally scheduled for September 30, was delayed until April 1. "Certainly the rule is a laudable goal," says Earls. "You don't want photocopying and fraudulent use of prescription pads, but policy makers often don't take into account what that means at the provider level in terms of the cost of doing business." Earls' members in Rhode Island have found that tamper-resistant pads cost about three times as much.

The National Council is involved in many other policy and legislative areas, and one of its overarching goals is to raise the profile of mental healthcare and addiction treatment. Earls says the National Council aims "to help people, whether a policy maker or a member of the general public, to understand that we do need a more public health response to these diseases which probably, if they were anything else, would be considered an epidemic."

For more information about the National Council's policy initiatives, visit www.thenationalcouncil.org/cs/public_policy.

BY DOUGLAS J. EDWARDS, EDITOR-IN-CHIEF