The Public Policy Environment

Ch. 26 week 1

Public Policy

A system of laws, regulatory measures, courses of action, and
funding priorities concerning a given topic promulgated by a governmental entity or its representatives

Reflects the values and objectives of citizens and governing bodies

Laws

Provides legal and institutional framework with which to implement policy

Goal is to protect the rights of the people in the community!

Regulations

Detailed rules for enforcing laws and process for monitoring enforcement

Politics

Activities by individuals or groups that influence the policies of government

Deinstitutionalization

psych institutions closed and replaced w community based approaches

Community Mental Health Centers Act (1963)

Provided federal funding for community mental health centers to shift from institutional to community based care

New services included: emergency, partial hospital programs, and outpatient

Transinstitutionalization

The movement of people with psychiatric disabilities from large institutional settings to different, smaller institutional settings
- Nursing homes
- Jails and prisons
- Homeless shelters

Policies Impacting People w Psychiatric Disabilities

Social Security Administration Policies

Non SSA Entitlements

Inpatient Commitment

Civil Rights

Insurance and Service Delivery Policies

Social Security Disability Insurance (SSDI)

Amendment to the SSA in 1956 to provide financial safety net for workers who BECOME disabled and were unable to continue working

Dependendent on SS taxes they have paid into program through employment

Supplemental Security Income - SSI

Admin by sates

Entitlement for people who DO NOT qualify for SSDI or SS Retirement benefits

Qualifying criteria same as SSDI w addition to limited resources

Medicare

A, B, C, D, and Medigap

Medicaid

National health insurance program funded through both state and federal dollars

Aids low income individuals and familes in covering healthcare costs

Medicaid in CT

Husky A, B (CHIP), C, and D

Supplemental Nutrition Assistance Program (SNAP)

Originally Food Stamp program

Food assistance

Emergency Food Assistance Program (TEFAP)

Provides food to low income individuals on an emergency basis at no cost

Makes use of surplus food + funds to purchase food specifically for program

Low Income Housing

Section 8 Housing Voucher System

Shelter plus care

Mental Health Parity and Addiction Equity Act

Federal law that prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on
medical/surgical benefits

Affordable Care Act

Triple Aim: reduce cost, improve patient health, and improve quality of care

Coverage for MH services is mandated for companies in state insurance exchanges

Rehab act of 1973

1st bill to ban discrimination on basis of disability

requires affirmative action in hiring people w disabilities

Section 504 - banned discrimination on basis of disability

Americans w Disabilities Act of 1990

Protects people from discrimination on the basis of disability in employment, state and federal government, commercial facilities, telecommunications, and transportation

Title II - shift to community based MH care

Olmestead Decision

Two women w disabilities who advocated for living in the community

Court ruled the unnecessary institutionalization constitutes discrimination, cannot be justified by lack of funding

President’s New Freedom Commision on MH

Unmet needs and barriers to mental health care
o Fragmentation and gaps in care across the lifespan
o High unemployment and disability for people with serious mental illness
o Lack of national priority for mental health and suicide prevention

6 Goals

Inpatient Commitment in CT

Patients can voluntarily or involuntary be admitted to inpatient psych care

Individuals subject to involuntary commitment are entitled to legal and procedural protections

An emergency certificate may authorize hospitalization PRIOR to hearing

Protecting Access to Medicare Act of 2014

Created Certified Community Behavioral Health Clinics

OTPS were involved and advocated for role in improving patient’s lives w serious mental illness

Occupational Therapy in MH Act

2015

Aim to create opportunity for OTPs to participate in National Health Service
Corps, which provides scholarships and loan repayment programs to students who practice in rural and underserved areas

Would make OTPs approved “mental health care providers”

Occupational Therapy in Mental Health Parity Act

Goal to expand access to occupational therapy for mental and behavioral
health disorders under Medicare and Medicaid
• Would address barriers that OTPs face in providing and billing for services in mental health settings